Health Equity Performance Measures Toolkit: A Guide for Local Health Departments

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This entry is part 44 of 64 in the series Wide World of Public Health Systems

This post highlights how the Health Equity Performance Measures Toolkit: A Guide for Local Health Departments may be used by public health systems practitioners at health departments of all levels. 

Timely Funding

In mid-2021, the Centers for Disease Control and Prevention (CDC) awarded approximately $2.25 billion to 108 recipients as part of its National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities (OT21-2103) grant. Under this initiative, local health departments (LHDs) received funding to enhance their capacity and capability to address health disparities related to COVID-19. In 2023, the National Association of County and City Health Officials (NACCHO) funded the Center for Public Health Systems (CPHS) at the University of Minnesota School of Public Health to create a toolkit to increase LHDs’ capacity to define, measure, and track progress toward health equity as a part of their performance improvement. 

Shaping the Toolkit

The development of this toolkit was based on three foundational sources. To best inform creation of a useful toolkit, CPHS first conducted an environmental scan in February and March 2023 of peer-reviewed literature (using Google Scholar) and compiled public health department plans written by public health departments (ie, Community Health Assessments (CHAs), Community Health Improvement Plans (CHIPs), Health Equity Plans, and Strategic Plans). Public health plans were obtained from a Google search. The goals of the environmental scan were to identify 1) How local health departments are defining health equity, including other sources they might be taking those definitions from, and 2) How local health departments are currently measuring and tracking progress towards more equitable health outcomes. The environmental scan report can be found on the NACCHO website and the CPHS website.

Next, CPHS held 3 listening sessions with public health professionals from LHDs across the country. The goal of the listening sessions was to understand LHDs’ working definitions of health equity, their health equity performance measures (HEPM) strategies, and their ‘go-to’ data sources.

  • About 40 LHD personnel attended the first listening session held on January 31, 2024. There were six LHDs whose personnel consistently participated in the conversation about how their LHDs define, measure, and track progress toward health equity as a part of their performance improvement.
  • Three LHDs participated in subsequent in-depth listening sessions held on February 20th and February 22nd, 2024. These conversations informed the main topics covered by the toolkit, which include: 1) defining and measuring health equity over time and identifying groups affected by interventions; 2) data disaggregation, particularly for racial/ethnic groups; 3) building community partnerships and trust; and 4) examples of HEPM logic models. These main topics are addressed throughout the toolkit.

What we learned from the listening sessions is captured in the LHD Voices call-out boxes in the toolkit.

Last, much of the content included in this toolkit builds on Measuring What Matters in Public Health: A Health Department’s Guide to Performance Management, published by NACCHO in 2018. This report provides guidance on building a performance management system, supplemented with templates, worksheets, and stories from the field. The guide contains content for LHDs launching a performance management system for the first time, while also offering ideas for improvement for LHDs with well-established performance management systems. We add to this report by focusing specifically on performance measurement (an aspect of performance management) of health equity.

Health Equity Performance Measures (HEPM) Toolkit

The Health Equity Performance Measures Toolkit: A Guide for Local Health Departments can be found on the NACCHO website and the CPHS website. The HEPM Toolkit comprises two main parts: 1) a background section covering the basics of health equity and HEPM and 2) a step-by-step guide for creating and tracking performance measures. Drawing on work from the CDC and NACCHO, we define health equity as ‘[a]ny identifiable effort or action whose purpose was to advance a “fair and just opportunity to attain their highest level of health,’” and performance measurement as “the use of quantitative metrics and indicators to collect data and track progress against strategy, goals, and objectives.” These two definitions serve as foundational knowledge for LHDs that are just beginning to operationalize their HEPM plans.

The second part of the Health Equity Performance Measures Toolkit: A Guide for Local Health Departments – the step-by-step guide – outlines seven HEPM activities. These steps are:

As previously mentioned, what we learned from the listening sessions is captured in the LHD Voices call-out boxes in the toolkit. Below are a few examples of how LHDs are incorporating the community and using data sources to identify health disparities in their performance measures:

Summary

The Health Equity Performance Measures Toolkit: A Guide for Local Health Departments is designed for public health departments at any level of HEPM expertise, but it is especially geared towards LHDs that are in the early stages of measuring health equity outcomes. There has been significant expansion of health equity-related work and measurement over the last several years, funded by grants specifically designed to mitigate health disparities related to COVID-19. Funding and work should continue to ensure health equity and health equity performance measures continue to be prioritized to build on the current foundation. Ongoing funding will allow LHDs, including those in the early stages of health equity measurement, to continue to undertake critical health equity challenges in the communities they serve. The NACCHO website and the CPHS website have a webinar where we showcase our toolkit.

Read Our Toolkit and Environmental Scan Report and Watch the Toolkit Webinar on the NACCHO website and the CPHS website.

About the Author

Skky Martin
Dr. Skky Martin is a researcher at the Center for Public Health Systems. Her research interests include health equity, health disparities, social determinants of health, and the interrelationship between public health and medical education. She has experience in qualitative methods and analysis, writing surveys, and using STATA to create and analyze quantitative datasets. Dr. Martin holds a doctoral degree and master’s degree in sociology and a Certificate in Public Health from Loyola University Chicago.

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