Purposes of Community-based Research: Addressing disparity, inequality, and inequity
What does it mean when something serves a purpose? It means it is the reason for which something exists, its intended use, and its importance. When something serves a purpose, it can help people get a job done or achieve a goal if used effectively.
Learning about and clearly understanding the purposes of community-based research can shed light on future possibilities of engaging community-based research.
At its core, community-based research serves as a powerful tool for advancing social justice and health equity by actively engaging communities, recognizing diversity, and advocating for systemic change based on the real needs and experiences of those affected.
Here are three high level themes of community-based research purposes. It is important to understand that within each theme are many sub-purposes of which a few will be mentioned. Often, any given community-based research project or study will involve a mixture of these three themes.
- Addressing disparity, inequality, and inequity
- Empowering communities
- Revealing models of practice
This article will cover the first theme of purposes of CBR: Addressing disparity, inequality, and inequity. Themes 2 and 3 will be covered in future Treehouse postings.
Addressing disparity, inequality, and inequity
There are many variations in definitions and perspectives about disparity, inequality, and inequity. It is a complex, nuanced subject and the boundaries of definition can often blur. In this article, the definitions and explanations provided are one more way of addressing the subject and PAN acknowledges that perceptions of what constitutes fairness and justice may vary among different individuals, communities, contexts, and environments.
DISPARITY is lack of similarity, a difference, or gap between groups or individuals. It typically involves differences in health outcomes, access to resources, opportunities, or other indicators between different population groups. Disparities may or may not be related to systemic factors and therefore may or may not be unjust. Disparity simply highlights and quantifies differences in outcomes or experiences.
The people affected by disparity are described by characteristics like race, ethnicity, gender identity, age, socioeconomic status, sexual orientation, abilities, or other relevant identities or affiliations. Disparity occurs for a variety of reasons like personal choice, nature, or system-related factors like in healthcare, education, government, or society in general.
Aspects related to time such as trends, seasonal variations, or changes in policy or social conditions influence disparity, as does spatial or geographic aspects that can include comparisons like urban-rural divide.
Example of disparity about access to healthcare services: In a particular city, there is a significant disparity in access to healthcare services between different neighborhoods. For instance, residents in affluent neighborhoods have easy access to high-quality healthcare facilities with shorter wait times, while those in low-income neighborhoods have limited access to healthcare due to a lack of nearby clinics or hospitals. This disparity highlights the difference in healthcare access based on socioeconomic status.
INEQUALITY is disparity caused by systemic factors that may be justified (fair) or unjustified (unfair) depending on the underlying reasons. Systemic factors are underlying conditions, processes, actions, methods, approaches, attitudes, and policies that shape the ways things function in organizations and social institutions like healthcare, education, business, and government. Examining inequality involves examining mechanisms in the system that causes disparity, the pathways of inter-connected systemic factors that led to disparity.
There are historical and current day contexts like when inequalities emerged, persisted, improved, or changed over time. And inequality has geographic and spatial settings that include organizations and institutions associated with systemic factors.
Essentially, inequality arises when comparing people reveals that some people are underserved because of reasons somewhere in a system. However, the underlying reasons for the inequality don’t necessarily involve biased-thinking, prejudice, or discrimination. But when those things are involved, then inequality becomes a matter of inequity.
Example of inequality about access to healthcare services: Upon closer examination of the example about disparity in access to healthcare services, it becomes evident that the unequal distribution of healthcare resources is rooted in systemic factors. For example, historical underinvestment in low-income neighborhoods has led to a scarcity of healthcare facilities and providers in these areas, perpetuating unequal access to healthcare. This inequality is unjustified and exacerbates health disparities among different socioeconomic groups which now becomes a matter of examining the example as inequity.
INEQUITY is disparity that is unfair or unjust because of systemic factors linked to biased-thinking, prejudice, or discrimination. When people are directly impacted by inequity, it is like they are pushed off to the side, systemically excluded, sometimes even viewed as insignificant. This is also known as marginalization.
In the picture of inequity, we not only look at the people being affected, but also the settings that appear to be perpetuating unjust/unfair conditions through mechanisms and pathways made of inter-connected systemic factors. Power dynamics play a strong role in inequity.
There are historical and current day contexts like when inequities emerged, persisted, improved, or changed over time.
Example of inequity about access to healthcare services: Further analysis of the example about disparity and inequality reveals that inequity exists within the healthcare system due to biased-thinking and discriminatory practices. For instance, even when healthcare services are available in low-income neighborhoods, residents may face discrimination based on race, ethnicity, or language proficiency when seeking care. This discrimination leads to unequal treatment and outcomes for marginalized groups, resulting in inequitable access to healthcare services.
Click the PDF to view/download a summary sheet that takes a deeper dive into understanding the differences between disparity, inequality, and inequity.
Research projects and studies that seek to address disparity, inequality, and inequity can examine things from a perpetuating or mitigating perspective. To perpetuate means to enable or allow the continuation of something into the future, whereas to mitigate means to reduce, make less severe, alleviate, or provide remedy.
When data through research can reveal evidence-based disparity, inequality, or inequity it can be translated into useful knowledge for action. It is about gaining a comprehensive understanding to help strategize efforts for advocacy, policy recommendations, and improved practices in programs and services.
Among many things, the role of community-based research could involve:
- Engaging community members to better understand what disparities exist.
- Learning about the specifics of community environments from a wide scope perspective to determine if there are any systemic factors contributing to barriers in access or negative impacts on health; systemic factors contributing to the disparity.
- Identify and analyze the practices and policies behind the contributing factors to determine whether any biased-thinking, prejudice, or discrimination exists that is causing inequity.
Using a PAN community-based research project as an example
The Making it Work Project wanted to understand whether people living with HIV, hepatitis C, and other related social and health conditions experience better health outcomes when they accessed services that approach care though an Indigenous view of health and wellbeing. Although intended for all people living with those conditions, Indigenous people were a focus for the project.
As context prior to the project, it was well established that the health outcomes of Indigenous people are disproportionately negative impacted because of systemic factors linked to biased-thinking, prejudice, and discrimination. To a degree, the same can be said for people living with HIV, hepatitis C, and other intersecting social and health conditions. And since the project explored whether Indigenous approach to care led to better health outcomes as a mitigating systemic mechanism, the Making it Work Project was addressing inequity.
Based on the project’s results, what organizational level mechanisms were revealed to help alleviate some inequity in health outcomes?
- Meet people where they are at when delivering services
- Link harm reduction with culture
- Value people and provide access to culture
- Provide access to peer-led programs and peer workers
- Link case management with community development programs
Stay tuned for future Treehouse posts about two more Purposes of Community-based Research:
Questions? Feedback? Get in touch!
This post was prepared for PAN’s Research and Evaluation Treehouse by:
Monte Strong, Research Coordinator, [email protected]