An Emerging Approach to Health Equity Practice: Exploring the Implementation of Organizational Health Equity Capacity Assessments

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Johns Hopkins University
Objective: Public health organizations play a key role in achieving health equity, but there are significant gaps in the literature related to the assessment of organizations’ health equity capacity. The purpose of this dissertation research was to strengthen the evidence base related to organizational health equity capacity assessments (OCAs). This research benefits health departments by providing strengthened evidence related to OCA selection and implementation, helping departments to better assess their organizational capacity to design, implement, fund, manage, evaluate, and sustain health equity-oriented work. Methods: This dissertation contains three manuscripts. The first manuscript is a scoping review characterizing the OCAs in the gray and peer-reviewed literature, providing a baseline for researchers and practitioners to find and utilize the OCA that best meets their needs. The second manuscript explores the factors that facilitate or inhibit OCA implementation, and documents the initial organizational impacts of these assessments, through two case studies conducted with the Kitsap Public Health District (KPHD) and the Rhode Island Department of Health (RIDOH). The third manuscript is a white paper exploring the programmatic opportunities for OCA implementation and recommends further research. Results: The scoping review identified and characterized 17 OCAs that met the inclusion criteria at the time of research. All identified OCAs assess organizational health equity readiness and/or capacity, but differ regarding thematic focus, structure, and intended audience. Implementation evidence is limited. The case study expanded this evidence base, providing implementation evidence drawn from the two health department OCAs that will be useful to other departments interested in assessing their capacity. Considerations for future OCA implementation are highlighted in the results. The white paper highlighted additional research needs to strengthen OCA impact and identified potential programmatic uses of OCAs including to strengthen equitable public health emergency preparedness, develop equity-oriented public health capabilities through accreditation, and facilitate multi-sectoral, collaborative progress towards improved health equity action. Conclusion: This dissertation advances the evidence base related to organizational health equity capacity assessments and identifies opportunities for OCA utilization and further research. Organizational health equity capacity is a unique type of capacity and should be an ongoing focal area for all health departments.
Health equity, health disparities, health inequity, social justice, organizational capacity, organizational change, public health organizations, local health departments, state health departments, capacity assessments