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Rural Health Information Hub

Developing Permanent Organizational Infrastructure for Health Equity

To ensure long-term change and sustainability of health equity efforts, rural organizations can look for opportunities to incorporate equitable changes into their systems, protocols, and processes. Some strategies for developing permanent organizational change for health equity include:

  • Embedding health equity staff positions in the organization or designating staff to serve on a health equity team that will help guide organizational health equity efforts
  • Assessing organizational policies to identify any challenges to engaging communities or addressing social determinants of health
  • Developing organizational strategic plans to eliminate disparities and advance health equity
  • Incorporating health equity into the organization's mission and/or vision
  • Formalizing partnerships and collaborations with partners through MOUs (memoranda of understanding) or other mechanisms
  • Infrastructure updates, such as renovations to improve accessibility or hardware/software updates to capture comprehensive demographic information

At the local government level, the National Association of Counties lists examples of counties that have issued county declarations and resolutions or instituted county committees and initiatives to advance diversity, equity, and inclusion. These policies and programs can keep local governments and elected officials accountable for addressing equity in all aspects of their work. Examples include commitments to:

  • Increasing diversity throughout local government, such as county boards and commissions
  • Building or expanding community partnerships
  • Allocating resources to address racism and disparities, such as by aligning a strategic plan for equity with the county's annual budget process
  • Working across government agencies to promote equity in policymaking (see Health in all Policies)
  • Providing training on topics like disparities and racial equity for county departments, agencies, and staff
  • Changing the county's recruitment practices

Examples of Communities Developing Permanent Organizational Infrastructure for Change

  • The Washington State Hospital Association's Health Equity Organizational Assessment notes that infrastructure changes could include a designated person or people who assume responsibility and accountability for implementing health equity efforts. Other infrastructure efforts include committing to the National Standards for Culturally and Linguistically Appropriate Services (CLAS), designating individuals who are responsible for leading health equity efforts, involving community members who experience inequities in the planning and implementing of health equity efforts, and prioritizing equity in organizational missions and goals.
  • The State of Connecticut Department of Public Health has Health Equity Policy and Procedures that apply to all department programs and services. Policies include adherence to the CLAS standards.
  • The County Board of Supervisors in rural Mono County, California, passed a resolution that recognized racism as a public health crisis and asserted a commitment to advancing racial equity and reducing disparities. Actions listed include participating in regular trainings on topics of diversity and discrimination and developing a workplan for efforts related to justice, equity, diversity, and inclusion.

Questions for Consideration

  • How is the organization holding itself accountable to advancing health equity?
  • Who at the organization is involved in planning, designing, and implementing health equity efforts?
  • How is the organization operationalizing health equity in its work?

Resources to Learn More

Improving Health Equity: Build Infrastructure to Support Health Equity Guidance for Health Care Organizations
Discusses efforts to build organizational infrastructure to support health equity with an emphasis on the collection and use of race, ethnicity, and language (REaL) data.
Organization(s): Institute for Healthcare Improvement
Date: 2019