Advancing Health Equity: Practical Actions for Implementing HEC’s Health Equity Framework
Apply Healthcare Excellence Canada's Health Equity Framework through practical, action-oriented guidance.
- Topics
- Health equity
- Health workforce
- Patient engagement
- Audience
Point of care provider
Healthcare leader
Community organization
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From framework to action
This resource builds on Healthcare Excellence Canada's Health Equity Framework by expanding on the actions that support more equitable health and care systems. It provides practical considerations, examples and guidance to support implementation across different contexts, moving from high-level concepts to applied practice. Designed to support ongoing progress, these actions can be adapted to meet the needs of diverse teams, organizations and communities.
Health Equity Framework actions
Build a more inclusive organization
Building a more inclusive organization means creating a culture in which all staff, healthcare providers, patients, and caregivers feel a sense of belonging and see themselves reflected in leadership, policies, and practices. When healthcare workers feel included and supported, they are better positioned to provide equitable, culturally safe care that centres the needs and experiences of patients and caregivers.
Creating a supportive environment can mean making changes to organizational practices and policies, offering learning opportunities, and fostering collaborative relationships among all team members. These efforts should be developed through equitable, structured processes that include staff at all levels, ensuring diverse perspectives shape organizational change.
When people and communities experience inequities that others do not, organizational policies and practices should directly respond.
Every organization will encounter its own unique opportunities and challenges when engaging in equity work. Creating psychological safety, establishing ground rules for respectful dialogue, and building accountability structures for addressing harm are essential foundations for this work.
Develop inclusive leadership practices.
Support leaders to model humility, vulnerability, openness to feedback, and a willingness to unlearn assumptions, narratives, and ways of thinking that reinforce unfair systems.
Ensure leadership reflects the diversity of staff and communities served so people can see themselves in roles of influence.
Create mentorship programs that build pathways to leadership for structurally marginalized people and communities.
Set and communicate clear, equity-related goals for creating an inclusive workplace.
Use workforce demographic data and belonging surveys to understand where you are starting from.
Set specific, measurable goals – for example, increasing leadership diversity and improving retention rates for staff from structurally marginalized people and communities.
Establish benchmarks and share progress transparently and regularly with all staff.
Develop equity-related goals that align with larger organizational priorities and strategic plans.
Establish new practices of hiring, retention, compensation, and promotion.
Build organizational structures that actively support equity, diversity, and inclusion across your workforce and culture.
Identify, hire, and support staff from different communities who reflect the diversity of the people your organization serves.
Create employee resource groups – identity-based, cross-identity, and ally-inclusive – focused on shared goals for workplace inclusion and equity.
Enable partnerships between human resources and equity, diversity, and inclusion leaders to implement new policies on hiring, retention, compensation, and promotion.
Build safer feedback practices for staff – in group and confidential individual formats.
Gather feedback about diversity, equity, and inclusion through multiple methods: surveys, feedback forms, suggestion boxes, interviews, and group discussions.
Communicate clearly about the purpose of collecting feedback and how information will be used and retained, and for how long.
Ask clear, concise, and specific questions.
Establish clear, safe pathways for staff to report experiences of bias, racism, discrimination, and moral injury, with transparent follow-up processes.
Foster relationships that drive change.
Create a culture of trust, respect, and understanding by building skills in communication, active listening, empathy, and conflict resolution.
Make time to build relationships within teams, across departments, and between all levels of the organization – from leadership to point-of-care staff.
Understand your history – and take responsibility for current harms.
Learn about the histories and experiences of structurally marginalized people and communities. Start with online resources and courses, then bring in expert facilitators in anti-racism and anti-oppression.
Acknowledge and address the past and current harms that healthcare organizations and systems have caused – and still cause. Build relationships with community partners and centre their voices in reconciliation and repair.
Partner with community leaders and knowledge holders from structurally marginalized communities, and pay them equitably for their expertise.
Recognize First Nations, Inuit, and Métis peoples as rights holders with a distinct relationship to truth and reconciliation.
Partner with First Nations, Inuit, and Métis leaders and knowledge keepers – including staff within your organization – and ensure their voices shape truth and reconciliation efforts through meaningful leadership and decision-making roles.
