On HRiA’s Research and Evaluation Team, we begin new projects by asking our clients “When we finish our work together, how will we know if we were successful?” On the surface, this question serves a practical purpose – to establish a shared vision and ensure that we are working toward common goals. Beneath the surface lie more complex questions: What is success? Whose values are reflected in our chosen definitions? Whose are excluded?

In our work, we engage with these questions through the practice of , which prompts us to question our “deeply held beliefs about ‘how things are done,’”[i] and pushes us to think critically about what evaluation in service of equity looks like in practice.[ii]

In this piece, we share our reflections on applying principles of equitable evaluation as the overarching evaluator for the . This initiative aimed to increase vaccine uptake in communities impacted by health inequities rooted in racism and other systems of oppression.

The Vaccine Equity Project (VEP) is a joint effort of the National Network of Public Health Institutes (NNPHI), community-based organizations (CBOs) from across the U.S., and project partners Texas Health Institute (THI), �鶹��� (HRiA), and Spitfire Strategies. Between 2021-2024, the VEP funded eight CBOs to implement projects designed to improve vaccine confidence and increase vaccine access and uptake in communities impacted by health inequities rooted in racism and other systems of oppression. The VEP was administered by NNPHI with funding from a Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services financial assistance award (CDC-RFA-IP21-2113: Immunization Research, Demonstration, Public Information and Education Training and Clinical Skills Improvement Projects).

The lessons we share here are not intended to serve as a how-to guide. Rather, they are an invitation to all involved in evaluation – funders, evaluators, and awardees – to reflect on how these questions come up in your work and what equitable evaluation means to you.

Equity as means: The VEP evaluation

Throughout the VEP, we encountered common challenges to the practice of equitable evaluation – funding requirements, limited timelines, and the prioritization of conventional evaluation approaches. Together with our partners, we worked to balance the imperative to center community voices with the need to satisfy project requirements. Several of our strategies are outlined below.

Engaging local evaluators

In the planning phase, HRiA recommended that community-based organizations (CBOs) partner with a local evaluator to conduct their site-specific project evaluations. This approach centered local knowledge, strengthened local partnerships, and enabled CBOs to ask evaluation questions beyond the scope of HRiA’s overarching evaluation. Upon request, HRiA also provided tailored technical assistance to CBOs and their local evaluators to build capacity for future evaluation work.

Engaging local evaluators has the potential to redistribute concentrated power and create space for multiple ways of knowing, being, and doing. In the context of the VEP, this approach more fully captured the on-the-ground realities and complexities of advancing health equity, ultimately enhancing the validity and rigor of the evaluation.

Expanding definitions of success

There were clear directives from our funders that the number of vaccinations provided, or “shots in arms,” was a key metric of success. Yet, the CBOs knew that this narrow definition of success would not fully capture what it takes to advance vaccine equity in their communities – communities where centuries of ongoing racism, discrimination, and medical abuse and neglect have left many deeply mistrustful of the government and public health systems now promoting COVID-19 vaccination.

In response, we collectively developed additional success metrics that our community partners viewed as central to the initiative – building trust, cultivating partnerships, and strengthening community capacity. These shared metrics became the heart of the evaluation story.

Exploring alternate data sources

Reporting requirements requested that participant race and ethnicity data be disaggregated beyond conventional Census categories – an important strategy for data equity. At the same time, CBOs knew that asking community members for detailed racial and ethnic background information could undermine trust and potentially harm undocumented residents and mixed status families.

To balance these competing priorities, we expanded our thinking beyond conventional individual-level data sources. Because CBOs hosted project events in a wide array of culturally and linguistically specific locations – a Hmong senior center, an Iowa Tribe of Oklahoma health clinic, a Ghanaian church – we were able to report on the more than 42 different racial and ethnic communities served by the VEP.

Equity as ends: A Community Guide to Advance Health Equity

HRiA shared initial evaluation findings with the CBOs, NNPHI, and other project partners at the end of the project’s first year. While we reported on “shots in arms” and related metrics, the most powerful story to emerge was about what it took to get there – the trust built, the partnerships cultivated, the capacity strengthened.

Collectively, we knew that these learnings belonged not to any single person or organization, but to everyone working to advance health equity in their communities. We began exploring ways to preserve and share lessons learned.

Through two project partner workshops, we collectively decided to develop a comprehensive document describing how VEP CBOs advanced health equity in their communities. This became A Community Guide to Advance Health Equity (the Guide).

At over 100 pages, the Guide offers examples, stories, templates, ideas, and reflection questions for CBOs engaged in health equity work. Although the principles and strategies discussed throughout are intertwined, each chapter of Guide stands independently. We encourage readers to seek out the sections and resources that are most relevant to their work.

Looking ahead

Equitable evaluation teaches us that equity is a means and an end – that transforming our practice of evaluation is equally as important as project outcomes when it comes to advancing equity.

This is an invitation to us all to continue applying the principles of equitable evaluation to navigate the boundaries between the world as it exists and the world we want to create.

A Community Guide to Advance Health Equity.

[i] Ausinheiler, J., & Kasper, G. (2015). Challenging the Orthodoxies of Philanthropy. Stanford Social Innovation Review.

[ii] The Equitable Evaluation Framework (EEF) has influenced our practice of equitable evaluation and many of the concepts discussed in this piece. We encourage readers to explore the EEF and consider how it may apply to their own work. 

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In the case of our grantmaking work, we keep our top of mind to help “ensure funding opportunities are accessible and transparent, prioritize resources for approaches that address the root causes of inequities, and shift the landscape of who predominantly receives funding,” says Jennifer Lee, HRiA’s Vice President of Grantmaking. We can all increase our impact by addressing barriers to funding diversification. The approaches below can get you started on the path to embedding equity throughout the preparation, writing, and application phases of the RFP development process.

[We aim to] ensure funding opportunities are accessible and transparent, prioritize resources for approaches that address the root causes of inequities, and shift the landscape of who predominantly receives funding.

