Why It Matters
Addressing inequities in health care requires identifying current strengths and opportunities for improvement.
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Tool: How to Know Where to Go on Health Equity

By IHI Multimedia Team | Thursday, March 12, 2020

How to Know

Photo by Aaron Burden | Unsplash

The Institute for Healthcare Improvement (IHI) developed the Improving Health Equity: Assessment Tool for Health Care Organizations to help health care organizations evaluate their current health equity efforts and determine where to focus improvement efforts. Teams use this assessment to provide direction for building an equity strategy and promote conversations within the organization to improve health equity.

The assessment was developed by working and learning alongside eight US health care systems participating in the two-year Pursuing Equity initiative (2017–2019) to understand key actions to make equity sustainable and impactful. The process of improving health equity is not linear; however, in using this assessment, your organization will be able to identify current achievements and opportunities to take action to further improve equity.


It is important to establish explicit definitions of several terms used in the assessment.

  • Health equity: “Health equity is achieved when every person has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.”
  • Health inequity: Differences in health outcomes that are systematic, avoidable, and unjust.
  • Institutional (or institutionalized) racism: The differential access to the goods, services, and opportunities of a society by race.
  • Multiple determinants of health: The range of personal, social, economic, and environmental factors that influence the health status.

Join the Pursuing Equity Learning and Action Network to guide your health equity efforts


The 2016 IHI White Paper, Achieving Health Equity: A Guide for Health Care Organizations, describes a five-component framework to guide equity improvement efforts (see Figure 1). Our work with the eight Pursuing Equity health systems validated the five components of the framework and added nuance. This assessment tool uses this revised five-component framework and our learnings from working with the eight health systems to enhance the initial assessment tool included in the white paper. This updated assessment tool went through several iterations of feedback from health system end-users and we expect the assessment, as a living document, will continue to evolve and be improved with continued testing and feedback.

Health Equity

Figure 1 IHI Framework for Health Care Organizations to Improve Health Equity

  • Make Health Equity a Strategic Priority
    • Organizational leaders commit to improving health equity by including equity in the organization’s strategy and goals. Equity is viewed as mission critical — that is, the mission, vision, and business cannot thrive without a focus on equity.
  • Build Infrastructure to Support Health Equity
    • Operationalizing a health equity strategy requires dedicated resources, including human resources and data resources, as well as an organizational infrastructure.
  • Address the Multiple Determinants of Health
    • Health care organizations must develop strategies to address the multiple determinants of health, including health care services, organizational policies, the organization’s physical environment, the community’s socioeconomic status, and encouraging healthy behaviors.
  • Eliminate Racism and Other Forms of Oppression
    • Health care organizations must look at their systems, practices, and policies to assess where inequities are produced and where equity can be proactively created.
  • Partner with the Community to Improve Health Equity
    • To support communities to reach their full health potential, health care organizations must work in partnership with community members and community-based organizations that are highly engaged with community members.

To learn more about this topics and how Health Care Organizations can improve health equity, download the full tool for free: Improving Health Equity: Assessment Tool for Health Care Organizations.

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