The future of education equity policy in a COVID-19 world: a qualitative systematic review of lessons from education policymaking

Background: COVID-19 had a major global impact on education, prompting concerns about its unequal effects and some impetus to reboot equity strategies. Yet, policy processes exhibit major gaps between such expectations and outcomes, and similar inequalities endured for decades before the pandemic. Our objective is to establish how education researchers, drawing on policy concepts and theories, explain and seek to address this problem. Methods: A qualitative systematic review (2020-21), to identify peer reviewed research and commentary articles on education, equity, and policymaking, in specialist and general databases (ERIC, Web of Science, Scopus, Cochrane/ Social Systems Evidence). We did not apply additional quality measures. We used an immersive and inductive approach to identify key themes. We use these texts to produce a general narrative and explore how policy theory articles inform it. Results: 140 texts (109 articles included; 31 texts snowballed) provide a non-trivial reference to policymaking. Limiting inclusion to English-language produced a bias towards Global North articles. Our comparison with a review of health equity research highlights distinctive elements in education. First, education equity is ambiguous and contested, with no settled global definition or agenda (although some countries and international organisations have disproportionate influence). Second, researchers critique ‘neoliberal’ approaches that dominate policymaking at the expense of ‘social justice’. Third, more studies provide ‘bottom-up’ analysis of ‘implementation gaps’. Fourth, more studies relate inequity to ineffective policymaking to address marginalised groups. Conclusions: Few studies use policy theories to explain policymaking, but there is an education-specific literature performing a similar role. Compared to health research, there is more use of critical policy analysis to reflect on power and less focus on technical design issues. There is high certainty that current neoliberal policies are failing, but low certainty about how to challenge them successfully.

An Evaluation Framework of a Transdisciplinary Collaborative Center for Health Equity Research

Over the last few decades, there has been an increase in the number of large federally funded transdisciplinary programs and initiatives. Scholars have identified a need to develop frameworks, methodologies, and tools to evaluate the effectiveness of these large collaborative initiatives, providing precise ways to understand and assess the operations, community and academic partner collaboration, scientific and community research dissemination, and cost-effectiveness. Unfortunately, there has been limited research on methodologies and frameworks that can be used to evaluate large initiatives. This study presents a framework for evaluating the Flint Center for Health Equity Solutions (FCHES), a National Institute of Minority Health and Health Disparities (NIMHD)-funded Transdisciplinary Collaborative Center (TCC) for health disparities research. This report presents a summary of the FCHES evaluation framework and evaluation questions as well as findings from the Year-2 evaluation of the Center and lessons learned.

Equity Tourism: Ravaging the Justice Landscape

As the long-standing and ubiquitous racial inequities of the United States reached national attention, the public health community has witnessed the rise of “health equity tourism”. This phenomenon is the process of previously unengaged investigators pivoting into health equity research without developing the necessary scientific expertise for high-quality work. In this essay, we define the phenomenon and provide an explanation of the antecedent conditions that facilitated its development. We also describe the consequences of health equity tourism—namely, recapitulating systems of inequity within the academy and the dilution of a landscape carefully curated by scholars who have demonstrated sustained commitments to equity research as a primary scientific discipline and praxis. Lastly, we provide a set of principles that can guide novice equity researchers to becoming community members rather than mere tourists of health equity.

Multiple Chronic Condition Combinations, Affect, and Memory Among Black and White Older Adults

Research demonstrates the adverse effects of coexisting multiple chronic conditions (MCCs) on older adults’ health and wellbeing. While most research relies on total counts of chronic conditions, little work explores how specific MCC combinations may have compounding effects on depression and memory. Furthermore, no published research explores differences in the prevalence and correlates of MCC combinations between Black and White older adults. The current study assesses within- and between-group heterogeneity in the prevalence and correlates of MCC combinations to advance health equity research. We utilize a sample of 16,757 Black and White older adults drawn from the 2014 wave of the Health and Retirement Study. Respondents were categorized into one of 32 MCC combination groups. Depressive symptoms and self-rated memory were calculated separately for Black and White respondents across each of the 32 groups. Chi-square tests, t-tests, and ANCOVAs were used to compare differences. Black and White respondents differed significantly in the prevalence of 14 out of 32 MCC combinations. Within-group differences were found such that 45% of Black respondents experiencing only Lung Disease met criteria for clinical depression; this rate is similar to Black respondents experiencing Diabetes + Heart Condition + Hypertension + Lung Disease (44.5%). Between-group differences revealed that Black respondents experiencing Arthritis + Diabetes + Hypertension had worse self-rated memory than White counterparts (MB = 3.24, MW = 3.13; two sample t[1139]= -2.04, p < .05; Cohen’s d = 0.13). Additional findings are presented, and theoretical and practical implications for this work are discussed.

