Collaborators Report on Successes and Challenges in Tackling Community Health Inequities

Effective collaboration across societal sectors—such as public health, housing, transportation, and social services—to address health inequities requires time, resources, and expertise, as well as a shared vision among stakeholders. These are among the key findings of an evaluation of Calling All Sectors, State Agencies Joined for Health, an initiative of the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.

Calling All Sectors provided grants to nine states and Washington, D.C., to create and support cross-sector, multi-agency teams to reduce inequities in maternal and infant health. These health inequities are preventable differences in the burden of disease, injury, violence, and opportunities to achieve optimal health that are caused by social, economic, and environmental factors.

The initiative started in 2019 with two main goals. The first was to create lasting culture, mindset, and infrastructure changes at the state or jurisdiction level so that cross-sector work would become the norm. And the second was to implement evidence-informed models, policies, and practices to address the social and economic drivers of gaps in maternal and infant health and well-being. The program awarded two-year grants to state agencies and community partner organizations to form teams that include local stakeholders from multiple sectors and people with lived experience from their communities. Together, the teams identified social determinants driving health inequities for mothers and infants; explored gaps in data, partnerships, and services; and developed plans to address deficiencies.

During the evaluation process, analysts examined the experiences of Calling All Sectors grantee team members—through surveys, interviews, and focus groups—to assess whether the initiative increased the partners’ capacity to help reduce inequities in priority groups, as well as specific factors that may have furthered or inhibited these efforts.

Top findings highlight strengthened relationships

First, grantees reported that participation in group convenings, webinars, peer learning, and technical assistance activities helped foster relationships and connections among core team members and local stakeholders. The process also helped create conditions for collaboration built on communication, trust, and commitment. State agencies reported more engagement with community-based partners and people with lived experience, as well as an increase in shared decision-making with these partners, than they had before the initiative.

Second, flexible funding allowed participants to dedicate staff, time, and resources to developing the knowledge they needed. For example, the D.C. team hired a health equity fellow specifically to coordinate efforts between multiple city agencies and their community partner, Community of Hope, to reduce homelessness among pregnant and postpartum individuals. The Virginia team, meanwhile, worked with the Virginia Neonatal and Perinatal Collaborative and the Virginia Hospital & Healthcare Association to provide grants to bridge new partnerships between birthing hospitals and community-based organizations to reduce inequities in access to prenatal and postpartum services throughout the state.

Third, state agencies worked closely with their community partner organizations to better define key problems and develop shared visions for equitable solutions. For example, in Washington state, Washington WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children) partnered with social services provider Byrd Barr Place to engage WIC and WIC-eligible participants and stakeholders to boost enrollment rates among African Americans. New Jersey worked with Community Doulas of South Jersey to understand resource and referral needs and experiences among pregnant and postpartum individuals.

The Mississippi and Louisiana grantee teams conducted listening sessions with Black women about their birthing experiences to understand inequities in care and services. And the Colorado and Michigan teams worked closely with their partner organizations—the Family Resource Center Association and Focus: Hope, respectively—to identify inequities in agency decision-making processes and to develop tools that promote more equitable outcomes.

Finally, grantee teams worked to identify needed data, which quickly became a top priority. The Minnesota team, for example, conducted “systems mapping,” an analytical tool that allowed them to define gaps in data, policy, and services for pregnant and postpartum individuals experiencing homelessness. The Kansas team used a similar approach to better understand the needs and circumstances of pregnant and postpartum individuals with substance use disorder and the organizations and providers that serve them.

Because the COVID-19 pandemic began just months into teams’ efforts, the initiative offered them extra time, flexibility, and resources. The Health Impact Project extended the grant period, provided additional funding to help meet basic needs on the ground, and allowed grantees to amend their work plans to reflect the changing circumstances. This flexibility was critical, participants said, to their teams’ ability to build strong foundations for cross-sector work and develop sustainable, community-driven strategies and solutions. Given the complexity of this work, similar initiatives would likely benefit from such an approach, even without the difficulties caused by a pandemic.

Participants did identify challenges that they had or areas where the program could improve. Grantees wanted more technical assistance related to data collection, sharing, and measurement from the start of the initiative, as well as more tailored and project-specific support, given the wide variation in needs and strengths among grantees. Assigning a team of coaches with subject matter expertise matched to grantees’ areas of focus and needs could be one strategy to accomplish this. In addition, longer grant periods are needed for work targeting systemic issues. Where shorter timeframes are required, the focus should shift to building a foundation that lays the groundwork required for systems change.

Ruth Lindberg directs and Maura Dwyer works on The Pew Charitable Trusts’ Health Impact Project.