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Rural Health Information Hub

Frameworks to Advance Health Equity

Communities working to achieve health equity often move beyond the social determinants of health (SDOH) to incorporate a systems approach to health. Health equity frameworks can help communities, health professionals, and others better understand how social, political, economic, and environmental factors affect health. This toolkit draws on promising practices and evidence-based models from a range of health equity frameworks. Rural communities may review and apply these frameworks to tailor their approach to health equity.

Thrive Rural Framework

The Community Strategies Group of the Aspen Institute's Thrive Rural Framework describes the local, systems, and foundational building blocks that contribute to healthy, thriving rural communities. The framework separates components into three key themes: Rural Voice and Power, Equitable Aims and Design, and Resources for Productive Action. Rural communities can use the framework to help with planning and prioritizing strategies to advance equity.

Communities in Action: Pathways to Health Equity Framework

The Communities in Action: Pathways to Health Equity framework discusses the need to promote health equity, the root causes of structural inequities in the U.S., and the steps communities can take to begin working toward the highest attainable health for all community members. The Communities in Action framework builds on the Robert Wood Johnson Foundation's Culture of Health in Action Framework and the Prevention Institute's Systems Framework to Achieve an Equitable Culture of Health. The framework's conceptual model focuses on community-driven solutions that target the social determinants of health through three strategies:

  • “Making health equity a shared value
  • Fostering multi-sector collaboration
  • Increasing community capacity to shape outcomes”

Additionally, this framework includes population and geographic considerations that discuss the intricacies and nuances of rural living and its impact on health.

100 Million Healthier Lives Initiative (100MLives)

100MLives is a global initiative that aims to change the way people think about, perceive, and engage with health, well-being, and equity. With the goal of making 100 million people healthier, 100MLives emphasizes the importance of forming partnerships and authentic collaboration. 100MLives provides communities with several resources to shift to incorporating equitable practices and policies at every level of a community program. Their Community of Solutions framework emphasizes skills and behaviors in 5 overarching categories:

  • “Leading from within
  • Leading together
  • Leading for outcomes
  • Leading for equity
  • Leading for sustainability”

The framework seeks to help communities develop, practice, and apply these behaviors, systems, and processes to create equitable change to improve health and well-being and increase positive community outcomes.

Human Impact Partners' Strategic Practices

Human Impact Partners' Strategic Practices framework aims to help local health departments advance health equity by addressing imbalances in power, resources, and opportunities that form the root causes of inequities. The four categories of strategic practices are “building internal infrastructure, working across government, fostering community partnerships, and championing strategic change.” The strategic practices are not intended as step-by-step guides. Instead, they should be adapted to local community contexts and priorities. Strategic practices include:

CDC's Community Strategies for Preventing Chronic Disease

The CDC's Community Strategies for Preventing Chronic Disease framework provides guidance and presents strategies to help public health practitioners focus on the policies, systems, and environmental changes that promote healthier spaces. The goal of this guide is to present ways to incorporate equity into the key public health skills and practices of:

  • “Building organizational capacity
  • Engaging community members
  • Developing partnerships and coalitions
  • Identifying and analyzing health inequities
  • Selecting, designing, and implementing strategies
  • Developing effective communication efforts
  • Conducting evaluations”

Tailoring Frameworks to Community Contexts

Rural communities may select other health equity frameworks that better align with their priorities or cultural and spiritual preferences. For example, the Menominee Indian Tribe implemented the Bridges Out of Poverty framework to begin addressing inequities within the community. This framework helped community leaders see a local public health crisis of high school dropout rates as a systemic issue, resulting from broader contextual factors rather than an individual one. Fostering Futures in Menominee Nation is featured in Rural Health Models & Innovations and offers additional information.

The Social Determinants of Health Toolkit offers more information on frameworks that address the social determinants of health.

Resources to Learn More

Addressing Societal Factors to Improve Health Equity
Describes a framework developed by the American Hospital Association (AHA) to support hospitals and healthcare systems working to improve health equity by addressing the social needs of patients, social determinants of health within the community, and systemic causes such as poverty and racism that result in poor health.
Author(s): Bathija, P. & Resnick, J.
Organization(s): American Hospital Association (AHA)
Date: 12/2020

Better Health through Equity: Case Studies in Reframing Public Health Work
Provides case studies of communities that have used health equity frameworks to address root causes of health disparities. Includes examples of two statewide approaches serving rural communities: the Virginia Department of Health and the Texas Department of State Health Services.
Organization(s): American Public Health Association (APHA)
Date: 3/2015

The Health Equity Implementation Framework: Proposal and Preliminary Study of Hepatitis C Virus Treatment
Discusses the application of a determinants framework to study the healthcare disparity challenges of treating older Black veterans living with hepatitis C virus (HCV) in the rural South.
Author(s): Woodward, E. N., Matthieu, M. M., Uchendu, U. S., Rogal, S., & Kirchner, J. E.
Citation: Implementation Science, 14(1)
Date: 3/2019