Equity Outcomes Research Articles

Policy Implementation Science - An Unexplored Strategy to Address Social Determinants of Health.

This commentary explores the ways in which robust research focused on policy implementation will increase our ability to understand how to - and how not to - address social determinants of health. We make three key points in this commentary. First, policies that affect our lives and health are developed and implemented every single day, like it or not. These include "small p" policies, such as those at our workplaces that influence whether we have affordable access to healthy food at work, as well as "large P" policies that, for example, determine at a larger level whether our children's schools are required to provide physical education. However, policies interact with context and are likely to have differential effects across different groups based on demographics, socioeconomic status, geography, and culture. We are unlikely to improve health equity if we do not begin to systematically evaluate the ways in which policies can incorporate evidence-based approaches to reducing inequities and to provide structural supports needed for such interventions to have maximal impact. A policy mandating physical education in schools will do little to address disparities in fitness and weight-related outcomes if all schools cannot provide the resources for physical education teachers and safe activity spaces. Second, as we argue for an increased emphasis on policy implementation science, we acknowledge its nascent status. Although the field of implementation science has become increasingly robust in the past decade, there has been only limited application to policy. However, if we are strategic and systematic in application of implementation science approaches and methods to health-related policy, there is great opportunity to discover its impact on social determinants. This will entail fundamental work to develop common measures of policy-relevant implementation processes and outcomes, to develop the capacity to track policy proposal outcomes, and to maximize our capacity to study natural experiments of policy implementation. Third, development of an explicit policy implementation science agenda focused on health equity is critical. This will include efforts to bridge scientific evidence and policy adoption and implementation, to evaluate policy impact on a range of health equity outcomes, and to examine differential effects of varied policy implementation processes across population groups. We cannot escape the reality that policy influences health and health equity. Policy implementation science can have an important bearing in understanding how policy impacts can be health-promoting and equitable.

Health-system equity, egalitarian democracy and COVID-19 outcomes: An empirical analysis.

Aims:The COVID-19 pandemic has led to a spate of studies showing a close connection between inequitable access to health care, welfare services and adverse outcomes from the pandemic. Others have argued that democratic governments have generally failed relative to more autocratic ones, simply because autocrats can make the hard choices required for stemming the spread of viruses. We address this question by asking whether more ‘egalitarian’ forms of democracy matter, given that they contain more equitable health-care access and societal infrastructure, such as social capital and trust.Methods:We use standard regression techniques, including instrumental variables analysis addressing endogeneity on COVID-19 testing and deaths data as of the end of May and beginning of September. We use novel data from the Varieties of Democracy Project on health-system equity and egalitarian democracy.Results:Our results suggest that more equitable access to health care increases testing rates and lowers the death rate from COVID-19. Broader egalitarian governance, measured as egalitarian democracy, however, shows the opposite effect. Thus, factors associated with health-care capacity to reach and treat matter more than broader societal factors associated with social capital and trust. The results are robust to alternative testing procedures, including instrumental variable technique for addressing potential endogeneity.Conclusions:Despite a great deal of public health focus on how equitable governance helps fight the adverse effects of so-called neoliberal pandemics, we find that broadly egalitarian factors have had the opposite effect on fighting COVID-19, especially when an equitable health system has been taken into account. Fighting disease, thus, might be more about the capacity of health systems rather than societal factors, such as trust in government and social capital.

