Collaborative Processes and Equity: Exploring Local Collaboration as a Tool to Address Health Disparities

• In Event: Policy With versus Policy On: Collaborative Decision-Making and Equity

Abstract

Health disparities, preventable gaps in health outcomes based on social status, are rampant in the US (Braveman et al., 2011). Racial disparities are especially prominent. People of color, on average, die younger, have lower access to health care, and are at higher risk of compounded disadvantage due to education, income, or neighborhood compared to their White counterparts (United States Department of Health and Human Services, 2011; Zimmerman & Anderson, 2019). Public participation and collaboration are increasingly recommended as critical to identifying the underlying contributors to these health disparities and designing sustainable and effective solutions (Israel et al., 2010; Labonté, 2021; Mattessich & Rausch, 2013; Solar & Irwin, 2010). 

This research investigates the potential of collaborative decision-making as an equity tool by empirically examining the relationship between local health department partnerships and racial disparities in health care utilization across U.S. counties. I explore whether collaboration characteristics—such as formality, relationship-building, and interdependence—improve access to preventative health services, specifically flu vaccinations and mammography screenings, among Black and White populations. I leverage survey and secondary data from 509 US counties to test this association. Results demonstrate that formality and relationship building are not associated with improved health outcomes, but collaboration interdependence is associated with higher utilization of vaccination and screening services across both Black and White rates. However, collaboration interdependence has a significantly greater positive association for White compared to Black vaccination rates in the same counties. As vaccinations are health care outcomes with wider disparities between the groups, this result suggests that traditional collaboration activities may not be sufficient to address significant and persistent health disparities.

This research underscores the importance of moving beyond symbolic collaboration to address the structural barriers faced by historically excluded communities. While interdependent collaboration may be a promising solution to addressing equity issues, those engaging in collaborative decision-making must question the underlying systems, design, and assumptions that govern these processes. Taking an equity approach to designing public participation and collaborative efforts will be critical to realizing their potential and avoiding exacerbating existing racial gaps. 

Author

• Margaret Swenson, University of Wyoming
  Presenting Author