Note: This blog was originally posted on my medium channel. I have since deleted my medium account and migrated all my blog posts to this website.
Many institutions are trying to reckon with their own failure in terms of equity and justice . These institutions often fall into two camps, 1) those responding to a recent incident/embarrassment (Jeffrey “Living and Learning” Lieberman) 2) or those trying to avoid one. Either way, institutions do not simply “become” equitable, and it isn’t like flipping a switch . Taking an ahistorical lens is a quick path to failure. If the bar for your system is in hell, don’t expect to skip steps and be in heaven over night. Get a realistic picture of who your organization has been, to see how much work needs to be put in for it to become who it needs to be. That’s why most new initiatives should start with an equity audit.
What is an equity audit?
As I define it, an equity audit is a systematic process of identifying where your organization (health care system, educational system etc) , fails to provide the same amount, or quality of services to individuals from different social classes subject to different forms of discrimination.
A framework I think through is below. The language is clunky but I think it’s simple. There are others, this is just the one that I think you can start with.
1) what you can see.
First step is using the information you have at hand. This is the easiest step and the thing you should do at the beginning and continuously as you try to improve. It varies by what your org does, but think of it as soul-searching for the demonstrated values of your organization. Screw what you say you value, what have you actually done. For a health system this looks like stratifying and cross-stratifying outcomes by different social groups to see who is or is not being treated the same. Which groups are having worse outcomes for the same conditions. Don’t get tricked into thinking you have to “adjust for the different factors first” . Equity and equality are not the same. Equity is about providing resources such that everyone can meet their needs, equality is giving everyone the same resources. If you have two patients with different barriers they will need different things for the same outcomes. Consider “clinic accessibility ” as the outcome. For patients who use wheelchairs that may be ramps, for trans patients, that might gender inclusive bathrooms. Looking at the data of how people from all these groups are served will help you begin to identify your failures. Go in under the assumption that you will find some challenges.
2) what you can’t see.
Your data only tells you how (in)equitable you are for the people who manage to reach you. For those people, getting access to your services at all integrates all the oppression your system and others causes them prior to that access. Some people don’t have the resources to subvert that oppression at all, so they are missed completely. Here you need to compare who you serve to who you should be serving community it is nestled in… you have a problem.
3) what you don’t know to look for.
If you did the first two steps right you’re probably overwhelmed and hopeless. Which at least means you have had an honest look. The next step is to go get the real knowledge from the source.. the people of the community you should be serving. The reality is 1) and 2) only paint a partial picture and only of the problems . There really only good at helping you identify who to prioritize in this step. Here is where you connect with community leaders and organizations (churches, barbershops, salons, recreation centers, libraries, etc) and compensate them (rent out their spaces, pay for their time) to set up open sessions with locals to figure out what you are doing wrong. Community members have the keys to their own liberation , you just can help contribute the resources . These sessions are really important and I think a key step to them is humility, honesty, and time investment. Openly translate and share what your audit revealed about your deficits and also ask them how they view your system, org etc. Do they see the same deficits? Do they view you as a resource ? A benefit? What do they think you provide vs what you actually do? If they aren’t aligned yet, can they be aligned?
These are all just my thoughts and the framework I use when thinking through how orgs can really get on track in this fundamentally inequitable system. They are assembled from my experience of being on “both sides” and I hope you find them useful.