Equity Approach Research Articles

OHL-ALL: a theory-informed and practice-orientated organizational health literacy equity approach

Abstract Background The OHL-ALL initiative was launched by Steno Diabetes Center Sjaelland and the Department of Public Health, Aarhus University and the OHL-ALL scientific group in cooperation with EUPHA-HL and M-POHL in November 2023. The OHL-ALL (Organizational Health Literacy for All) approach offers an opportunity to rethink and develop organizational health literacy (OHL) with an explicit normative basis for equity. The goal is to establish a theory-informed, practice-oriented, multifaceted, and implementable approach. In the OHL-ALL approach, we define equity as the normative anchor, and we suggest using the Capabilities Approach to embed improved equity in design, implementation, and evaluation of interventions. Methods The process of developing the OHL-ALL was guided by applying core ideas from Amartya Sen’s Capability Approach. Five intervention principles were derived from the existing organizational health literacy literature: organizational change, workforce responsiveness, user involvement and person-centered care, access and navigation and internal and external partnerships. After an international expert working group meeting in November 2023, we formed four work packages. Results At the EPH conference, a status of the progress in the four work packages will be presented: WP1. OHL-ALL Framework development based on capability, fairness, and equity. WP2. Initiatives and testing of the OHL-ALL framework. WP3. Evaluation of OHL-ALL (i) the capability approach and (ii) outcome domains. WP4. Plans for the future, including advocacy and outreach - ideally via a conference in 2026. Conclusions The OHL-ALL project presents a novel approach to advancing equity in health by improving users’ capabilities. Based on an explicit normative framework it is expected to offer theoretical and practical guidance for organizations that chose to implement a health literacy approach.

Impact of Climate Change on Mental Health Among Vulnerable Groups: A Systematic Literature Review

Objective: This study aims to explore the impact of climate change on mental health among vulnerable groups, including low-income populations, Indigenous communities, children, women, and the elderly, to highlight their unique vulnerabilities and mental health outcomes. This aligns with the United Nations' Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 13 (Climate Action), addressing the need for climate resilience and mental health equity. Theoretical Framework: The research is grounded in social vulnerability theory, emphasizing how structural inequalities exacerbate the impact of climate change on mental health. The framework integrates psychological theories of eco-anxiety and solastalgia, which explain the mental distress caused by environmental changes. Method: A systematic literature review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. This involved a comprehensive search of academic databases, screening studies, and qualitatively synthesizing data from 35 peer-reviewed articles published between 2000 and 2023. Results and Discussion: Findings reveal that climate change exacerbates mental health issues such as anxiety, depression, and PTSD among vulnerable groups due to their limited adaptive capacity and exposure to climate-related hazards. Vulnerable communities, including Indigenous groups and low-income populations, experience heightened psychological impacts such as eco-anxiety and solastalgia. The results underscore the importance of integrating mental health considerations into climate adaptation policies and developing targeted interventions to enhance resilience among these populations. This study also supports global efforts toward achieving SDG 10 (Reduced Inequalities) and SDG 11 (Sustainable Cities and Communities). Research Implication: The study suggests the need for comprehensive and equitable mental health strategies that prioritize vulnerable groups in climate change adaptation planning. Policymakers must consider social equity and community-based approaches to mitigate the mental health impacts of climate change. Originality/Value: This review uniquely addresses the intersection of climate change and mental health within marginalized populations, emphasizing the need for mental health integration in climate adaptation frameworks. The study highlights the underexplored psychological dimensions of climate change, providing valuable insights for developing inclusive and sustainable adaptation strategies. sustainability

Leading for Equity and Inclusion at the Intersections of Disability and Race: A Call to Action Through Interdisciplinary Engagement

In this special issue, we asked contributing authors to identify complex and intersectional equity concerns in special education and to tie those concerns to leadership and to the Individuals with Disabilities Education Act (IDEA). Our goal was to create teaching cases that could empower aspiring and current leaders with the knowledge and skills necessary to support and promote social change and justice for students with disabilities at their intersections. Each case situates the enactment of the IDEA within a local context, allowing readers to understand how the interaction between leadership, IDEA, and intersectional equity concerns relate. Throughout the special issue, we encourage readers to move beyond compliance with IDEA, to engage with intersectional and expansive equity approaches, and to address both ableism and racism.

