Health Evaluation
Jennifer Latham (she/her/hers)
Evaluator, Health Equity Zone Initiative
RI Department of Health & Brown University
Barrington, Rhode Island, United States
Jennifer Latham (she/her/hers)
Evaluator, Health Equity Zone Initiative
RI Department of Health & Brown University
Barrington, Rhode Island, United States
Location: White River Ballroom D
Abstract Information: How do we evaluate health equity? It is notably easier to evaluate health inequities than equity, as these are reflected in differences in health outcomes and access to treatment. But is that enough? The answer is clearly no because we know that up to 80% of health outcomes stem from root causes in the surrounding physical, social, political, and economic environment. We also know that those who most often face disparate health outcomes include communities of color and low-income families. Addressing these drivers of inequity can help improve health and opportunity for all; therefore, evaluation of health equity, and not only inequitable health outcomes, is critical. Within the context of Rhode Island’s Health Equity Zone (HEZ) Initiative and its associated theory of change, contribution analysis using causal diagramming and systems theory were used to identify key contributory factors and pathways within a complex system to incorporate multiple levels of influence. At the same time, equity-centered approaches of empowerment and transformational evaluation were embedded to lift the narratives of people with lived experience in the communities. This mixed methodology was used to develop an innovative theory-based approach, termed contributory complex system equity-based (CCSE) evaluation, which is designed to capture the dynamic contributions of the multiple levels of influence and narrative storytelling to understand and demonstrate improvement in health equity within a place-based initiative.
Relevance Statement: Public health evaluation has yet to fully capture health equity and how to assess movement toward more equitable and healthy communities. This novel evaluation framework was developed from an intensive exploration of the factors and pathways that contribute to health equity within the place-based health equity zone initiative in Rhode Island. Community-led, place-based initiatives are increasingly prevalent as they strive to raise the bar on supporting health equity by meeting people where they are, but there is a significant need to provide an evaluative approach that can demonstrate the impact of these efforts using foundational theory and mixed methods to draw evidence-based conclusions that will align with funder evaluation and reporting requirements, while fully respecting the expertise of the community and the residents who live there. This theory-based, mixed method evaluation framework is designed to capture the dynamic contributions of the multiple levels of influence and narrative storytelling to understand and demonstrate improvement in health equity within a place-based initiative. The Contributory Complex System Equity-based evaluation approach seeks to harness evidence from multiple levels of contributory factors and narrative detail to support evidence-based conclusions and demonstrate impact on health equity.