How California health departments are advancing health equity: Lessons learned on community, collaboration, and communication

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It wasn't that long ago when health departments began to ramp up their message that racial and health inequities exist and must be addressed. Too many people, they pointed out, were living shorter, sicker lives, and by increasing access to good jobs and housing, safe places to play and work, quality schools, and affordable transit options, these inequities could be prevented. But even as this rallying cry got louder, there were very few examples of what it looks like for a health department to rethink its public health practice and develop solutions that move us toward health equity.

That's why The California Endowment, with help from leaders in the field, created the Advancing Health Equity Awards — a ceremony and set of grants aimed at accelerating progress, lifting up examples of promising initiatives to advance health equity, and inspiring more health departments to take on this challenging but critical work. And while there is much more to be done, new case studies of recent awardees' work show us just how far we've come, as they highlight concrete solutions, community power-building, passionate people, and real change that matters for health.

It's no surprise that strong partnerships with community organizations, coalitions, and residents are essential for local health departments working toward racial and health equity. And these case studies illustrate just how important community partnerships are in every aspect of this work, including building health department capacity, understanding the root of the problem, developing equity-focused solutions, building the political will to move forward, and — the area we spend most of our time on at BMSG — communicating effectively every step of the way. This blog highlights one angle that shines through each of the newly released case studies: Strong communication starts with community collaboration and partnerships.

Here's a look at some of the lessons we can learn from the health department awardees in Monterey, Napa, and San Mateo counties:

1. Effective communication is inclusive

While health departments are working to get information out to residents and partners about their commitment to tackling social issues that impact health equity, they are also developing deeper relationships with community members and building infrastructure so that communication can flow the other way, and residents can consistently inform the work of health departments.

For example, in San Mateo County, the Health System's Health, Policy and Planning team held workshops and focus groups and conducted surveys to learn what community members' top health concerns were and prioritize their work accordingly. San Mateo also conducted interviews to make sure low-income residents, communities of color, and hard-to-reach populations were included in their feedback-gathering process. Similarly, as Monterey County Health Department pursued their community health assessment as part of the accreditation process, they engaged residents in community dialogues to determine how best to meet the region's health needs. Through those conversations, they realized they needed to shift their perspective — and work — to focus on systemic and structural causes of poor health, rather than primarily looking at services and individual lifestyle changes. They have also engaged a variety of traditional and nontraditional partners, such as other city and county agencies, affordable housing developers, and community-based organizations, to ensure that the whole community understands how their work relates to health. This has allowed the health department to bring a health equity focus to decision-making in areas like land use, which are not typically thought of as health issues, even though they have major implications for health.

And, in Napa County, public health leaders changed their approach to data as a first step toward transforming their public health practice and communication to focus on equity. In addition to gathering traditional data from public health sources, they began to conduct outreach to residents and collect qualitative data that tell the story behind the numbers. They used town halls, community surveys, large summits, and more to learn from residents and other stakeholders how one of the area's main issues – housing – impacts health. This allowed them to understand not only which health inequities were present, but also why they were occurring, and to create community community-supported and, in some cases, community-led solutions.

2. Powerful communication is tied to community power-building

Inclusive communication is also a critical step toward creating a transformative public health practice in which health departments and community residents and organizations and working side-by-side to achieve health equity. Monterey, Napa, and San Mateo are all investing in building community power, which, in turn, sets the foundation for powerful communication. In Monterey, a key goal is creating more transparent, open, and democratic governance processes so residents can more easily have a say in the decisions that affect their lives. For example, a health department-supported program called enLACE helps residents gain a voice in local decision-making and become powerful advocates. Participants attend council meetings, take part in advocacy days at the State Capitol, and get to know their elected officials so that when concerns come up, they are comfortable picking up the phone and advocating on behalf of their community.