An innovative framework to advance workplace equity

Reliance on traditional Diversity, Equity, and Inclusion approaches, such as implicit bias and anti-harassment trainings, have failed to address systemic inequities embedded within organizations. In response, we first interviewed business leaders/practicing managers and then fielded a nationally representative survey of 1,062 businesses in the United States (in partnership with the Society for Human Resource Management). Based on our findings, we developed an innovative, two-dimensional framework, the Equity of Employment Systems Framework, that addresses root causes of workplace inequity. Rather than focusing solely on an overall measure of equity for an organization, this Framework focuses on 7 systemic components (“Levers for Change”) that measure and impact equity in an organization’s 10 Employment Systems. Levels of equity vary greatly among the 10 Employment Systems within organizations: Recruitment & Hiring, Compensation & Benefits, and Orientation & Onboarding representing the strongest measures of equity and Supervision & Mentoring, Job Structures, and Resources & Supports as the least equitable. To help practicing managers strengthen the equity of their Employment Systems, we outline a 5-step process based on our innovating Equity of Employment Systems framework. Our 5-step process can help practicing managers to advance equity within their organizations, creating more inclusive, agile, and innovative businesses.

Improving Musculoskeletal Health by Incorporating Equity, Diversity, and Inclusion Approaches Into Research Practices.

Improving Musculoskeletal Health by Incorporating Equity, Diversity, and Inclusion Approaches Into Research Practices.

A Research-Practice Partnership to Develop the R-CITY Multi-Component, Equity-Focused Social–Emotional Learning Intervention

There is growing interest in the integration of social–emotional learning (SEL) and equity approaches in schools, yet systematic research on how to blend these two frameworks is limited. In this article, we describe the process by which a research-practice partnership (RPP) collaborated to iteratively co-create a multi-component equity-focused SEL preventive intervention in the context of a politically charged landscape related to the ‘dual pandemics’ of racial injustice and COVID-19 in the early 2020s. We conducted a document review of informal data sources (e.g., meeting minutes, correspondence) and analyses of formal data sources (i.e., teacher interviews, student focus groups) to describe how we overcame challenges to form an RPP, to demonstrate our collaborative intervention development efforts, and to assess feedback on the contextual appropriateness of the intervention. We discuss lessons learned from our partnership efforts and reflect on future directions for RPP-driven work to advance equity-focused SEL in K-12 public schools.

Anti-Racism, Diversity, Equity, and Inclusion Perspectives Across the Explicit Curriculum: Insights and Efforts from a School of Social Work

ABSTRACT Principles of diversity and difference are and have historically been, essential to social work education. However, preparing students with the knowledge, awareness, and skills of anti-racist and anti-oppressive practices has been less central in social work education until recently. In June 2022, the Council on Social Work Education issued new Educational Policy and Accreditation Standards (EPAS) guidelines. Most notable was the addition of EPAS 2.0, requiring social work programs to integrate anti-racism, diversity, equity, and inclusion (ADEI) approaches throughout social work programs’ context and learning environment. Responding to EPAS 2022 and our program’s commitment to social and racial justice, this article presents our school’s process for critically assessing and revising how our explicit curriculum integrates critical ADEI perspectives. We highlight the findings from a rapid scoping review of ADEI content in the social work literature. Additionally, we discuss the revisions and recommendations used in our school to ensure the intentional integration of ADEI critical perspectives in our curriculum and the future efforts our school is making to support ADEI perspectives.

A policy window for equity? The American Rescue Plan and local government response

ABSTRACT How have local governments incorporated equity into their investments of state and local rescue funds from the American Rescue Plan Act? We explore the multiple mechanisms localities used to incorporate equity approaches through case studies based on a strategic equity framework of redistributional, procedural and conceptual equity. We identify the importance of political will, planning and strategic partnerships with community agencies and businesses to experiment with new initiatives, and feedback loops with higher levels of government for policy change. Equity was often hidden in program design, rather than explicitly articulated. We find that cities are leading with actions, while values still primarily focus on economic development benefits. However, these actions may subtly shift values toward a broader conception of the local government role in advancing equity.

Variability in public health programming and priorities to address health inequities across public health units in Ontario, Canada.

