News & Analysis

Moving Beyond SWOT in Health Equity

Headshot of Brian Ackerman, partner at Ascendient

Brian Ackerman

A white swan is reflected on the still surface of a lake

If any part of the US healthcare system ought to be leading the way on health equity, surely it would be local health departments (LHDs). Thanks to their public funding and focus on population health, LHDs are perfectly positioned to take the lead in promoting more equitable health outcomes for everyone in their community.

At Ascendient, we’re seeing real proof that that’s happening. While more and more nonprofit hospitals and health systems are emphasizing health equity as part of their strategic planning process, LHDs are taking that a step further by engaging us for standalone health equity assessments.

Strategic planning is in our DNA, but we’ve noticed something interesting in these latest engagements: The traditional tools of healthcare strategic planning aren’t always a great fit for “pure” health equity assessments.

Take the SWOT analysis, for instance. Anyone who sat through Business 101 knows that SWOT stands for Strengths, Weaknesses, Opportunities, and Threats. The idea is that you map your Strengths and Weaknesses as an organization against the Opportunities and Threats in your environment in order to devise a strategy to survive and thrive in a competitive market.

But the health equity assessment isn’t focused on competition, so you’re less concerned with external, competitive Opportunities and Threats. When the goal is reducing health disparities, your only real competition is the status quo – and that means you need a different lens for understanding your environment.


Instead of Opportunities and Threats, we work with LHDs to identify the Assets and Needs that are unique to their community. For instance, maybe you have consistent support from county commissioners, an active interfaith network, robust school clinics, and strong mobile health services. All of those are valuable Assets for reducing health disparities.

On the flip side, maybe your community has intractable food deserts, a dwindling supply of affordable housing, and growing demand for mental health services. Identifying and addressing those Needs could go far in reducing inequities.

Similar to SWOT, the SWAN analysis allows you to plot both internal and external factors that are either helpful or harmful to advancing health equity. Your scatterplot should give you a good idea of where you stand and where you might prioritize to see the greatest change.

Why SWANs Get Stuck

Speaking of change, one thing I like about the SWAN acronym is that it suggests movement. The whole point of a SWAN is that it shows you where you are and points the direction that you’d like to go. But getting from Point A to Point B won’t be a graceful, effortless glide. You’re bound to encounter barriers along the way, and it’s worth accounting for those in your health equity assessment in order to avoid surprises or discouragement.

Barriers can be physical, observable phenomena such as unreliable public transportation or a widely scattered, rural population. Geographic and demographic barriers are very common in most communities, and you’ll need to recognize them in your health equity assessment.

But attitudinal barriers are just as real, even if they’re harder to observe or quantify. Cultural norms, lack of awareness, and resistance to change can be huge impediments for any LHD trying to reduce health disparities.

At Ascendient, our health equity assessment process always includes a thorough discussion of barriers – both visible and invisible – along with concrete strategies and tactics for addressing the most important issues. For instance, in a community where awareness of health equity is low, we might recommend a marketing and PR strategy that includes a series of public forums, regular stories in local media, and even volunteer initiatives to get LHD leadership on key boards and commissions.

Want to know more about SWAN analysis and how to use it in a health equity assessment? Contact us for a free discussion with one of our Public Health experts.