The System exChange
The Sustem exChange provides powerful tips and ideas for transforming your local community.
Part 2 in the series on Equity
The  System exChange  is a bi-monthly resource full of cutting edge tools and ideas to help change agents, just like you, transform their local community.

The last issue of the System exChange introduced the concept of equity and provided a series of tools and resources to help bring an equity focus into local conversations. Click here f or this last issue.

This week's System exChange builds on these ideas and highlights several additional approaches for pursuing equity in your community.

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Powerful Equity Practices:
Disaggregate Data
America has some of the biggest differences in health and wellbeing outcomes across groups of people (Robert Wood Johnson Foundation, 2016). Unless these differences are uncovered, understood, and addressed, your efforts could inadvertently increase local inequities (Stroh, 2015). For example:

  • Access Inequities. Adding program slots could disproportionately advantage individuals with more resources if they are better able to access these opportunities (e.g., they have transportation, knowledge of the program, accommodating work schedules, money, etc.).

  • Benefit Inequities. Some evidenced-based practices disproportionately benefit some types of people over others – the spread of these practices could lead to greater disparities in outcomes.

As you explore data on local outcomes, “disaggregate” the information by different demographic categories (e.g., race/ethnicity, age, gender, etc.) to understand which groups in the community are experiencing the worst outcomes compared to other groups.

Then, ask questions to understand why these inequities are happening and design your efforts to address the root causes.
Example demographic categories you could use to disaggregate your data:
  • Age
  • Race/Ethnicity
  • Gender/Gender Identity
  • Sexual Orientation
  • Religion
  • Education Level
  • Household Composition
  • Geographic Area/Neighborhood
  • English Language Proficiency
  • National Origin
  • Immigration or Documentation Status
  • Disability Status
  • Employment Status
  • Income
  • Connection to Services/Supports
  • Insurance Coverage
  • Other

Remember, the greatest inequities are often at the intersection of multiple groups (e.g., race, gender, income). You can explore these intersections by comparing outcomes for multiple demographic categories at the same time (e.g., look at the outcomes for different racial/ethnic groups for both men and women across income levels).
Recommendations for how to find, use, and promote disaggregated data to further health equity

Source: Robert Wood Johnson Foundation
Case study on why the collection, analysis, and use of race and ethnicity data should be an integral part of any strategy, initiative or legislative agenda affecting children, families and communities.

Source: The Annie E. Casey Foundation
Highlighted Equity Approach:
Targeted Universalism
Universal strategies are a common community problem-solving approach aimed to improve outcomes for everyone. While the universal approach has good intentions, it often fails to improve outcomes for disadvantaged groups.

Why? Because universal strategies are typically not designed to meet the unique needs of disadvantaged groups and are often more accessible to people with existing advantages (e.g., resources, knowledge, location, etc.).

Targeted Universalism is an alternative approach to improve outcomes for all groups by paying attention to the unique needs and circumstance of people experiencing the greatest inequities (Powell, Menendian, & Reece, 2009).
Try out the Targeted Universalism approach by using these 3 steps (Powell et al., 2009):
  1. Identify who is experiencing the most inequities related to your targeted problem and why
  2. Design strategies to address the specific needs and circumstances of these groups
  3. Broaden strategies to benefit as many additional people in the community as possible
The video describes the Targeted Universalism approach and how it can help promote equity. 

Source: Haas Institute for a Fair and Inclusive Society
Overview of the difference between Universal and Targeted Universalism approaches. 

Source: National Collaborating Centre for Determinants of Health, 2013

 Powerful Equity Practices:
Re-Centering the Margins
Residents – especially those experiencing local inequities - have critical perspectives and ideas for how to solve community problems. Unfortunately, organizations and change initiatives often ignore or "marginalize" these individuals and as a result are less successful at reaching their goals (Thomas et al., 2011).

Consider how your organization or group can “re-center” its focus around these marginalized perspectives by engaging local residents experiencing inequities to help understand why community problems are happening and how to address them.
Explore this guide to help re-center your work in the margins by gathering input from residents experiencing inequities.
Community Case Study
 In Everett, Massachusetts, residents experiencing health inequities come from a variety of backgrounds, including English, Spanish, Portuguese, Arabic, French, Italian, and Creole heritage. To better understand the diverse experiences of these often marginalized residents, the community used the following approaches:
  • Community organizations structured multi-language workshops to engage residents in providing feedback about the needs of the community, and simultaneously inform them of local resources and opportunities.
  • Local Latino, Haitian, and Brazilian communities formed a coalition called “One Everett’ where volunteers engaged residents for their perspectives on a variety of issues including housing, jobs, education, transportation, immigration and city services. 
  • As a way to build trust, the Everett Police Chief engaged local teens in discussions about a variety of topics related to community relations, personal needs, and race and policing. 

Source: RWJF, 2017 Everett Culture of Health Story   
CHIR Connection
Reach out to your local CHIR to share ideas and take action to promote greater health equity in your community.
Join a discussion forum with CHIRs across the state on

Current Discussion Topic:

How could you use a Targeted Universalism approach in your efforts?
Q & A

Q : We're trying to summarize some local disaggregated data. How can we make this data easy for people to use without getting overwhelmed? 

A: People often find disaggregated data easier to use when it's summarized visually. Try organizing your data into a table that color codes which demographic groups are experiencing the best and worst outcomes. This can help stakeholders easily pick out inequities in the data and use this information to priorities targets for change. See this tool for an example of how to set up this type of table. 

Submit your questions on the Contact Us page of the MICHIRLearning website
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July 2019
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Annie E Casey Foundation (2006). Race matters. Retrieved from

Annie E. Casey Foundation. (2014). Race equity and inclusion action guide. Retrieved from  

john powell, Stephen Menendian & Jason Reece. (2009). The Importance of targeted universalism. Poverty & Race. 18(2).

Just Health Action (n.d.) Introduction to environmental justice, equity, and health. Retrieved from ?

Robert Wood Johnson Foundation. (2010) A new way to talk about the social determinants of health. Retrieved from content/uploads/2016/08/rwjf63023.pdf 

Robert Wood Johnson Foundation. (2016). From vision to action: A framework and measures to mobilize a culture of health. Retrieved from

Robert Wood Johnson Foundation (2017) Everett culture of health story. Retrieved from 

Thomas, S. P., Quinn, S. C., Butler, J., Fryer, C. S., & Garza, M. A. (2011) Towards a fourth generation of disparities research to achieve health equity. Annual Review of Public Health 32(3), 399-416.