TABLE 1.

Alignment of the LHS core values with health equity

LHS Core Value	LHS Core Value Description	Alignment with Health Equity
Person-focused care	The LHS will protect and improve the health of individuals by informing choices about health and health care. The LHS will do this by enabling strategies that engage individuals, families, groups, communities, and the general population, as well as the United States health care system as a whole.	To ensure person-focused care that includes individuals, families and communities from diverse backgrounds, culturally competent strategies that address SDH, health literacy, and other unique factors may be needed. The role of these factors, especially the role SDH play within a community, should not be underestimated, as interventions effective within one community or patient population may not work in others.
Privacy	The LHS will protect the privacy, confidentiality, and security of all data to enable responsible sharing of data, information, and knowledge, as well as to build trust among all stakeholders.	Data privacy and security is important to populations experiencing health disparities and to build trust among these stakeholders; they should be involved in decisions around privacy and security to the extent possible.
Inclusiveness	Every individual and organization committed to improving the health of individuals, communities, and diverse populations, who abides by the governance of the LHS, is invited and encouraged to participate.	Community and individual participation is critical to eliminating health disparities. In the context of LHS, active participation may necessitate going beyond invitation and encouragement, to overcoming the SDH, which can pose barriers to participation. Receiving buy-in from well-respected community leaders can facilitate the building of trust needed to engage the community.
Transparency	With a commitment to integrity, all aspects of LHS operations will be open and transparent to safeguard and deepen the trust of all stakeholders in the system, as well as to foster accountability.	Due to historical abuses of minorities and vulnerable populations, mistrust of health care and research institutions may require intentional strategies to engage these communities and demonstrate the integrity and transparency embedded in this core value.
Accessibility	All should benefit from the public good derived from the LHS. Therefore, the LHS should be available and should deliver value to all, while encouraging and incentivizing broad and sustained participation.	Accessibility to advancing health equity should be executed in different ways to reach different audiences, understanding that diverse communities have different needs. The SDH and community engagement also play a significant role in operationalizing this value, as accessibility cannot be determined by those providing access, but must be measured by those attempting to access.
Adaptability	The LHS will be designed to enable iterative, rapid adaptation, and incremental evolution to meet current and future needs of stakeholders.	Continuous data collection, including stratification by racial and ethnic subgroups, the SDH, and other disparity variables is the best way to monitor disparities and to adapt strategies to address them. Demographic and social factors should be routinely and systematically integrated into all analytics and decision-making processes.
Governance	The LHS will have that governance, which is necessary to support its sustainable operation, to set required standards, to build and maintain trust on the part of all stakeholders, and to stimulate ongoing innovation.	Governance structures should ensure that sustainability measures and standards are inclusive of the needs of minority and underserved populations and targeted to reduce health disparities. Sustainability will require buy- in from the community, which is achieved through inclusion of the community in governance structures.
Cooperative and participatory leadership	The leadership of the LHS will be a multistakeholder collaboration across the public and private sectors including patients, consumers, caregivers, and families, in addition to other stakeholders. Diverse communities and populations will be represented. Bold leadership and strong user participation are essential keys to unlocking the potential of the LHS.	Intentional inclusion of minority patients, consumers, caregivers, and families is essential to a participatory structure that will reduce health disparities. In addition, ensuring that SDH do not pose a barrier to participation. Examples may include evening and/or weekend meetings so participants do not have to take time off work, compensation and child care, holding meetings in locations convenient to public transportation.
Scientific integrity	The LHS and its participants will share a commitment to the most rigorous application of science to ensure the validity and credibility of findings, and the open sharing and integration of new knowledge in a timely and responsible manner.	The existence of health disparities associated with many different health outcomes is demonstrated by a strong evidence base. However, the science on the elimination of health disparities is less clear, constantly evolving and unique to individual patient populations and communities. Therefore, it is even more critical that LHS prioritize the identification of best practices and to continuously evaluate effectiveness of targeted health disparity interventions.
Value	The LHS will support learning activities that can serve to optimize both the quality and affordability of health care. The LHS will be efficient and seek to minimize financial, logistical, and other burdens associated with participation.	The costs of health disparities are significant, with regard to financial burden on individuals and the health care system, loss of productivity, and early death. LHS that address health inequities will provide value to individuals and the system.