Jennifer Lee, VP of Grantmaking

Preparing to write the RFP

Before writing an RFP, take a step back to align stakeholder and funding needs with an eye toward equitable practices and outcomes. Establish a diverse writing team to ensure representation of many perspectives. Key considerations include:

• Previous RFPs. Analyze past RFP processes to uncover strengths and potential opportunities. Spend time discussing where greater attention to equity is needed. Include voices that may have been missing from your prior endeavors. Distill the most salient points to elicit the critical information needed from applicants.
• Timeline. Create reasonable application and programmatic timelines. Accelerated timelines limit the types of organizations and entities that can submit a competitive application and/or complete the scope of work. Early planning helps advance equity and optimize the grantee/awardee match.
• Budget. Align your budget with the needs of potential applicants. Assess market rates for your requested services or deliverables to inform your planned investment. Confirm the scope of your project can be accomplished within the available budget.
• Eligibility. Ask how eligibility criteria can facilitate a more inclusive applicant pool. For instance, potential applicants might not have 501c3 designation and rely on a fiscal agent. If your funding source allows, make sure your RFP is inclusive of broad applicant types.

Writing an equitable RFP

An equitable RFP communicates the information needed by the funder with clarity, conciseness, and consistency. It offers a glimpse into what a partner can expect when working with you and helps build trust between the two parties. As writing continues, be mindful of the following:

• Audience. Will your audience be able to apply with relative ease? Consider the types of organizations you hope to fund. Some may not have the grant writing or administrative capacity to support proposal development, so clarity is of utmost importance. Use headings in your document, keep sentences short, and avoid jargon.
• Proposal requirements. What are the essential requirements for your RFP? Including a lengthy list of must-haves will limit your pool of applicants. Keep requirements to the necessary items that meet your needs to cast the widest net.
• Proposal format. Can you offer flexibility in submission format? Present multiple options for applicants to submit their proposals. For example, the advises applicants to use “a mix of bulleted lists, narrative writing, and visual media” in their proposals.
• Proposal guidelines. Are your instructions clear and straightforward? Include enough specifics around scope of work, budget, and evaluation criteria so that applicants can respond appropriately, but not so much that the requirements become muddled and confusing.
• Program requirements. Have you plainly stated your non-negotiables? Be transparent about required activities so prospective applicants can decide if they can do the work for the funding level you’ve offered.
• Budget details. Who will cover the cost of any required activities? Be explicit about whether required activities should be included in the proposed budget, or if you as the funder will cover them. For instance, if you have specific evaluation or reporting requirements, include that information up front, providing applicants a chance to assess the capacity and resources needed to meet those requirements.
• Triple check information. Do you need to update any key details? Check for inconsistencies, such as dates that don’t match, typos, and misspelled words. Ensure all assumptions and requirements are addressed. If there are last-minute changes to the budget, timeline, forms, etcetera, confirm they are included in the final version of your document.

Facilitating an equitable application process

An equitable RFP goes beyond writing. Generating awareness and facilitating a smooth submission process are essential steps to creating an equitable funding opportunity. Below are three areas within the application experience that should not be overlooked.

• Messaging and dissemination. Determine the channels you will use to help applicants learn about your RFP, including any partners that could amplify your reach. Ensure your promotional messaging is straightforward. Address any anticipated literacy and language needs among your audience.
• Application support. Acknowledge and address barriers to participation. For example, schedule your pre-submission events, such as your bidders’ conference or funding announcement session, at different times to account for people who work atypical hours. Record your sessions and make them available for applicants through your website or portal.
• Submission procedures. Evaluate the proposal submission process for barriers. Create multiple touchpoints for prospective applicants. Offer applicants the opportunity to ask questions and receive answers well before the due date.

Conclusion

Equitable RFPs are easy to understand, transparent, internally consistent, reasonable, and facilitate diversity in applications. However, the RFP is one piece of a larger puzzle. We must apply an equity lens to the entire grantmaking process, including proposal review and scoring, contracting, payment, and reporting. By challenging our assumptions, we can transform the RFP into a vehicle to advance economic, health, and racial equity.

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We believe that it is not only possible but imperative to address emergent needs in the field for an organization to remain relevant and compelling. To do this, philanthropic organizations must creatively shift their investment strategies at pivotal moments. HRiA’s Pivot framework (Figure 1) offers guidance on how to realize these changes while remaining true to the organization’s purpose. Using our work with a long-time client, we illustrate how to implement investment shifting activities.

The Jeffress Trust Pivot

The Thomas F. and Kate Miller Memorial Trust (herein the Trust) has worked with HRiA since 2013. The Trust provides funding to Virginia-based scientists conducting research in bioinformatics, astrophysics, drug development, and material science to benefit residents of Virginia.

Below is a synopsis of how the Pivot framework informed our work with the Trust.

A Final Note

The Trust will soon announce its third cohort of recipients. We invite you to about the work of current awardees and follow their progress.

HRiA seeks to address the root causes of health across all its funding mechanisms. our experienced and trusted team members to learn how we can support you.

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To reverse current trends, we must build broad community capacity in overdose prevention and rescue. These skills are simple to learn and easy to perform—anyone can do them. This is the foundation of HRiA’s You Can initiative.

You Can Save a Life

HRiA recently launched the You Can Save a Life (or You Can) campaign at . Funded by the Substance Abuse and Mental Health Services Administration (through the MA Department of Public Health), the You Can suite of resources is designed to build community-wide capacity to reduce deaths from overdose. Through a series of educational and storytelling videos, You Can focuses on disseminating these key messages and skills:

• Anyone can save a life by knowing the signs of an overdose and how to respond.
• Rescue breathing is a free and critical part of responding to an overdose.

The initiative is complemented by:

• Statewide distribution of fentanyl test strips and You Can branded materials to harm reduction providers by the (a program administered by HRiA),
• Training in overdose rescue and prevention by HRiA’s ,
• Collaboration with , a life-saving overdose detection resource for people who use drugs, and
• Partnership with advocates and organizations across the state.

