Table of Contents
- Introduction
- Action Areas
- Action Area One: Situate research to be accountable to communities
- Action Area Two: Prioritize the social impact of research findings
- Action Area Three: Embed principles of justice and liberation in health equity …
- Action Area Four: Work in coordination to achieve collective action
- Action Area Five: Bolster the infrastructure needed to support an equitable and…
Introduction
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.
A transformed health science knowledge system is possible. Now, our collective task is to put these actions into practice!
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Action Areas and Priority Actions
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
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.
Priority Actions
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.
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
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
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
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.
Priority Actions
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.)
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
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)
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
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.
Priority Actions
Example in action
To increase the capacity of the Ways of Knowing ecosystem to embed principles of justice and liberation in health equity research culture, Funders can provide capacity-building support as identified by non-profits throughout the grant period; Journals can develop and support mentorship and health equity training programs; Academia can train senior faculty to apply anti-racist and anti-colonial principles in their research, teaching, and service, while ensuring students develop the same competencies through required coursework; and Non-profits can develop internal research capacity within non-profits and build a pipeline of community leaders by training residents as future community researchers, data stewards, community evaluators, nonprofit leaders, and community advocates.
Funders
- Reimagine and adopt flexible reporting and evaluation requirements that respect community-defined measures of success
- Provide capacity-building support as identified by non-profits throughout the grant period
- Define and continuously reflect on what equity and justice mean for your organization to guide processes and requirements
- Commit to analyzing who is applying, who is being funded, and where inequities exist in the funding allocation process
- Increase transparency in decision-making processes by providing feedback to applicants and grantees
Academia
- Redesign faculty recruitment and onboarding processes to attract, support, and retain a more diverse faculty body
- Train senior faculty to apply anti-racist and anti-colonial principles in their research, teaching, and service, while ensuring students develop the same competencies through required coursework
- Review existing academic program requirements to identify where these competencies are addressed, and, if missing, develop and embed them into the curriculum
- Equitably compensate community research partners
Journals
- Develop and support mentorship and health equity training programs, including commissioning writings and mentorship opportunities for graduate students, early-career scholars of color, and community researchers, offering paid editorial residencies, training reviewers to identify bias, and compensating community members to participate in manuscript review
- Identify and address potential biases in author representation by tracking demographics (authorship, rejection rates)
- Implement public portals to track and annotate the ways racism shows up in the peer review process and train reviewers to identify bias
- Hire a Health Equity Associate Editor to establish anti-racist/anti-colonial work standards and metrics within journal operations
Non-profits
- Establish written agreements and publishing expectations or procedures with research partners (e.g., require co-authorship, prior community review and approval, appropriate acknowledgments, and open access)
- Develop internal research capacity within non-profits and build a pipeline of community leaders by training residents as future community researchers, data stewards, community evaluators, nonprofit leaders, and community advocates
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.
Priority Actions
Example in action
To achieve collective action, Funders, Journals, Academia, and Non-profits, can invest in and commit to working in partnership with one another to build national and local coalitions to support and advance a liberated HSKS, engage in multi-sectoral convenings, and peer-learning networks to co-create shared values, norms, and practices, develop success metrics and accountability measures, grow trust, share (and shift) power, and scale innovations for long-term impact.
Funders
- Facilitate and fund networks of people and organizations interested in achieving a shared goal to promote collaboration over competition
- Funders pool resources across philanthropies to create greater collaboration and translate ideas into action
Academia
Incentivize and reward interdisciplinary and interdepartmental collaboration among faculty, staff, and administrators, and concretize effective practices into formal internal policies and processes.