In Napa County, the Public Health Division of the Health and Human Services Agency (HHSA) is supporting two community-led taskforces, one of which is focused on putting a human face on data through community stories and coordinated messaging. Additionally, a range of local programs and resource centers, which are operated by the health department's partner On the Move, are helping to increase parent and caregivers' engagement in their children's schools and the surrounding community. As a result, parents and caregivers are using their voices to build and support the government's capacity to be responsive and fill community needs; they are sharing stories about how helpful parent engagement programs have been for them, as budget cuts put these services at risk.

In San Mateo, the health department funded the Youth Leadership Institute (YLI) to engage young people in the county, especially from underserved areas. YLI involves youth in community-based participatory research and helps them become advocates who build their power by sharing their stories and engaging in the civic process. They conduct surveys, sit on commissions, and are a critical part of current and future health equity work for the county. The health department also tracks vacancies on boards and commissions with an eye toward recruiting for those seats from within diverse communities. All of these efforts to build community power lead to more strategic communication tactics and more powerful messages about racial and health equity.

3. Building a strong foundation in racial justice and intersectional approaches creates stronger communication

A growing number of health departments are involved in initiatives to focus on racial equity as foundational and critical to achieving health equity. There is more work to be done, but this investment in building a movement for racial and health equity, including a focus on intersecting forces that create and perpetuate inequities, is evident in how health departments are building their partnerships and communicating about their work.

Many health departments in California and across the country are part of the Government Alliance on Race & Equity (GARE) and are working to "achieve racial equity and advance opportunities for all." Monterey County describes how their Board of Supervisors is supporting a group of county employees to participate in GARE and seek ways to truly govern for racial and health equity. Since 2012, they've trained more than 2,000 county staff and residents on using a Health in All Policies approach, with a focus on institutional racism and implicit bias. San Mateo County Health System is partnering with their County Office of Education to address the racial gap in educational opportunities and achievement. And Napa County knows that Latino residents face increased barriers to housing security and have focused on training partners to host bilingual focus groups and town halls to ensure that their qualitative data are representative.

This work is challenging, but by building a focus on racial equity into the foundation of the work, when it comes time to communicate about it, there is already some shared language and a common framework guiding the work. For example, by ensuring that the data on the problem reflect a diversity of voices and lift up the stories that are usually left out, the solutions and the messages about them will be more likely to include an explicit focus on racial equity as a cornerstone in the movement for health equity.

4. Language and location matter

To build a strong communication infrastructure with concerns, ideas, supports, and solutions flowing in multiple directions, each awardee paid close attention to language and location. In terms of location, Monterey's enLACE program focuses on meeting residents where they are because they recognize that social determinants of health, like transportation, impact residents' ability to participate. San Mateo County created a five-part video series on the four community-identified priorities, like housing, jobs, and education, and focused on using clear, jargon-free language. And, as described, Napa County has worked to ensure their approaches to collecting qualitative data are bilingual and highlight residents' own words about the causes of health inequities.

Building the health equity movement

In these ways, effective communication is not just about information flowing to and from health departments and community members or partners. It's also about building strong partnerships to build community power, collectively develop policy and community goals, transform narratives, and develop strong communications plans where each partner plays a key role in the path towards racial and health equity. 

These are just a few of the lessons that the health departments in Monterey, San Mateo and Napa counties have learned in their efforts to better support health for all members of their communities. Each awardee entered into health equity work in a different way, and their approaches reflect their local contexts. But what cuts across all three health departments is the fundamental need to center communities, especially those most deeply impacted by health inequities, and build strong partnerships that help build community power. At BMSG, we often say you can't have a media strategy without having an overall strategy, or knowing what you want to achieve. From the hard work of these health departments, it's clear that you can't have an overall strategy that really gets to health equity without having strong community partnerships. This sets the foundation for effective and powerful communication that will keep us advancing toward racial and health equity.

Want to learn more?

These case studies are part of a series developed by Berkeley Media Studies Group (BMSG) and supported by The California Endowment (TCE) that highlights the innovative work local health departments in California are doing to advance racial and health equity. BMSG would like to thank the health department staff and partners who contributed to the case studies, as well as the reviewers.

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