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State Health Equity Plan

State Health Equity Plan2024-09-30T12:43:25-07:00

Advancing Equity in Community Health

The California Department of Public Health has been working in collaboration with local health jurisdictions (LHJs), community-based organizations (CBOs), and other key partners to develop and implement a State Health Equity Plan (SHEP). The SHEP will serve as the shared equity strategy and implementation plan for Let’s Get Healthy California – the State Health Improvement Plan (SHIP). These efforts aim to collectively advance health equity and improve community health, especially for populations experiencing significant disparities across health outcomes.

The initial phase of the State Health Equity Plan (SHEP) development process has focused on identifying existing state and local equity efforts and compiling that information into a — SHEP Preliminary Framework — a tool for organizing and aligning equity-focused activities. Research and feedback were incorporated into this working draft to share innovative and best practices and support future engagements that aim to strengthen areas in need of further development.

Preliminary Framework

Learn more about the . Click on the areas of focus within the four domains below to see the associated strategies and sample actions.

Emergency Preparedness and Response (EPR) Domain

Activities to enhance collective capacity to prepare for and respond to all types of public health emergencies and hazards, with an emphasis on strengthening infrastructure and resilience. This domain will continue to be refined to incorporate activities that represent equitable response and recovery efforts and lessons learned.

Area of Focus:

EPR-1 Emergency Operations Planning and Management

Strategies:

  1. : Conduct a comprehensive risk assessment to identify existing and emerging public health threats and populations at higher risk of adverse outcomes during emergencies, evaluate emergency operations protocols and infrastructure, and identify assets and resources to inform equitable emergency preparedness and response planning
  2. : Develop, exercise, and maintain preparedness and response policies and plans in collaboration with communities and/or organizations that represent populations disproportionately impacted by public health emergencies
  3. : Develop and enhance systems and protocols to embed equity principles into emergency preparedness and response activities, including efficient development and mobilization of funding, procurements, regulatory guidance, and other operational infrastructure
  4. : Ensure adequate and diverse staffing and capacity to support emergency response and recovery activities

Area of Focus:

EPR-2 Readiness and Response Coordination

Strategies:

  1. : Develop and maintain a bi-directional information-sharing protocols and infrastructure with partners and the public to support proactive communication and coordination and inform decision making
  2. : Collaboratively define the scope, roles, and responsibilities of response and establish trust to enable coordinated action before, during, or after public health emergencies
  3. : Work with partners and the community to plan and deploy responsive equity solutions, with a particular focus on individuals with access and functional needs, to support equitable recovery from public health emergencies
  4. : Leverage data and community insights to focus investments and resources to address disparities and promote equitable recovery among communities that are disadvantaged and/or disproportionately impacted by public health emergencies

Area of Focus:

EPR-3 Laboratory, Data, and Investigation Capacity

Strategies:

  1. : Enhance public health laboratory testing, coordination, and reporting capacity
  2. : Implement data modernization strategies to improve data access, quality, and timeliness for use in identifying and responding to acute outbreaks, emergencies, and other health hazards
  3. : Strengthen capacity to conduct case investigation, contact tracing, exposure assessment, and other investigation activities in partnership with communities

Area of Focus:

EPR-4 Prevention and Mitigation

Strategies:

  1. : Identify priority or essential public health functions and the staffing and resources needed to maintain continuity of services during an emergency
  2. : Develop and deliver unified, accurate, culturally and linguistically relevant, timely and accessible information to prevent and mitigate the impacts of public health threats and/or emergencies in communities
  3. : Coordinate with programs, services, and communities to provide emergency resources to aid people affected by the emergency and strengthen community readiness for future response
  4. : Support the provision of and linkage to mental health, substance use, and stress management services and resources to people affected by the disaster

Area of Focus:

EPR-5 Community Preparedness and Recovery

Strategies:

  1. : Strengthen community partnerships and provide training and guidance to support community involvement with emergency preparedness
  2. : Work with communities to identify and monitor recovery needs, support community-based recovery efforts, and implement solutions to mitigate adverse impacts from future emergency incidents

Area of Focus:

EPR-6 Responder Safety and Health

Strategies:

  1. : Identify and implement policies and activities to assess risk and ensure safety and protections of personnel during emergency activations
  2. : Provide education, services, and resources to address trauma exposure, prevent burnout, and promote overall wellbeing

Area of Focus:

EPR-7 Facilities and Support Structures

Strategies:

  1. : Establish and promote single or satellite sites that address day- to-day needs, build a social safety net, and provide a place for community resources in emergency
  2. : Derive plans and strategies that support mass care, coordinate services, address emergent challenges and barriers, and incorporate equity considerations in response to mass all-hazards evacuations
  3. : Provide emergency and temporary housing, food assistance, and other services to individuals, families, people with functional and access needs, and animals in congregate and non-congregate facilities and settings
  4. : Provide resources to support people who have been displaced as a result of public health emergencies and need to transition from a shelter to an alternative housing setting

Area of Focus:

EPR-8 Climate and Environmental Resilience

Strategies:

  1. : Develop an environmental justice strategy for identifying, monitoring, and addressing the environmental burden and cumulative risk among historically disadvantaged communities
  2. : Provide information, resources, and capacity building activities to strengthen climate literacy among emergency response partners, staff, and the public
  3. : Work in collaboration with partners and communities to integrate equity principles into climate change policies, plans, and programs and advance resilience activities that support equitable preparedness, response, and recovery from climate-related disasters and environmental threats

Health Outcomes (H) Domain

Key health issues [or groups of issues] that have emerging or long-standing disparities and require focused efforts to support equitable outcomes.

Area of Focus:

H-1 Maternal and Family Health

Strategies:

  1. : Prioritize research, education, and resources to address the maternal and infant mortality crisis
  2. : Provide programs and services with tailored strategies to meet the specific needs of populations that experience disparity in maternal and infant health outcomes

Area of Focus:

H-2 Early Childhood Development and Resiliency

Strategies:

  1. : Promote early childhood development, supports, screenings, and interventions
  2. : Educate parents, caregivers, practitioners, and communities about the impact of ACEs on health
  3. : Promote screening for ACEs to support detection and interventions that aim to improve quality of life and health outcomes
  4. : Advance solutions that build PCEs to drive healthy development and mitigate effects of Adverse Childhood Experiences (ACEs)

Area of Focus:

H-3 Mental and Behavioral Health

Strategies:

  1. : Utilize health promotion activities to improve awareness of mental and behavioral healthcare services and resources
  2. : Provide access to services and resources to address mental and behavioral health needs and build resilience
  3. : Provide prevention and intervention services for people experiencing harmful use and effects of alcohol, tobacco, other substances, and/or problem gambling
  4. : Provide response services for people experiencing a mental health, drug or alcohol-related crisis and deploy strategies to build resilience for people (individual, family, and community) impacted by the use and misuse

Area of Focus:

H-4 Injury and Violence Prevention

Strategies:

  1. : Provide outreach and resources to report and prevent child abuse and neglect
  2. : Provide access to resources, social networks, and programs to support people experiencing domestic or intimate partner violence and reduce the factors that place them at risk
  3. : Provide prevention and intervention services for those experiencing psychological and social factors that may lead to suicidal ideation
  4. : Create and implement violence prevention strategies that reduce youth violence in schools and communities through promotion of safe places, positive behaviors, and increase in protective factors
  5. : Develop and implement violence prevention strategies to reduce the risk, incidence, and harmful effects of violence especially for populations experiencing disproportionate rates of injuries and death
  6. : Develop and implement policies, programs, and surveillance systems to prevent deaths and disability from unintentional injury, including promoting safety for active transportation

Area of Focus:

H-5 Disease Prevention and Health Promotion

Strategies:

  1. : Implement prevention strategies that address shared risk across multiple health conditions
  2. : Strengthen healthcare delivery system policies and infrastructure to support uninterrupted access to treatment for non-communicable diseases (e.g., heart disease, stroke, cancer, diabetes, chronic lung disease, etc.) during times of emergency response/crisis
  3. : Assess population oral health needs and engage in education and outreach to promote preventive care to reduce incidence of oral disease

Area of Focus:

H-6 Communicable Disease Control

Strategies:

  1. : Utilize resources to access health care practitioners for diagnostic needs and treatment of communicable diseases
  2. : Provide resources to support access to treatment for people experiencing COVID-19 infection and/or prolonged illness or long-term effects (post-COVID conditions or long COVID)

Area of Focus:

H-7 Sexually Transmitted Infections

Strategies:

  1. : Provide health education, resources, and services including screening, testing, and treatment of sexually transmitted infections (STIs) to reduce stigma, risk, and transmission and improve overall health and wellbeing among populations that are disproportionately affected
  2. : Provide services and resources, utilizing a whole person and client centered approach, to individuals diagnosed and living with HIV/AIDS
  3. : Provide services and resources to address sexually transmitted infection rates particularly in areas with high disease burden

Area of Focus:

H-8 Environmental Health

Strategies:

  1. : Utilize a One Health Approach through close collaboration with state and local partners to create a multidisciplinary platform for sharing varying priorities and new perspectives and ideas to addressing complex health challenges that impact animals, humans, and the environment
  2. : Share timely and relevant public health education and resources to mitigate risk and inform partners and the public about the health impacts from common environmental or toxic exposures
  3. : Develop and implement policies, programs, and surveillance to prevent, mitigate, and respond to adverse health impacts due to biological, chemical, and radiological threats and other environmental exposures

Structural and Social Determinants of Health (SDOH) Domain

Focus on upstream factors and conditions, particularly amongst populations at highest risk and underserved.

