Building and measuring coalition health equity capacity

Background: Transform Wisconsin (TWi) is a five-year initiative that supports 28 county-based coalitions in efforts towards evidence-based policy, systems and environmental (PSE) change related to tobacco exposure, active living, and food systems. Health equity is addressed through focusing on the social determinants of health and the social inequities, institutional power, and living conditions that precede them.  We predict that coalitions with greater health equity capacity engage community members on a deeper level and will, over time, produce more equitable PSE change.

Methods: We define organizational health equity capacity as the degree to which organizations understand, have the skills, orient themselves towards, and implement strategies to advance health equity. Based on the dimensions of health equity capacity - conceptual foundations, collective impact, and civic orientation - we assess coalitions’ capacity through survey and analysis of coalition documents (e.g., meeting minutes), meetings with coalitions, and self-reported progress.

Results: Preliminary results suggest that many coalitions have strong collective impact structures and practices, but variable understanding of health equity among members and low levels of civic orientation. As a whole, TWi coalitions demonstrate hesitation and/or difficulty in engaging everyday community members in decision-making and leadership, especially individuals most impacted by health inequities and in ways that confront established power dynamics.  

Conclusions: Coalitions must make deliberate efforts to ensure the understanding of members of health equity and use such understanding to reorient their engagement with the broader community. By deeply engaging community members most affected by health inequities, coalitions can progress significantly towards health equity.