Equity Lens: How JACARDI’s local projects incorporate equity and diversity into their work

Ensuring that no one is left behind is one of JACARDI’s key principles. 143 local projects across Europe are working to improve cardiovascular disease and diabetes care, while also putting equity-related principles into practice. JACARDI’s 4Cs framework (Critical reflection, Context and data, Codesign, Inclusive and accessible communication) and the Equity and Diversity Maturity Matrix tool support projects in integrating equity and diversity into their work and developing it further. 

The aim is to ensure that services and products are suitable for diverse needs and population groups. JACARDI’s Maturity Matrix is a tool for assessing understanding of equity and diversity at different stages of project implementation, using three categories: approaching, meeting and exceeding. Pilots are advised to use the tool during the planning of implementation to ensure a more comprehensive consideration of equity, diversity, and inclusivity aspects. Pilots complete the matrix during four phases of implementation during JACARDI, and two rounds have now been completed.

At the end of May, JACARDI’s equity and diversity experts Laura Musta, Natalia Skogberg, Maria Nousiainen organised a workshop for consortium members, where they shared feedback and results on how local projects are addressing equity and diversity, based on responses collected through the Maturity matrix tool.

Promising early results: local projects are developing more equitable workflows, and a clear commitment is evident

The results of the Equity and Diversity Maturity Matrix show that most JACARDI local projects are progressing steadily in integrating equity and diversity principles. Most teams are positioned at the “approaching” or “meeting” levels, with only a few consistently reaching the most advanced “exceeding” level. This outcome was expected and reflects a realistic development path rather than a shortcoming.

Local projects demonstrate commitment to and awareness of equity and diversity principles. However, there is variation in how these principles are implemented in practice.

The progress of the pilots provides clear evidence: in the first round of the Maturity Matrix, the tool was completed during the early stages of the work. According to these early-stage responses, projects had built strong foundations in team setup, capacity, and goal setting, often using internal critical reflection and some stakeholder consultation.

However, stakeholder engagement was usually limited to consultation, with less emphasis on co-design or continuous collaboration, reducing stakeholders’ influence on outcomes. Measuring impact, especially equity outcomes, remained challenging, and equity and diversity were not always central when selecting and implementing best practices.

After the second round of completing the matrix tool, the results show clear improvement, with many projects adapting their work based on feedback and using iterative approaches. Team capacity has strengthened, and good practices, such as co-design, multidisciplinary collaboration, continuous feedback, and inclusive communication, have emerged.

“These results underline that JACARDI pilots are on a positive trajectory, with strong commitment and clear progress over time. Of course there is still work to do. The next step is to move from awareness to consistent, actionable practice ensuring that equity and diversity are fully embedded in how pilots are designed, implemented, and evaluated,” senior planning officer Laura Musta summarises.

User feedback matters

During the second round of completing the maturity matrix, users also responded to a questionnaire assessing how relevant they find the tool.

According to the feedback, local projects consider the tool helpful in strengthening their understanding of equity and diversity, as well as in identifying key areas for action. The tool also functions as a continuous reporting mechanism that aligns closely with final implementation requirements.

At the same time, more work is needed to adapt the tool for use beyond JACARDI. This highlights the need for further simplification and adaptation.

“Overall, the results show that the matrix not only measures progress but also actively supports learning and reflection across the pilots”, chief researcher Natalia Skogberg concludes.

Infobox: Maturity Matrix Tool

• The 4Cs framework, critical reflection, context and data, co-design, and inclusive and accessible communication, guides projects towards more equitable workflows.
• The Equity and Diversity Maturity Matrix is a tool for pilot projects to strengthen inclusiveness and equity. It operationalises the 4Cs principles by providing concrete examples of how an equity and diversity lens can be applied at different levels within JACARDI’s methodology.
• The matrix consists of 41 statements that cover project phases from start to finish.
• The matrix is being completed four times during the project; two rounds have now been completed (in 11/2024-1/2025 and 11/2025-2/2026).

Further reading:

Skogberg et al. (2025) 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). BMJ Global Health.

About the JACARDI Equity Lens Series:

Throughout this series, we share why equity and diversity are not optional add-ons but core components of truly equitable healthcare as well as a shared responsibility for everyone working in the field. To share the knowledge generated within JACARDI, the Equity Lens article series draws on the JACARDI Equity Masterclass series that provides an in-depth look into matters related to equity and diversity for JACARDI pilot teams conducting 143 healthcare interventions across Europe. The article series offers insights shared by a diverse pool of public health professionals within the consortium. By looking through an equity lens, we can build a more inclusive system for everyone. Join us in learning how an equity lens can shape daily practice and drive meaningful change.

Read the frevious articles in the series:

→ JACARDI’s 4Cs framework for advancing equity and diversity
→ Antiracism is integral to reducing health inequalities
→ Reframing NCD surveillance for equity-driven health systems