10

A Pathway Forward for Equity

In the final session of the workshop, the forum’s cochairs, William Beardslee and Hendricks Brown, along with moderators from sessions earlier in the day, summarized key points from the presentations and discussions. Particular attention was given to discussion items that contributed to our collective understanding of health equity and how we as a society can pave the pathway toward achieving equity.

Participants were reminded of Camara Jones’ presentation earlier in the day when she explained that health equity is “the assurance of the condition of optimal health for all people.” In order to achieve health equity, she said that it was important to value all individuals and populations equally, recognize and rectify historical injustices, and provide resources not equally but according to need. She also prompted further discussion to think beyond what we know about social determinants of health and address systems of power that emerge in forms like racism, sexism, heterosexism, and ableism.

Harolyn Belcher reported on the session that focused on historical and generational trauma. She highlighted the importance of interventions being cross-generational, homegrown, embedded in the community, and inclusive of youth leadership/youth voice. She cautioned against the universal adoption of evidence-based treatments that were not developed with consideration of populations suffering the most inequalities. Finally, she said embracing culture can help those who have experienced trauma move forward by teaching accurate accounts of history, telling authentic stories of survival, and allowing communities to have their own trauma narrative in their words.

Hendricks Brown and Peter Margolis explained how changes in the way to do research can contribute to a better understanding of health equity. They recognized the value of establishing learning collaboratives as an innovative way to bring fields together and address issues of practice. There was also consideration of the value of big data but with more consistency in reporting race/ethnicity and geographic areas. Changes in organizational infrastructure—away from traditional top-down or matrix-type organizations—and increasing the use of learning systems models may support self-organizing behavior and allow for more effective implementation in communities. And finally, they asked the participants to consider research design carefully, as this contributes to the value of improving health equity across diverse populations.

Felesia Bowen reported on her key takeaways from the session on engaging communities. Among them, she highlighted the importance of addressing sustainability from the beginning of the research design—to have a plan for funding in place by the end of the study timeline so that communities continue to reap the intended benefits. It was also noted that ideas from those living in the community are crucial to research design and should not be dismissed or marginalized by having members participate solely as tokens of the community. Youth voice was another component that Bowen said should be included, and whenever possible. Furthermore, participants of this session recognized that engaging youth in an authentic manner teaches them that they have some power in making positive changes, so hopefully they will continue to engage as they age.

David Hawkins recapped the session on family-focused interventions. He explained that while all families should have access to these interventions, it is important to recognize that disparities emerge when the most advantaged parents are the ones who have the most access to them. To improve access, common barriers such as stress, trauma, and financial burdens need to be addressed. This is one reason why the primary care setting is ideal, since nearly all families connect with these providers at least once per year, and more frequently in a child’s first 3 years of life. Providing interventions in primary care can help provide tools and skills for parents to foster their child’s behavioral health well-being, like learning emotional self-regulation.

Joyce Sebian ended the day with considerations from the session on securing equity through restorative practices. She explained that the restorative approach has tremendous history with indigenous roots worldwide. Restorative practices are relationship-based and focused on healing, as opposed to the traditional Western world approach that is more hierarchical and focused on retribution or punishment. The approach is becoming more common in school settings, with some school districts reporting that there are more overall shifts in improved school climate as well. In addition to

schools and juvenile justice settings, restorative practices can also play a role in strengthening a family. Sebian concluded that restorative practices are creating opportunities that had not previously been imagined, which is particularly powerful for children and families that have greater challenges to overcome in life.

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