Engaging Community Members Affected by Health Inequities
Communities affected by health inequities should be given opportunities to shape programs and policies that
affect their well-being. Community members should be authentically involved in all steps of program development
and implementation, such as designing and administering needs assessments, validating findings from data
collection, identifying priority issues for their communities, and advancing strategies to achieve health
Rural communities should avoid tokenism and instead promote authentic engagement of community members who
experience inequities. Tokenism occurs when individuals are included for symbolic purposes but are not
authentically engaged in the process to advance their priorities. Rural communities should consider how their
health equity efforts allow communities that experience health inequities to not only consult on proposed
activities but also make decisions about how to proceed. Research on rural multi-sector
collaborations has shown that partnerships with shared leadership structures are often effective at
fostering communication and engaging partners over time.
The Public Health Accreditation Board's Health
Departments and Authentic Community Engagement report provides a range of recommendations from local
health departments for building effective partnerships. The Minnesota Department of Health also developed Principles
of Authentic Community Engagement that may help rural communities understand how to meaningfully engage
communities. Key principles include:
Fostering trust, which involves relationship-building, the ability to listen, and being
intentional about addressing power imbalances when engaging community members.
Supporting community-led solutions, including sharing power with communities that
experience inequities and allocating resources to support the sustained involvement of community members in
Promoting social change, which refers to a long-term commitment to addressing structural
roots of inequities and strengthening communities.
The Washington State Hospital Association created a Community Engagement Toolkit
for Rural Hospitals that emphasizes the importance of community engagement for the future sustainability
of rural providers. For example, rural hospitals are increasingly participating in value-based payment
mechanisms that require demonstrating clinical outcomes affected by addressing the social determinants of
health. Building trusting relationships with community members can also encourage them to seek local care. The
toolkit provides recommendations for engaging community partners to create a shared vision — including
like community asset mapping — and design the initiative, which may include creating a logic model that links inputs, activities, outputs, and
Rural Examples of Authentic Engagement to Advance Health Equity
The Southeast Arizona Area Health Education
(SEAHEC) Healthy Farms Program first trained community members to serve as promotores de salud, with
the goal of building trust between the Winchester Heights community and local health and social services
organizations. SEAHEC provided training and capacity-building assistance to guide the promotores as they
built a system to help residents navigate local resources. Promotores also collected information about
priority health issues and began mobilizing residents to help improve community health.
The West Marion Inc. in
rural McDowell County, North Carolina, hosts forums that empower residents to develop a shared vision for
their neighborhoods, engage in open and honest dialogue, identify barriers, build relationships, and develop
plans for action. This work is rooted in structurally excluded communities in McDowell County, NC,
including: West Marion, East Marion, and Old Fort.
The American Indian Cancer Foundation (AICAF) works with
tribes and tribal organizations to assist them with identifying and implementing strategies to prevent cancer
that are rooted in indigenous ways of knowing. The approach emphasizes the importance of
relationship-building and community conversations where tribal community members are empowered to develop
The California Accountable Community for Health Initiative
sites (including rural Humboldt County) engaged in training
to authentically engage their communities in conversations around systems-level approaches to
improving health. The Accountable Community for Health program is organized around the Theory U
framework, which emphasizes shared intent and gaining a systems perspective.
Rural communities should carefully consider barriers that may prevent community members from participating in
initiatives to advance health equity. Potential barriers include:
- Language access and availability of translation services
- Fear of drawing attention to citizenship status
- Lack of transportation to in-person meetings
- Lack of childcare
- Lack of broadband or facility with technology to participate in Zoom meetings
- Inability to miss work for engagement opportunities
One way to help address these barriers is working with community liaisons like community health workers or social service providers who have
close relationships with communities that experience inequities. These individuals can provide recommendations
for helping address challenges to participation.
Questions for Consideration
How are we facilitating participation of communities that experience inequities (for example: meeting time,
compensation, meeting location, language services)?
Are we engaging community members to inform our understanding of the policy environment?
Program Clearinghouse Examples
Resources to Learn More
Authentic Engagement Of Patients And
Communities Can Transform Research, Practice, And Policy
Discusses authentic stakeholder engagement in population health research where all relevant stakeholders are
full partners actively involved in each stage of the study. Identifies two examples demonstrating this concept:
engaging patients in practice-based research and engaging the community in health equity research.
Author(s): Woolf, S. H., Zimmerman, E., Haley, A., & Krist, A. H.
Citation: Health Affairs, 35(4)
Communities Through Issues Forums: A How-To Guide for Onsite and Online Community Engagement
Offers suggestions to Cooperative Extension staff using issues forums to engage communities.
Author(s): Braun, B., Pippidis, M., Ketterman, J. M., Inwood, S., & Wright, N.
Organization(s): The Ohio State University Extension, University of Delaware, University of Maryland
Principles of Community
Engagement: Second Edition
Provides an overview of community engagement principles and a guide for public health professionals, healthcare
providers and organizations, researchers, and community-based leaders working to improve population health
through community collaboration. Includes examples of community engagement in rural communities.
Organization(s): National Institute of Health (NIH), Clinical and Translational Science Awards Consortium