Measuring the How Along with the What

Equity-centered policy development

Health equity is a way, not just a what

Public health and commercial tobacco prevention practitioners have increasingly centered equity in policy development to ensure that policies to combat commercial tobacco–related harms do not unintentionally perpetuate or exacerbate health disparities. This shift includes efforts to improve evaluation activities to better measure health equity impacts related both to outcomes and to how the policy was developed and implemented.

Three principles underlie ChangeLab Solutions’ equity approaches to commercial tobacco prevention policies:

Partnerships, data, and messaging are all foundational ways that each step of the policy process can center community.

Partnerships are worth the time

Equity-driven policymaking is strengthened when decision makers share power with the people whose lives are most affected by the problem that the policy addresses. Though partnerships take time and resources to build, research increasingly shows the effectiveness of building community power to achieve health equity.

Along with a spectrum of approaches to building community partnerships, the evidence base is growing for hard-to-measure benefits such as improved involvement and agency, social connectedness, governmental and institutional trust, and more.

Data sometimes tell only part of the story

Everyone deserves the chance to live their healthiest life, regardless of who they are — including their race, ethnicity, immigration status, disability status, sexual orientation, gender, gender identity, and other characteristics — yet opportunities to thrive are not fairly distributed in our communities. Many researchers, residents, and policymakers understand health inequities as a fundamental issue of civil rights and justice.

Data can help tell that story. However, data can oversimplify issues and the people experiencing them. Structural and institutional discrimination and violence against people of color — particularly Black Americans and Native Americans — mean that data collection can be perceived as harmful surveillance. Such distrust often stems from knowledge of historical harms perpetrated in the name of data collection. Furthermore, constitutional limitations prevent governments from using some group identifiers for decision making. Many groups are identifying ways to mitigate those risks and limitations — for example, when prioritizing rural, tribal, racial, or other types of equity. The measures discussed in this web tool provide more ideas on evaluating efforts to close persistent data gaps.

How we talk about policy will change how policy works

Research consistently shows how conversations can create change and motivate action. But sometimes messages created to raise awareness about commercial tobacco harms can unintentionally and even unconsciously reinforce biases, leading listeners to shift blame from the industries and systems that are doing the harm to the individuals most harmed by unhealthy products. Other times, messaging might cause people to feel that they can’t change anything because the problem is too hopeless. Still other times, messaging might give people the idea that the problem will just resolve on its own.

Rather than focusing on individual-level behavior change, we can change our framing to orient listeners to community-wide factors and environments that shape the choices available to some people and not others. We can talk about policies that can create community-level change and refocus on the benefits of making healthier environments available to all residents.

Reframing Example: The Economic Case

Sharing data about consumer spending or health care costs might be important, but without context and framing, such data might inadvertently shift the focus to individual choice. That shift risks stigmatizing communities that are disproportionately harmed by commercial tobacco. To avoid contributing to these outdated narratives, describe assets, benefits, and savings rather than costs.

Explore the metrics

We invite you explore our lists of metrics for measuring the community impacts of policy partnership in four areas (below). These lists are intended to spark conversation and consideration among policymakers and community leaders who are developing evaluation provisions and plans.


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