Despite concerted national efforts to create healthier, more equitable communities, health disparities and health inequities still “loom large” in the United States, particularly for people of color and rural communities.
According to the recently released 2020 Regional Health Equity Survey Report (RHES), a way to address health equity issues may lie in cross-sectoral collaboration between Arizona’s top community leaders — those whose individual work, when brought together, directly affects all aspects of creating a healthy and vibrant community through improving social, environmental or economic conditions.
Researchers from Northern Arizona University’s Southwest Health Equity Research Collaborative (SHERC) Community Engagement Core (CEC) recruited more than 200 community, organizational, and grassroots leaders from five northern Arizona counties — Apache, Coconino, Mohave, Navajo, and Yavapai — to participate in the RHES.
The RHES is comprised of 48 questions and includes topics related to the distribution of resources in the communities served, personal understanding of social determinants of health, organizational capacity to address health inequities, extent and focus of cross-sectoral partnerships, use of data in decision making, and the role of research in addressing health inequities in the community.
The CEC researchers developed the survey questions with the assistance of an 11-member Community Advisory Council composed of leaders from sectors including early childhood development, education, criminal justice, public health, and policy.
“The RHES was designed to engage leaders beyond the health care and public health sectors but essential to achieving health equity locally, such as leaders in the education, justice, economic development and transportation sectors to name a few. We asked these leaders to identify the local root causes of health equity from their perspective with the hope of developing a long term partnership to address these community identified issues,” said Samantha Sabo, CEC core co-lead and an associate professor in the NAU Department of Health Sciences and the Center for Health Equity Research (CHER).
Sabo said that given the complex and interrelated nature of these determinants, developing policies that will advance health equity requires collaboration across sectors outside of health. She said that employing a multi-sectoral approach to improve health equity can have multiple benefits including pooling resources, leveraging unique knowledge bases, expanding reach, and avoiding duplication of work.
In addition to Sabo, the CEC research team consists of Mark Remiker, Dulce Jiménez, Alexandra Samarron Longorio and Carmenlita Chief, all senior program coordinators with CHER, Heather Williamson, assistant professor in the NAU Department of Occupational Therapy and CHER, and Nicolette Teufel-Shone, associate director of CHER, professor in the Department of Health Sciences, and co-lead of the CEC.
The leadership positions of RHES participants included county managers and department directors, police chiefs, superintendents, presidents, CEOs, and executive directors in federal, state, county and municipal organizations. A vast majority of the leaders work directly with community members or supervise staff who work directly with community members.
The leaders were asked questions on subjects that directly affect their communities, such as food security, community safety and violence prevention, early childhood development and education, transportation, availability of affordable housing, racial justice, quality public education, youth development and leadership, recreation opportunities, and arts and literature.
In the RHES, CEC researchers reported that survey respondents had a deep knowledge of the drivers of health inequities in their communities, and they were especially aware of how their own beliefs, values and privilege influence their worldviews on issues of equity, racial equity in particular.
“From the results of the RHES, we gained a clear understanding of how northern Arizona practitioners and decision-makers understand health equity in the regions they serve. Health equity is the systematic, avoidable, and unfair differences in health status across population groups, sustained over time and generations, that are most often beyond the control of individuals,” Sabo said. “These leaders reflection on local health equity issues is profound and as research partners gives us deep insight in how we could better partner to address the social determinants of health and engage in cross-sectoral partnerships in the region.”
Based on responses from leadership, the most frequently cited characteristics for developing a successful multisectoral partnership were communication, shared vision, and trust.
The community leaders who participated in the survey recommended 10 strategies to advance equity in northern Arizona:
- Build community knowledge and capacity
- Develop economic, workforce and infrastructure
- Activate collaboration and partnerships
- Establish referral and resource systems
- Provide direct services
- Ensure flexible, fair and equitable access to health and health services
- Conduct community outreach and engagement
- Engage in advocacy and policy change
- Be culturally and community responsive
- Utilize evidence-based practices
Findings from the RHES have given the CEC researchers a better understanding of each region’s current capacity to impact the root causes of health inequity using a multi-sectoral approach. In the future, through the RHES dissemination, the CEC team hopes to support a strategic planning through multi-sectoral collaborations.
Mark Remiker, lead of the RHES and a senior program coordinator at the Center for Health Equity Research, said that their goal is to use the information to create trainings and inform policies that address the community-identified health equity issues.
“Without a clear consensus on the root causes of health equity and greater cross-sectoral collaboration, the development of effective policy and practice objectives aimed at reducing health disparities and improving health equity will be limited,” Remiker said.
“While collaboration with governmental and non-governmental sectors outside of health is required to develop policies and programs to advance health equity, establishing and maintaining effective cross-sectoral partnerships is not an easy task,” Remiker said. “Engaging relevant stakeholders, tapping into their unique knowledge systems, and identifying common objectives across sectors requires time and resources not often afforded to governmental and non-profit agencies.”
Remiker said that by analyzing the RHES study results, the researchers found that the leaders thought that research on social determinants of health were highly valuable and that the leaders were already actively engaged in cross-sectoral partnerships.
SHERC is a grant-funded initiative of CHER and is supported by funding from the National Institute on Minority Health and Health Disparities of the National Institutes of Health (U54MD012388).