How can we use data to inform practices to advance health equity?

In public health, much of our work depends on having accurate data, so we know what’s happening both on the ground and at a population level. Unfortunately, in many cases data has erased diversity by collapsing distinct groups of people into “convenient” categories for statistical purposes. This erasure frequently occurs when people from across the Americas are all labeled as Hispanic/Latinx, when hundreds of distinct tribal communities are all coded as American Indian, or when everyone who is not cis-gender or heterosexual is grouped together as LGBTQ+. Sometimes these groupings reflect coalitions amongst its members, and strength in numbers can lead to power to advocate for change. However, these data are superficial and generalize incredibly diverse communities. So, instead of perpetuating erasure or stereotypes for statistical convenience, how can data be used to advance equity?

It starts with recognizing the need to balance the accumulation of data with respecting the needs and desires of the community. As researchers, we frequently want more data but need to ask ourselves some questions such as:

What burden does data collection place on the community?

Who is participating and who is excluded from the decision making?

Does this information already exist elsewhere?

Would knowing this information inform our policies and programming?

What are the consequences of collecting this data?

How will results be communicated back to the community?

With that in mind, it is essential that health departments working with their cross-sectoral partners consider how data can be collected and used both internally and externally.

Generally, when public health professionals speak about data collection, they are referring to learning more about a specific population in their jurisdiction. But to truly advance equity, public health professionals need to look inward at the deep-seated roots of health inequity that may exist within their own organizations and understand how they might be inadvertently perpetuating structural racism, white supremacy, and discrimination internally through their policies, procedures, and practices. This could be reflected in racial differences in leadership compared to frontline staff, in pay differences between staff with similar job titles but different genders, or in the history and composition of community partners who may or may not be rooted in the communities we are asking them to serve. For health departments to truly advance equity, they should lead by example in becoming fully inclusive, anti-racist, multicultural organizations that have not only diversity, equity, and inclusion, but also justice built into their DNA.[1] To do that, equity considerations must be incorporated into the day-to-day activities and operations of every staff member at all levels of the organization. One way to operationalize equity is to use resources such as the Racial Equity Toolkit from the Government Alliance on Race & Equity (GARE). This tremendous tool provides a step-by-step approach to put equity into practice.[2]

The journey from hegemonic white supremacy to total equity and justice is long, but there are many ways that data can be used to help advance this work internally. Survey data and statistics on hiring, promotions, and retention collected longitudinally can track some metrics of staffing equity over time. Qualitative data collection can be used to better understand the work environment, how toxic it is, the frequency and types of aggressions experienced, and the impact on staff wellness, safety, morale, and retention. These data can also be used to develop programs to mentor and support staff from under-resourced communities, to create conflict resolution mechanisms based on mediation and relationship healing in the face of power differences, and to develop educational resources to relieve people of color from the dual role of victim and teacher so other staff can do the work needed to challenge the modern American caste system. In the end, data is a double-edged sword that can perpetuate inequities or advance equity and justice. It just depends on how you use it. We choose to ask tough questions, challenge the status quo, and seek real change. What will you choose?

[1] Continuum on Becoming an Anti-Racist Multicultural Organization (https://philanos.org/resources/Documents/Conference%202020/Pre-Read%20PDFs/Continuum_AntiRacist.pdf)

[2] GARE Racial Equity Toolkit (https://www.racialequityalliance.org/wp-content/uploads/2015/10/GARE-Racial_Equity_Toolkit.pdf)