You Can Week

As with all resources, their effectiveness requires audience awareness.��To spread the word about these powerful tools the You Can team hosted a series of exciting activities to amplify the reach of the campaign during the week of March 4^th:

• Community partners visits. The team visited the community partners who had helped develop the You Can branded materials, such as rescue breathing masks, lighters, pens, wallet cards, and buttons in English and Spanish.
• HRiA staff training. The team facilitated three overdose rescue and harm reduction trainings, where 94 HRiA staff members learned about the You Can resources and how to reverse an overdose.
• Community event. Over 100 people convened at the You Can Save a Life event in Boston on March 6^th, including providers of harm reduction services and people with lived and living experience of substance use. Attendees explored the You Can website, picked up resources and You Can branded items (including fentanyl test strips), and heard from Stephen Murray and Kimber King of the Overdose Prevention Helpline.

  

Key Lessons from You Can

You Can’s lessons are simple and powerful.

You can use more safely. If you or a loved one uses drugs, here’s how to use more safely:

• Always use with someone (if alone, you can call the (now known as Safe Spot) for someone to be on the phone with you while you use).
• Test your supply with fentanyl test strips.
• Go low and slow. Start with a small amount of the drug and increase a little more at a time.

You can rescue breathe. Overdose happens when too many opioids cause breathing to be slowed or stopped. Rescue breathing simply means giving breaths to someone in a state of overdose to keep their brain and body alive.

• Tip the head back, pinch the nose, and give 1 breath into the mouth every 5 seconds.
• Rescue breathing can be done through a rescue breathing mask, an article of clothing, or direct mouth-to-mouth.
• Used alone or with Narcan, rescue breathing can prevent overdose fatality.
• Learn more: .

You can save a life.��If someone overdoses while using drugs, here are the steps to respond:

• Call 9-1-1.
• Give 1 dose of Narcan (if you have it).
• Perform rescue breathing.
• If they don’t wake up after 3 to 5 minutes, give them a 2^nd dose of Narcan.
• Keep rescue breathing until they wake up or help arrives.

Take Action

You Can is a celebration of the power of individual action and community commitment to stopping these preventable deaths.

As a public health organization, HRiA is committed to addressing this public health crisis by:

• Educating our staff on recognizing and responding to overdose,
• Understanding harm reduction and how it applies to our public health work,
• Challenging the harmful narratives that perpetuate drug-related stigma, and
• Helping organizations build capacity to address substance use and harm reduction needs.

We invite our partners to join in our commitment. Below are actions we can all take to build our own capacity to reverse overdose.

• Engage with a resource on the .
• Order rescue breathing masks and other You Can materials on the .
• Get trained on overdose rescue by the .
• .

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“This��gift is an incredible recognition of the collaborative work HRiA does with our community partners and clients to transform practices, policies, and systems to enable individuals to thrive in more equitable and just communities,” said Steven Ridini, HRiA CEO and President. ��“It is our staff’s passion, vision, and tireless commitment – over the decades and today – that set the stage for this tremendous opportunity. Thanks to this gift, HRiA can expand our impact in centering community voices to address health and racial equity.”

We are deeply grateful to MacKenzie Scott and Yield Giving for sharing our vision of healthy people thriving in equitable and just communities.

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Background

Leaders in the neighboring towns of Andover and North Andover, Massachusetts knew youth mental health was a key concern in both communities. Using funds from the American Rescue Plan Act (ARPA), leaders asked HRiA for a joint community health assessment (CHA) and community health implementation plan (CHIP). Youth mental health was on the list of topics to explore.

Approach

After reviewing data and speaking with local leaders, HRiA confirmed the concern about youth mental health. Our approach, centered in our Health Equity Framework, considers the voices not at the table. In this case, our team worked with local leaders to engage young people for whom mental health was a concern. HRiA spoke with youth to hear the issues most impacting their lives and to understand the changes they wanted to see in their communities.

Impact

HRiA heard from young people in two formats—focus groups and key informant interviews. In focus groups, young people shared their experiences with mental and behavioral health. Of this project’s nine focus groups, five included youth or parents of youth. Six of 17 interviewees held experience or expertise in working with youth. These experiences later informed each town’s community health improvement plan.

In place of a lengthy report, the HRiA Team developed one-page infographics for each of the three priority areas identified by youth and adults during the assessment process. The towns shared these digestible findings on their websites. Abby Atkins, Managing Director of Community Health Assessment, commented on this approach: “The infographics highlighted key data and plan elements so the towns can easily communicate the process, priorities, and plans for the future.”

Following the assessment, HRiA and town residents—including youth—collaboratively developed a shared three-year community health improvement plan. They also created a detailed annual action plan to guide efforts in the first year of plan implementation.

Reflections

This collaborative endeavor demonstrates the drivers behind some of our key approaches. Below, we reflect on how this project benefited from amplifying voices, diverse perspectives, and collaboration.

• Amplifying Voices. Youth, school officials, and parents shared their experiences with the pressure to succeed, the impact of the COVID-19 pandemic, and the influence of social media. Based on these findings, members of the planning teams developed objectives to normalize and increase access to mental health support. Hearing directly from those most impacted by the issues helped the towns craft short- and long-term plans to address their most salient community needs.
• Diverse Perspectives. We encourage our HRiA staff and supporting teams to bring their unique identities, geographies, skills, and experiences to all projects. In addition to strategic support, staff on this project brought experiences of working with youth, exploring health inequities, and a focus on mental health. Diversity within the project team improves results by reducing the potential for groupthink and bias.
• Collaboration. We define collaboration as intentionally and respectfully leading, partnering, and following to strengthen relationships, uplift different voices, and build trust. As a partner, we supported the collaboration between the towns of Andover and North Andover through a combination of advisory, assessment, and planning services. We followed each town’s lead as they finalized community stakeholders to engage in the assessment and planning processes.

Rather than providing standardized strategies or predetermined answers, HRiA brings expertise in facilitation, listening, and empathy to ensure we are centering the voices of those most impacted. Our strategies are thoughtfully designed to amplify the voices of those closest to the issues, strengthen relationships, and co-create healthy, equitable communities where all can thrive.

Learn more about the Andover/North Andover CHA-CHIP in .

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The has announced the 2024 recipients of its Awards Program in Research Advancing Health Equity. Congratulations to the awardees!

Scroll to see the 2023 recipients.

