A Conversation Guide for Health Equity

"It's worth noting that communities where people are more connected with each other tend to be healthier than ones where they aren't. So in the case of health equity, conversation might do more than enable change. It may, itself, be literally healing."

Citing evidence that up to 40% of health outcomes are driven by inequitable social and economic factors, Reos Partners developed this conversation guide to advance the cause of health equity in the United States (US) and beyond. It provides tools to foster conversations between people engaged in medicine, business, nonprofit work, education, government, finance, entertainment, technology, faith-based initiatives, and the media. The purpose of this guide is to provide a tool that anyone can use to convene, host, and facilitate a conversation with members of their community on how to collaborate and act to achieve health equity.

Reos Partners explains that the health inequities the Conversation Guide is designed to illuminate are vast. Because of differences in access to care, education, employment, housing, income, safety, and environment, there can be as much as a 20-year difference in life expectancy between Americans who live just a few miles apart. These inequities often stem from the historical legacies of slavery, racism, and colonialism. As the interconnections become clear, so does the fact that health equity is beyond the power of any individual institution, sector, government, or region to achieve. The aim of the Health Equity Lab, supported by the Robert Wood Johnson Foundation (RWJF), then, is to build a community of committed system leaders who cross and connect these. (Click here to learn more about RWJF's Culture of Health approach.) Making decisions through an equity lens could influence, for instance: the range of diverse stakeholders that are engaged, hiring practices and staff team composition, distribution of resources, leadership opportunities, and decision-making protocols.

Based on dialogue interviews with thought leaders, the guide begins with a conversation "launch pad", which outlines 4 themes that point to ways in which we need to think and act differently: adopting a systemic view, leveraging an equity-based approach, changing our narratives, and convening the full spectrum of stakeholders. (On the latter point: Fundamental to collaboration, according to Reos Partners, is the inclusion of those most affected by the inequities. In addition, neighbourhoods that have experienced the most positive changes have been successful, in part, because of informal networks, community-building initiatives, and peer groups.)

The second section points to and guides discussion of 8 factors - and the relationships among them - that the interviewees identified as hindering or contributing to health equity. They include:

• "Power, leading to unilateral responses
• Historical legacy of enslavement of both Africans and Native Americans
• Policy leadership
• Neighborhood
• Hope
• Impact of funding
• Connecting with others
• Connecting with self"

Readers are encouraged to respond to the questions after each item in this section to clarify how these elements influence the health equity challenges that concern them.

The instructions then continue: "After reading and discussing the Launch Pad, gathering your initial reflections, and reviewing the Introduction to the Conversation Worksheet, fill out the Conversation Worksheet with your insights. Your local conversation is part of a larger dialogue about health equity that is taking place across the United States. To plug in to the nationwide conversation, we encourage you to post on social media, especially on Twitter. Using the hashtags [#PromoteHealthEquity and #CultureofHealth], share highlights from your conversation, post photos of your worksheet or your conversation group, and see what others have to say about health equity."