Catalyze equitable policy
Health equity policy work involves developing, implementing, and evaluating the policies and funding models that shape how resources are allocated and how care is delivered to people facing the greatest barriers.
Policy operates at multiple levels: system mandates and funding, organizational priorities, program and operational workflows, and point-of-care practice. Catalyzing equitable policy means creating and advancing policies that reduce systemic barriers and intentionally redistribute resources and power, including supporting staff to understand and request for changes to policies that affect them and the communities they serve.
This work requires partnership across roles and levels of an organization. Even well-designed policies fall short unless adequate support is provided for managers and operational leaders to interpret a policy’s intent, support their teams, and address barriers to implementation. The work also requires looking beyond individual organizations to understanding how system-level equity policies can create lasting improvements in care and community well-being.
Community partnership is essential here: community members can co-lead in setting policy priorities, co-design policy solutions, define measures of success, and ensure policies reflect lived experience and community knowledge.
Identify and eliminate organizational policies that create barriers or cause harm to structurally marginalized communities.
Start with policies that communities have already identified as barriers or harms – through feedback, advocacy, or complaints.
Conduct systematic equity audits of policies across all organizational areas: human resources, service delivery, governance, facilities, data practices, and finance.
Engage community members as co-reviewers and co-decision-makers in policy analysis, recognizing their expertise in how policies affect their lives and communities.
Include diverse staff at all organizational levels, and prioritize voices of staff from equity-denied communities.
When setting priorities for change, lead with the change’s potential impact on equity, not just how easy it will be to implement, and act urgently on policies causing immediate harm.
Build capacity of staff and community members to engage in policy development.
Provide training on policy analysis, identifying equity impacts, writing policy briefs, and building coalitions.
Allocate dedicated time and resources for policy work as part of regular duties, not as an add-on.
Clarify organizational positions on policy issues and the boundaries within which staff can engage.
Support and ensure the safety of staff from structurally marginalized communities who are personally affected by inequitable policies.
Catalyze evidence-driven policy changes at relevant levels that advance health equity within your organization and beyond.
Ground policy priorities based in community-identified needs and barriers, including evidence of systemic inequities.
Build coalitions with community organizations, health providers, and community groups to strengthen your collective voice and influence.
Centre and amplify community voices. Create space, dedicate organizational resources, and use your influence to support community priorities.
Keep sight of the bigger picture, which is that individual experiences of inequity are shaped by institutions and systems, and that lasting change requires addressing root causes at the policy and structural level, not only through local action.
Use multiple approaches tailored to your audience, including policy briefs, media engagement, public awareness campaigns, direct relationship-building with decision-makers, and participation in policy consultations at local, regional, and national levels.
Support funding and payment models that enable equitable care.
Build partnerships in solidarity between well-resourced organizations and community-based organizations.
Share or pool resources – funding, space, infrastructure, and administrative support – across organizations to increase collective capacity.
Co-develop services to meet community needs
This action represents a fundamental shift away from traditional top-down service planning, which has historically relied on one-time consultations with community members that may not address what communities identify as most important.
Co-developing services with community members as partners – that have decision-making power – is essential for ensuring services meet community needs. Community members know the strengths of their communities and can identify their needs. Services that are co-developed with communities are more relevant and effective, and build trust among everyone involved. It is also important that community members receive fair compensation and recognition for their expertise and contributions.
Co-developing services allows health and social care organizations to better reflect community needs, build on existing strengths, and advance health equity. Needs assessments are one tool communities may draw on to help organizations understand those strengths and identify gaps between current services and community priorities. But they work best as part of a broader approach, conducted in partnership with community members and across health and social organizations, with a clear eye on how social and structural factors impact health and access to care.
Examples of community-identified services that address social determinants of health include food security programs, housing stability supports, peer navigator programs, and newcomer settlement or language-access services.
Build and sustain authentic community partnerships.
Build relationships over time without predetermined agendas, investing in trust before making asks. Draw on established guidance and resources to support this relationship building.
Offer compensation to community members for their time, expertise, and work.
Address power imbalances that often show up in engagement practices – e.g. who speaks, who is heard, and how decisions are made).
Partner with community organizations, social services, housing services, and other allied partners who are already doing this work.