2024 Awardees

Partnership/Collaborative Establishment Awards

Advancing Health Equity for Birthing People With Substance Use Disorders: Capacity Building Of A Community Partnership Team For Intervention Development And Implementation Research��

Caitlin Martin, MD, MPH��
Virginia Commonwealth University
in collaboration with Urban Baby Beginnings, Rams in Recovery & OB MOTIVATE Clinic��

Data demonstrates that structural racism is a key driver of large gaps in treatment continuity experienced by Black birthing individuals with substance use disorder in central Virginia. VCU and collaborators will develop and implement a patient navigation model specifically for Black birthing people with SUD. This model will incorporate peer recovery support specialists, doulas, and people with lived experience as Black birthing parents with addiction.����

RVA Latino Youth Coalition: A Community-Academic Partnership to Support The Mental Health Of Latino Youth In Richmond��

Gabriela León-Pérez, PhD
Virginia Commonwealth University
in partnership with Waymakers Foundation, Richmond Public Schools, the City of Richmond’s Office of Immigrant and Refugee Engagement & Virginia Department of Health��

The mental health problems experienced by Latino immigrant youth in Richmond, Virginia are well-documented. To address these inequities, VCU and collaborators will create a community-academic partnership – the RVA Latino Youth Coalition. The project team will establish Youth and Parent Advisory Groups comprising Latino community members to advise the coalition, facilitate a community-informed strategic planning process, and conduct a participatory community assessment to identify the drivers of mental health inequities and existing mental health resources and services available to Latino youth in Richmond.��

Building Enclave Solidarity to Improve Health Outcomes��

Carol Cleaveland, PhD
George Mason University
in collaboration with Gainesville-Haymarket Rotary �鶹���& Georgetown South Community Foundation��

Undocumented Latino immigrants experience pronounced health inequities, often exacerbated by a lack of health insurance. GMU and collaborators will establish a research consortium to improve access to preventative care for undocumented Latino immigrants by strengthening social networks and knowledge-sharing among community members. The team will develop a strategic plan, with the aim to deliver vaccines and preventative health services to 10,000 Latino individuals living in low-income neighborhoods.��

Virginia Healthy Pantry Initiative

Meaghan Butler��
in collaboration with Blue Ridge Area Food Bank, Capital Area Food Bank, Feed More, Inc., Feeding Southwest Virginia, Fredericksburg Regional Food Bank, Foodbank of Southeastern Virginia and the Eastern Shore, Virginia Peninsula Foodbank��

Led by the Federation of Virginia Food Banks, the Virginia Healthy Pantry Initiative (HPI) is a statewide movement of advocates and pantries committed to breaking the cycle of food insecurity and poor health. More than half of Virginia’s 1,100 pantries have already joined the Healthy Pantry Initiative. The Federation seeks funding to better understand the practices’ successes and challenges at scale and ensure equitable access for people and places most in need. Collaborators have committed to regular peer support, data sharing, and consistent evaluation practices with a vision to improve hunger and health outcomes for more than 800,000 Virginians facing hunger.��

Research Award

(Re)Building Trust in Tap Water through Community Advocacy and Action��

Sarah Holland��
in collaboration with Virginia Tech and Virginia Community Health Workers Association��

Mistrust in and subsequent avoidance of tap water has critical implications for health equity. The project will employ iterative cycles of participatory action research in geographically focused communities across Virginia that are most impacted by water inequities. Community health workers serving as water advocates will play an integral role in facilitating the research process, sharing findings back to community members, and (re)building trust in tap water. Acknowledging that water issues and solutions are highly localized, this project lays the groundwork for the development of a statewide network of communities that act, advocate, and engage in local decision-making to advance water security.��

2023 Awardees

Partnership/Collaborative Establishment Awards

Impact of Medical-Legal Partnership (MLP) Collaborative Upon Social Determinants of Health of Low-Income Individuals in Rural Southwest Virginia

Matthew Loos, MD, FACS, MBA
Ballad Health, in partnership with Appalachian School of Law – Virginia Tech – STRONG Accountable Care Community

Despite the establishment of numerous MLPs throughout the U.S., there are few published studies on the impact of MLPs on healthcare and outcomes. This collaborative project establishes an Advisory Council to collectively study and develop MLP best practices for programmatic and coordinated community response. We anticipate the data will illuminate how health-harming legal needs are impacted through MLP intervention with free legal services to address social determinants of health (SDOH).

Centering Black Voices: An Exploration Of Current And Historical Black Breastfeeding Experiences In Their Own Words

Sara Rothenberg, MPH
Eastern Virginia Medical School, in partnership with The Consortium for Infant and Child Health – SonShine and Rainbows Lactation – From the Start Holistic Doula Services – #757Breastfeeds

The project seeks to address and uproot structural racism that underpins maternal and child health inequities by centering Black voices, building community capacity, and decolonizing breastfeeding research.�� Through sustainable, respectful collaboration, this project will lay the groundwork for future research, publication, and more effective public health strategies for advancing maternal child health equity.

Advancing Health Equity through a Regional Coalition for Reducing Opioid and Substance Use

Shuntay Z. Tarver, PhD, MSW
Old Dominion University, in partnership with African American Creative Community Series – James Barry Robinson Institute – Hampton-Newport News Community Services Board

There is a critical need in Virginia to reduce opioid and substance use (O/SU) and overdose related deaths. The project seeks to advance health equity with the development of a culturally-informed, data-driven regional coalition. The desired outcome is to decrease O/SU and overdose-related deaths among Black and low-income families within the cities of Norfolk, Hampton, and Newport News, VA.

Research Awards

Keep People Covered: Analyzing the Medicaid Unwinding and Redetermination Process through a Person-Centered, Racial Equity Lens

Freddy Mejia
The Commonwealth Institute for Fiscal Analysis, in partnership with Sacred Heart Center – Peter Paul Development Center – Virginia Poverty Law Center – Virginia Community Voice

In April 2023, Virginia will begin to review all Medicaid enrollees’ eligibility, a process called “unwinding” and start ending coverage for those found ineligible. The unwinding process will require enrollees to update contact information and submit all required paperwork in a timely fashion. Caught in the middle of this process are approximately 160,000 individuals and families who remain eligible but are most at risk of losing coverage because of administrative hurdles and/or language access issues. The current administration in Virginia has not shared its posture on the Medicaid redetermination process. This is concerning to advocates due to national research from the Department of Health and Human Services. Research estimates children, Black, and Latino individuals are most likely to be disenrolled while still being eligible for coverage.