How the Large Scale Assessment Tests Help in Achieving Sustainable Development Goals: A Critical Perspective

The 2015-2030 sustainable development goal is the first developmental goal to include targets for educational equity and learning outcomes. Current globalized testing culture suggests the need to develop standardized literacy and numeracy measures for monitoring learning at the international stage. The underlying study has critically assessed the large scale assessment tests and has highlighted limitations associated with each test (including PISA 2012, PIRLS 2011, TIMSS 2011, SACMEQ 2007, TERCE 2013, PASEC 2014). The study has extracted the data from regional and international assessment tests that are widely used to monitor the progress towards attainment of Sustainable Development Goals. For this purpose, the study has assessed the ability of students to reach minimum proficiency level in science, mathematics and reading. The research has attempted to prepare comparable proficiency scores for around fifty countries by extracting and analyzing the additional data and evaluating the major indicators in the education sector. Moreover, there are certain limitations associated with the study. The research has not included hybrid or national assessments, and for the ease of analysis, only most recent large scale assessment tests have been included. The findings have suggested a need to introduce some standardized assessments to encourage the collaboration among different organizations. The main purpose behind the execution of research was to provide support and practical guidance to international organizations and policymakers to design, develop and implement largely standardized scale assessment tests that can accurately measure the educational equity and learning outcomes across the world.

Outcomes of a Community-Based Participatory Research Partnership Self-Evaluation: The Rochester Healthy Community Partnership Experience.

Outcomes of a Community-Based Participatory Research Partnership Self-Evaluation: The Rochester Healthy Community Partnership Experience Marcelo M. Hanza*, MA, Abigail L. Reese, CNM, PhD, Adeline Abbenyi*, CPH, BS, Christine Formea*, PharmD, Jane W. Njeru*, MB, ChB, Julie A. Nigon*†, BA, Sonja J. Meiers*, PhD, Jennifer A. Weis*, RN, MAN, Andrew L. Sussman, PhD, Blake Boursaw, MS, Nina B. Wallerstein, DrPH, Mark L. Wieland*, MD, MPH, and Irene G. Sia*, MD What Is the Purpose of This Study/Review? • This article describes the qualitative and quantitative research methods, group analysis, and outcomes of a self-evaluation performed by a well-established community-based participatory research (CBPR) partnership. What Is the Problem? • Case studies in CBPR partnership evaluation are needed to better understand processes and dynamics associated with outcomes and to identify factors that contribute to partnership sustainability. What Are the Findings? • The evaluation showed that partnership processes were its most important products. • We also identified associations between partnership practices, dynamics, and outcomes. • Positive partnership dynamics were associated with perceptions of improved health and equity outcomes. • Insights gained from the evaluation are being used to guide decisions about future directions for the partnership and sustainability. Who Should Care Most? • This study is relevant for members of CBPR partnerships who seek to better understand partnership processes and dynamics that influence partnership outcomes. Recommendations for Action • CBPR partnership evaluation facilitates structured reflection about processes that contribute to outcomes, sustainability, and future directions. • Partnerships should seek out established and validated measures to evaluate CBPR partnership processes and dynamics, and evaluation designs should be adapted to suit their specific needs. [End Page 143] Marcelo M. Hanza Department of Development, Mayo Clinic Abigail L. Reese Center for Participatory Research, University of New Mexico Adeline Abbenyi Division of Clinical Microbiology, Mayo Clinic Christine Formea Pharmacy Services, Mayo Clinic Jane W. Njeru Division of Community Internal Medicine, Mayo Clinic Julie A. Nigon Hawthorne Education Center, Rochester Public Schools Sonja J. Meiers Department of Graduate Nursing, Winona State University-Rochester Jennifer A. Weis Department of Research Administration, Mayo Clinic Andrew L. Sussman Center for Participatory Research, University of New Mexico Blake Boursaw Center for Participatory Research, University of New Mexico Nina B. Wallerstein Center for Participatory Research, University of New Mexico Mark L. Wieland Division of Community Internal Medicine, Mayo Clinic Irene G. Sia Division of Infectious Diseases, Mayo Clinic * Member of the Rochester Healthy Community Partnership; †. Retired. Copyright © 2021 Johns Hopkins University Press

Outcomes of a Community-Based Participatory Research Partnership Self-Evaluation: The Rochester Healthy Community Partnership Experience.

