Implementation Challenges for Health Equity Programs and Initiatives
Many implementation challenges faced by rural health equity programs are common challenges experienced by other
rural health programs. For an overview of rural implementation issues, see Common Implementation Challenges in the Rural
Community Health Toolkit. See the Social Determinants of
Health Toolkit for resource considerations. Some of the unique challenges rural health equity programs
face are described below.
Health equity initiatives will benefit from long-term, flexible, sustainable funding sources, but this type of
funding is often hard to secure. Many funding opportunities only last for a few years and do not accommodate the
activities necessary to sustain their work, partnerships, and community engagement over time. Some funding
opportunities only support specific priorities and activities, rather than the cross-cutting work required to
advance health equity. In addition, the measurement frameworks that accompany funding opportunities do not
always align with health equity outcomes.
By nature, health equity programs focus on complex and systemic issues, underlying causes of inequities, and
intersecting challenges. Progress occurs over a long period of time and is frequently not linear, and programs
may experience setbacks as part of their journey. Some programs may experience opposition and gaps in funding,
which can be discouraging and make it difficult to meet objectives on schedule. It is important to balance
short-term and long-term work and goals and to measure and celebrate early successes. Large-scale disruptions
and shifts, such as economic downturns, policy changes, natural disasters, impacts of climate change, and other
emergencies can present new challenges and exacerbate existing issues.
Buy-In and Readiness for Change
Resistance to change among the communities, systems, and organizations implementing health equity programs can
be a challenge. Some organizations may need to undergo a shift in their culture before they are ready to embrace
change and implement health equity programs. Committed and accountable leadership and staff are also
foundational for program success. A lack of support, political will, and buy-in from governmental entities,
businesses, and other organizations can hinder progress and can also create other challenges, such as resource
and funding limitations.
Community and partner engagement are necessary for successful programs seeking to advance health equity.
Programs incorporating equitable practices must be community-driven and have ongoing engagement with the
community and partners. It is essential that programs center community members' voices and respect the
expertise, experiences, wisdom, knowledge, and viewpoints of community members. Factors that may complicate
community engagement dynamics and efforts include:
Differences in power held by groups and organizations in the community
Timelines that do not account for the deep community engagement required
Mistrust or fear of governmental agencies, community organizations, or healthcare systems among groups that
have had negative experiences with or been harmed by these organizations
Lack of broadband access, which can affect access to resources and information
Tensions between organizations or subgroups in the community
In some communities, terms related to health equity may be politicized, and some population groups may
experience discomfort or push back during discussions about equity or needs in the community. The messaging and
language used to describe health equity issues, data, and programs should be appropriate for and tailored to the
community. Developing messages on health equity issues and needs in collaboration with the population of focus
can help to ensure that messages are not offensive and that they resonate with the community. Appropriate
messaging can increase buy-in and support for health equity initiatives. In addition, there are differing
definitions of health equity and related concepts, so communities should develop a shared understanding of these
terms. Module 2 provides additional considerations for framing
Resources to Learn More
Strategies for Overcoming Barriers to Advance Health Equity
Discusses structural, institutional, political, financial, and analytical barriers to achieving health equity.
Provides examples of strategies to address these challenges.
Organization(s): Manatt Health, Princeton University School of Public and International Affairs