At the core of this project are three goals:

• First, through research and analysis, act as a watchdog that brings accountability and an equity focused lens on a complex process that may leave individuals and families uninsured on account of technicalities.
• Second, drive education efforts to help as many people as possible weather the “unwinding” storm and preserve their health insurance.
• Third, leverage the research to change systems to improve the current redetermination process in the moment and create better health access programs, processes, and communications in the future.

Using a participatory research approach combined with analysis of data from EnrollVA and state agencies, and advocacy action we can achieve both meaningful research findings and changes in public policies. We plan to create and maintain a real-time dashboard that can inform decisions during the three year period. Additionally, we will disseminate findings with strategic communications and coordinate with our partners including members of the Collective Work coalition focused on racial justice and the Health Equity Action Leaders program.

Uncovering Immune Inflammatory Axes of Racial Disparities Linked with Gestational Weight Gain in Pregnant Women

Sepideh Dolatshahi, PhD
University of Virginia

Obese Black women experience an increased risk of inadequate Gestational Weight Gain (iGWG) compared to White women within the same BMI groups. Importantly, obesity and iGWG are both associated with adverse pregnancy outcomes such as preterm birth, which in turn predispose the newborn to a myriad of early-life health complications. As such, concurrent higher prevalence of iGWG and obesity in non-Hispanic Black women points to distinct profiles of Social Determinants of Health (SDoH) that separately drive these risk factors to birth disparities.

The proposed study aims to dissect these two hypothesized distinct pathways of racial disparities from the root/trunk (SDoH) to the middle branches (perturbed baseline immunity and the immune remodeling) to the outer leaves (adverse clinical outcomes) of the tree. While sparse attempts to stratify the contributors to obesity and iGWG as they relate to pregnancy outcomes have been published, these studies are essentially lacking in the Virginia. Moreover, African Americans have been underrepresented in immunological studies of pregnancy.

To address these limitations, we will use innovative systems biology and data-driven statistical modeling approaches to examine a unique cohort of racially diverse pregnant women of Virginia. By combining SDoH information with high-plex maternal and placental measurements, we anticipate that we will identify novel social and immune axes that may inform the design of preventative, diagnostic, and therapeutic strategies that will improve pregnancy outcomes.

About the Trust

The Thomas F. and Kate Miller Jeffress Memorial Trust, founded in 1981 by Robert M. Jeffress in memory of his parents, is guided by its mission to benefit the people of Virginia and their research in chemical, medical, or other scientific fields. Since its founding, the Jeffress Memorial Trust has been a steadfast benefactor in support of scientists and research across the state of Virginia supporting mathematical modeling/simulations and analytics in bioinformatics, astrophysics, mathematical biology, drug development, and material science. To further the mission of the Jeffress Trust to benefit the people of Virginia, the program was changed in 2022 to the��Jeffress Trust Awards Program in Research Advancing Health Equity.

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Organizations such as the are working to improve the availability and affordability of housing in Massachusetts. In the spring of 2023, we asked Dana LeWinter, the former Director of Municipal Engagement at CHAPA, about the organization’s approach to this important work.

Affiliated with CHAPA for nearly 20 years, Dana’s aim has been to move housing policy forward. After working as a CHAPA intern in 2004, she returned in 2009 to manage the Collaborative for two years. In 2018, she came back to CHAPA to transform local housing policy through an exciting initiative described later in this post. Dana is now the Chief of Public and Community Engagement at Massachusetts Housing Partnership.

The Start of the Citizens’ Housing and Planning Association (CHAPA)

In 1967, a small group of community leaders established CHAPA. Their mission remains the same as it was then—to encourage the production and preservation of affordable housing. CHAPA’s work is guided by the belief that everyone should have safe, healthy, and affordable housing. The defines affordable housing as when “the occupant is paying no more than 30 percent of gross income for housing costs, including utilities.”

And, according to Dana, affordable housing solutions must fit residents’ needs and budget. Healthy housing looks different depending on people’s varying needs. This includes the standard definition of healthy housing——as well as appropriateness for family size, mobility needs, and access to essentials like grocery stores, pharmacies, and public transit.

Addressing the Root Causes of Housing Inaccessibility

One of CHAPA’s approaches to increase affordable housing in the Commonwealth is to reduce racial patterns of segregation in Massachusetts communities. , much of which can be attributed to the historical practice known as redlining seen in Figure 2.

“REDLINING: A discriminatory practice that consists of the systematic denial of services such as mortgages, insurance loans, and other financial services to residents of certain areas, based on their race or ethnicity. Redlining disregards individual’s qualifications and creditworthiness to refuse such services, solely based on the residency of those individuals in minority neighborhoods; which were also quite often deemed ‘hazardous’ or ‘dangerous.’” ()

This harmful practice has left many Black families unable to build generational wealth the same way that white families have, producing and perpetuating a racial homeownership gap.

In addition to redlining, exclusionary zoning practices have also contributed to the Massachusetts housing crisis by preventing new homes from being built and limiting the types of housing that can be built in certain communities. To expand those who can access affordable housing, CHAPA is currently supporting the , which aims to create more housing opportunities for people who have historically been excluded. The 175 communities with stations outside of Metro Boston must zone at least one district “of reasonable size” for multi-family housing near stations. This zoning mandate will not require building new homes but rather and make it easier for more housing to be built. For example, the zoning mandate moves municipal zoning decision-making from groups of people who often don’t represent the broader needs of their community to the residents who will be most impacted by these decisions. .

Dana sees CHAPA’s constellation of approaches as crucial to advancing housing equity. “[T]here’s a tendency, I think, for folks to want to see one thing as the solution,” Dana explained. “Is it rental assistance? Is it zoning changes? Is it state funding or one of these things? But it really does have to be this holistic approach, and that’s the attitude that we try to take at CHAPA, to put all those tools towards our efforts.”

