Table 4 Strategies to Address Root Causes of Health Inequity (n = 130)

Build Community Knowledge and Capacity

Provide general education and raise awareness across a range of topics; ensure appropriate framing and messaging are used when sharing information; support and equip people with tools to be successful

“Education and awareness building to support people to become their own advocates.” [Regional director, multisector]

“Honest education regarding risk/benefits of chosen lifestyles that contribute to long term poor health and poor quality of life.” [Registered nurse, health and human services]

Develop Economic and Workforce Infrastructure

Develop the local economic and physical infrastructure, including employment opportunities and professional development; expand existing services; and seek funding for further development

“We have been trying to attract some different types of businesses that could employ people who have little or no secondary education.” [City manager, multisector]

“Economic development efforts, development of regional transit service.” [Community development director, community and economic development]

Activate Collaboration and Partnerships

Actively search for opportunities to collaborate across organizations, sectors, and with community; build partnerships and capitalize on existing partnerships; network, share resources, align priorities, and fill gaps to achieve health equity

“Collective community collaborations, sharing of resources among community agencies, looking for avenues to partner with others.” [CEO, health and human services]

“Community partnership to tackle infrastructure challenges together versus in silos. Strength is in numbers and joining forces is critical for funding and future enhancements.” [Chief information officer, other sector]

Establish Referral and Resource Systems

Connect individuals to and provide assistance in navigating needed resources and services; raise awareness of and encourage engagement in existing resources and services

“Linking people to community resources is the best strategy I see to help individuals and families address the challenges they face and find support to overcome many of the problems that occur.” [Faculty, health and human services]

“The school district provides a full time RN to services our students. She provides referrals as needed.” [Superintendent, education]

Provide Direct Services

Address health equity by directly providing services and resources that respond to community needs

“Delivery of services which are responsive to these challenges.” [Director, health and human services]

“Provide as much food as possible so no one goes hungry.” [Soup kitchen supervisor, food systems]

Ensure Flexible, Fair, and Equitable Access

Provide services and resources to everybody regardless of financial or other barriers; ensure resources and services are free of cost or low cost and accessible; meet people where they are by providing services where they are needed

“Meeting clients where they are. Coming to them.” [Health educator, food systems]

“Providing services to all regardless of income or ability to pay; hiring compassionate, non-judgmental, knowledgeable service providers.” [Division manager, health and human services]

Conduct Community Outreach and Engagement

Have an active presence in the community, build rapport and trust with communities, conduct outreach via various communication means to connect with the community, listen and respond to the need, and learn from the community to work together toward health equity

“Putting a 'face' to local government–helping residents see that public servants are not part of a nameless machine, rather they are friends, neighbors and live in the same communities.” [Assistant county manager, policy]

“Work with positive community members that want to help students, participate in local radio show in the past to give positive messages, newsletters, open listening, focus decisions on what is best for students, try and recruit positive role models for children.” [Superintendent, education]

Engage in Advocacy and Policy Change

Advocate and lobby for resources, services, and policy changes based on community needs; raise awareness of locally-identified issues and influence decision-makers to take action

“Provider groups banding together to lobby for change.” [CEO, multisector]

“Advocating for system review/change. Push for outcomes vs outputs. Asking 3 questions: How much did you do, how well did you do it and is anyone better off?” [Director and chief health officer, multisector]

Be Culturally and Community Responsive

Recognize and honor the uniqueness of different cultures and communities; provide services and resources that are grounded in the culture and community

“Our organization tries to bring together professionals from a range of sectors, help ensure that prevention strategies are culturally, linguistically, and age appropriate, and that they match people’s health literacy skills, provide internet skill-building courses to help residents find reliable prevention services.” [Executive director, multisector]

“Acknowledgment of historical trauma and focus on resiliency building for children and youth.” [Executive director, multisector]

Utilize Evidence-Based Practices

Stay informed on and implement evidence-based practices into strategies used to address health equity

“Being informed on evidence-based practices and incorporating them into our strategies. Updating policies to prioritize addressing root causes, rather than how we ‘feel’ about them.” [Chief probation officer, multisector]

“Working with community residents and partners, achieving agreement on proposed service delivery models, implementing evidence-based programs, and monitoring/providing feedback on program results. When supported, adopt public health ordinances to promote health (i.e., smoking ordinances, texting while driving ordinances, etc.).” [Deputy director, health and human services]