Area of Focus:

SDOH-1 Inclusive Economic Development

Strategies:

  1. : Strengthen the social safety net to provide access to benefits and financial support to individuals and families experiencing economic burden and poverty
  2. : Establish reemployment and workforce development strategies and interventions to assist the unemployed and underemployed to obtain employment as a means to stimulate economic recovery, increase financial stability, and eliminate working poverty
  3. : Develop financial investment approaches and/or strategic partnerships to address the impact of social determinants of health on place-based disparities and community health and wellbeing

Area of Focus:

SDOH-2 Housing and Homelessness

Strategies:

  1. : Expand and/or provide housing support for people experiencing housing related economic burden
  2. : Expand and/or provide housing options for people experiencing chronic homelessness
  3. : Provide education, supplies, and services to support the basic needs of people experiencing chronic homelessness

Area of Focus:

SDOH-3 Food and Nutrition Security

Strategies:

  1. : Improve access to nutritious foods to promote healthy eating for those demonstrating medical need, economic disparities, and/or isolation
  2. : Provide assistance, including financial support, food preparation, and/or meal delivery services, to aid individuals and families experiencing challenges to obtaining healthy and nutritious food

Area of Focus:

SDOH-4 Access and Linkage to Services and Care

Strategies:

  1. : Provide access and referrals to housing, financial, medical, dental, and mental and behavioral health services
  2. : Provide access to health care providers and models of care beyond the traditional healthcare delivery system

Area of Focus:

SDOH-5 Social Support, Inclusion and Non-Discrimination

Strategies:

  1. : Provide resources and services to caregivers for children, older adults, and people living with a short- or long-term condition who require assistance with social and/or health needs.
  2. : Develop and implement strategies to address inequitable health outcomes for groups of people with common risks and unique needs that require special consideration

Area of Focus:

SDOH-6 Equitable Learning Environments

Strategies:

  1. : Support efforts to embed equity in the policies and practices of learning environments
  2. : Promote programs and resources to support whole child wellness in learning environments

Area of Focus:

SDOH-7 Natural and Built Environment

Strategies:

  1. : Participate in shared land use and built environment planning and development to inform strategies that promote equitable health outcomes and community resiliency
  2. : Assess and monitor environmental risks and vulnerabilities, provide regulatory oversight, and implement activities to protect workers and the public from environmental hazards and threats, especially among populations who may have experienced disproportionate exposure
  3. : Promote programs and interventions that increase technology and internet access and availability to support equitable access to education, outreach, and services

Area of Focus:

SDOH-8 Anti-Racism

Strategies:

  1. : Declare racism a public health crisis and address the impact of race-based inequity

Equity Infrastructure (EI) Domain

Ensures an infrastructure is in place to be responsive to diverse needs and support efforts to advance heath equity; it is foundational to all other domains.

Area of Focus:

EI-1 Workforce and Capacity Building

Strategies:

  1. : Recruit, hire, and retain a workforce that reflects the populations served
  2. : Establish an Equity Lead and/or other staff positions dedicated to advancing equity throughout the organization via capacity building initiatives and activities
  3. : Provide equity-focused training, development, and support to cultivate an inclusive workplace culture

Area of Focus:

EI-2 Organizational Policies and Practices

Strategies:

  1. : Assess organizational equity capacity by identifying and evaluating the level of equity integration into the organization’s infrastructure, culture, and communication
  2. : Establish an infrastructure and culture that values diversity of thought and supports equal opportunities to provide feedback and participate in decision making
  3. : Assess barriers to funding and resource allocations and implement solutions that support and advance diversity, equity, and inclusion

Area of Focus:

EI-3 Accountability and Performance Management

Strategies:

  1. : Integrate equity principles into the organization’s plans, policies, and programs

Area of Focus:

EI-4 Governmental Policy and Planning

Strategies:

  1. : Incorporate equity principles in policy and planning

Area of Focus:

EI-5 Assessment and Surveillance

Strategies:

  1. : Conduct or update a community health assessment to reflect the experience of communities impacted by inequities and make it accessible for shared use in policy and program planning
  2. : Embed equity in data use, research, and reporting, and develop and utilize tools to test data for bias
  3. : Improve monitoring and reporting on social determinants of health to inform upstream approaches and interventions and increase opportunities to achieve equitable health outcomes

