Health Opportunity and Equity (HOPE) Initiative Project

HOPE Initiative Project:



People with less income, education, social mobility, and people of color experience poorer health in the U.S. Research suggests that the same factors that shape these health inequities are the same as those that determine social status, income and the conditions where we live, work and learn. For the past few decades, health experts have been focused on documenting differences in health outcomes, which has been a necessary step in identifying the issue. The time has come, however, for new thinking about the inequity problem.

First, the problem is less about equality than opportunity. The American dream does not promise equal outcomes but rather an equal opportunity to create a good life. Second, the opportunity gap is not just about health. Health is part of a larger set of elements that define wellbeing, which are together affected by opportunities. Lastly, experts have a tendency to concentrate on the inequities in their field (e.g., environment injustice, unfair housing, health inequity) and miss how solutions may be interconnected.

Measuring the opportunity gap is imperative for the nation—to chart progress in how we are performing on opportunity just as we track the Consumer Price Index or other indicators we value—but also for states and communities. The HOPE Initiative project, funded by the Robert Wood Johnson Foundation, has been launched to start a new conversation about the opportunity gap and to develop metrics that can be used to chart progress towards health equity.

Led by National Collaborative for Health Equity (NCHE) and Texas Health Institute (THI), working in collaboration with Virginia Commonwealth University’s Center on Society and Health (CSH), the HOPE Initiative project has two primary goals: (1) reframing the health disparities conversation in the context of health equity and opportunity and, (2) developing a set of broadly accessible measures that illustrate the gaps in opportunities that shape health outcomes.
We aim to expand understanding of the determinants and drivers of health opportunity for a diverse set of stakeholders including policymakers, researchers, advocates, public administrators and communities and provide analyses that spur action on inequities. Our objectives are:

(1) To reframe the national discourse on health equity using an opportunity lens;
(2) To identify the drivers and upstream determinants of health opportunity;
(3) To measure the magnitude of differences in health opportunity; and
(4) To measure the “distance to go” and identify promising solutions for communities to close health opportunity gaps.

Our initial set of products will be a framing document that lays out our theoretical framework on health opportunity, a state level analysis that identifies the magnitude of relative and absolute disparities in health outcomes and opportunity gaps among health equity determinants, and a national level report that depicts opportunity gaps across the country.