Changing Local Housing Policies through the Municipal Engagement Initiative

Housing infrastructure and policy across the Commonwealth is highly variable. “We have 351 cities and towns here in Massachusetts that all have their own form of government. They have their own zoning and planning boards,” Dana shared. “And if we can’t move forward actions at that local level, we’re never going to meet our real housing needs as a state.” Advocacy efforts throughout the state can benefit from sharing their resources and best practices for driving housing policy change in their communities. CHAPA’s (MEI) serves as a resource for residents throughout Massachusetts. MEI informs Massachusetts residents about housing policy and increases learning across coalitions.

Created six years ago to target local housing policy, MEI is one of CHAPA’s largest programs. The impact of their work can already be seen at the local level. To date, MEI participant communities have (1) passed inclusionary zoning, which requires affordable units to be set aside when new market-rate development is built, (2) created Housing Trust funds, (3) passed housing production plans, and (4) advocated for their town-owned land to be set aside for affordable housing. Not only have these wins happened in individual towns, but Dana believes that MEI has created broader impact by emphasizing the importance of having adequate, diverse housing opportunities in every community.

MEI is funded in part by the Massachusetts Community Health and Healthy Aging (MACHHA) Funds, a collaborative project of the MA Department of Public Health (DPH) and �鶹��� (HRiA). Figure 3 shows Dana and colleague Lily Linke in 2022 at the MACHHA Funds showcase event holding their poster illustrating MEI’s impact.

CHAPA: Fostering Diverse, Sustainable Communities Through Planning and Community Development

MEI is just one of CHAPA’s many programs, all designed to improve housing access. Collectively through their portfolio of programs, they aim to create 200,000 new homes by 2030. Achieving this goal drives progress toward more equitable housing and social outcomes throughout Massachusetts.

Acknowledgments

Many thanks to Reena Dixit, former BU Activist Fellow, for her role in concept development and interview facilitation, as well as Christine Gordon-Davis and Erna Alfred Liousas for their editing support.

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Connection to others is a vital component of recovery and harm reduction. In this post, we explore the concept of connection through the lens of HRiA’s Helpline Champions Program.

The Need: Getting to the First Call

When our Screening and Information Specialists answer a call or message, they lay the foundation for connection; a real, live person responds to every inquiry. They take the time to understand a caller’s needs. The next step is for the specialist to offer referrals to appropriate services. At that time, the caller must take a step toward further connection by reaching out to those service providers. Each of these actions require enormous courage. We are here to help.

Many people who could benefit from helpline services are hesitant to make the initial call. One of the most powerful ways to overcome the many barriers to calling a helpline is with the encouragement and support that comes from a familiar and trusted source. This is where the Helpline Champions come in.

The Approach: The Helpline Champions Program

Helpline Champions are a group of exceptional individuals. They reach out in simple yet powerful ways within their communities to increase use of harm reduction services, substance use treatment, and recovery support services in and . As trusted members of communities often disproportionately impacted by the opioid epidemic, Champions are uniquely positioned to reach people wherever they are. Through efforts like street outreach, youth engagement, and programs for those who are justice-involved, the Champions create human connections, reduce stigma, and promote more equitable access to substance use services.

Beyond community and cultural connections, many of our Champions have lived and living experience of substance use and recovery. Sharing their stories can provide a vital sense of belonging, support, and hope to anyone in need, allowing them to see what is possible. Champions with  lived experience know how to navigate services and supports essential for harm reduction and recovery. This knowledge is a valuable resource to others who may be actively using or seeking treatment, and for their loved ones.

Creating Connection for our Champions

What makes someone a Champion? Many Helpline Champions have been long-time advocates for people using substances or experiencing substance use disorders. The Helplines launched the Champions program to more formally acknowledge these community experts and offer a semi-structured space to connect with other advocates working toward the same goals. Champions meet monthly to share ideas, network, learn, and fill their cups. By connecting with others doing similar work, Champions can avoid duplication of services and learn about work happening in communities outside their own.

Connecting Back to the Helplines

The Champions program informs the efforts of our Helpline outreach teams and helps us improve the information in the referral systems that our Specialists use. This work augments the reach of, and value delivered by the Helpline. Champions ensure that people know the Helpline is available as a resource to connect them to a spectrum of services and supports, from harm reduction services to treatment programs and other recovery resources.

Hear from our Champions

The Helpline Champions are changing the way people and communities view recovery, providing the connection people need to remain safe regardless of where they are on their journey. Hear from a few of our amazing champions:

“The unique role that the Champions play in our communities is the ability to address barriers as well as provide information on a broader scale which allows for solutions. Therefore, closing the gaps ultimately allowing the communities to see the changes, which has increased collaborations.”

–Dr. Karen White (she/her), Addiction Recovery Specialist, T.E.E.C.H (Transforming, Educating, and Empowering Children and Humanity) Foundation, IL Helpline Champion.

Dr. Karen White has seen the effects of drugs firsthand – in her family and community. . &�Բ�����;

“Being a Champion has fueled my interest more in helping individuals with addictions. I am working on becoming a LADC [licensed alcohol and drug counselor] so that people of color can see folks that look like them in treatment facilities when they take that step to start their recovery journey.”

–Aishea Henry (she/her), M.A., C.R.C., Mental Health Counselor, Massachusetts Rehab Commission, Malden, MA Helpline Champion.

“I love being a part of a community that values and respects human dignity and human rights. Harm reduction and overdose prevention strategies are in an uphill battle right now, in terms of people understanding their benefit and necessity – so I love being a part of a community that aligns with my views and is doing something to get it more accessible and mainstream. If I can have any part of that – I am in.”

–Julia Bentley (she/her), MPH, Senior Project Coordinator, MASBIRT TTA, Clinical Addiction Research and Education Unit; MA Helpline Champion

“Being a community advocate and working with individuals and families who are challenged by substances can be emotional, but Champions learn how to cope with those things, protect their mental health, and keep going. We serve a purpose, and the Champion program helps to affirm that and keep us going.”

