Study: Exploring How Health Equity is Addressed in Accountable Communities of/for Health (ACHs)

This study from PHI’s Population Health Innovation Lab (PHIL), advances understanding of how Accountable Communities for Health (ACH) advance equity by asking, “how are ACHs collaboratively addressing equity in communities?”

  • Sue Grinnell, BS, MPH
  • Stephanie Bultema MAAL, PhD
    Kendra Piper PhD, MPH
    Esmeralda Salas BS
    Peter Forberg MA
group with hands in a huddle

Accountable Communities for Health (ACHs) are formal, community-based partnerships that bring together public organizations such as local health departments, schools, local government, and law enforcement, with private organizations such as hospitals, health clinics, health plans, and community-based organizations to transform community health systems in pursuit of improved population health and well-being.

This study from PHI’s Population Health Innovation Lab (PHIL), published in Health Services Research, advances understanding of how ACHs advance equity by asking, “how are ACHs collaboratively addressing equity in communities?” While current literature argues that multisector health initiatives are integral for advancing health equity, there is a lack of research on how these initiatives advance equity in practice. Thus, this paper provides generalizable strategies that can be further investigated to optimize progress toward health equity.

This study identifies strategies for advancing health equity in multisector collaborative ACHs in Washington and California, which are devoting resources to ensure health equity is central to their work. The numerous approaches ACHs use to advance health equity are important to ensure everyone can reach their full health potential.


read the study

Three distinct features of ACHs:

  • First, they have a staffed backbone function dedicated to supporting multisector collaboration.
  • Second, community partnerships are a baked-in part of the ACH model.
  • Third, the ACH model formally states that equity should be kept at the center of the partnership, spanning all other elements of ACH work.

The five specific approaches used by ACHs to collaboratively address health equity include:

  1. Providing equity education and training to participating organizations and community groups
  2. Including diverse community voices in collaborative decision-making
  3. Changing practices in their participants’ daily operations
  4. Improving existing services and developing new services
  5. Actively promoting a culture of keeping equity at the center of ACH efforts
Our equity accountability council [is] a space where we recognize that we were often asking to give feedback on whether or not a decision we were making was going to promote health equity or if there might be unintended consequences for a community that wasn't represented at the decision-making table. Washington ACH participant
That led us to be like, ‘let's move away from equity as this thing that we do’ to ‘it's a requirement and all of our work.’ We moved to basically require a number of our partners to take a 10-hour equity training. Washington ACH participant
Something that I've seen in the larger community that [the ACH] has been responsible for really, is the foundational work on a community information exchange…They needed investment and assistance to make it part of their organization, to make it a part of their workflow, to make it a valuable tool, and [the ACH] really invested that time and that money…I'm already seeing as an organization that uses that tool, as well. I'm seeing benefits from it for our health plan members. Washington ACH participant

Originally published by Health Services Research

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