Identify A Health Equity Focus
What does it mean to identify a health equity focus, and why is it important?
Identifying a health equity focus means selecting a specific inequity for your initiative to address. A clear, well-defined focus keeps interventions targeted and actionable, and allows your team to align resources, design effective interventions, and track meaningful progress. Your focus might center on a social driver of health (e.g., housing instability) or a specific health outcome (e.g., blood pressure control among Black patients with hypertension). Health and healthcare inequities vary across populations, regions, and healthcare systems. There are always numerous inequities that could become the focus of a health equity initiative. In multi-organization collaboratives, partners may have different views on which inequities to prioritize and address. This can introduce challenges for identifying a focus area.
When should I identify a health equity focus?
This component should be one of the first steps in any health equity initiative. Without a clear focus, teams risk designing interventions that are too broad, ineffective, or fail to address the most pressing inequities. It is especially critical to work through this component when:
- Launching a health equity initiative – Ensuring the team has a shared understanding of the problem.
- Reviewing or revising organizational quality improvement priorities – Aligning equity efforts with existing quality improvement work. An equity focus should be incorporated into all quality improvement activities.
The chart below details the steps as well as the approximate number of meetings for which to plan, while recognizing that the estimates will vary from team to team.
| Key Activities | Time Estimate: ~15+ Hours |
|---|---|
| Understand the priorities of the people you serve, team members, and other leaders | Variable – based on relationships already established |
| Measure the experience of the people you serve | 4-6 one-hour meetings |
| Stratify your data and learn about gaps | 4-6 one-hour meetings |
| Analyze priorities and opportunities for action | 3-6 one-hour meetings |
| Select a focus | 4-6 one-hour meetings |
How should I diagnose root causes with an equity lens?
Begin by having your team review the Diagnosing Root Causes With an Equity Lens presentation. Be sure to set-aside time for discussing the content. Then, have each team member read the Conducting a Root Cause Analysis with an Equity Lens: Key Considerations tool, followed by a group discussion of their perceptions and questions regarding the information within it. Use the Diagnose Root Causes Facilitator Guide to help plan and facilitate root cause analysis sessions with key stakeholders as described in the presentation.
Next, review four key resources:
Applying an Equity and Anti-Racist Lens to Quality Metrics and Data explains how presenting health data without a racial equity lens can unintentionally reinforce racism. It offers guidance for presenting stratified data in ways that highlight systemic causes rather than individual deficits — including choosing equitable benchmarks, naming root causes explicitly, and using strengths-based framing.
Using Data to Reduce Disparities and Improve Quality provides a high-level introduction to key concepts underlying the use of stratified data to identify disparities, design equity-focused interventions, measure impact, communicate findings with stakeholders, and sustain equity work over time. It also provides real-world examples and evaluation tools and introduces the topic of integrating quantitative and qualitative data.
Advancing Health Equity: An Approach to Systematically Identify and Evaluate Health Disparities from the Institute for Healthcare Improvement (IHI) presents a detailed, four-step approach for identifying inequities and constructing metrics that advance health equity for healthcare organizations and systems. It is based on the current, cumulative state of health equity measurement, research, and practice, representing the consensus of more than 35 subject-matter experts from an array of healthcare settings, including clinical, quality, payer, academic, and administrative, as well as the relevant quality improvement and disparities reduction literature. Finally, the Health Equity Focus Worksheet helps teams by providing a convenient structure to consistently document key information and evaluation criteria to facilitate systematic comparison of potential health equity focus areas. We encourage teams to adapt and tailor the worksheet criteria to meet their needs.
Resources to Identify a Health Equity Focus
Identify a Health Equity Focus
This presentation introduces core concepts linking quality, disparities, and equity, and guides teams through the process of selecting a health equity focus. Key topics include intersectionality, systems thinking, targeted universalism, and using data effectively. Built-in breakout activities help teams align on a focus area and plan next steps.
Applying an Equity and Anti-racist Lens to Quality Metrics and Data
This resource explains how presenting stratified health data without a racial equity lens can unintentionally reinforce racism. It offers six concrete practices for more equitable data presentation — including choosing equitable benchmarks, disaggregating data, naming root causes, and using strengths-based framing — with real perinatal care examples illustrating each.
Using Data to Reduce Disparities and Improve Quality
This resource outlines a step-by-step approach to using stratified quality data to identify disparities, design equity-focused care interventions, and measure impact. It emphasizes integrating both quantitative and qualitative data, engaging patients and community members in root cause analysis, and communicating findings effectively to different stakeholder groups. It also includes practical guidance on choosing the right denominators and sustaining equity work over time.
Health Equity Focus Worksheet
This worksheet helps teams systematically evaluate and compare potential health equity focus areas using consistent criteria — including documented disparities, structural factors, existing momentum, available measures, actionability, community partnership, and scalability. An example using asthma control is provided to guide teams through the process.
