Using the ECHO Public Health Model to Address Racism and Improve Health Inequities

Last year, a wave of health departments and other public agencies declared racism a public health crisis or emergency. As the American Public Health Association (APHA) notes, “These declarations are an important first step in the movement to advance racial equity and justice and must be followed by allocation of resources and strategic action.” A crisis as complex and harmful as racism must be addressed through all available approaches, including policy and systems change, intentional investments in health and racial equity work, as well as workforce training and education. Many of these strategic actions must first be dealt with internally. Public health organizations and agencies cannot serve their communities equitably without honing internal practices, like equitable strategic planning, data collection and analysis, and policy change.

ECHO Public Health is one training model that the National Coordinating Center for Public Health Training at NNPHI is leveraging to address systemic public health challenges at the community level. The model facilitates a space for expert and peer learning to understand the complex and multifaceted ways that racism operates in public health systems. It also identifies solutions and creates paths to move forward.

Questions ECHO can help address:

  • How do my organization’s systems, processes, and programs perpetuate racism?
  • In what ways does racism influence how we allocate resources or interact with our communities?
  • How does my organization hire, retain, and promote staff who are reflective of the communities we serve?
  • In what ways does my organization think it’s helping where it may be unintentionally harming?

All Teach, All Learn

One cornerstone of the ECHO model is that it intends to create a supportive environment through peer-learning and ongoing mentorship. Training programs that address racism and health inequities require a high level of trust and understanding to foster a safe space for learning and growth. Presentations, stories, and experiences from subject matter experts help participants learn and grow. This aids in mitigating some of the feelings of discomfort and awkwardness that can accompany discussions about racism. The urgency of addressing racism means that public health practitioners must band together to overcome this fear of the unknown. ECHO is one successful model for building a peer learning community to work towards health and racial equity.

The ECHO model also encourages cross-sector learning through various roles in each training session. The presenter is often a subject matter expert who provides the foundational knowledge. They help ground each session in a common understanding, while also drawing on their own experiences and stories. Panelists often come from a different background or work in a different sector than the presenter, helping them contextualize the presentation and provide a unique perspective. Take, for example, a series addressing community engagement in a community health assessment (CHA) process. Panelists might include people working for non-profits, community-based organizers, practitioners from fields such as criminal justice or housing, or even a public health professional who recently led a CHA in their district. Hearing from experts in different fields weaves together the presentation’s concepts and real-life examples to show where racism exists and how it might be addressed.

Ground Learning in Real Experiences

Many health equity and anti-racist trainings in public health focus on teaching definitions and concepts, which is necessary and important to build a strong foundation in this work. The ECHO model takes these basics to the next level by focusing on applying knowledge to real problems and scenarios through a case experience presentation. This component supports participants’ anti-racism journeys in a few important ways:

  • The case experience allows participants to be vulnerable by sharing real challenges they are seeing in their organization. It quickly becomes clear that no one person has all the answers, but problem-solving together can lead to tangible solutions.
  • The case experience helps people realize where racism exists in their own organization. Racism can operate in covert ways, and implicit bias is often present in systems, processes, and policies. It can shine a light on racism in all forms, illuminating solutions through presentation and discussion.

Impact Through Action

The goal of the ECHO model is action: an actual behavior change, and in the case of ECHO Public Health, systems changes. That often begins with one person identifying the problem and seeking solutions to address it. In the ECHO series on racism and health inequities, that action might be learning how to identify racism and call it out in your own organization. It might mean understanding how we can make small changes that can lead to systemic change. Or it could include practicing using language to increase support among leadership to prioritize health equity. Individual people can and must change the systems that perpetuate racism. What makes ECHOs so impactful is that we’re doing it together in agencies across the country.

NNPHI is currently partnering with the Michigan Public Health Institute to deliver an ECHO series on addressing health and racial equity in performance management for members of the Public Health Performance Improvement Network (phPIN) online learning community. For more information on this series or for using the ECHO model to address racism and improve health equity, please reach out at

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