In 2018, Ontario Public Health Standards were updated to include the foundational Health Equity Standard to guide planning, implementation, and evaluation of public health programs and services. Public health units (PHUs), the regional public health bodies, are now required to address health equity through four requirements: (a) Assessing and Reporting; (b) Modifying and Orienting Public Health Interventions; (c) Engaging in Multi-sectoral Collaboration; and (d) Health Equity Analysis, Policy Development, and Advancing Healthy Public Policies. This qualitative descriptive study explored how the 27 participating PHUs (out of 34) serving urban (N = 10), mixed urban-rural (N = 15), and rural (N = 9) populations addressed the Health Equity Standard. Using document analysis, we inductively and deductively coded the content of 68 PHU Annual Service Plan and Budget Submissions from a 3-year period (2018-2020) received from the 27 PHUs. Emergent categories were organized into the four requirements and one additional emergent theme: Organizational Implementation of Health Equity. The approaches of embedding health equity into PHUs' activities varied across groups. Urban PHUs presented more diverse strategies, including working with a larger number of organizations, and participating in academic research projects. We found more process standardization and greater discussion of capacity building in urban and mixed urban-rural PHUs. Rural PHUs strategically addressed the needs of their diverse populations through relationship building with Indigenous communities. Findings suggest broad implementation of health equity approaches in public health independent of PHUs' geographic size and population dispersion, though strategies and key challenges differ across units.

Examining How the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model Improves Health Equity for Underserved Communities and Safety Net Hospitals in New York State.

Safety net hospitals (SNHs) are essential to our healthcare ecosystem, providing quality healthcare to underserved communities. These institutions offer specialized services and acute medical care to populations facing structural or systemic healthcare barriers. However, for decades, the NYS Medicaid program reimbursed hospitals less than the cost of care, resulting in several independent SNHs becoming financially distressed, with many facing closure. Recently, the Center for Medicaid and Medicare Service Innovation Center (CMSI) introduced the State All-Payer Health Equity Approaches and Development (AHEAD) Model, which aims to support the financial needs of providers while also addressing the complex medical and social circumstances of underserved communities. This article will explore how the AHEAD model can be utilized as an alternative payment method for SNHs in New York State (NYS) to improve healthcare for underserved communities.

Strategies for Effective Capacity-Building in the Fight Against Commercial Tobacco.

The Center for Black Health & Equity's approach to addressing health inequities relies on the inherent ability within community-based organizations to respond to public health priorities while addressing the political and social determinants of health. By using Dr. Robert Robinson's Community Development Model as a foundational framework, communities can address systemic barriers that impede optimal health outcomes. The model includes community engagement and mobilization activities that motivate communities to achieve equity-centered policy change and offers milestones that show progress made toward their goals and objectives. We operationalized the Community Development Model into the Community Capacity Building Curriculum to train community partners to form a multicultural coalition through asset mapping as a tool for community mobilization. This curriculum is both cost effective and efficient because it enables communities to address health disparities beyond tobacco control, such as food and nutrition, housing, and environmental issues. Coalitions are prepared to identify and make recommendations to address policies that perpetuate health disparities. Facing off against a powerful tobacco industry giant is challenging for small grassroots organizations advocating for stricter tobacco regulations and policies. Such organizations struggle for resources; however, their passion and dedication to the mission of saving Black lives can promote change.

Strategies and indicators to integrate health equity in health service and delivery systems in high-income countries: a scoping review.

The objective of this review was to describe how health service and delivery systems in high-income countries define and operationalize health equity. A secondary objective was to identify implementation strategies and indicators being used to integrate and measure health equity. To improve the health of populations, a population health and health equity approach is needed. To date, most work on health equity integration has focused on reducing health inequities within public health, health care delivery, or providers within a health system, but less is known about integration across the health service and delivery system. This review included academic and gray literature sources that described the definitions, frameworks, level of integration, strategies, and indicators that health service and delivery systems in high-income countries have used to describe, integrate, and/or measure health equity. Sources were excluded if they were not available in English (or a translation was not available), were published before 1986, focused on strategies that were not implemented, did not provide health equity indicators, or featured strategies that were implemented outside the health service or delivery systems (eg, community-based strategies). This review was conducted in accordance with the JBI methodology for scoping reviews. Titles and abstracts were screened for eligibility followed by a full-text review to determine inclusion. The information extracted from the included studies consisted of study design and key findings, such as health equity definitions, strategies, frameworks, level of integration, and indicators. Most data were quantitatively tabulated and presented according to 5 secondary review questions. Some findings (eg, definitions and indicators) were summarized using qualitative methods. Most findings were visually presented in charts and diagrams or presented in tabular format. Following review of 16,297 titles and abstracts and 824 full-text sources, we included 122 sources (108 scholarly and 14 gray literature) in this scoping review. We found that health equity was inconsistently defined and operationalized. Only 17 sources included definitions of health equity, and we found that both indicators and strategies lacked adequate descriptions. The use of health equity frameworks was limited and, where present, there was little consistency or agreement in their use. We found that strategies were often specific to programs, services, or clinics, rather than broadly applied across health service and delivery systems. Our findings suggest that strategies to advance health equity work are siloed within health service and delivery systems, and are not currently being implemented system-wide (ie, across all health settings). Healthy equity definitions and frameworks are varied in the included sources, and indicators for health equity are variable and inconsistently measured. Health equity integration needs to be prioritized within and across health service and delivery systems. There is also a need for system-wide strategies to promote health equity, alongside robust accountability mechanisms for measuring health equity. This is necessary to ensure that an integrated, whole-system approach can be consistently applied in health service and delivery systems internationally. DalSpace dalspace.library.dal.ca/handle/10222/80835.