–Aisha Esquivel (she/her), founder, #breanaland project, IL Helpline Champion.

Aisha lost her eldest daughter to substance use. She’s turning her pain into purpose.

Get Involved

Not every state or community has a Champions program, but anyone can become a Champion in their own community! Champions come from many different backgrounds, each bringing their own unique experiences to the role. These include but are not limited to:

• People actively using substances
• People in recovery – early and long-term
• Providers/referrers
• Young adults
• Concerned and affected family members and friends
• Coalition members
• Recovery coaches
• Peer support specialists
• Retirees
• Faith leaders

If you live or work in IL or MA and would like more information, please visit the or the .

Another way to get involved is to become a Screening & Information Specialist for the Helplines! HRiA is always looking to expand our team of full- and part-time Specialists. for more information.

For more information on our substance use helplines, check out the resources below:

• Blog post: (2022)

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Since 1991, the Smith Family �鶹���has supported 218 scientists with research funding totaling $50.4 million. HRiA has partnered with the �鶹���since the inception of this work, providing expert grantmaking and biomedical research consulting to optimize their investments and impact. In 2021, the Smith Family �鶹���asked us to ideate new methods of researcher support, beyond financial grants. This inquiry led to the launch of a foundational communications training initiative. Through targeted scientific communications training and coaching, this endeavor equipped researchers with skills to convey their scientific ideas in clear and engaging ways. This project resulted in the production of a compelling, professional video for the researchers. The videos feature each researcher using their elevated communication skills to shine further light on the significance of their work.

We are thrilled to present the first cohort of videos featuring the Smith Family Foundation’s early-career biomedical grant recipients. These videos showcase the talent and groundbreaking research undertaken by these exceptional researchers. UPDATE 6/4/24: We added videos from the second cohort.

Excellence Awardees

The mission of the Smith Family Awards Program for Excellence in Biomedical Research is to launch the careers of newly independent biomedical researchers with the goal of achieving medical breakthroughs. Excellence awardees explore fundamental questions about biology using approaches spanning disciplines such as biology, physics, chemistry, computer science, and engineering.

Alleviating antifungal resistance to strengthen agricultural resiliency

Sibongile Mafu, PhD, 2018 Excellence Awardee
Assistant Professor of Biochemistry and Molecular Biology, University of Massachusetts – Amherst

Fungal diseases are a growing threat to plants, animals, and humans in a myriad of ways. Dr. Sibongile Mafu wants to understand how plants adapt to their changing environments and use that knowledge to ensure the sustainability of our food system. “Understanding that enables us to be able to build more resilient plants that are going to be able to adapt to the different climate changes and other challenges we may be facing.”

Investigating the boundaries of biology by observing shapeshifting parasites

Lillian Fritz-Laylin, PhD, 2019 Excellence Awardee
Associate Professor of Biology, University of Massachusetts – Amherst

According to Dr. Lillian Fritz-Laylin, over 99% of organisms in our world are underexplored. She and her lab are evaluating the shapeshifting mechanisms of two specific parasites to find out if existing scientific knowledge applies to these parasites—or if they are governed by a completely different set of rules.  “We get to see something that nobody’s ever seen before. It’s intoxicating.”

Determining the trajectory of COVID-19 pathology via nasal swab

José Ordovás-Montañés, PhD, 2019 Excellence Awardee
Research Faculty, Division of Gastroenterology, Boston Children’s Hospital

Dr. José Ordovás-Montañés and his colleagues did not know that they would be studying SARS-COV-2 when this work began, as it didn’t yet exist. Their work evolved to study the differences in the nasal cells collected through the nasopharyngeal swabs used to diagnose COVID-19 infections, yielding fascinating results.

Using microbes to prevent and treat disease

Babak Momeni, PhD, 2017 Excellence Awardee
Assistant Professor of Microbial Systems Biology, Boston College

Not all microbes are disease-carrying enemies, according to Dr. Babak Momeni. From bench science to mathematical modeling, his lab is exploring microbial interactions and how they might be useful in the prevention and treatment of antibiotic resistant illnesses.

Investigating the intricacies of cancer cell division

Amity L. Manning, PhD, 2017 Excellence Awardee
Associate Professor, Department of Biology and Biotechnology, Worcester Polytechnic Institute

“There’s still so much we don’t understand about how cells divide,” says Dr. Amity Manning. She and her colleagues are working to understand the details of cell division as well as how this process goes awry. Their findings could inform the development of powerful cancer therapies.

Understanding the human brain through the neural patterns of fruit flies

James Jeanne, PhD, 2019 Excellence Awardee
Assistant Professor of Neuroscience, Yale University

Dr. James Jeanne believes that the future is bright for people who have lost brain function. His lab is striving to break the “neural code,” making it possible to interface with the brain. And they’re doing it by examining the neural networks of fruit flies.

Transforming treatment for drug-resistant cancer

Bryan Q. Spring, PhD, 2017 Excellence Awardee
Professor of Biomedical Physics, Northeastern University

Professor Spring’s calm approach impacts both the energy in his interdisciplinary lab and his vision for the future of oncology.

Addressing allergic disease at the cellular level

Gowthaman Uthaman, PhD, 2021 Excellence Awardee
Assistant Professor of Pathology, UMass Chan Medical School

Could the future be one without severe allergic disease? Gowthaman Uthaman thinks so. “Our lab has discovered a cell type that is present in those severe allergic individuals that is not present in the general population,” explains Dr. Uthaman. He and his colleagues were then able to remove those cells in mouse models. Their findings could lead to better treatment and prevention of allergic disease.

Unearthing the secrets of DNA

Seychelle Vos, PhD, 2021 Excellence Awardee
Assistant Professor of Biology, Massachusetts Institute of Technology
Howard Hughes Medical Institute Freeman Hrabowki Scholar

How do all our cells use the same DNA sequence and yet end up so varied? Seychelle Vos and her colleagues are investigating this fundamental question of biology. They hypothesize that understanding how DNA works can lead to the development of targeted therapeutics for developmental disorders and cancers. “There’s so much that we don’t understand,” says Dr. Vos, “and every time we gain a little bit more knowledge, we just realize there’s a lot more out there that we have to learn.”

