From Principles to Action: The Ways of Knowing Action Agenda

Ways of Knowing Action Agenda on Transforming the Health Science Knowledge System for Racial and Indigenous Health Justice

Working to cultivate a more holistic appreciation of the different ways people understand the world and foster a more inclusive and equitable standard for health equity research

What would it take to truly shift the health science knowledge system so that communities historically excluded from defining “evidence” are centered as co-creators of knowledge and health justice?

Transforming the systems that determine what research is valued, funded, published, rewarded, and put into practice - known as the Health Science Knowledge System (HSKS) - requires reimagining what constitutes knowledge, how it is produced, and how it is shared. These determinations are shaped not by any single individual or actor, but by a complex ecosystem of institutions and players whose policies, practices, incentives, and norms collectively define the HSKS. If we want an HSKS that is connected to and serves communities, we must change the institutions that sustain it, or build new infrastructure that uplifts the varied experiences, cultures, knowledge, expertise, and power of communities.

This Action Agenda is an invitation to collectively do just that – transform the HSKS. It expands on decades of work led by communities, researchers, advocates, policymakers, funders, journal editors, academics, and many other community and institutional leaders who have pushed boundaries to meaningfully advance health justice. It focuses intentionally on changing systems. It offers an array (or menu) of possible solutions for the institutions, sectors, and players that shape the HSKS, recognizing that lasting transformation requires collaborative action across the ecosystem. While this Action Agenda does not capture every sector with a role to play (e.g., government agencies), anyone who sees themselves in this work, can (and should) contribute to this work. The actions presented here are intended to catalyze collaboration, strengthen (or reform) the infrastructure needed for change, and mobilize decision-makers to use their influence and power to create an HSKS that recognizes, reflects, values, and serves communities.

Priority Action Areas
Action Area One
Action Area Two
Background & Glossary

Priority Action Areas

Transforming the HSKS requires sectors to work together rather than in silos. Each sector has a role to play in moving the HSKS forward, sometimes by pulling a specific lever, and sometimes by acting in concert with others. In some cases, change may happen sequentially, like a domino effect. In other cases, change requires simultaneous action across sectors. Below, within each action area, we highlight an “example in action” of how priority actions across sectors can reinforce one another and collectively drive meaningful change.

Action Area One: Situate research to be accountable to communities

Research practices, funding, and sharing of findings are ethically accountable to communities, are led or co-led by community members, and build on community-centered knowledge, wisdom, beliefs, and lived experience, rather than validating or verifying them. The leadership and knowledge of community-based research are uplifted and embraced as part of the larger action research ecosystem, situated equitably alongside and in collaboration with academic and industry research.
Action Area Two: Prioritize the social impact of research findings

The priority of health equity research is to center action and advance social change. Research metrics and incentives are tied to how the work advances racial and Indigenous health justice and helps shape policy and practice, shifting the focus from individual achievement or institutional net profit to collective social impact. Needs and solutions identified by communities serve as the foundation for community-research collaboration that draws from multiple knowledge sources to increase both breadth and depth of action research impacts.
Action Area Three: Embed principles of justice and liberation in health equity research culture

Researchers, funders, journal editors, academics, and community partners are equipped through training, mentorship, and institutional support to apply situationally appropriate anti-racist and anti-colonial principles in the design, implementation, and sharing of research.
Action Area Four: Work in coordination to achieve collective action

Funders, journal editors, academic institutions, and community partners (i.e., HSKS decision-makers and players) work in tandem, rather than within competing systems, through coordinated networks and coalitions, and foster a culture of collaboration among people and organizations working towards a shared goal. This effort begins with like-minded organizations committed to working together to change how the HSKS operates and how its actors engage with one another.
Action Area Five: Bolster the infrastructure needed to support an equitable and durable health equity research ecosystem

Researchers, funders, journal editors, academic institutions, and community partners collaborate in coalition to bolster sustainable and long-term infrastructure within the HSKS, investing resources to support the system and its actors, creating learning infrastructure, and establishing effective communication systems. This strengthening establishes and actualizes the value of health equity research, provides protections and support for those doing that work, and enables the research ecosystem to operate more cohesively and equitably across emergent challenges.