Integrating the customer equity and brand equity approaches to the financial value of marketing

Integrating the customer equity and brand equity approaches to the financial value of marketing

Understanding racial equity in research with Indigenous Peoples: including anti-racism and decolonization approaches

ABSTRACT Colonization of Indigenous Peoples living in what is now called the U.S. and U.S. territories began over 500 years ago, yet colonization continues today and results in historical trauma and inequities for Indigenous people. This paper describes the current application of racial equity in research and its limitations when applied to work with Indigenous Peoples. It highlights how the existing racial equity framework falls short in (1) respecting Indigenous sovereignty, (2) addressing historical and ongoing colonization through land dispossession and codified racism in blood quantum, and (3) acknowledging the profound impact of historical, cultural, and intergenerational trauma. We propose an expanded racial equity approach to research that incorporates an anti-racist and decolonizing approach. We conclude by outlining specific strategies researchers should adopt when employing a racial equity lens in their work with Indigenous populations.

Adapting to changing risk environments: examining overdose risk and socio-spatial patterns of unstably housed people who use drugs during converging public health crises

Background The COVID-19 pandemic exacerbated the US overdose crisis and disproportionately impacted unstably housed people who use drugs. Measures to address the pandemic within the context of crisis produced differential effects, particularly among people who use drugs. Examining how unstably housed people who use drugs adapted to shifting risk environments is imperative to responding to future crises. Methods Rapid ethnographic data was collected from June 2020 to April 2021 in Rhode Island. Data include in-depth interviews with 39 unstably housed people who use drugs and approximately 50 hours of fieldwork. Findings COVID-related service disruptions and policing of public space (e.g. city curfews) reinforced participants’ marginality and increased surveillance. This heightened visibility disrupted participants’ socio-spatial patterns as they were regularly relocated and faced increased risk of arrest due to public drug use and housing instability. Participants regularly weighed overdose risk reduction against COVID-19 exposure and risk of arrest, which increased harm. Conclusion Findings demonstrate how COVID-related public health measures intersected with participants’ socio-spatial and drug use patterns in ways that increased overdose risk. Drawing on health equity approaches when responding to crisis situations is critical to address intersecting inequities faced by unstably housed people who use drugs.

Rights and responsibilities: Women leadership for health in Kyrgyzstan.

The World Health Organization (WHO) is committed to empowering countries by implementing a gender, equity, and human rights approach in the health sector. The objective of this gender and inclusion analysis is to assess potential gender disparities of health sector management in the Kyrgyz Republic. The employed mixed-method approach takes advantage of data triangulation. Besides information from the literature and policy documents available at the international and national levels, the analysis includes interviews and data from the self-assessment of health services managers in the Kyrgyz Republic. A convenience sample of 75 health managers was taken and after up to three reminders a commendable response rate of 80% was achieved which resulted the final sample size of N = 60. A factor analysis using quartimax orthogonal rotation was applied to investigate the correlation between Teaching Qualification, Digitalization, Training Usefulness, Computer Workplace, and Gender Equality. In 2021, the Kyrgyz Republic adopted a new Constitution, which provides a sound legal framework to support gender equality and promote women's empowerment. However, according to a survey, only 42.9% of the respondents felt that equal rights and opportunities were integrated into their job descriptions. Similarly, only 40.7% believed that their institutions' written documents reflected a commitment to equal rights and opportunities for both genders. Two factors were identified as influencing gender equality: (1) personal and (2) technical aspects. Regarding personal aspects, gender equality, teaching qualification, and training usefulness were found to be significant. Regarding technical aspects, the computer workplace was related. In recent years, the Kyrgyz Republic has been developing a culture of gender equality. Political will is essential to promote and make organizational change possible. It is important to create a written mid-term policy that affirms a commitment to gender equality in organizational behavior, structures, staff, and management board compositions. Healthcare institutions need to prepare strategic and operational plans that incorporate gender equality principles.