Co-design needs assessments with communities to understand health needs and priorities.
Before conducting needs assessments, check whether communities have already identified their needs through existing advocacy, organizing, research, or data sources.
Ensure a strengths-based approach that not only identifies needs, but also recognizes the community’s existing strengths.
Secure resources and decision-making authority to act on findings before conducting the assessment.
Draw on leading practices for conducting equity-centred needs assessments. This includes co-designing how data are collected, interpreted, and shared, and jointly identifying priority areas for investment.
Share findings with communities first, in accessible formats, and jointly determine next steps before broader dissemination.
Engage point of care staff and community members as partners in identifying service gaps and opportunities.
Recognize that staff working directly with structurally marginalized people and communities often have valuable insights into barriers to care and opportunities for improvements.
Ensure staff insights complement – but never replace – direct community leadership and engagement.
Create opportunities for staff and community members to collaborate in identifying solutions that build on existing community strengths.
Support staff to advocate for resources and changes that people and communities have identified as priorities.
Allocate resources to address social and structural determinants of health based on community context and priorities.
Partner with communities to understand the root causes of health inequities affecting them specifically. That shared understanding opens the door to collaborating on new service areas and sustainable solutions that build on existing community strengths.
Be open to community priorities that may differ from organizational assumptions, and to new approaches that require working across traditional boundaries and silos.
Fund services and initiatives that communities have identified as priorities, with flexible and sustained funding that allows community organizations to enhance capacity and sustainability.
Collect and use equity-focused data
Used well, equity-focused data reveals how systems create and maintain inequities affecting structurally marginalized people and communities, both within organizations and in the care they provide. These data help identify disparities, target interventions, and measure progress toward more equitable organizations and services.
Historically, communities have often been excluded from decisions about what data are collected and how they are used. This has caused harm: communities have been surveilled, their data extracted without consent or benefit, and information about them misused in ways that reinforce discrimination and distrust. Given this history, organizations must collect and use data in ways that are grounded in community consent, control, and benefit to communities.
Organizations should establish formal community engagement processes that position affected staff or community members as co-decision-makers about data collection (not just participants). Ongoing partnerships with community members and staff to determine how and why data are collected and used are central to equity-focused data practices. Community-developed data governance frameworks, such as the First Nations principles of ownership, control, access, and possession (OCAP), provide essential guidance for respectful data practices.
Build authentic partnerships with the communities whose data you are collecting.
Draw on established frameworks and resources to guide community engagement for equity-focused data initiatives.
Support affected staff or community members to co-create data collection and related initiatives.
Offer recognition and compensation to affected staff or community members for their time, expertise, and work.
Address power imbalances in engagement by creating structures where community voices shape outcomes – e.g. who speaks, who is heard, and how decisions are made.
Ensure staff involved in partnerships on data collection and use are adequately trained and supported.
Apply community-developed governance frameworks and guidelines.
Apply established frameworks, such as the Ownership, Control, Access, and Possession (OCAP) framework noted above and the Engagement, Governance, Access, and Protection of data (EGAP) Principles for Black communities in Canada. These frameworks help organizations align their data practices with the needs, priorities, and rights of structurally marginalized people and communities.
Recognize that different communities have developed specific data governance frameworks based on their histories and priorities. Seek out and apply frameworks relevant to the communities you serve.
Ensure that those who are collecting data understand why and how to do so, and feel comfortable asking questions when needed.
Use comprehensive implementation guidelines for equity-focused data collection.
Identify guidelines that relate to the particular needs, experiences, and wishes of the communities your organization serves, such as the Measuring Health Equity guide noted in the resources section to support learning section. These guidelines provide practical advice and tools for collecting, analyzing, and using demographic data (including race, ethnicity, gender, language, income, disability, and geographic location) in healthcare settings.
Ensure the organization has the infrastructure, expertise, and resources to collect and use equity-focused data in meaningful ways.
Ensure that adequate data protections are in place and that organizational leaders remain accountable for the security and integrity of data collected.
Develop equity metrics in partnership with communities.
Ensure metrics reflect community-identified priorities, not only organizational goals.
Establish clear accountability practices and processes for acting on what the data reveals.
