BUILD's Health Equity JourneyBuilding BlocksEquity JourneyKey TakeawaysResources

Moving to Center:

BUILD's Journey to Advance Health Equity

Since our launch in 2015, The BUILD Health Challenge® (BUILD) has pursued the bold goal of improving health for all through cross-sector, upstream, and community-driven approaches. While that’s always been our intent, the role of health equity — and our understanding of it — has evolved the way we work and shaped who we are today. Along with our evaluation partners at Equal Measure, we’ve captured key moments in the equity journey for the many stakeholders who have been involved in BUILD over the years — awardees, funders, technical assistance (TA) and communications partners, and field partners. Each stakeholder in BUILD has contributed to the journey in critical ways that tested the model and pushed for a clearer focus on equitable change. In 2021, we can look back with new eyes on BUILD’s journey, as we learn from a year of collective pain and respond to calls to action to address health inequities and racism.

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BUILD cycled through three stages in its equity journey that each emphasized different areas of focus:

Discerning

Equity
  • Listen
  • Evaluate
  • Test
  • Refine

Formalizing

Equity
  • Shared language
  • Shared frameworks
  • Build capacity
  • Transfer power

Centering

Equity
  • Clarity
  • Lived experience expertise
  • Community ownership
  • Equity goals
BUILD's Health Equity JourneyBuilding BlocksEquity JourneyKey TakeawaysResources

Equity Journey

We illustrate here the evolution of equity to document the critical voices, actions, and learning that BUILD’s many partners and stakeholders encouraged along the way. While there is no one roadmap to embedding and advancing equity in communities, we offer BUILD’s journey as a tool for other partnerships and initiative leaders rethinking and repositioning their work.

Soon after the first cohort of BUILD awardees began their work in 2015-2017, a growing chorus of stakeholder voices sought to understand and center equity more explicitly. BUILD was facing a challenge that many in the field grappled with  — clearly defining equity among partners from widely different backgrounds and contexts, and intentionally embedding equity in all aspects of the work. Questions arose including:

  • How does BUILD define equity for the model and its work in communities? Who defines equity for BUILD?
  • How can the BUILD award catalyze changes in mindsets, practices, and use of data that are critical to developing a cohesive and equity-focused vision for communities in the long run?
  • How are communities addressing power differentials and access to resources, particularly among community-based organizations and large partners like hospitals and health systems?
  • How resonant are the issue areas and solutions proposed by awardees to the residents most affected by health and social inequities?
  • In what ways are award partners balancing a focus on bold systems change with efforts to build trust and relationships with community members with urgent needs?

We can now look back with new eyes on BUILD’s journey, here in 2021, as we leave behind a year of collective pain and calls to action to address health inequities and racism. BUILD cycled through three stages:

Emerging clarity from early learning

As the efforts of this new initiative and first cohort of communities progressed into a second and third year, BUILD leveraged its spaces and wide range of stakeholders to learn — remaining receptive to insights, feedback, and trends from awardees and BUILD staff. Regular conversations between technical assistance providers and awardees, annual convenings of stakeholders, findings from the initiative-level evaluation, and funder retreats all served as openings to understand and strengthen the model. These opportunities for dialogue allowed for continuous learning and for equity to emerge as an area to further understand and elevate.

What we learned

  • Equity outcomes are nascent
  • Power issues are real
  • Equity approach is buried
  • Capacity slowly building

    • How we pivoted

    1
    Shifted equity as a standalone and implicit concept in evaluation metrics and outcomes to embedding equity throughout key outcome areas.
    2
    Shifted application for the second cohort of communities to reflect a more significant role for community actors and leaders.

    Endorsement of equity strategy

    When a second cohort of communities became awardees, the learning and refinements from the Discernment stage made their way into the work in myriad ways — through funding, technical assistance (TA), community foci, convenings, evaluation, and communications. When it came to equity, power, and community centeredness, conversations were difficult, and agreement was not always possible. Importantly, the funder collaborative persisted in developing equity into a more central pillar of the work. The W.K. Kellogg Foundation made an added investment in technical assistance supports dedicated to equity and community engagement.

