Swimming upstream: The challenges and rewards of evaluating efforts to address inequities and reduce health disparities

Racial and ethnic disparities in the health of Americans are widespread and persistent in the United States despite improvements in the health of Americans overall. Increasingly, strategies for reducing disparities have focused on addressing the factors that contribute to – if not fundamentally underlie – health disparities: social, economic, and environmental inequities, which limit access to resources and cause unhealthy exposures. As public health shifts to interventions that seek to improve the circumstances of disproportionately affected populations and achieve equity through policy change, alternative methods to evaluate these efforts are also required. This paper presents an example of such approaches to addressing asthma disparities through Regional Asthma Management and Prevention's (RAMP) programmatic efforts and an evaluation of these activities. The paper describes RAMP's targets and strategies, as well as the specific evaluation methods applied to each, including activity tracking, observations, surveys, key informant interviews, and case studies. Preliminary evaluation findings are presented, as are lessons learned about the efficacy of the evaluation design features – both its strengths and shortcomings. Findings discussed are intended to contribute to the growing literature that provides evidence for the application of emerging approaches to evaluation that reflect non-traditional public health and support others interested in expanding or replicating this work.