With the immense changes we have faced this past year – including a worldwide pandemic, a polarizing political climate, and a reckoning with inequity – it is only natural for things to feel unstable. However, from these changes stems an opportunity to transform systems, institutions, and policies that have perpetuated inequity for far too long.

In October, the BUILD Health Challenge® joined with the Michigan Public Health Institute (MPHI) to hold a virtual convening on racial equity to lean into the opportunity for change with representatives from dozens of BUILD partners across the country. The conversation, facilitated by Shavon Arline-Bradley and supported by the BUILD technical assistance team at ChangeLab Solutions, centered around moving past the idea of racial justice as a single component of health equity, and instead, recognizing it as inextricably linked to the work we do to foster better health for all. Learnings from the second BUILD cohort on how to operationalize health equity were shared to ground the work in real-world experience and examine what the intersection of racial justice and health equity looks like in our communities.

What drives health equity

Paula Braveman, director of the Center on Social Disparities in Health at the University of California San Francisco, defines health equity as both a process (removing economic and social obstacles to health such as poverty and discrimination) and an outcome (everyone having a fair and just opportunity to be healthy). Building off this, Linda Gordon of MPHI’s Center for Health Equity Practice emphasized that health equity is really a call to change policies, laws, systems, environments, and practices to eliminate the social conditions that give rise to health inequities in the first place.

This emphasis on how we define health equity is crucial when we start to look at the interaction between the social determinants of health and the social determinants of health equity. We recognize the social determinants of health as economic stability, education, social and community context, health and healthcare, and the neighborhood and built environment. While we often stop here when considering upstream factors, taking a deeper dive into health equity reveals an outer circle of belief systems, held in place by institutions, that perpetuate the disparities seen between populations when it comes to these determinants of health. These worldviews — namely sexism, ableism, heterosexism, classism, and importantly, racism — are the forms of oppression that are recognized as the social determinants of health equity and reinforce inequity through systemic processes.

Translating concepts into practice

So what does this mean for the work BUILD communities do? It boils down to the significance of thinking systemically. To effect change, it is critical to build capacity to recognize the history, institutional practices, and environments of discrimination that have given rise to the unequal distribution of resources and health in the first place. Thus, addressing the root causes of inequality becomes a necessity of all health equity work.

Read more in BUILD’s report, Community Approaches to System Change: A Compendium of Practices, Reflections, and Findings.

Drawing from the experience of past BUILD awardees, five strategies were discussed during the conversation to organize efforts and translate these concepts into impactful practices.

  • Building a shared vocabulary: Health equity means many different things to different people. Sharing a definition and understanding of the core concepts of health equity is vital to functioning as an organization working toward a collective goal. Discussing the concept of health equity with BUILD sites early and often helped underline equity as a foundation of our work.
  • Organizational readiness and capacity building: A dialogue-based tool was used to assess the readiness and capacity of BUILD sites to implement their interventions and engage their communities within the framework of health equity. By probing readiness, BUILD sites were able to find an entry point to begin their equity work.
  • Facilitated dialogue: BUILD sites built muscle in engaging and discussing tough concepts such as racism and classism through open conversation around root causes and health inequity. Ultimately, this serves the goal of dismantling and reshaping entrenched patterns of thought.
  • Building a community of practice: BUILD collaboratives create a network of partners actively involved in the equity space, allowing them to collaborate, share resources, and create change across sectors.
  • Action planning: Grounded in the analysis of case studies and the lived experience of community partners, strategies were developed to introduce project focus for equity-forward action planning with the goal of addressing upstream root causes and health equity.

Health and racial equity are inextricably linked. In many cases, the overarching systems and institutions that have historically discriminated against Black, Indigenous, and people of color individuals and communities are the same systems and institutions that influence and inform the health of populations. While health equity has always been a focus of BUILD, we are still listening, learning, and evolving our work to impact systems and create a just opportunity for health, for all. We hope you will join us on this path to change.



Adam Britton is an intern with de Beaumont Foundation and supports The BUILD Health Challenge®. He is currently a student at the University of Maryland.