Table 2.

Evaluative criteria for accountability in addressing racism as a public health crisis.

Criteria	Definitions
Actionable	Declarations can propose a theory of change to public health institutions toward achieving a collective vision of racial equity in health. Plans can drive institutional and structural change if they are actionable (42). This requires resources to implement time, money, skills, and effort. It requires local governments' will and expertise to change policies, practices, habits, and cultures (43). For example, declaring a national holiday in recognition of children descended from slaves does little to repair inequity in education. In contrast, eliminating school suspensions and implementing restorative justice practices serves to disrupt the school to prison pipeline (44).
Financially responsible	Cost effectiveness, while a traditional consideration in policy analysis is distinct from financial responsibility (45). Financial responsibility uses an equity lens in particular highlighting Dr. Jones' third equity domain providing resources according to need (4). It considers intangible individual, community, and societal costs and additionally considers how funding is allocated and creates space for equitable funding analysis, tools, and concepts of reparations and debt forgiveness (46). This can include use of race equity budget tool, reparations frameworks, or debt forgiveness.
Addresses structural determinants of equity	A structural determinant of equity (SDoE) approach will frame any interventions, models or programs in focusing on structural or root causes. For example, as defined by Healthy People 2020 and Healthy People 2030, structural determinants of health (SDoH) are “the conditions in the environments where people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning, and quality-of-life outcomes risk” (47). Understanding health disparities requires a holistic perspective where “social determinants are often the root causes of illnesses, disease and disparities” because of racialized, systematic oppressions imposed and perpetuated (48). SDoE challenge the current distribution of SDoH by addressing factors that determine the range of contexts observed in each place and time and the distribution of populations in those contexts (49). SDoE focuses on structural or root causes, recognizing that addressing health disparities requires a holistic perspective; authentic processes in mitigating inequity require addressing the unequal allocation of power and resources (50). This includes disaggregation and stratification of data by race (51).
Participatory	Meaningful engagement of community across all levels of public health practice through culturally grounded and community led processes, programs, and interventions (52) through participatory frameworks allow for analyses of power, profit, control, exploitation, ableism, oppression, violence, and trauma across health systems with a focus on addressing harm and generational healing (53). Participatory processes can serve as an aspect of healing justice if it seeks to address systemic oppression through community/survivor-led responses to support community well-being across ecological levels and ecosystems (54). Participatory engagement and processes includes, but is not limited to, building and maintaining relationships to the land and nature, centering patient autonomy and consent, and foregrounding sustainability as a political practice (the creation of advisory councils, participatory budgeting processes, engagement in the policy process, etc.) (55).