There should be no such thing as an “Equity Dashboard”
By: Dr. Sarah Marie Martin
Tags: Public Health, Data Visualization, Health Equity, Startup Life, Race

This month, I received three magazines in the mail: Men’s Health, Runner’s World, and Vanity Fair. Here they are, laid out on my table.

Do you notice anything? Three different magazines, three different audiences, each with the same inspiration for a “special edition.” It isn’t a coincidence that these magazines devoted an issue to centering the Black experience — understanding our shared responsibility to pursue racial equity in America. But while I appreciate the synchronized focus on racism, I hope that justice demands aren’t a one-time-a-year special edition or a singular corporate statement. I hope that these efforts are sustained and engrained, and they start with a level-set discussion of what equity is.

Equity is not a verb; it is a state. It is something we achieve through equitable actions, be they internal decisions or external policies. Equity is the absence of significant demographic predictors of a hoped-for outcome where those demographic characteristics have no logical bearing on the result’s likelihood. In the health equity space, you can think of it like this — folks with ancestral roots in some parts of the globe may have a genetic predisposition to certain diseases. Epidemiology explains why Black Americans are more likely to get Sickle Cell Anemia, regardless of their skin color, or why Jewish populations are more susceptible to Tay-Sachs. White Supremacists used these geographic connections to genetics for generations as a way to tie race to biology, which helped them root their dominance in junk science. (If you’re super interested in this topic, check out the documentary series “Race: The Power of an Illusion”).

In a state of inequity, the color of someone’s skin, their social class, biological sex, gender identity, sexual orientation, or other characteristics predict outcomes that have no scientific connection to an effect. Race continues to significantly predict infant death and chronic disease, even when controlling for things like income, education, or individual behaviors. This connection signals that we are not living in a state of equity. This imbalance is inequity, and it isn’t random.

Put more bluntly, equity does not mean diversity. It does not imply inclusion. Diversity is an outcome that includes people from many different backgrounds. Inclusion is the act of creating a culture that lifts marginalized and oppressed people (themselves, two different concepts. The former connotes being left out, and the latter alludes to active, often-violent, methods of keeping folks sick, poor, and struggling ). I love Paula Braverman’s definition of equity (adapted for a health lens): “In operational terms, and for the purposes of measurement, equity in health can be defined as the absence of disparities in health (and in its key social determinants) that are systematically associated with social advantage/disadvantage.” At mySidewalk, we use the word inequities because it implies disparities that are not accidental or natural.

When we talk about equitable policies or programs that our customers pursue in advancing towards equity, we choose our words carefully. Simply “doing what’s right” isn’t equitable. Equitable policies are those that redistribute resources towards the folks who need them the most — many times to the (apparent) disadvantage of the dominant class. A progressive property tax on homes valued over 75% of the median home value to fund uninsured health care is an equitable policy. A regressive 1-cent sales tax on all goods that supports early childhood education is not. The latter approach may have noble intentions and political feasibility, and it may very well get us to an equity state, but it is not equitably designed at its core. Equitable policies can come from any political philosophy, as long as their focus is fixed on the outcome of equity.

Over the last few months, I’ve fielded multiple requests for something like an “Equity Dashboard”. Often, the conversation goes like this:

Joe S.: “Do you guys sell an Equity Dashboard?”

Me: “Great question. What story are you interested in telling?”

Joe S.: “Well… um… an equity story?”

Me: “Ok, equity related to health? Race? Citizenship? What are the main drivers of health inequities in your town?”

Joe S.: “[Long pause] I don’t know. With all of this pressure to talk about equity, I just need to do something.”

***

I don’t blame Joe for “wanting to do something.” But partitioning equity into a separate team, a separate dashboard, or a separate story does not infuse it into your organization. Equity work is expansive enough for all of us to share. Every city plan, economic development roadmap, Community Health Assessment, Health Improvement Plan, Internal Strategic Plan — equity should live at the core of all of it. A hunger for equity is a value, not a one-off solution.

For more best practices in framing equity, check out our recent Webinar on Public Health Storytelling.