Community-based participatory research (CBPR) can effectively address health disparities among groups that are historically difficult to reach, disadvantaged, of a minority status, or are otherwise underrepresented in research. Recent research has focused on the science of CBPR partnership constructs and on developing and testing tools for self-evaluation. Because CBPR requires substantial investment in human and material resources, specific factors that support successful and sustainable research partnerships must be identified. We sought to describe the evolution, implementation, and results of a self-evaluation of a CBPR partnership. Academic and community members of the Rochester Healthy Community Partnership (RHCP) and researchers from the University of New Mexico-Center for Participatory Research collaborated to evaluate RHCP with qualitative and quantitative research methods and group analysis. The self-evaluation was used to provide an overall picture of the "health" of the partnership, in terms of sustainability and ability to effectively collaborate around community priorities. RHCP members revisited the partnership's mission and values; identified associations between partnership practices, dynamics, and outcomes; and elicited insight from community and academic partners to help guide decisions about future directions and the sustainability of the partnership. Positive partnership dynamics were associated with perceived improvements in health and equity outcomes. Although engaging in a comprehensive self-evaluation requires substantial investment from stakeholders, such assessments have significant value because they enable partners to reflect on the mission and values of the partnership, explore the history and context for its existence, identify factors that have contributed to outcomes, and plan strategically for the future.

Global Mindset Initiative Paper 1: Growth Mindset Cultures and Teacher Practices

This article forwards a vision for enhancing equity and educational outcomes by creating growth mindset cultures in schools and classrooms. In growth mindset classroom cultures, teachers provide a coherent meaning system for students’ mindsets, goals, beliefs, and behaviors. By normalizing and infusing growth mindset beliefs and behaviors into routine practices and interactions, these classroom cultures give students (and teachers) a shared and productive way to understand challenges, setbacks, and learning inside and outside the classroom, ultimately benefiting their longer-term academic trajectories. In describing the possibility and promise of growth mindset cultures, we focus on the role of teachers and their instructional practices in creating these cultures. We provide a framework for integrating evidence-based instructional practices and growth mindset research. Finally, we chart an ambitious research agenda describing questions the field must answer if we are to create effective growth mindset cultures that spur students’ motivation and learning in school.

Treatment Effects in Strategic Management: With an Application to Choosing Early Stage Venture Capital

This paper uses the Rubin Causal Model to formalize the treatment effects of a firm choice on its performance. Building from Porter, a firm choice can shape profitability through both strategy and operational effectiveness, but they are distinct in how they do so. The strategic treatment effect is the benefit that is predictable from a firm's characteristics (i.e., resources) and their joint configuration. The strategic determinant function is a mapping of resources to treatment effects, and the role of resource interactions in it determines the importance of coherence for a strategy. Under unconfoundedness, the strategic treatment effect, strategic determinant function, and coherence can be estimated in high-dimensional observational data using machine learning. I present an application estimating the gains from choosing venture capital as early stage financing versus other forms of capital. The results highlight the advantage of considering strategic benefits in this choice. For equity outcomes, there is no average treatment effect of early stage VC, but there is significant heterogeneity: some entrepreneurs can benefit substantially from raising early stage VC, while others be negatively affected. This heterogeneity is predictable from founder, industry and location characteristics. The estimated role of coherence in this choice is moderate. The formalizations in this paper also show that several additional assumptions are required when assessing strategic benefits compared to the usual causal inference. R code to replicate these functions will be included.