Investigating cellular aging in people with Type II Diabetes

Cristina Aguayo-Mazzucato, MD, PhD, 2021 Excellence Awardee
Assistant Professor of Medicine, Harvard Medical School
Assistant Investigator, Joslin Diabetes Center

Researchers in the lab of Cristina Aguayo-Mazzucato have demonstrated that people with type 2 diabetes experience an accelerated rate of cellular aging. However, according to Dr. Aguayo-Mazzucato, “exercise is a very effective way to render cells to function with a younger profile.” Her lab seeks to understand the accelerated aging process of people with type 2 diabetes. Eventually, these findings may translate to clinical applications that can slow or reverse the aging process.

The science of sight

Liang Liang, PhD, 2021 Excellence Awardee
Assistant Professor Neuroscience, Yale University

After seeing an optical illusion in high school, Dr. Liang Liang became curious about how the brain processes visual information. “[It] takes multiple stages of visual processing in the brain to gradually combine…simple features into something more complex and meaningful.” Her lab aims to understand visual computation to support the development of treatments for conditions like blindness.

Odyssey Awardees

The Smith Family �鶹���Odyssey Award was created in 2017 to fuel creativity and innovation in junior investigators in the early-stage research. The Award supports the pursuit of high impact ideas to generate breakthroughs and drive new directions in biomedical research. Odyssey awards fund high-risk, high-reward pilot projects solicited from junior faculty in the Greater Boston area.

Investigating how mechanical forces regulate the function of proteins

Wesley P. Wong, PhD, 2019 Odyssey Awardee
Associate Professor, Harvard Medical School

“My lab develops ways to look at, visualize, and manipulate molecules in order to understand how they work and how they fail with disease,” says Dr. Wesley Wong. Their findings may lead to new treatments for a variety of diseases, including cancer and diabetes.

Examining how the brain-gut connection relates to digestive disorders

Meenakshi Rao, MD, PhD, 2020 Odyssey Awardee
Boston Children’s Hospital

The digestive system has its very own branch of the nervous system. Dr. Meenakshi Rao’s lab aims to expand our understanding of how it works to inform the diagnosis and treatment of digestive disorders. “My hope is that we can build on some of these observations we’re making in the lab and apply them to advancing human health in very tangible ways.”

Exploring how nature optimizes cellular function

Gene-Wei Li, PhD, 2016 Excellence Awardee and 2020 Odyssey Awardee
Associate Professor of Biology, Massachusetts Institute of Technology

“Oftentimes, what makes a cell have a disease is the amount of proteins that are dysregulated,” says Dr. Gene-Wei Li. This is why he and his lab are working to glean information from genomic data to better understand protein production and cellular function.

The science of limb regeneration

Jessica Whited, PhD, 2013 Excellence Awardee and 2019 Odyssey Awardee
Assistant Professor of Stem Cell and Regenerative Biology, Harvard University

Over 2 million Americans have undergone limb loss. Nonetheless, prosthetic technology is still too limiting for Dr. Whited’s taste. Her lab’s study of salamanders could lead to the ultimate innovation—full limb regeneration.

Examining the cellular pathways by which zebrafish regenerate after injury

Jenna Galloway, PhD, 2021 Odyssey Awardee
Associate Professor of Biology, Massachusetts General Hospital

Why can a zebrafish, an organism with surprising similarities to humans, regenerate to their original form and function after injury, but a human cannot? Jenna Galloway and her colleagues aim to learn how. By identifying the differences in cell types and active pathways between zebrafish and mammals, the Galloway lab’s findings could lead to breakthroughs in orthopedic medicine.

Alleviating the impact of chronic parasitic infections

Sebastian Lourido, PhD, 2021 Odyssey Awardee
Associate Professor Biology, Whitehead Institute

In Sebastian Lourido’s native Colombia, infectious disease continues to be a major public health burden and barrier to development. By studying the parasite Toxoplasma gondii, Dr. Lourido and his colleagues have identified the process by which a parasitic infection transitions from acute to chronic. The Lourido lab is working to reverse the infection back to the treatable acute state “not only to impact global health, but to understand new fundamental aspects of biology.”

Researching the rise of allergic and autoimmune disease

Andrew Wang, MD/PhD, AB, 2021 Odyssey Awardee
Associate Professor of Internal Medicine (Rheumatology, Allergy, and Immunology), Yale University

So many more people experience allergic and autoimmune disease today than in the past, and Andrew Wang and his colleagues want to find out why. The Wang lab is exploring the immune system response to changes in our environment, including sleep, food, and stress. “When we published our acute stress story,” Dr. Wang explains, “a lot of patients felt very validated that what they were experiencing, [that] there was some explanation for it.” The results of this research are likely to introduce new therapeutic possibilities.

The neuroscience of nurture in mammalian development

Marcelo Dietrich, PhD, 2021 Odyssey Awardee
Associate Professor of Comparative Medicine, Yale University

What role does nurture play in early mammalian development? Marcelo Dietrich is investigating the brain mechanisms that connect an infant and their caretaker. “Understanding early life,” says Dr. Dietrich, “can help us understand our own health and the long-term impact that early childhood has on human health.”

Taking control of infectious disease transmission

Lydia Bourouiba, PhD, 2018 Odyssey Awardee
Associate Professor, The Fluid Dynamics of Disease Transmission Laboratory, Fluids and Health Network, Massachusetts Institute of Technology

Existing mental models of how pathogens move from host to host while remaining virulent are outdated, according to Lydia Bourouiba. Using an interdisciplinary approach, she and her colleagues seek to shift the paradigm of understanding of the spread of infectious disease. The ultimate goal of their research is to “stop the transmission of infectious diseases and develop tools to tackle the path of transmission from one host to the other.”

The and the Smith Family �鶹���Odyssey Awards continue to launch careers and fuel creativity and innovation in early-career researchers. We are proud to showcase this innovative capacity building project and look forward to following the exciting research careers of these inspiring grantees.

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