Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States.
C. S. Mott Department of Public Health and Department of OBGYN and Reproductive Biology, Michigan State University, Flint, MI, United States.
Front Public Health. 2023 Sep 26;11:1226175. doi: 10.3389/fpubh.2023.1226175. eCollection 2023.
Sustainability and health inequities are key challenges in public health and healthcare. Research suggests that only about half of evidence-based interventions (EBIs) are sustained over time, and settings and populations experiencing systemic and structural barriers to health (e.g., poverty, racism, stigma, and discrimination) experience even greater challenges to sustainability. In this article, we argue that an enhanced focus on sustainability in the field of implementation science is critical in order to maximize the long-term health benefits and broader societal impacts of EBIs for all populations and settings. From an equity perspective, a focus on sustainability is particularly critical to prioritize among population sub-groups that have not historically received the benefits of health-related EBIs. We discuss how a health equity framing is essential to sustaining EBIs in under-resourced communities, and requires moving away from a deficit mindset that focuses on why EBIs are challenging to sustain, to one that focuses more on identifying and nurturing existing assets within individuals and communities to increase the likelihood that EBIs are sustained. We conclude with a discussion of future directions as well as recommendations and resources (e.g., frameworks, tools) to advance and make progress toward sustainability from a health equity mindset, including: (1) Actively planning early for sustainability alongside key partners; (2) Tracking progress toward enhancing sustainability and being accountable in doing so equitably for all settings and populations; and (3) Focusing on both equity and engagement early and often throughout the research process and all implementation phases.
可持续性和健康不平等是公共卫生和医疗保健的主要挑战。研究表明,只有大约一半的基于证据的干预措施(EBIs)能够随着时间的推移持续下去,而那些经历着系统性和结构性健康障碍的环境和人群(例如贫困、种族主义、污名化和歧视),在可持续性方面面临着更大的挑战。在本文中,我们认为,在实施科学领域加强对可持续性的关注对于最大限度地提高 EBI 对所有环境和人群的长期健康效益和更广泛的社会影响至关重要。从公平的角度来看,关注可持续性对于优先考虑那些历史上没有受益于与健康相关的 EBI 的人群亚组尤为重要。我们讨论了如何从健康公平的角度出发,将可持续性框架应用于资源匮乏的社区,这需要摒弃关注 EBI 为何难以持续的缺陷思维模式,转向更关注个人和社区内部现有资产的识别和培养,以增加 EBI 持续的可能性。最后,我们讨论了未来的方向,以及从健康公平的角度出发,推进和取得可持续性进展的建议和资源(例如框架、工具),包括:(1)与主要合作伙伴一起尽早积极规划可持续性;(2)跟踪增强可持续性的进展,并在所有环境和人群中公平地做到这一点;(3)在研究过程和所有实施阶段,尽早并经常关注公平性和参与度。