Making the connection between health equity and sustainability

Area of Science:

• Public Health
• Implementation Science
• Health Equity

Background:

• Sustainability of evidence-based interventions (EBIs) is a major public health challenge, with only about half being sustained.
• Settings and populations facing systemic barriers (e.g., poverty, racism) encounter greater sustainability challenges.
• Health inequities persist, disproportionately affecting under-resourced communities' access to and benefit from EBIs.

Purpose of the Study:

• To argue for an enhanced focus on sustainability in implementation science to maximize long-term health benefits and societal impacts of EBIs.
• To highlight the critical role of a health equity framing in sustaining EBIs, particularly for historically underserved populations.
• To shift from a deficit-based approach to an asset-based approach for fostering EBI sustainability.

Main Methods:

• Conceptual analysis and argument development.
• Review of implementation science literature through a health equity lens.
• Discussion of asset-based community development principles applied to EBI sustainability.

Main Results:

• An enhanced focus on sustainability within implementation science is crucial for equitable health outcomes.
• A health equity framing necessitates identifying and nurturing community assets to support EBI sustainability.
• Moving beyond deficit mindsets is essential for successful long-term EBI implementation in diverse settings.

Conclusions:

• Prioritizing sustainability from a health equity perspective is vital for maximizing the impact of EBIs.
• Recommendations include early planning for sustainability with partners, equitable progress tracking, and continuous focus on equity and engagement.
• Future directions involve developing and utilizing frameworks and tools that support equitable sustainability practices.