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

## TL;DR

This paper describes how equity and diversity principles were integrated into a large European health initiative involving 21 countries and 142 projects.

## Contribution

The novel contribution is a 4Cs conceptual framework and associated tools to operationalize equity and diversity in multinational health programs.

## Key findings

- A conceptual 4Cs framework was developed to guide equity and diversity integration.
- Tools like a terminology glossary and maturity matrix were created and implemented.
- Capacity development supported uptake of these methods across diverse partners.

## Abstract

Reducing 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 programmes and policy development, thereby reducing the need for costly corrective measures. This practice paper outlines the design and first-year experiences of embedding equity and diversity principles in the European Union co-funded Joint Action on Cardiovascular Diseases and Diabetes (JACARDI). JACARDI involves 21 countries, 76 partners and 142 pilot projects, systematically integrating equity, diversity and inclusion across all activities. To support a shared understanding among partners on why equity and diversity are important and what are the key principles to consider during implementation, a conceptual 4Cs framework (critical reflection, context and data, co-design, communication) was developed. The framework was operationalised through a shared terminology glossary, integration of an equity and diversity lens within the JACARDI harmonised XV-step implementation methodology and an equity and diversity maturity matrix to guide and assess implementation. Uptake of these was systematically supported with capacity development. The developed methods and tools are designed to be transferable and scalable, with potential for supporting sustainable and inclusive health policy and practice across diverse contexts.