Report findings first to the communities whose data were collected, with transparent information about how data will drive action.
Share progress publicly to build trust and invite broader engagement.
Equip team members with critical skills
Equipping all team members with critical skills related to equity is essential for creating meaningful and sustainable change toward health equity. Such skills enable team members to recognize inequities, interrupt harmful practices, and partner to co-develop more equitable systems.
Building health-equity skills requires giving team members ongoing opportunities to learn about cultural safety, as well as anti-racist, anti-oppressive, and trauma-informed care. Equally important are that staff be given opportunities to unlearn harmful beliefs and practices – this can mean examining assumptions, confronting biases, and questioning approaches previously understood as neutral – and that they be supported to approach the work with humility.
These spaces for learning, unlearning, and growing together build a sense of belonging among the health workforce and strengthen their capacity for equitable care. Equity skill building goals should be incorporated into organizations’ learning and development plans for every role and level. These goals should include clear expectations for how team members apply health-equity skills in daily work, with support structures and accountability mechanisms to enable success.
Create ongoing, tailored learning opportunities that build equity skills.
Offer multiple learning formats – such as group workshops, self-guided modules, and unlearning spaces – to meet the diverse learning needs of team members and promote wider engagement.
Tailor learning goals, delivery formats, and resources to different roles – for example, senior leaders may need to focus on accountability structures and modelling humility, while point-of-care staff may need to address unconscious bias – and ensure all have adequate time and support for learning.
Foster relationships between staff members and community members through collaborative learning. These connections are essential for equity work.
Dedicate time during and after learning activities for individual and collective reflection and sharing.
Foster psychologically safe learning environments where team members can take risks, make mistakes, and grow.
Ground all learning in an intersectional understanding of oppression and equity.
Recognize that people experience multiple, intersecting forms of oppression – such as racism, sexism, and ageism – that create unique experiences of advantage and disadvantage.
Use case examples that reflect intersectional realities, including opportunities to share lived experiences and stories.
Examine how policies and practices may address one form of inequity while perpetuating others, and work toward solutions that advance equity across multiple dimensions.
Embed equity competencies into all organizational learning systems.
Include equity, diversity, inclusion, and anti-oppression competencies in new employee orientation and learning requirements.
Re-visit and deepen these core concepts over time. Sustained engagement signals organizational commitment and supports ongoing skill development.
Include equity skills in performance expectations and evaluations for all staff, making equity as important as clinical, operational, or financial performance.
Build skills in reflection and reflexivity.
Create regular opportunities for individual and team reflection, with a focus on how power shapes interactions and outcomes.
Build reflexivity skills that support in-the-moment awareness of biases, assumptions, and power dynamics.
Provide spaces for teams to process challenging experiences together.
Normalize discomfort and imperfection in learning, creating space for people to acknowledge when they’ve caused harm and engage in repair and growth.
Improve how services are delivered
Many traditional service delivery models in Canada have been designed for people in dominant groups, creating disadvantages and barriers for structurally marginalized populations, thereby perpetuating inequities. These systems operate on a "one-size-fits-all" model that often excludes or underserves people with diverse needs, experiences, and circumstances.
Improving service delivery means designing systems to be accessible, inclusive and responsive to the people and communities being served. This includes examining and changing the timing, staffing, workflows, and accessibility of services. It requires organizations to follow community leadership in designing services and to shift power to community members and people using the services.
Progress requires asking critical questions: Who benefits from current service delivery models? Who is excluded? Who is burdened? How can we reduce disparities in access and outcomes? Answering these questions meaningfully demands accountability mechanisms that ensure community feedback drives actual changes – for example, through regular community reviews of services that are linked to specific improvement initiatives.
Employ community health workers, peer navigators, and cultural liaisons from the communities served.
Recognize and value the expertise held by people with lived and living experience. These qualifications stand alongside professional credentials.
Hire people who have lived and living experience, and cultural knowledge relevant to the people and communities served by the organization.
Create training opportunities and career pathways for community members to enter into health and social care roles.
Ensure these workers are fully integrated into care teams as valued contributors – not as tokenized add-ons – while also offering equitable compensation and meaningful opportunities for professional development.