    What we learned

  • Equitable approach needs specificity
  • Audiences need frameworks
  • Communities take the lead
  • Boost from key funders

    • How we pivoted

    1
    Identified equity experts join BUILD’s TA team, building capacity and a roadmap with BUILD’s local stakeholders.
    2
    Shared language from TA providers makes equity more “discussable” across BUILD stakeholders: funders, awardees, and providers in the network.
    3
    TA providers encourage a dual and complementary approach to success in communities: 1) systems change to address structural inequities, blended with 2) programmatic approaches to create close, trusting community ties.
    4
    Community ownership and capacity is recognized as a path to sustainability and equity; some awardees transfer training, convening, and professional development resources to community leaders.
    5
    TA providers guide local readiness dialogue, pushing partnerships toward more representative and diverse decision makers.
    6
    Awardees facilitate conversations between residents closest to issues and system partners – hospital leaders and healthcare payers — as a powerful route to understanding and policy change.
    7
    Evaluation points to power dynamics of BUILD funders, shifting parameters of the funding collaborative closer to the strengths and constraints of small and regional funders.

    Prioritizing equity in the field and in practice

    In 2019, BUILD invited a third round of awards with a sharpened focus on communities, addressing systems, and centering equity. A record number of communities applied for a BUILD award — many demonstrating new approaches that elevate those most affected by inequities and disparities to drive local efforts, build and sustain local leaders, and heal communities.

    Within six months of the third round of BUILD awards, the world was facing a pandemic and the United States saw incredible momentum building around racial justice action. Many BUILD partners were transitioning from a phase of solidifying priorities and approaches with their communities. Around the nation, communities faced immediate uncertainty and crisis. Within months, COVID-19 unmasked systemic racism and structural inequities on an undeniable scale.

    BUILD partners were committed to helping those most vulnerable and affected. A number of awardees harnessed the realities on the ground to shift the narrative among local decision makers and experienced the precursors to equitable change: enhanced knowledge, strengthened community ownership, and transforming norms. At the same time, the BUILD partners were forced to maintain a fragile balance of maintaining health and safety among efforts to be responsive to the social determinants of health, be inclusive of local stakeholders, and continue to address sustainable systems change.

    What we are learning

  • Philanthropic structures may be limiting
  • Resetting priorities at kickoff
  • Field shifting alongside BUILD
    • BUILD's Health Equity JourneyBuilding BlocksEquity JourneyKey TakeawaysResources

    Key Takeaways

    BUILD was prepared for the critical shift among awardee communities towards a sharpened focus on residents, addressing systems, and centering equity; six years of progress had deepened how equity is examined, and how structures and infrastructure are refined across their work, conversations, and relationships.

    BUILD’s journey surfaced the following key takeaways that we share to inform leaders who are on a similar journey of change in pursuit of greater health equity:

    Community members make this work sustainable; bolster their leadership, capacities, and ownership to contribute to strategy and nurture systems change.
    Establish trust and credibility with community members and those most affected by the issues as a critical first step.
    Actions matter. Move beyond equitable intention toward trauma-informed, healing, and transformative approaches to catalyze equity locally.
    When the topic of equity is still emergent in partnerships, dedicated technical assistance, activities, and metrics are critical.
    Elevate the full chorus of voices, even when they are not yet in sync, to develop shared equity definitions and approaches.
    Equity is an activator and an anchor once it becomes a shared priority in the community to generate solutions, deepen issue understanding, identify local leaders, and reallocate resources toward equity.
    Continuing Our Equity Journey
    The full story of BUILD’s equity journey is yet to be written. Yet two patterns emerged about the cumulative nature of this work over the past six years that has influenced our own thinking as we look to the future of BUILD and the movement toward greater health equity:
    First, once equity becomes an explicitly stated and committed value in the work, the opportunities to pivot and grow rapidly increase. With a new and collective lens for interpreting information and making decisions, the opportunities to embed equity throughout the work become visible.
    Second, individual “moments” of the equity journey become more interdependent with time — and that creates the potential for deeper change. When a dynamic mix of shared definitions, equitable strategies, targeted supports, and frameworks take hold, the resonance of each learning or pivot point fades and the journey becomes a continuous flow.
    A third and informal reflection is that the work of advancing equity is never done. While our path forward from this point on is still being created and evolving over time, one thing is clear – it is the only sustainable path forward to achieve better health for all. To build this path forward requires change, both systemic and programmatic. BUILD and its stakeholders are committed to continuing our own reflection, learning, pivots, and growth as we move forward, and to sharing our journey with our fellow changemakers. We invite you to share your own journey with us.
    BUILD's Health Equity JourneyBuilding BlocksEquity JourneyKey TakeawaysResources

    More equity resources from BUILD

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