Mobilizing the Power of Lived/Living Experiences to Improve Health Outcomes for all

Abstract

Introduction

Health Equity Assessments (HEAs) are decision-support frameworks or tools used to evaluate the equity impacts of policies, programmes and initiatives. However, HEAs are often conducted without meaningful engagement from the individuals and communities most affected by health inequities. This lack of social participation limits the relevance and effectiveness of HEAs, leaving systemic inequities unaddressed and opportunities for impactful change unrealized. An alternative is to involve people with diverse lived/living experiences in conducting and offering HEAs—so that people most impacted, and most excluded by decision-making can offer recommendations to improve the way they access and utilise care.

Methods

Equity Mobilizing Partnerships in Community (EMPaCT) is a scalable, participatory citizen engagement model that integrates lived/living experiences into the HEA process. EMPaCT's Five Steps to a Community-Engaged Health Equity Assessment (CEn-HEA) was co-designed with community members typically excluded from decision-making. This process fosters psychological safety, trust-building, and power-sharing between underserved communities and decision-makers. The CEn-HEA systematically analyzes inequities across downstream (individual), midstream (community), and upstream (structural) levels to generate actionable, equity-focused recommendations.

Results

The EMPaCT CEn-HEA framework produces context-specific recommendations that address immediate project needs while advancing long-term, systemic change. The framework is a participatory process that centres community voices, builds trust, amplifies lived/living expertise, and fosters equity-driven decision-making that can lead to measurable improvements in healthcare policies, programmes, and practices.

Conclusion

In this paper, we examine the challenges and opportunities associated HEAs; introduce EMPaCT's CEn-HEA framework as a co-designed, innovative, and community-engaged approach to health equity analysis; and discuss methods for measuring and evaluating the health equity impacts of these efforts.

Patient or Public Contribution

Patient and community involvement were central to the design, development and implementation of this project and resulting manuscript. Equity Mobilizing Partnerships in Community (EMPaCT), including its Community-Engaged Health Equity Assessment (CEn-HEA) framework, was co-created with diverse patient partners who have lived/living experiences of health inequities. In the preparation of this manuscript, patient partners were involved in codesign sessions to define the focus, structure and language of the manuscript. They collaborated in discussions to refine key concepts, articulate challenges and highlight solutions that are grounded in their lived realities. In the preparation of this manuscript, patient partners reviewed early drafts, contributed feedback to ensure accessibility and relevance of the content and shaped the actionable recommendations. This manuscript reflects EMPaCT's commitment to justice, inclusion and meaningful change.