Eliminating Disparities and Achieving Health Equity Using Implementation Science

Eliminating health disparities and achieving equity are central to aging services, programs, and research, as we work to ensure older adults are treated equitably compared to their younger counterparts. Additionally, aging services, programs, and research are not immune from the structural racism and other inequities that plague all facets of our lives, and we must work to eliminate disparities within them as well. This presentation will discuss how Implementation science can be used to advance both of these fronts. Implementation science frameworks can be used to ensure multiple levels of context are considered, which is critical when working against something as pervasive and structural as racism. Implementation science can also guide the adaptation of evidence-based interventions for different populations, including for older adults or for different racial or ethnic groups. Furthermore, there are important ways health equity research can improve implementation science that advance the shared goal of eliminating disparities.

A Multisectoral Approach to Advance Health Equity in Northern Arizona: County-level Leaders’ Perspectives on Health Equity

Background Multisectoral and public-private partnerships are critical in building the necessary infrastructure, policy, and political will to ameliorate health inequity. By focusing on health equity, researchers, practitioners, and decision-makers make explicit the systematic, avoidable, unfair, and unjust differences in health status across population groups sustained over time and generations, beyond the control of individuals. Health equity requires a collective process in shaping the health and wellbeing of the communities in which we live, learn, work, play, move, and grow. Methods Data are drawn from the Southwest Health Equity Research Collaborative Regional Health Equity Survey (RHES). RHES is a community-informed, cross-sectional online survey comprised of 31 quantitative and 17 qualitative questions. Generated to elicit an interdisciplinary body of knowledge and guide future multisectoral action for improving community health and well-being, the RHES targeted leaders representing five large rural northern Arizona counties and 13 distinct sectors. To explore, multisectoral leaders’ knowledge, attitudes, and actions to address the social, environmental, and economic conditions that produce and sustain health inequity were analyzed using a priori coding scheme and emergent coding with thematic analysis. Results Although leaders were provided the definition and asked to describe the root causes of inequities, the majority of leaders described social determinants of health (SDoH). When leaders described root causes of health inequity, they articulated systemic factors affecting their communities and described discrimination and unequal allocation of power and resources. Most leaders described the SDoH of their communities by discussing compounding factors of poverty, transportation, and housing among others, that together exacerbate inequity. Leaders also identified specific strategies to address SDoH and advance health equity in their communities, ranging from providing direct services, to activating partnerships across organizations and sectors in advocacy for policy change. Conclusion Our findings indicate that community leaders in the northern Arizona region acknowledge the importance of multisectoral partnerships and collaborations in improving health equity for the populations that they serve. However, a common understanding of health equity remains to be widely established, which is essential for conducting effective multisectoral work with the goal of advancing health equity.

Critical Narrative Intervention for Health Equity Research and Practice: Editorial Commentary Introducing the Health Promotion Practice Critical Narrative Intervention Special Collection

This special collection of Health Promotion Practice introduces critical narrative intervention (CNI) as a key theoretical framing for an asset-based, narrative, and participatory approach to promoting health and addressing social inequality. Innovative digital and visual methodologies highlighted in this special collection—comics and graphic novels, cellphilms and other participatory film, story booths, digital storytelling, and photovoice—are changing the way critical public health researchers and practitioners forge new knowledge, creating new possibilities for interdisciplinary and activist-based inquiry. Public health research and engagement efforts that critically contend with historically repressive structures and intervene through narrative and participatory processes to enact change with and for disenfranchised communities are long overdue. This special collection showcases six CNI projects that promote equity and justice in the context of LGBTQ, nonbinary, and other gender-diverse young people; people who inject drugs living with hepatitis C virus; young women who trade sex; undocumented and formerly undocumented immigrants; and people living with HIV/AIDS. It is our intent that this collection of exemplars can serve as a guidepost for practitioners and researchers interested in expanding the scope of critical public health praxis. Individually and collectively, the special collection illustrates how CNI can create space for the increased representation of historically silenced populations, redress stigma, and provoke important questions to guide a new era of health equity research.