An Environmental Equity Assessment Using a Social Vulnerability Index during the SARS-CoV-2 Pandemic for Siting of Wastewater-Based Epidemiology Locations in the United States

Research has shown that there has consistently been a lack of equity and accessibility to SARS-CoV-2 testing in underserved and disadvantaged areas in the United States. This study examines the distribution of Wastewater-Based Epidemiology (WBE) testing placement across the United States (US), particularly within the context of underserved communities, and explores an environmental equity approach to address the impact of WBE on future pandemics. The methods combined the Centers for Disease Control Social Vulnerability Index (CDC-SVI) data set at the county level in a geospatial analysis utilizing ArcGIS and multilinear regression analysis as independent variables to investigate disparities in WBE coverage in the US. The findings show that disparities exist between counties in the use of WBE nationwide. The results show that WBE is distributed inequitably on national and state levels. Considering the nationwide adoption of WBE and funding availability through the CDC National Wastewater Surveillance System, these findings underscore the importance of equitable WBE coverage for effective COVID-19 monitoring. These findings offer data to support that a focus on expanding WBE coverage to underserved communities ensures a proactive and inclusive strategy against future pandemics.

Healing from Intersectional White Supremacy Culture and Ableism:

In this exploratory article, we build on the existing literature to identify and discuss the patterns of white supremacy culture (WSC) that are pervasive in our organizational spaces. We argue that because WSC, racism, and ableism are deeply intersectional forms of oppression, our social equity approaches must include a disability justice (DJ) lens, which centers the leadership of multiply marginalized disabled, queer, trans*, Black, Indigenous, and negatively racialized People of Color (QTBIPOC). Using an embodied approach, we invite our readers into a deeper reflection and critical analysis of the intersectional manifestations of white supremacy culture and ableism in organizational spaces. We explore the ways in which the 10 principles of disability justice could serve in creating supportive countercultural norms, values, and behavioral practices needed to create the conditions for healing from white supremacy culture.

Advancing Diversity in Behavior Genetics: Strategies for Incorporating Undergraduates into Student-Driven Research.

Undergraduate research experiences are crucial for fostering the next generation of behavior genetics researchers. However, incorporating undergraduates into research can be challenging for faculty mentors. In this article, we provide strategies for successfully integrating undergraduates into behavior genetics research based on our experiences mentoring undergraduates in our lab. These strategies include: (1) Practicing reflexivity, specifically an ongoing self-examination and critical self-awareness of personal biases, beliefs, and practices; (2) Implementing an Inclusion, Diversity, Equity, and Access (IDEA) centered approach; (3) empowering students through clear expectations; (4) Providing focused training and mentorship; (5) Aligning research projects with student interests; (6) Assigning meaningful tasks; and (7) Facilitating professional development opportunities. By following these strategies, faculty mentors can cultivate a supportive and inclusive research environment that empowers undergraduates for successful careers in behavior genetics research.

Do impact investing opportunities exist in public equity? An empirical examination

Even though impact investing increasingly establishes a presence in public equity, research confirming that this asset class is feasible for impact investments is lacking (Phillips & Johnson, 2021). This has resulted in queries about unrealistic assumptions of achieving positive social and environmental impact, alongside financial returns, in a public equity setting (Bernal et al., 2021; Boscia et al., 2019). Resultingly, the public equity approach to impact investing has been accused of being the first step towards a total dilution of the industry’s original mission of attaining goals that are not feasible through neither pure philanthropic grants nor conventional investments. Aimed at bridging the current research gap, within the literature of impact investing, this paper examines whether impact investing opportunities exist in public equity. Based on an empirical foundation of 163 publicly listed companies, which are the target of impact investments made through impact funds, it is found that impact investing opportunities exist in public equity when evaluated based on long term measures of shareholder value creation. Theoretical implications suggest that the concept of impact investing does not need to be refined in a public equity setting and that the field could advance from discussing the fundamental assumptions to start defining the boundaries of impact investing in public equity.