Action Area One: Situate research to be accountable to communities

An Example in Action

To ensure the HSKS is operating in service to community betterment, funders can co-develop funding opportunities with community input and leadership (from design to review); Academia can expand avenues (resources, positions, etc.) to support, connect, and share work led by community and grassroots researchers (in addition to support for researchers housed within the academy), and leverage institutional positionality to achieve greater impact; Journals can create special issues to help build internal and external capacity for publishing more community-generated knowledge; and Non-profits can establish community feedback mechanisms that hold institutional partners and non-profit governance structures accountable to community priorities throughout and after research projects, and ensure that institutions are accountable for results that are desired by the community.
Journals
Create special issues to help build internal and external capacity for publishing more community-generated knowledge
Diversify editorial boards and peer reviewers to include community members and practitioners
Consider using a co-editor model to offset editorial burdens and diversify leadership/perspectives
Prioritize open-access by adopting strategies such as: transformative agreements (where libraries pay for both reading and publishing rights to remove fees for authors and readers), partnering with external funders to subsidize open access fees, creating nonprofit journals that operate as public goods with donor support, and implementing sliding-scale open access fees, which recognize research as a public good
Publish research that includes an acknowledgment of the research team’s perspectives and positionality
Funders
Co-develop funding opportunities with community input and leadership (from design to review)
Diversify boards of directors to include people with relevant lived experience
Build relationships among foundation staff and community groups by employing foundation staff from geographically and contextually relevant communities
Promote authentic power-sharing within research teams throughout the research process by directly funding community organizations to lead or co-lead research projects
Require an acknowledgment of the research team’s perspective and positionality in the application process
Provide flexible and long-term funding
Academia
Revise tenure and promotion criteria, practices, and processes to demonstrate and actualize the value of community partnerships and real-world impact over publication and citation metrics, ensuring consistent standards within academic departments
Create a parallel community Institutional Review Board (IRB) to guide and review the relevance of research to community members
Expand avenues (resources, positions, etc.) to support, connect, and share work led by community and grassroots researchers (in addition to support for researchers housed within the academy), and leverage institutional positionality to achieve greater impact
Non-profits
Establish organizational governance and decision-making structures in which directly impacted community members share decision-making authority (e.g., as board members or part of a community accountability council to monitor institutional commitments, partnership agreements, dissemination plans, and implementation outcomes)
Create opportunities for directly impacted community members to define research priorities, interpret findings, and shape recommendations as equal partners throughout the research process (e.g., by serving as Co-PIs on research grants or on a community institutional review board, based on their desired level of involvement)
Create community-centered engagement practices for shared learning, data interpretation, knowledge creation, and decision-making, such as data dinners, scenario workshops, community writing groups, or public interpretation sessions
Establish community feedback mechanisms that hold institutional partners and non-profit governance structures accountable to community priorities throughout and after research projects, and ensure that institutions are accountable for results that are desired by the community
Invest in building the long-term organizational capacity of non-profits, including the contracting, budgeting, auditing, and negotiating expertise necessary to secure equitable contracts or grant agreements to retain greater control over the research process

Research practices, funding, and sharing of findings are ethically accountable to communities, are led or co-led by community members, and build on community-centered knowledge, wisdom, beliefs, and lived experience, rather than validating or verifying them. The leadership and knowledge of community-based research are uplifted and embraced as part of the larger action research ecosystem, situated equitably alongside and in collaboration with academic and industry research.

Action Area Two: Prioritize the social impact of research findings

Non-profits
Co-develop dissemination products (i.e., lay summaries, policy briefs, fact sheets, newspaper commentaries, accurate multilingual materials, community reports) that support community desired framing, action, decision-making, advocacy, and problem-solving
Document and elevate community stories, lived experiences, and community-defined knowledge alongside traditional research findings, and advocate for institutional and government policies that recognize these forms of knowledge as equally valuable sources of evidence
Example in Action

To elevate the value of community knowledge and ensure it is translated into action, Academia can redefine tenure and promotion criteria to recognize research quality, research dissemination and publications outside traditional academic outlets, social impact, and relationship-building as demonstrations of research productivity over publication quantity or secured funding; Non-profits can co-develop dissemination products (i.e., lay summaries, policy briefs, fact sheets, newspaper commentaries, accurate multilingual materials, community reports) that support community desired framing, action, decision-making, advocacy, and problem-solving; Funders can allow grantees to share findings in their preferred way (e.g., storytelling, videos, a social media campaign); and Journals can publish editorials, commentaries, articles, field notes, and special issues emphasizing anti-colonial, anti-racist, and intersectional frameworks and equitable research practices.
Funders
Fund research methods and approaches that align with the research question(s) and the social/cultural norms that are appropriate in the community where the research is being conducted
Support capacity building that addresses needs identified by non-profits
Allow grantees to share findings in their preferred way (storytelling, videos, a social media campaign, etc.)
Prioritize and support high-impact dissemination activities (e.g., advocacy training, media prep, messaging campaigns, and other communications support, convenings, etc.)
Journals
Publish editorials, commentaries, articles, field notes, and special issues emphasizing anti-colonial, anti-racist, and intersectional frameworks and equitable research practices
Update instructions for authors to highlight openness to diverse methods and perspectives
Present at conferences (AcademyHealth, IAPHS, APHA) or local community meetings, etc., to normalize health equity-centered publishing practices (change the narrative)
Academia
Reward and provide faculty with resources for mentorship of junior and mid-career scholars
Redefine tenure and promotion criteria to recognize research quality, research dissemination, and publications outside traditional academic outlets, social impact, and relationship-building as demonstrations of research productivity over publication quantity or secured funding
Develop documentation guidelines and metrics to reflect these activities

The priority of health equity research is to center action and advance social change. Research metrics and incentives are tied to how the work advances racial and Indigenous health justice and helps shape policy and practice, shifting the focus from individual achievement or institutional net profit to collective social impact. Needs and solutions identified by communities serve as the foundation for community-research collaboration that draws from multiple knowledge sources to increase both breadth and depth of action research impacts.