Best Practices for Institutionalizing Fair and Inclusive Health Care Practices and Measuring Progress from the Institute for Healthcare Improvement’s Advancing Health Equity: An Approach to Systematically Identify and Evaluate Health Disparities; Appendix B).
This resource guides organizations in developing a strategy to maximize the chances of successfully identifying, reducing, and eliminating health and health care inequities. Implementing the strategy and tracking progress will provide key data to organization leadership regarding the status of the organization’s equity efforts.
In addition to addressing the advancement of equity for patients and health plan participants, this practical guidance also addresses equity, inclusion, and belonging for the organization’s employees.
Assessing Activities to Identify a Health Equity Focus
This resource will help you assess and address three common challenges in identifying a health equity focus: information overload leading to analysis paralysis; accessing, reporting, sharing, and analyzing data; and excluding patients and community-based organizations from the process of identifying a health equity focus.
| Topic | Next Steps |
|---|---|
| Difficulty identifying a health equity focus area. Difficulty agreeing on a health equity focus for a multi-organization collaborative. | Sometimes it can be difficult to select a health equity focus due to the large amount of healthcare quality and outcome data available for analysis. Also, there are typically numerous disparities and inequities identified in the data. As a result, individual organizations and multi-organization collaboratives can experience “analysis paralysis”; engaging in a seemingly endless series of conversations and deliberation meetings without landing on a decision. Part of the difficulty is that there are many contextual factors that can influence the selection of a health equity focus. Reviewing these factors can help narrow the field of options and facilitate decision-making. Instructions: Use the following prompts to identify quality improvement and health equity priorities and the larger context driving them. For multi-organization collaboratives, have at least one representative from each organization utilize the prompts to describe their organization’s priorities for a health equity focus and the context in which they work. Record the priorities for each organization so that they can be compared side-by-side. What is the patient population of interest (e.g., statewide, specific counties or other geographic areas, patients attributed to a specific payer)? What healthcare and health equity topics have community-based organizations or coalitions serving the patient population prioritized? Are there financial or contract-related motivations that impact the decision (e.g., specific expectations embedded in value-based payment contracts, reducing the overall cost of care, Medicaid 1115 waiver requirements)? Are there existing or planned quality improvement objectives or initiatives that factor into the decision (e.g., reducing avoidable 30-day readmission rates, improving overall rates of blood pressure control for patients with chronic hypertension, improving door-to-balloon time in the treatment of ST-segment elevation myocardial infarction)? Are there politically-related motivations that impact the selection of a focus area (e.g., a special focus on a particular health issue or inequity promoted by the governor, pro- or anti-sentiment held by elected officials regarding specific healthcare issues or policies)? Are there influential key stakeholders invested in the decision? What are their desires? What are their concerns? Are there other factors to consider? For multi-organization collaboratives: After each of the organization representatives has shared their priorities, compare and contrast them to identify priority areas and motivations held in common. Is it feasible to identify more than one health equity focus? |
| Data opportunities and challenges | Identifying a health equity focus requires accessing, reporting, sharing, and analyzing data. Ensure that your organization or team is prepared to evaluate the quality of the data you will use and to anticipate data-related challenges. First, review the following resources: Anticipate Data Needs and Opportunities (Presentation) Anticipate Data Needs and Opportunities (Tool) Considerations for Accessing, Collecting, and Sharing Data (Tool) Discuss the following questions as a team to identify next steps: What did you learn by reviewing and using the resources that can guide the work of identifying a health equity focus? What quantitative data will your team use to identify a health equity focus? What are the potential biases and weaknesses of this data? What qualitative data will your team use to identify a health equity focus? What are the potential biases and weaknesses of this data? |
| Partnering with Patients and Community Based Organizations | It is important to partner with patients and community-based organizations when identifying one or more health equity focus areas. Consider the following questions and use responses to identify next steps. Do not forget to utilize the resources in the Partnering with Patients and Community-Based Organizations component of the Roadmap. Have patients been involved in the work of identifying a health equity focus? If yes, what have they shared about the health conditions or decision-making factors that are most important to them? If not, why not? How can you partner with them and include their perspectives in the decision-making process? Are there any community health needs assessments conducted by your organization or others (e.g., public health agencies) that can inform the process of identifying a health equity focus? Does your organization currently partner with any community based organizations? How can you learn about their ideas and recommendations regarding identifying a health equity focus? What health and healthcare equity activities are taking place in the communities of the patients/members that you serve? What existing publications, websites, or other types of communication describe healthcare and health equity topics prioritized by community-based organizations or coalitions in your service area? How can these inform your decision-making? |
About the Roadmap Goal and Objective Setting Tool
This tool helps your team realize your vision to reduce and eliminate health and healthcare inequities by providing a centralized resource to:
- Establish process goals that align with each Roadmap component;
- Document task status, champions, and detailed notes;
- Monitor progress across multiple Roadmap components simultaneously; and
- Promote consistent team communication, accountability, and progress.
Use this tool to facilitate and document the development, implementation, and evaluation phases of your health equity initiative.