Who Deserves a Healthy Life? How Implicit Deservingness Assessments Impact Efforts to Build a Culture of Health

ARCHES | AmeRicans’ Conceptions of Health Equity Study  is a two-phase research study funded by the Robert Wood Johnson Foundation ($699,960). Phase 1 of ARCHES has involved a systematic qualitative investigation of the ways that people think about what we need to be healthy and flourish, what role society can play in ensuring access to the things people need, how do individual’s views and values shape these perspectives, and how do those view change over time. Key to this is exploring and unpacking the idea of ‘health equity’ and what has shaped individual’s perspectives on fairness, health, and race/ethnicity. We are interested in how life stories and experiences shape views and values and what language people use to describe ideas around “deservingness.”

We use in-depth, semi-structured interviews and ethnographic observations at HIP-Cuyahoga events to explore these ideas and discover what role a health equity initiative, like HIP-Cuyahoga, plays in shaping perspectives. The diverse sample in this qualitative phase allows us to compare individuals exposed to health equity work with individuals who are not, to explore the impact of HIP-Cuyahoga.  We also, innovatively, have interviewed key decision-makers, health practitioners (clinicians and public health professionals), community leaders, and residents of Greater Cleveland from a variety of ideological and demographic backgrounds to explore these ideas around fairness and health.

To date, we have conducted interviews with 1645residents of Northeast Ohio and ethnographic participant observation at a range of HIP-Cuyahoga events. We are currently finishing interviews and transitioning from the Phase 1 to Phase 2 where we will take the insights garnered in the Phase 1 qualitative research to develop, validate and conduct a survey with a national, probabilistic sample of approximately 3,000 American adults. The transition from Phase 1 to 2 (January -May 2019) has involved time-intensive and rigorous analysis of the data in relation to the project’s research questions.