Background & Glossary

Why was this Action Agenda created?
Knowledge, what we know and believe to be true, is derived from a variety of sources – education, experience, instinct or intuition, and experimentation. Historically, the scientific community has placed greater value on experimental knowledge, elevating not only the information it provides, but also the methods by which it is obtained. This thinking has created a scientific knowledge system that is insulated and limited. In recent years, deep politicization of science combined with a public reckoning with racism in the United States (and in science) has spurred a reevaluation of what constitutes knowledge. Despite growing attention to research focused on racial and Indigenous equity, structural racism and settler colonialism are embedded in how the current research ecosystem operates - from how research is done, to who gets tenure and how it is incentivized and achieved, from who and what research is funded, to the type of research that is published and cited.
In recognition of the importance of a more holistic basis of knowledge, constructed from multiple sources and approaches, the Robert Wood Johnson Foundation (RWJF) is working to transform the “Health Science Knowledge System” to shift the paradigm around how knowledge is created, valued, and distributed. The aim of this effort is not to eliminate or exclude the scientific method, but to expand on it, recognizing that it is one of many valuable ways of knowing and generating knowledge for a broader understanding of what is needed to advance racial and Indigenous health equity. Scientific knowledge has been - and continues to be - incredibly valuable for understanding health and wellbeing in communities. But other forms of knowledge generation, including lived experience, community knowledge, and Indigenous Ways of Knowing, are equally important for understanding the conditions that shape health and identifying solutions to improve it. These forms of knowledge should be equally valued and used to inform action to advance health equity. For instance, quantitative research is often privileged as the gold standard for determining what constitutes rigorous science, but we recognize that this is flawed. Communities should not have to wait for a scientific study to validate what they already know through lived experience before their experiences and priorities elicit action.
What is the Ways of Knowing Initiative?

The Ways of Knowing initiative, co-developed by two Robert Wood Johnson Foundation programs, Evidence for Action (E4A) and Partners for Advancing Health Equity (P4HE), in close collaboration with expert co-organizers, is an ongoing effort to leverage collective wisdom and action to transform the HSKS. This transformation aims to uplift the knowledge, expertise, and power of people and communities who have been continuously oppressed and marginalized, and advance health equity research along a continuum towards health justice.
The Ways of Knowing initiative is also an effort to redefine rigor in the health sciences, moving from a narrow methodological hierarchy that heavily favors causal inference designs to a broader definition that accounts for both how the research is conducted (and assess the methods based on their ability to answer the research question) and whether the research has an impact, noting that impact is not confined to policy reform but rather relates to whether it results in some benefit to the community.
Why are Non-profit organizations included in this Action Agenda and what unique role do they play?

Non-profit organizations play a vital role in transforming the HSKS because they often serve as the bridge between communities and research institutions, including academia, funders, and journals. Typically rooted in the communities they serve, non-profit organizations are uniquely positioned to translate community priorities to institutional partners while also helping communities navigate and engage in the research process. In doing so, they can serve as trusted connectors and holders of accountability, ensuring that research remains responsive to community priorities and that institutions are accountable to the people they aim to serve. While not traditionally categorized as gatekeepers within the HSKS, non-profits do wield power and have an important role to play in knowledge generation, translation, and implementation, especially community-based organizations that are grounded in their local communities, for example. This Action Agenda encourages non-profits to recognize and embrace this power by using their position to push boundaries, advocate for more equitable partnerships, and help build the capacity of community members to meaningfully participate in and lead research.
We recognize that non-profits are diverse. They vary in size (from small community-based organizations to large, national think tanks), mission, and resources, and their experience engaging in research ranges from extensive to limited. Some have dedicated research infrastructure and longstanding partnerships, while others are just beginning to build this capacity. The recommendations in this Action Agenda are intended primarily for non-profits that are engaged in research partnerships with other institutions. Consequently, not every priority action can be accommodated by all non-profits.
What is the Health Science Knowledge System?

The Health Science Knowledge System (HSKS) is defined as a system of knowledge generation, currently heavily influenced by institutional gatekeepers or decision-makers of scientific knowledge—academic and other research institutions, journals, scientific review boards, research funders, and other entities (e.g., the government)—that make decisions about what constitutes scientific knowledge, what we produce, collect, and share. For this reason, this Action Agenda specifically focuses on decision-makers in positions of power or influence within the current HSKS, who we can collectively hold accountable to make changes in the processes, policies, and procedures of their institutions to support a more holistic HSKS (e.g., academic administrators, journal editors, and research funders).
What is the Ways of Knowing Ecosystem?

In this Action Agenda, beyond the HSKS decision-makers, the Ways of Knowing ecosystem represents the players within the HSKS who share values related to advancing health equity and justice. Within this ecosystem are health equity scholars, grassroots researchers, non-profit organizations, members of communities most impacted by injustices, and others with a vested interest in using research as a tool for advancing health equity. These players have diverse lived experiences and represent diversity across positions of power and privilege within the HSKS and beyond. As our ecosystem continues to expand and welcomes new voices and perspectives, we anticipate that this work, including the shared language we use to describe it, will evolve to better honor the dignity and representation of our growing collective.

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