Located in the southern San Francisco Bay Area, Santa Clara is home to many start-up and global technology companies and is one of the wealthiest counties in California. While Santa Clara’s 15 cities appear to be healthy and wealthy, many communities experience significant disadvantage.
In 2014, the Santa Clara County Public Health Department (SCCPHD) began revising their strategic plan, in part as a requirement for public health accreditation. At that time, the Department had a longstanding commitment to health equity and a strong reputation for Community Health Assessments that link the social determinants and poor health across subpopulations, including people of African/African ancestry, Latinx, Vietnamese, children, and LGTBQ communities. Yet SCCPHD grappled with how to better operationalize their health equity work, and whether they should lead with race by explicitly naming the communities most impacted by racial inequities.
An SCCPHD team with deep commitment to social and racial justice, quality improvement, and strong qualitative and quantitative methods facilitated the strategic planning process to develop a set of priorities. After leadership approved the priorities, workgroups defined goals and objectives for each priority, and the strategic plan was finalized in late 2015.
The strategic plan included a new Department priority — “Advancing racial and health equity to eliminate health disparities” — which would be accomplished by the following goals:
- Prevent violence and its negative health impacts
- Strengthen Department programs, services, and policies to address racial and health equity
- Build county capacity and community awareness to mitigate and address climate change health effects
Over the summer and fall of 2015, SCCPHD underwent a reorganization to support the new strategic plan. The County Health Officer became the new Director of Public Health, and leadership established a new Office of the Director where racial and health equity work was housed. Critical to establishing the infrastructure to support the racial and health equity work was the request and allocation of resources to hire a Senior Health Program Manager by the County Board of Supervisors.
In 2017, the County Board of Supervisors also approved funding for 3 additional racial and health equity staff to implement recommendations from the 2016 Children’s Health Assessment. These recommendations focused on addressing the structural and institutional racism, discrimination, harassment, and biases across systems that contribute to inequitable outcomes for children and families.
Leadership participates in Government Alliance on Race and Equity
SCCPHD applied to participate in a year-long training cohort sponsored by the Government Alliance on Race and Equity (GARE) in order to strengthen and advance their racial and health equity work. The SCCPHD GARE team was comprised of the Health Officer/Public Health Director, Deputy Director, Executive Director, 3 mid-level managers, staff from 3 SCCPHD departments, and a representative from the county-level Office of Cultural Competency. The first cohort began its GARE journey in January 2016 and “they haven’t looked back since.” SCCPHD also signed up to participate in the second GARE 2017 cohort, inviting staff from the Offices of Social Services, Behavioral Health, Probation, and Cultural Competency to join the team.
Department staff participate in racial and health equity committee and workgroups
SCCPHD developed a cross-department racial and health equity steering committee to expand understanding of and application of principles and practices to achieve racial and health equity. The committee ensures that training, communication, and other necessary resources are available to employees to establish a uniform understanding of and commitment to equity. The committee is comprised of 25 SCCPHD staff including nurses, a workforce development coordinator, a communication specialist, community health workers, program managers, a nutritionist, an epidemiologist, deputy health officers, and 3 executive directors.
There are multiple staff engagement opportunities in which leadership actively encourage staff to participate. As described below, a training workgroup developed a racial and health equity training plan and curriculum to provide introductory training to all public health employees. And SCCPHD is in the process of convening a workforce equity team to create a workplace culture where racial equity is valued and operationalized. They will conduct an analysis of racial representation across the Department’s workforce, with the goal of establishing a pipeline program to diversify the workforce.
Operationalizing racial and health equity workplan
As a result of SCCPHD participation in GARE, the Department completed an organizational assessment that informed the development of a robust racial and health equity workplan. It outlined strategies to normalize conversations about race, organize the Department to achieve racial equity, and operationalize new policies, programs, and budgetary decisions using a racial equity lens.
The department adapted GARE’s Racial Equity Toolkit into a Budget Equity Assessment Tool and then piloted this tool for the FY 2018 budget process. Its application provided important information to prioritize Department budget proposals. The Department is also exploring the use of racial equity tools in program and policy development, and including health equity in their quality improvement work to support public health accreditation.
Developing all staff trainings on equity
One of SCCPHD’s first tasks was to develop an introductory training for all 460 staff on core equity topics. SCCPHD staff identified equity champions in their workforce and recruited them to participate as trainers, using a train-the-trainer model to build internal capacity and expertise.
The SCCPHD Racial and Health Equity Learning Institute was designed to provide staff with a shared understanding, language, and framework to advance racial and health equity within government systems. The in-person training consists of 6 workshops, ranging from 1.5 to 4 hours each. The workshops are a mix of didactic content, interactive exercises, and videos around the following topics: 1) Introduction to Racial and Health Equity, 2) Structural Racism 101, 3) LGBTQ Health, 4) Climate Change, 5) Cultural Humility and Competency, and 6) Community Engagement.
The trainings aim to develop a shared understanding of equity among staff, and provide a safe and inclusive space to discuss the legacy of discrimination, implicit bias, and structural racism in their work and in their lives. The goal is to build a movement and identify change agents to transform how the organization approaches its work.
Engaging community partners wherever possible
In addition to focusing on getting their “internal house in order,” whenever there is an opportunity to invite the community to participate in Department processes or trainings, SCCPHD invites community members to share their experiences, perspectives, and recommendations. Moving forward, the Department will work with community partners to share the work that is being done internally, and will work with community organizations to further develop trainings. SCCPHD is figuring out how to fairly compensate community members for their time and participation.