Renewable Energy Investments and Social Equity: Evaluating the Low-Carbon Energy Transition

This research examines the societal impacts of varying energy policy approaches and the progress of the energy transition toward a low carbon energy-based regime internationally. Using indicators relevant to energy policy and the energy transition, five critical social equity impacts of environmental improvement, health, employment, participation, and energy cost are investigated from the viewpoint of an ‘equitable’ energy transition. We investigate the correlation of quantitative social equity impacts of the shift toward new renewable energy-based electricity from 1990 to 2015, for 99 nations with differing development levels, energy resources and policies. We find that increased levels of new renewable energy deployment generally accompany social equity improvement, however geography, national income level and complementary energy policies are also important. Our results highlight specific issues for developing nations, whereby electricity needs are often met by fossil fuels prior to the large-scale penetration of renewables. These nations enjoy short-term social equity benefits, at the risk of long-term negative social equity outcomes. This study’s holistic evaluation of energy transitions and social equity outcomes enables proactive policy development which contributes to the realization of a more equitable energy transition.

School Facilities Are Grooming Primary Schools Academic Performance in Pakistan: A Longitudinal Evidence from Punjab Province

The Pakistan government is exhausted with the despicable rate of return from education. Punjab province took the preponderance amount of the budget for quality education due to the large population density. Thus, this study longitudinal study embraces the distribution and effectiveness of necessary facilities that consume most educational budgets through extensive analysis. Hence, the main finding indicated that the Punjab province showed a radical improvement in resource equity and student learning outcomes. However, the study noted that a lot has to be done to evaluate resources since significant improvements are observed, but not an achievement.

Contracting Out of Health Services for Province-level Integration of Healthcare System: Effect on Equity

Background. The recently enacted Universal Health Care (UHC) Act prioritizes the provision of a comprehensive set of quality and accessible services. However, the devolution of health services has led to inequitable investments in healthcare resulting to disparities in health outcomes between areas. One of the strategies considered that could minimize these differences is the contracting out of health services to the private sector. This review focuses on mapping equity-related issues and concerns with regard to contracting out health services.
 Methods. A modified systematic search of literature using published journal articles through PubMed and Google Scholar and other pertinent reports and manuals was conducted on issues of equity and health service contracting.
 Results and Discussion. There is currently a dearth of literature on the effect of contracting services on health equity outcomes, particularly on the impact of contracting out on equity. Limited studies showed that contracting out can potentially improve equity by increasing service utilization. Mechanisms on how contracting out could potentially affect equity were also found.
 Results mainly suggest that concrete steps should be taken to ensure equitable access and improvement in health outcomes among population subgroups. To provide a framework in applying possible insights from the review, discussion of the literature review was framed in the context of establishing performance-based contracting. It was emphasized that including representatives from the underserved populations and patient groups during stakeholder consultations were crucial to provide localized context for the inclusive development of contracting arrangements. Other strategies that were highlighted included: establishing monitoring systems that disaggregate data between groups, selecting contractors that have the capacity to reach and provide services to the underserved, and making sure that these contractors are also open to data sharing for economic evaluation of services.
 Conclusion and Recommendations. Despite the paucity of data on the impact of contracting out services on equity, mechanisms explaining the effect of contracting on equity were put forward and illustrated. These findings can be considered by policy makers and program developers in the operationalization of service agreements between the public and private sectors.

Embedding public health advocacy into the role of school-based nurses: addressing the health inequities confronted by vulnerable Australian children and adolescent populations.

There has been a growth in Australian school-based nurses to address the inequities confronted by vulnerable students and school populations. Failure to address inequities can be evidenced in intergenerational poverty, poorer health and educational attainment and diminished life opportunities. School-based nurses are ideally located to advocate for public health policies and programs that address social determinants that detrimentally affect the health of school populations. However, school-based nurses can confront professional and speciality challenges in extending their efforts beyond individual student advocacy to effect change at the school population level. Guidance is required to redress this situation. This paper describes public health advocacy, the professional and speciality advocacy roles of school-based nurses and the barriers they confront in advocating for the health of school populations and strategies that can be used by key stakeholders to enhance school-based nursing public health advocacy efforts. School-based nurses who are competent, enabled and supported public health advocates are required if we are to achieve substantial and sustained health equity and social justice outcomes for vulnerable school populations.

National nutrition policy in high-income countries: is health equity on the agenda?