Journals
- Engage with multi-disciplinary journal editors to share, formalize, and implement inclusive health equity and health justice research standards across the publishing enterprise
- Encourage diverse citation and theoretical sources, including community-based knowledge and research, grassroots and place-based experimentation, and emergent strategies across sectors
- Encourage or require publications to include directions for action that draw from research findings
Non-profits
- Build and sustain coalitions among established and emerging non-profits – ensuring meaningful decision-making authority and representation from smaller sub-populations – through peer learning networks, mentorship opportunities, resource sharing partnerships, capacity building opportunities, and collaborative research initiatives, to strengthen coordination, reduce duplication, and increase collective impact
- When working in coalition, engage in a shared strategic planning process to identify common priorities, agendas, and motivations for research and data activities, and establish the values that will guide collaborative decision-making and collective action
- Formalize equitable partnership roles with funders, academic institutions, and other decision-makers (e.g., co-principal investigator positions, fair and equitable compensation, and community-led dissemination plans) to build power and hold institutions accountable to community priorities
- Establish practices for coalition trust-building, conflict resolution, and relationship repair (e.g., facilitated dialogue, shared agreements, feedback processes, and restorative conversations) to strengthen collaboration among non-profits, navigate disagreement constructively, and sustain long-term collective action
- Establish community-based implementation and learning laboratories/innovation hubs that enable communities and research partners to test, evaluate, refine, and scale evidence-informed solutions in real-world settings, with clear implementation plans, outcome measures, and accountability processes that demonstrate how findings will contribute to sustainable community change
- Build and sustain coalitions among established and emerging non-profits – ensuring meaningful decision-making authority and representation from smaller sub-populations – through peer learning networks, mentorship opportunities, resource sharing partnerships, capacity building opportunities, and collaborative research initiatives, to strengthen coordination, reduce duplication, and increase collective impact
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.
Priority Actions
Example in action
To bolster or reform the HSKS infrastructure, Funders can start creating the conditions (i.e. funding, networks, infrastructure, etc.) to support an alternative health equity research enterprise; Academia can work with accrediting bodies to formalize curriculum requirements related to health justice research practices at scale; Journals can translate innovations into concretized author guidelines and push for adoption through national and international committees (e.g., ICMJE) and at the publisher level; and Non-profits can reduce dependence on external institutions' (e.g., governmental and academic) research and data infrastructure by investing in internal or coalition-shared data sovereignty capacity (e.g., dedicated data/research staff, shared governance functions, data management systems and technical assistance partnerships).
Funders
- Fund/provide backbone support for coordinated networks, coalition building
- Support or launch the infrastructure for a new journal run as a public good with no fees and no profit expectations
- Redesign funder applications to be more accessible, inclusive of communities, as opposed to rigid, nonrelational transactional processes
- Start creating the conditions (i.e. funding, networks, infrastructure, etc.) to support an alternative health equity research enterprise
- Provide technical support and training opportunities for needs across the field
Academia
- Situate senior leaders to serve as long-term champions of health equity principles and practices, with resources and dedicated staff to ensure it’s sustained and institutionalized, rather than a one-time effort
- Work with accrediting bodies to formalize curriculum requirements related to health justice research practices at scale
Journals
- Acknowledge and offset the burden of peer reviewing and serving on editorial boards by compensating these roles
- Translate innovations into concretized author guidelines and push for adoption through national and international committees (e.g., ICMJE) and at the publisher level
Non-profits
- Establish community data stewardship and governance practices (e.g., data governance policies, community review processes, data-sharing agreements, and decision-making protocols) to strengthen community ownership of data and ensure information is collected, used, interpreted, and shared in ways that reflect community priorities
- Create community-owned data dashboards and shared measurement systems that allow residents, non-profits, funders, researchers, and policymakers to monitor progress toward community-defined outcomes in real time (monitoring and accountability infrastructure, to the extent possible, should be accessible and owned by the community)
- Reduce dependence on external institutions' (e.g., governmental and academic) research and data infrastructure by investing in internal or coalition-shared data sovereignty capacity (e.g., dedicated data/research staff, shared governance functions, data management systems and technical assistance partnerships)
- Establish standardized agreements, frameworks, or processes for data ownership, access, use, and dissemination when partnering with researchers, funders, and other institutions (e.g., standing data-sharing agreements or templates, memorandums of understanding or agreement, funding pass-through agreements, free, prior, and informed consent processes, and community approval processes) to promote transparency, accountability, and equitable use of community knowledge
- Establish community data stewardship and governance practices (e.g., data governance policies, community review processes, data-sharing agreements, and decision-making protocols) to strengthen community ownership of data and ensure information is collected, used, interpreted, and shared in ways that reflect community priorities