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Rural Health Information Hub

Framing Health Equity

Successfully advancing health equity may require framing the issue in a way that resonates with community members, partners, and other key collaborators. Thoughtful messaging about health equity and the social determinants of health can be critical to gaining support for these concepts in rural communities.

Every rural community is different and will have different priorities and preferences for framing health equity. However, research into health equity communications highlights some suggestions about effective messaging.

Consider Phrasing Carefully

Terms like social determinants of health and health equity are commonly used in public health work, yet these phrases may not resonate with other audiences. For example, some people may think of equity in relation to financing, and some people may have a hard time distinguishing between equity and equality. Program planners can work with community organizations, groups, and members to ensure that health equity efforts use language that aligns with the way that the community self-identifies.

Find Common Ground

Research into messages that work in rural areas found that communications are effective when focused on key conditions that people connect with. These included concepts like access to broadband and healthcare, good and reliable jobs, and safe neighborhoods. Effective messaging also conveys health equity as an issue affecting all community members. Emphasizing beliefs of justice and opportunity for all are also effective framing mechanisms.

Be Mindful About Framing Health Disparities

Advancing health equity requires understanding and addressing the fundamental, structural drivers of inequities. Using consistent messaging about the systemic factors that cause inequities means that people are less likely to place the blame on individual behavior. In Framing Health Equity: Communication Strategies that Work, FrameWorks emphasizes the importance of attributing the problem and the solution to the systems level. For example, instead of framing rural residents as “sicker” than urban residents, messages can highlight the importance of addressing rural food insecurity and connecting rural residents with the transportation they need to receive preventive care.

Research has also shown that messages acknowledging the role of individual and personal responsibility also appeal to rural communities. Communications about health equity can combine the systemic roots of inequities with individual behaviors to appeal to a broader audience. For example, one message that combines both notions states:

“Personal responsibility plays a key role in health, but the choices we make depend on the choices we have available to us. It's hard to be healthy without access to good jobs, good homes, and good schools.”

Focus on Solutions

Framing health equity around potential solutions can help make large, systemic issues more concrete and approachable. FrameWorks Institute conducted years of research into how people think about racial equity and how a solution-based frame was effective in building support for policies focused on decreasing racial inequities. Being clear about the proposed changes also helps lessen feelings of hopelessness or concerns that inequities are impossible to address.

Tailor Messages Based on Readiness to Have Conversations About Health Equity

The American Heart Association's Racial Equity in Public Policy: Message Guide provides examples of messages that were tested with state and local government representatives, elected officials, community leaders, and other decision-makers. The findings show that messages test differently depending on mindsets about racial equity and readiness for direct conversations on the subject. Rural communities can explore opportunities to talk about subjects like racial inequities in ways that diverse audiences will be willing to listen to.

Implementation Considerations

Rural communities currently working to advance health equity emphasize the importance of distinguishing between health equity, social determinants of health, and health disparities. These three terms are closely related but refer to different concepts.

Social determinants of health refer to the conditions that affect health and well-being. These conditions include economic stability, education, social and community context, health and healthcare access, and the neighborhood and built environment. Health disparities refer to preventable differences in health status between groups.

One way to understand the relationship between health equity, social determinants of health, and health disparities is to consider health equity as the goal (equal opportunity to be healthy and the absence of obstacles to health). Addressing the social determinants of health can serve as a strategy to advance the goal of health equity. Health disparities serve as a way to measure and track progress on the goal of achieving health equity. Reducing health disparities is one way to demonstrate progress toward achieving health equity.

Questions for Consideration

  • How are we talking about populations that experience inequities in our work?
  • Are we engaging the community to help frame our communications related to health equity?
  • When we talk about health equity, are we proposing solutions?
  • What metrics are meaningful in our community to track progress toward the goal of health equity?

Resources to Learn More

Communicating About Equity in Health Impact Assessment: A Guide for Practitioners
Offers strategies and tips to help practitioners plan and conduct health impact assessments (HIAs) when advocating for the advancement of health equity.
Organization(s): Society of Practitioners of Health Impact
Assessment (SOPHIA) Equity Workgroup
Date: 3/2016

Communicating in Conservative Contexts: Strategies for Raising Health Equity Issues Effectively
Discusses research-based strategies to influence public opinion and advocate support for health equity issues in conservative states and regions.
Author(s): Sweetland, J.
Organization(s): Dialogue4Health, Public Health Institute (PHI)
Date: 7/2021

Framing and Messaging
Offers a collection of tools, guides, and articles describing different strategies for effectively communicating about health and racial equity.
Organization(s): Racial Equity Tools

Messaging to Advance Health Equity in Public Policy– A Culture of Health Webinar
Provides research-based strategies for communicating the value of health equity to diverse audiences. Includes a case study demonstrating how value-based messaging can be effective in unifying communities to bring about needed change.
Author(s): Dreyzehner, J., Heilbronner, J. M., Schmauss, B., & Ahmed, L.
Organization(s): National Academy of Medicine (NAM)
Date: 6/2019

Strategic Messaging
Provides toolkits for strategic messaging about public health, including a collaboration and storytelling toolkit that may assist in cross-sector collaboration.
Organization(s): Public Health Reaching Across Sectors, de Beaumont Foundation, The Aspen Institute

Using a Health Equity Lens
Highlights key concepts for discussing the systemic roots of health inequities. Suggests opportunities for involving the community in the development of culturally relevant and unbiased communication strategies.
Organization(s): Centers for Disease Control and Prevention (CDC)