Equity-oriented policy actions are a key public health principle. In this study, how equity and socioeconomic inequalities are represented in policy problematizations of population nutrition were examined. We retrieved a purposive sample of government nutrition-policy documents (n = 18) from high-income nations. Thematic analysis of policy documents was informed by a multitheoretical understanding of equitable policies and Bacchi's "What's the Problem Represented to be?' analysis framework. Despite common rhetorical concerns about the existence of health inequalities, these concerns were often overshadowed by greater emphasis on lifestyle "problems" and reductionist policy actions. The notion that policy actions should be for all and reach everyone were seldom backed by specific actions. Rhetorical acknowledgements of the upstream drivers of health inequalities were also rarely problematized, as were government responsibilities for health equity and the role of policy and governance in reducing socioeconomic inequalities in nutrition. To positively influence health equity outcomes, national nutrition policy will need to transition toward the prioritization of actions that uphold social justice and comprehensively address the upstream determinants of health.

Co-designing eHealth and Equity Solutions: Application of the Ophelia (Optimizing Health Literacy and Access) Process.

Background: The unequal access, challenges and outcomes related to using technology have created the digital divide, which leads to health inequalities. The aim of this study was to apply the Ophelia (Optimizing Health Literacy and Access) process, a widely used systematic approach to whole of community co-design, to the digital context to generate solutions to improve health and equity outcomes.Methods: This was a mixed method study. A cross-sectional survey was undertaken at 3 health organizations in Victoria, Australia using the eHealth Literacy Questionnaire (eHLQ) as a needs assessment tool. Cluster analysis was conducted to identify subgroups with varying eHealth literacy needs. These data, combined with semi-structured interviews with clients, were used to generate vignettes representing different eHealth literacy profiles. The vignettes were presented at co-design workshops with clients and health professionals to generate solutions for digital health services improvement. Expert validation and proof-of-concept testing was explored through mapping the process against Ophelia guiding principles.Results: The cluster analyses identified 8 to 9 clusters with different profiles of eHealth literacy needs, with 4 to 6 vignettes developed to represent the eHealth literacy strengths and weaknesses of clients at each of the 3 sites. A total of 32, 43, and 32 solutions across 10 strategies were co-created based on ideas grounded in local expertise and experiences. Apart from digital solutions, non-digital solutions were frequently recommended as a strategy to address eHealth literacy needs. Expert validation identified at least half of the ideas were very important and feasible, while most of the guiding principles of the Ophelia process were successfully applied.Conclusion: By harnessing collective creativity through co-design, the Ophelia process has been shown to assist the development of solutions with the potential to improve health and equity outcomes in the digital context. Implementation of the solutions is needed to provide further evidence of the impact of the process. The suggested inclusion of non-digital solutions revealed through the co-design process reminds health organizations and policymakers that solutions should be flexible enough to suit individual needs. As such, taking a co-design approach to digital health initiatives will assist in preventing the widening of health inequalities.

Income inequality and macroeconomic instability

AbstractThis paper examines the relationship between macroeconomic instability, as measured by the variance of inflation and output, and income inequality. We develop a panel data set consisting of 61 developed and developing economies for 1990–2019. Our results highlight a positive relationship between past inflation variance and subsequent inequality. We find that this relationship is nonexistent in developed countries but is strong for developing economies. Developing countries that have adopted an inflation targeting (IT) regime are insulated from the regressive effect of inflation volatility. From the point of view of achieving an even income distribution, IT may be consistent with better equity and efficiency outcomes simultaneously. The main findings are robust to a rich set of controls, alternative measures of volatility and inequality, various subsample checks, and dynamic panel specifications.

