Equity Lens: JACARDI’s 4Cs framework brings structure to advancing equity and diversity in diabetes and cardiovascular health
From the outset, JACARDI committed to embedding equity and diversity across all aspects of its work. This ambition includes the design and implementation of our 143 pilot projects across Europe. To share the knowledge generated and make lessons learned widely accessible, JACARDI is launching the Equity Lens article series. Following an introduction to the concept and the tools created, upcoming pieces will draw on the JACARDI Equity Masterclass series, offering insights from a diverse pool of public health professionals within the consortium. Each contribution highlights practical approaches to tackling inequalities in healthcare to improve health outcomes for all.
From the very beginning, the challenge was clear: in order to reduce health inequities, deeply embedded structures reinforcing inequities must be addressed.
How can equity be systematically integrated into practice and policy?
To find answers, we turned to theory, research, consultation with experts, and the extensive collective expertise within our consortium. Based on these, we identified four simple steps that help us move towards equity and inclusion in practice and policy. To make them easy to remember we call them the 4Cs Framework.
The 4Cs Framework
- Critical reflection
- Context and data
- Co-design
- Communication
Together, the 4Cs prompt us to consider what shapes our ways of thinking, who is visible or invisible in the data, who participates in decision-making, and whose voices remain absent. They also encourage us to think intentionally about what we communicate, how we communicate it, and whom it reaches.
Maturity matrix tool and capacity-development activities support continuous learning
To further embed equity in practice, JACARDI developed an equity and diversity maturity matrix that supports JACARDI’s 143 pilot teams all across Europe in planning, implementation, and progress monitoring. In parallel, we introduced a set of capacity-development activities to deepen understanding of practical ways to promote equity and inclusion across diverse contexts.
We are continuing to learn, but early results are highly encouraging. The methods and tools developed within JACARDI are helping teams across Europe integrate equity more systematically. This work has the potential to influence more inclusive and sustainable health policy and practice across Europe.
A detailed description of the methodology, tools, and capacity-building activities can be found in the following publication in BMJ Global Health:
Skogberg N, Spadea T, Armocida B, Zaletel J, Formenti B, Fullaondo A, et al. 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). BMJ Global Health. 2025;10:e019829. https://doi.org/10.1136/bmjgh-2025-019829
Janne Sørensen: Being aware of one’s own biases is part of a patient-centered approach
The diversity of JACARDI’s experts is a tremendous asset to the project, as it brings many different perspectives to the table, according to Janne Sørensen, diversity expert at the University of Copenhagen in the Department of Public Health. As a member of JACARDI’s Scientific Advisory Board, she shines a light on how vulnerable groups are impacted by diabetes and cardiovascular disease, and how healthcare professionals can better answer their needs. Her message to people working in healthcare is to see the whole person in front of them and to consider implementing equity as a lifelong learning process.
What significance does JACARDI hold for you and your organisation in terms of its mission and values?
As a public health expert, one of the core elements of my work is addressing health inequalities and striving for greater health equity for all. JACARDI’s focus on combating these inequalities, particularly in the context of cardiovascular diseases and diabetes, resonates deeply with both my personal mission and the goals of my organization.
How do you see JACARDI’s role in tackling the increasing prevalence of cardiovascular diseases and diabetes in Europe?
Well, this is a big question and a significant challenge, as diabetes is on the rise. We need to stop its progression and bring the situation under control. JACARDI is a large initiative and, I believe, a serious attempt to address this challenge. You are confronting the problem head-on with innovative approaches. JACARDI positions itself at the heart of the EU’s efforts to tackle this issue. It is an impressive project, and I am very happy to be part of it.
How do you see our role in promoting equity in healthcare?
JACARDI plays a significant role here because it aims to address inequalities. In other words, we see disparities affecting many vulnerable groups who are significantly impacted by these health issues. For example, people with lower socio-economic status, migrants, ethnic minorities, and LGBT groups all have a higher prevalence of diabetes and cardiovascular diseases.
I must say this is an ambitious objective for such a large project, and it might be quite challenging to mainstream diversity, reach everyone, and ensure that everyone adopts principles of equity and diversity.
How do you see the significance of cultural diversity in the development of diabetes and CVD treatment? And what is the most important or critical aspect of this?
This is significant because you are addressing these particularly vulnerable groups. It is therefore crucial to ensure that you consider meeting people with their diverse identities, vulnerabilities, and characteristics in order to effectively tackle the issues of diabetes and cardiovascular disease.
Implementing diversity can be challenging, but you’ve brought it to the forefront. Ideally, the insights gained from this project will inspire experts to incorporate them into their own work and organizations long after it concludes. JACARDI brings together a diverse group of experts, representing a wide range of educational backgrounds, nationalities, ethnicities, and experiences. This diversity is a tremendous asset to the project, as it brings many different perspectives to the table.
You are providing training for healthcare professionals on cultural diversity. Are there questions that professionals often ask?
Some people ask why it is necessary to discuss diversity, especially if they are already working with a patient-centered approach. My answer is always that while you might have a patient-centered approach, it doesn’t necessarily require that you, as a health professional, reflect on your own background, biases, and stereotypes. Understanding these is crucial when interacting with patients.
Additionally, we discuss health inequalities: that many people are worse off in terms of health because they have fewer opportunities from the beginning of their lives, simply because they belong to specific groups and face discrimination within the healthcare system. These differences also exist among various groups, such as people with disabilities or those from the LGBT community, and so on.
What is your message to healthcare professionals then?
My message is that you need to see the whole person in front of you, in addition to knowing the prevalence of diseases and risk factors and being able to diagnose. This is not easy, because as a healthcare professional, you have to consider many things during a short appointment.
I believe we are trying to improve communication and interaction between healthcare professionals and patients by raising awareness of the disadvantages the patient may face, as well as the risk factors. At the same time, it’s important to recognize what professionals bring into the meetings.
This is a lifelong learning process, not something that can be mastered through a short course. Applying these lessons in practice after completing a course is an entirely different challenge.
Janne Sørensen is a specialist in diversity and diversity competence, based at the Department of Public Health at the University of Copenhagen. Her work focuses on integrating diversity competence into medical education through training programs for students and healthcare professionals. Alongside her teaching, Janne conducts research on various aspects of diversity and addresses issues of discrimination within medical student communities.
Learn more about Janne Sørensen and her work and connect on LinkedIn.