For much of the workforce in the healthcare industry, health equity is still a relatively new area of focus. Before health equity leaders can ask their colleagues to take on new responsibilities of embedding equity into their day-to-day work, leaders must ensure staff are equipped with baseline knowledge and skills. Health equity leaders can:
 

• Start to develop their partner teams’ understanding of the topics of structural racism, power, and privilege. To get started, share the Diversity, equity, and inclusion conversation starters and Racism and healthcare: Your reading list, and point your colleagues to our Health Equity landing page for more. 
• Paint the vision of your organization’s health equity end goals. It’s important to understand the problems, but it’s helpful to articulate a positive vision of what the organization’s efforts are aiming for. Describe that an equitable healthcare organization must fulfil each of three pillars below — and use examples to bring each pillar to life: 
  • Workforce: Build diversity, equity, and inclusion among your staff and leaders
  • Patients: Ensure equitable biopsychosocial care for all patients
  • Community: Address social determinants of health and their root causes
• Guide people to communicate using inclusive language. This includes using “person-first” language (e.g., use “patient with a disability” rather than “disabled patient”) and avoiding gendered terminology. But this doesn’t mean using euphemisms instead of being specific (e.g., use "Black patient" rather than "diverse patient"). It’s helpful to be precise, as long as it’s relevant to the discussion at hand. Review our Incorporating Inclusive Language resource and the APA’s Inclusive Language Guidelines for more tips.

While education is important, health equity is a vast field, and it’s not feasible to expect that every team and department will become experts. Instead, help your partner teams pair foundational understanding with “health equity humility.” Drawing from the concept of cultural humility, health equity humility indicates an understanding that every individual brings their own identities, privileges, and unconscious biases into their work, making it important to remain open to continuous learning and feedback, even when it’s uncomfortable. Building this humility across your workforce can help avoid the formation of “health equity tourists” who “parachut[e] in to ‘discover’ a field that dates back more than a century…publishing naive and uninformed, and sometimes racist, research and ‘erasing’ scholars of color who created much of the discipline’s foundational work.”

Please note this does not mean an individual must have a certain identity to contribute meaningfully to health equity. That approach inadvertently puts all the work on historically marginalized groups, who may or may not want to be owners of the work or may feel tokenized. Health equity should be a core competency for all employees, though individuals from historically privileged groups should share their platforms and be especially open to critiques of their work and processes.

Even with the fundamentals down pat, functional leaders across the organization may need support in identifying the specific role they and their teams can play within the broad umbrella of health equity. The size and scope of each team’s health equity focus will inherently vary. Health equity leaders can play a valuable role in the brainstorming and opportunity assessment phase before handing off strategic planning and implementation to department leads. Use the following table as inspiration for finding your partner teams’ health equity niches.

No matter the focus area, every department-level initiative must be paired with a thoughtful strategic plan to minimize resources spent and maximize potential impact. For the most part, drafting a health equity strategic plan is very similar to conducting any other. However, there are some unique dynamics to keep in mind. Encourage your partners across the organization to:
 

• Consult non-traditional stakeholders across the life cycle of the initiative, but especially during the planning phase. Diversifying outreach or creating a community advisory board will surface lesser-known perspectives. In addition to aiming for demographic diversity across the stakeholders themselves, depending on the initiative planned, aim for a mix of “traditional” internal experts and “nontraditional” community-based contacts who are more in tune with on-the-ground nuances.
• Incorporate data with caution. Whether you’re working with internal or external data, it’s likely incomplete, imperfect, or even misleading, like with inconsistent racial group definitions. Proactively surface the data set’s limitations (use our Disparity in Data resource to help), but don’t let perfect be the enemy of the good. Review this piece for tips on how to move forward with imperfect data in a thoughtful way: 3 ways to navigate health equity data challenges.