Best response dynamics improve sustainability and equity outcomes in common-pool resources problems, compared to imitation dynamics

Shared resource extraction among profit-seeking individuals involves a tension between individual benefit and the collective well-being represented by the persistence of the resource. Many game theoretic models explore this scenario, but these models tend to assume either best response dynamics (where individuals instantly switch to better paying strategies) or imitation dynamics (where individuals copy successful strategies from neighbours), and do not systematically compare predictions under the two assumptions. Here we propose an iterated game on a social network with payoff functions that depend on the state of the resource. Agents harvest the resource, and the strategy composition of the population evolves until an equilibrium is reached. The system is then repeatedly perturbed and allowed to re-equilibrate. We compare model predictions under best response and imitation dynamics. Compared to imitation dynamics, best response dynamics increase sustainability of the system, the persistence of cooperation while decreasing inequality and debt corresponding to the Gini index in the agents’ cumulative payoffs. Additionally, for best response dynamics, the number of strategy switches before equilibrium fits a power-law distribution under a subset of the parameter space, suggesting the system is in a state of self-organized criticality. We find little variation in most mean results over different network topologies; however, there is significant variation in the distributions of the raw data, equality of payoff, clustering of like strategies and power-law fit. We suggest the primary mechanisms driving the difference in sustainability between the two strategy update rules to be the clustering of like strategies as well as the time delay imposed by an imitation processes. Given the strikingly different outcomes for best response versus imitation dynamics for common-pool resource systems, our results suggest that modellers should choose strategy update rules that best represent decision-making in their study systems.

Seeing Merit as a Vehicle for Opportunity and Equity: Youth Respond to School Choice Policy

School choice policy is ubiquitous in urban school districts. Evidence suggests that it has not fully delivered on its proponents’ promises of equitable educational opportunity. While scholars and policymakers scrutinize data to determine school choice’s equity outcomes, little attention has been paid to how school choice policy directly influences youth understanding of educational equity and opportunity. This study therefore explores how youth who engage with school choice policy come to understand and act upon the distribution of educational opportunities, and the extent to which their understandings and actions vary by social identity, family resources, school resources and admissions outcomes. 36 youth, engaged in the high school choice process, participated in this study, which is guided by policy enactment theory. Across subgroups, participants overwhelmingly valued merit as the best principle by which to distribute educational opportunity. Alongside this near-universal embrace of merit and widespread participation in choice policy-required actions, those who accessed the highest-performing schools often did so by activating non-academic resources that required financial capital. These findings highlight a shared ritual that serves to instantiate and reinforce ideals of meritocracy. Findings inform our discussion of school choice policy’s educational equity and civic implications.

Gender equality and the governance of long-term care policy: new comparative models and paradigms

AbstractThere is a long-established link between care policies and gender equality outcomes, and much modelling of welfare state typologies look at care provision as a distinguishing feature. However, to date, little research has been done which has systematically and critically examined those links by examining the policies and the way they operate, how and why they affect gender equality, and the governance of care policies in a comparative way. This paper draws on evidence from a recently completed comparative study looking at long-term care and gender equality. A CQA (Comparative Qualitative Analysis) approach was used to identify case studies, and further analysis carried out which focussed on: overall, how the policies and the way they operated to achieve gender equality; the governance and design of policies that led to good gender equality outcomes; the level of policy making; the role of the state, the family, the community and the nonstatutory civic sector in designing and delivering effective policies; and how context specific the ideas, actors and institutions supporting the policies were. Instead of using existing welfare typologies that were not driven by gender equality as the defining outcome variable, the author takes an inductive approach to policy analysis to compare policy outcomes according to gender equity outcomes. She devises two new models of long-term care policy: the Universal Model and the Partnership Model, both of which lead to improved gender equality in different ways. This paper concludes by noting the need to move beyond existing welfare state typologies in examining gender equality outcomes, which will result in new models as depicted here.

