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Rural Health Information Hub

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 health equity.

Resources to Learn More

State 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
Date: 11/2020