The next milestone health equity leaders can expect to assist with is in the assessment of investments and ensuring accountability for improvement. No team or department will execute their health equity efforts flawlessly, no matter their experience. Even with good intentions, many investments are designed to look good, not maximize a positive impact on marginalized populations. Bring a discerning eye to regular progress check-ins and help your partner teams identify where to apply appropriate skepticism. Some red flags include:

• Press releases and plans for the future unaccompanied by tangible commitments.
• Frequent use of buzzwords and scant use of details or data for accountability.
• Limited staff and resources dedicated to executing the health equity vision.
• Conflating individual-level interventions with structural change (e.g., delivering an internal DEI training to address structural racism, referring patients to food banks vs. ending local food deserts).

Share progress updates with senior leaders as a regular way to promote transparency and accountability for success. Ideally, your partner teams will have to select and share KPIs with senior leaders and may even have performance evaluations or compensation tied to the success of their efforts. These tactics help to ensure partner teams are applying the same level of strategic rigor to their health equity strategies as they would to any other key priority area.

As part of an effort to ensure strategic rigor, your partner team leaders will likely be asked to identify the direct financial ROI of their investment. For some business models, there will be a clear and measurable case. But chances are, if the business case for health equity initiatives were very strong, more of the industry would have acted by now. Your partner teams should highlight how equity work contributes to business impact beyond a direct financial ROI and articulate what senior leaders need to do differently to build a more meaningful business imperative.

However, focusing solely on business imperatives rather than the moral case for investment can alienate progressive partners and other stakeholders. As one community health equity leader put it, "The idea that we have to make a case for equity sickens me. It's immoral to ask the question...This work has to be based in the mission of healthcare, not the margin.”

The high stakes of this work can sometimes make teams hesitant to even begin. Be ready to reassure your partner teams that they will inevitably make mistakes in their health equity efforts, that is okay as long as individuals remain open to feedback, reflection, and adjust accordingly.

Scaling health equity work across the organization may garner internal and external pushback about the value of this investment. Inherently, health equity work will be perceived as more controversial or inflammatory than traditional initiatives and requires cross-organizational leaders to put an ethical stake in the ground around the mission of the organization. As such, the health equity leader should prepare their partner teams across the organization with communication and negotiation skills. Partner teams should be able to:
 

• Create an airtight argument with purposeful framing around the reasoning for their health equity investment. Precision in language and defensible data and sources especially matter for topics where some are primed to bring a microscope to your work. It is also helpful to develop a clear understanding of common arguments of potential detractors. During the planning and fact-finding stage, staff should purposefully seek out opposing perspectives to be able to understand (and counter) those points. Though this takes time, it helps teams preempt criticisms and respond deftly to detractors. The table below outlines common areas of pushback to get you started.

Reassure your partners that sometimes the emotional reaction to the work is more important to get in front of than the factual specifics of a counterargument. Pushback is often rooted in defensiveness, and some people will instinctively feel targeted or blamed for being part of a historically privileged group, unless staff are able to quell those fears.

• Be comfortable with the uncomfortable — to a point. No matter the strength of the argument, some will disagree with the initiative, activities, or processes on political grounds or because of conflicting business incentives. Health equity efforts must challenge the status quo to be effective, but this does mean that these topics can elicit angry or unprofessional responses.

One question to ask to determine whether to engage in a confrontation: Is this person making an argument in good faith, or are they simply trying to undermine me? If the latter, it’s not worth your energy to engage. Remain polite, but firmly back up the value of your work and move on. But if it’s the former, engaging in a calm, open dialogue could shift someone from a detractor to a supporter. Be careful not to inadvertently undercut your work or cosign any biases in an effort to placate the detractor, as that can damage your standing with your supportive colleagues and health equity champions.

Health equity leaders are tasked with achieving ambitious goals — and rightly so, as the industry has far to go to achieving equitable outcomes in healthcare. The more these leaders can scale their impact by embedding health equity across the entire organization, the faster organizations will see progress across their KPIs.