The use of branding strategies to increase the uptake of modern contraception among Kenyan youth

Building brand equity is a strategic process that can boost normative and behavior change campaigns. However, the use of brand equity within the social and health sciences remains an under-researched field in lower income countries. This work examines Shujaaz, a multi-channel communication platform that uses branding strategies to create positive associations with safe sexual and reproductive health (SRH) practices among Kenyan youth. This study has the following three goals: (1) define and measure Shujaaz brand equity and its components (i.e., loyalty, awareness, perceived quality, popularity and brand personality), (2) analyze if Shujaaz brand equity components are associated with changes in SRH practices among youth, and (3) explore if Shujaaz brand loyalty could be better defined as an outcome, not a component of brand equity. The study uses data from a survey among 450 Kenyan youth interviewed three times; in 2016, 2017, and 2018. The analytical sample includes only those participants who self-reported exposure to Shujaaz. Fixed-effect logistic regression models were used to analyze the association between measures of brand equity and SRH outcomes, and to measure the association between brand equity measures and brand loyalty. Regression estimates indicate that loyalty to the Shujaaz brand was significantly associated with ever using condoms ( OR = 1.79), ever using modern contraception ( OR = 1.95), and with the likelihood of recommending condoms ( OR = 1.88). Shujaaz brand personality was significantly associated with ever using a condom ( OR = 1.87). When analyzing brand loyalty as the outcome of interest, we observe that brand personality, brand awareness, and popularity are positively associated with loyalty. However, no significant association was observed for perceived brand quality. This study underscored the role of brand loyalty as a determinant of health behavior change. However, loyalty to the brand is strongly associated with popularity, awareness, and brand personality, highlighting the need for mediation models to further study the dynamics of brand equity.

Effect of Group and Leader Attributes on Men and Women Farmers’ Participation in Group Activities in Zambia

ABSTRACT Since development agencies often implement interventions through collective-action groups such as farmer cooperatives and self-help groups, there is a need to understand how participation is affected by group-level and leader attributes. This study collected gender-disaggregated, quantitative and qualitative data on sixty-eight self-help groups in Zambia to understand the participation of men and women farmers in different crop-production activities. Results show that participation rates of men and women are the same across all maize production activities except harvesting. The gender composition of members influenced men’s and women’s participation in group activities: when men were fewer in a group, they (men) participated more, while when more women were in a group (above 53 percent), the women participated less. Leader’s education level, knowledge of group agenda, and frequency of meetings also affected participation rates. To design collective action groups that promote gender equity outcomes, gender composition of groups should be considered. HIGHLIGHTS Agricultural collective-action groups assembled by development organizations attempt to bolster women’s participation and leadership within the group and the community. These empowerment groups may inadvertently reproduce traditional gender labor roles, particularly when membership increases women’s workload. Attention to group dynamics demonstrates that minority group members – who are usually men – work harder and overperform due to their increased visibility within the group. Thus, increasing women’s numbers in groups has not aided the goal of increasing their participation. Policymakers should consider the gender composition of the group, labor roles, time commitment of participation, and leader attributes when forming collective-action groups in order to achieve gender-equity outcomes.

Health Disparities, Transportation Equity and Complete Streets: a Case Study of a Policy Development Process through the Lens of Critical Race Theory.

Historic disinvestment in transportation infrastructure is directly related to adverse social conditions underlying health disparities in low-income communities of color. Complete Streets policies offer a strategy to address inequities and subsequent public health outcomes. This case study examines the potential for an equity-focused policy process to address systemic barriers and identify potential measures to track progress toward equity outcomes. Critical race theory provided the analytical framework to examine grant reports, task force notes, community workshop/outreach activities, digital stories, and stakeholder interviews. Analysis showed that transportation inequities are entrenched in historically rooted disparities that are perpetuated in ongoing decision-making processes. Intentional efforts to incorporate equity into discussions with community members and representatives contributed to explicit equity language being included in the final policy. The potential to achieve equity outcomes will depend upon policy implementation. Concrete strategies to engage community members and focus city decision-making practices on marginalized and disenfranchised communities are identified.