Embedding equity and diversity principles in a complex multi-national setting: methods, tools, capacity development and experiences from the first year of the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI)

Effective reduction of social inequities in health requires acknowledgement of the deeply embedded intersectional nature of systemic drivers of these inequities. With increasing population cultural and ethnic diversity, it is essential to embed principles of equity, diversity, and inclusion from the outset of programs and policy development. This is likely to reduce the need for more costly corrective measures. While application of these principles does not necessarily require substantial additional resources, a structured and systematic approach is crucial for initiating a paradigm shift. It also requires deliberate efforts, practical tools, and capacity development to ensure embedding and uptake of these principles. The unprecedently large European Union (EU) co-funded Joint Action on Cardiovascular Diseases and Diabetes (JACARDI) involving 21 countries, 76 partners and 142 pilot projects, cross-cuttingly and systematically embeds equity, diversity, and inclusion principles in all its structures. JACARDI serves as a unique platform for development, introduction, and evaluation of methods and tools for embedding equity, diversity, and inclusivity principles in a complex and multidimensional real-life setting. This practice paper outlines the design and experiences from the first year of the JACARDI project applying the Normalisation Process Theory (NPT) for describing the developed methods, including the 4Cs framework (Critical reflection; Context and data; Co-design; and inclusive and accessible Communications), an equity and diversity maturity matrix, and capacity development. Key success factors and challenges are also discussed. Developed novel methods and tools aim to be transferable and scalable, thus contributing to more effective, sustainable, and inclusive public health policy and practice.