Protect staff from equity-deserving communities from carrying a disproportionate burden of equity work and ensure improvement initiatives are adequately supported by organizational resources.
Ensure all staff and leaders practice culturally safe, equitable, and trauma-informed care.
Support staff and leaders to develop and apply equity skills in real-time interactions through coaching, mentorship, and supervised practice.
Provide appropriate supervision and non-punitive feedback that helps staff and leaders improve their practice of applying trauma-informed, culturally safe care.
Facilitate regular team debriefs and discussions on challenging situations to support emotional safety, continuous learning, and critical reflection on practice.
Establish clear processes for addressing harm when bias, discrimination, or culturally unsafe care occurs, with accountability for learning and change.
Design services to reduce barriers and meet diverse needs
Offer services at times that work for people and communities, not just during standard business hours.
Provide services in multiple locations – such as community-based settings, mobile clinics, and virtual options – not only in institutional facilities.
Ensure interpretation services are available in the languages spoken by the people and communities served, and provide materials in plain language.
Offer multiple ways to access services – e.g. walk-in, same-day appointment, scheduled visits – to accommodate different needs and circumstances.
Provide navigation support to help people access and coordinate care across a complex system of providers.
Evaluate and redesign service delivery through an equity lens
Conduct equity impact assessments, together with community members, before implementing or changing services, asking: Who benefits? Who is excluded? Who is burdened? What barriers are created? What might cause harm?
Ensure community members have decision-making authority in the design, implementation, and monitoring of service delivery.
Co-develop evaluation processes with people using services, ensuring they define success measures and interpret findings.
Collect demographic data to identify disparities in who accesses services and who experiences better or worse outcomes. Ensure that individuals provide informed consent and that communities have a say in how their data is collected, used, and shared.
Disaggregate data by race, ethnicity, income, geography, language, and other relevant factors to identify which communities experience disparities.
Remove barriers that data and other sources of knowledge reveal, rather than simply documenting barriers without acting on them.
Practice ongoing and responsive accountability
Accountability means taking responsibility for decisions, actions, and their consequences – both individual and collective. It includes acknowledging mistakes, recognizing harm, and taking concrete steps toward repair and learning. When done well, accountability transforms equity commitments into action and builds trust with the people and communities an organization serves.
Accountability to communities also means ensuring they have real authority to hold organizations accountable – through formal governance roles, transparent reporting, and shared responsibility when commitments are not met.
Effective accountability processes are grounded in reciprocal, long-term relationships with people and communities. Building these relationships requires transparent accountability mechanisms founded on humility, honesty about challenges, and sustained commitment and trust. For example, some primary healthcare organizations have established community governance structures that guide program design and resource allocation. These structures help ensure that equity initiatives are properly resourced and implemented.
A strong culture of accountability encourages everyone to take ownership of their actions and learn from setbacks. Without clear processes to hold one another accountable, efforts to advance health equity and make systemic changes risk losing momentum, which erodes trust and creates barriers to care for those who need it most.
Establish community leadership and governance roles with real decision-making authority and influence.
Establish formal co-leadership roles for community members on strategic initiatives, committees, and governance bodies, such as boards of directors.
Ensure these roles have real decision-making authority and do not function solely in an advisory capacity. Community leaders and representatives must have power to approve, reject, or redirect organizational decisions.
Include multiple community members to avoid tokenism and reflect diverse community perspectives.
Provide equitable compensation, along with the support and resources needed for community co-leaders to participate fully.
Create clear pathways for community co-leaders to provide feedback and raise concerns.
Co-develop equity objectives, metrics, and accountability expectations with community partners.
Work with community members and community-based organizations to co-develop initiatives and accountability systems.
Develop objectives and metrics aligned with actions of the HEC Health Equity Framework, tracking both progress and areas for improvement.
Establish accountability agreements that formalize mutual commitments, timelines, and expectations between organizations and community partners.
Integrate equity accountability into performance management and organizational incentives.
Include equity competencies and outcomes in performance expectations and evaluations for all staff and leadership.
Recognize that relationship and trust building with people and communities accessing services is a core competency – e.g. acting with humility, listening to understand.
Evaluate all services and organizational activities through an equity lens, and make equity performance a core measure of success.
