Sayani Ambreen, Monteith Linda, Shahil-Feroz Anam, Srinivasan Diya, Amsdr Isra, Awil Fatah, Cordeaux Emily, Garcia Victoria, Hinds Ryan, Jeji Tara, Khan Omar, Lee Bee, Musawi Mursal, Robinson Jill, Sterling Staceyan, Wardak Dean, Wu Kelly, Khawari Mohadessa, Gilfoyle Meghan, Maybee Alies
Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Equity Mobilizing Partnerships in Community (EMPaCT), Women's College Hospital, Toronto, Ontario, Canada.
Health Expect. 2025 Apr;28(2):e70212. doi: 10.1111/hex.70212.
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.
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.
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.
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 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.
健康公平评估（HEA）是用于评估政策、计划和举措的公平影响的决策支持框架或工具。然而，健康公平评估往往在没有受到健康不平等影响最大的个人和社区有意义参与的情况下进行。这种社会参与的缺乏限制了健康公平评估的相关性和有效性，使系统性不平等问题得不到解决，有影响力的变革机会也无法实现。另一种选择是让有不同生活经历的人参与健康公平评估的开展和提供，以便受影响最大且在决策中最被排斥的人能够提出建议，以改善他们获得和利用医疗服务的方式。
社区公平动员伙伴关系（EMPaCT）是一种可扩展的、参与式公民参与模式，将生活经历融入到健康公平评估过程中。EMPaCT的社区参与健康公平评估（CEn-HEA）的五个步骤是与通常被排除在决策之外的社区成员共同设计的。这个过程促进了服务不足社区与决策者之间的心理安全、信任建立和权力共享。CEn-HEA系统地分析下游（个人）、中游（社区）和上游（结构）层面的不平等现象，以生成可操作的、以公平为重点的建议。
EMPaCT CEn-HEA框架产生针对具体情况的建议，既能满足项目的即时需求，又能推动长期的系统性变革。该框架是一个以社区声音为中心的参与过程，建立信任，放大生活经验和专业知识，并促进以公平为导向的决策，从而在医疗政策、计划和实践中带来可衡量的改善。
在本文中，我们研究了与健康公平评估相关的挑战和机遇；介绍了EMPaCT的CEn-HEA框架，这是一种共同设计的、创新的、社区参与的健康公平分析方法；并讨论了衡量和评估这些努力的健康公平影响的方法。
患者和社区参与是本项目及由此产生的手稿的设计、开发和实施的核心。社区公平动员伙伴关系（EMPaCT），包括其社区参与健康公平评估（CEn-HEA）框架，是与有健康不平等生活经历的不同患者伙伴共同创建的。在撰写本手稿时，患者伙伴参与了共同设计会议，以确定手稿的重点、结构和语言。他们在讨论中合作，完善关键概念，阐明挑战，并突出基于他们生活现实的解决方案。在撰写本手稿时，患者伙伴审查了初稿，提供反馈以确保内容的可及性和相关性，并形成可操作的建议。本手稿反映了EMPaCT对正义、包容和有意义变革的承诺。
