Health Equity in Action: The Learning and Action Tool for State Health Departments
December 2017

Julia Heany, PhD
Center for Healthy Communities
Michigan Public Health Institute

Angela Precht, MSW, MPH
Special Projects Manager
Center for Healthy Communities
Michigan Public Health Institute

As the field of public health turns attention toward addressing social determinants of health (SDoH) and the root causes of social and economic inequities, public health departments seek strategies for identifying and addressing gaps in their capacity to effectively advance health equity. The Foundational Practices for Health Equity: A Learning and Action Tool for State Health Departments  – developed through the Health Resources and Services Administration’s (HRSA’s) Collaborative Innovation and Improvement Network for Infant Mortality (IM CoIIN) –  introduces a set of seven foundational practices to advance health equity. The tool was designed to encourage reflection and discourse about the capacity of state public health departments to address SDoH and advance health equity and to support departments in building competencies to advance health equity.

Prior to releasing the tool, its developers piloted it among a small group of states – Wisconsin, North Carolina, and Nebraska – between March-August 2017. The developers then partnered with the Michigan Public Health Institute’s Center for Healthy Communities, which evaluated the pilot with the goal of learning about the piloting states’ experiences with the tool and developing lessons learned, including opportunities for improvement. The goal of this evaluation was to inform improvements to the tool and assess its promise for achieving outcomes. The states participated in key informant interviews and a focus group and responded to an online survey.

The evaluation found that:

  • States decided to pilot the tool because it was seen as a natural complement to their other efforts.
  • States used a variety of strategies to engage with the tool, but they all used a combination of individual and group review, struggled to find enough time, and planned to continue engaging with the tool past the pilot period.
  • Participants identified several emergent outcomes associated with using the tool:
      • It generated important conversations and supported learning challenging concepts.
      • It helped build competencies.
      • It spurred action or, more commonly, laid the ground for action.
  • Participants noted several strengths of the tool:
      • The background section was informative and helpful.
      • The foundational practices provided a clear and complete organizational structure.
      • The critical capabilities and discussion questions were clear and helpful in spurring discussion.
  • Participants also noted several helpful suggestions for improving the tool:
    • Offer states an orientation to the concepts in the tool, as well as the tool itself.
    • Include more guidance in the instruction section.
    • Offer suggestions and examples of how the tool can be used by public health departments.
    • Include or link to strategies public health departments can use to go from discussion to action.
    • Suggest strategies for identifying priorities and assessing improvement over time.
    • Provide recommendations for how to encounter the interrelated nature of the practices.

These findings suggest that the tool shows promise for achieving its intended outcomes for state public health departments and that key revisions and additions will make the tool more accessible and actionable. According to Jeanette Kowalik, co-project director of the IM CoIIN SDOH project at AMCHP, the tool will be used as a part of the 13-state needs assessment. The utility of the tool will be discussed post-administration, so stay tuned for an update. The goal is to continue to share the tool with local and state health departments so that they may benefit from its systematic features and enhancements to strategic planning.

For more information about the tool and to see the tool itself, visit:

“We are now working on bringing all strategies together under one framework. This is why it was exciting to be able to use this self-assessment Tool because it really brings together everything we’ve been working on in the last few years under one health equity approach. Not just understanding where the unfair difference is but really start to frame this into how we start to put into place strategies that stress fairness in resources and fairness in our narrative.” – Pilot Participant