Ensure accountability exists at all levels – individual, team, and organizational – with clear responsibilities at each level.
Position equity performance alongside financial, clinical, and operational performance as a core component of evaluation.
Address failures and harms through community-led processes for accountability, repair, and learning.
Facilitate dialogue co-led by community members (such as restorative circles) that brings together those who have caused harm and those who have been harmed to discuss the incident and its impact.
Develop concrete action plans, agreed upon by all participants, to repair harm, rebuild trust, prevent recurrence, and ensure accountability for follow through.
Acknowledge areas for growth and commit to specific changes to prevent future harm. Follow up with affected communities to report on actions taken, assess whether repair has been adequate, and adjust approaches based on their feedback.
Community Engagement: A Foundational Practice of Community Change
See an example of how to develop an accountability agreement, from Tamarack Institute, specifically on pages 7–8 in the following document: accountability matrix guide.
Shift power and create space for communities to lead
Historically, health systems have controlled priority setting, resource allocation, service design, and overall decision making for services. This has often excluded communities most affected by health inequities.
Shifting power means creating space for communities to lead and play an active role in health planning, decision making, priority setting, and service design. This approach prioritizes community ownership of decisions, control over resources, and recognition of community knowledge as expertise. It recognizes that communities have strengths, knowledge, expertise, and the right to self-determination.
For example, some organizations redirect resources – such as funding or infrastructure – so they can be managed, accessed, or distributed by communities in ways that respond to their needs. Such approaches are grounded in long-term efforts to build relationships with communities. The goal is to create the conditions for community leadership to be recognized and embraced within health systems. This is not about organizations “giving” power, but about relinquishing control and removing barriers that have historically excluded communities.
It is critical to understand how organizations block or limit community power through gatekeeping, rigid processes, unequal control of funding and information, or exclusionary decision-making structures. Shifting power requires organizations to change how decisions are made, how resources are controlled, and whose priorities count.
Shifting power is uncomfortable and may be met with resistance, especially when it changes long-standing roles and control over decisions and resources. Building organizational readiness – through clear expectations, training on power-sharing, and accountability to community leadership – is essential for navigating this discomfort.
Build authentic, long-term relationships based on mutual respect and reciprocity.
Invest time in building relationships without predetermined agendas or expectations of what communities should do for the organization.
Meet in spaces that communities identify as comfortable and accessible – e.g. community centres, homes, faith spaces, outdoor spaces.
Listen deeply to community priorities and act on what you hear, rather than simply collecting input.
Partner with trusted community organizations that have established relationships and credibility, rather than competing with or duplicating their work.
Ensure reciprocity by clearly understanding what the organization offers to communities beyond engagement opportunities, such as resources, influence, connections or amplification of community priorities.
Demonstrate trustworthiness through consistent action by following through on commitments, being transparent about constraints, acknowledging mistakes, and engaging in repair when harm occurs.
Sustain relationships over years – not just for specific projects or funding cycles – recognizing that trust and partnership deepen over time.
Share program governance and support the self-determination, autonomy, agency, and empowerment of communities.
Establish community governance structures with real authority and shared decision-making over issues that affect the communities.
Support the specific goals, desires, and initiatives articulated by communities.
Support community members to co-design and co-lead activities, including board and committee participation, grantee decision-making, and presentations at conferences.
Include community members in dialogue to learn about community-held expertise in particular areas of focus.
Recognize the inherent strengths of communities (not the deficits) and the expertise they hold about their needs, priorities, and potential solutions.
Create formal co-leadership roles – not just advisory positions – for community members with decision-making authority.
Support community-based organizations to lead initiatives and programs.
Dismantle barriers to community leadership in governance by removing unnecessary credential requirements, eliminating jargon, simplifying processes, redesigning meeting cultures so they welcome diverse ways of communicating, and providing compensation for community time and expertise.
Identify and remove organizational barriers that limit community power.
Examine policies, procedures, and cultural norms that exclude or marginalize community voices.
Simplify grant applications, reporting requirements, and compliance processes that burden community organizations.
Address power dynamics in meetings and decision-making processes.
Create clear mechanisms for communities to challenge organizational decisions and trigger organizational responses.
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