Area of Focus:

EI-6 Cross-Sector Partnerships for Health Improvement

Strategies:

  1. : Conduct shared analysis and planning to explore root causes of problems and co-develop strategies and solutions
  2. : Collaborate across sectors – using a Health in All Policies (HiAP) or similar approach – to address health equity and the root causes impacting social determinants of health (environmental, social, and economic)

Area of Focus:

EI-7 Community Power Building and Partnership

Strategies:

  1. : Establish structures, venues, and forums that develop and support meaningful community partnership and engagement opportunities
  2. : Build trust with the community/residents through transparent and inclusive communication, respectful co-learning, and leveraging community expertise to inform equitable practices
  3. : Strengthen partnerships with Tribal entities to support health planning

Area of Focus:

EI-8 Health Education, Communications, and Outreach

Strategies:

  1. : Formulate a communication plan, strategy, and/or messaging that is inclusive and responsive to diverse populations
  2. : Create language access policies, plans, and/or procedures to make information accessible to diverse audiences
  3. : Increase knowledge of health equity principles to build awareness of health disparities and inequities in impacted communities

Frequently Asked Questions

The California Department of Public Health has been working in collaboration with local health jurisdictions (LHJs), community-based organizations (CBOs), and other key partners to develop and implement a State Health Equity Plan (SHEP). The SHEP will serve as the shared equity strategy and implementation plan for Let’s Get Healthy California – the State Health Improvement Plan (SHIP). These efforts aim to collectively advance health equity and improve community health, especially for populations experiencing significant disparities across health outcomes.

The SHEP will include 1) an overarching framework for organizing, communicating, and aligning equity-focused activities and elevating creative and best practices, and 2) a shared equity strategy and implementation plan (Plan) for collectively advancing equity over the next three to five years. The Plan is meant to establish shared commitment to action across state and local efforts and will include statewide equity goals (results), shared strategies and actions, and metrics to evaluate progress.

The current phase of this work is focused on learning about existing equity efforts and opportunities and organizing that information into a preliminary framework. The next phase of this effort will include shared prioritization and action planning and development of a comprehensive statewide equity strategy and implementation plan.

The State Health Equity Plan (SHEP) Preliminary Framework incorporates state and local efforts, various stakeholder plans, activities from diverse funding streams, and equity-related literature, models, and frameworks. This comprehensive development approach utilizes the following research strategies to inform the framework:

  1. Review of existing equity-related efforts and investments.
  2. Evaluation, reflection, and alignment with state and local priorities.
  3. Application of evidence-based public health practice and equity-related models and frameworks.

The State Health Equity Plan (SHEP) Preliminary Framework is systematically organized to align equity-focused activities through use of the following design elements:

  • Domains: Represent broad-based areas of public health practice that categorically organize areas of focus, strategies, and sample actions.
  • Areas of Focus: Broad public health areas that encompass diseases, conditions, and emerging issues that impact population health.
  • Strategies: Plan of action or policy to achieve results within an area of focus.
  • Sample Actions: Examples of how a strategy can be (and often have been) implemented at the state, local, and community levels. The sample actions were based on compiled research and engagement and will continue to be refined with partners.

A results-based approach will be used during a future shared action planning process to establish statewide equity goals, shared strategies and actions, and meaningful metrics to track progress on shared priority areas.

The State Health Equity Plan (SHEP) Preliminary Framework was designed to align with commonly recognized models and frameworks:

  • Organizational Assessment for Equity Infrastructure (administered by California Department of Public Health, Office of Health Equity) core competencies align with many areas of the Equity Infrastructure: Asset and Capacity Building domain.
  • Let’s Get Healthy California – State Health Improvement Plan (SHIP) – shared priorities directly align with areas of focus within the Health Outcomes and Structural and Social Determinants of Health domains.
  • Foundational Public Health Services – Foundational Areas are aligned with the Health Outcomes domain and Foundational Capabilities align with many areas of focus in the Equity Infrastructure: Asset and Capacity Building domain.
  • Healthy People (HP) 2030 aligns with multiple aspects of the SHEP areas of focus and HP 2030 measurement and target-setting methodologies are being reviewed to inform SHEP strategy and indicator development.
  • Public Health Accreditation and 10 Essential Public Health Services (EPHS) align with many of the areas of the Equity Infrastructure: Asset and Capacity Building domain and some of the SHEP equity strategies may support fulfillment of accreditation measures.

Intersectionality between and across domains will be addressed in future iterations of the State Health Equity Plan (SHEP) Preliminary Framework in collaboration with cross-sector partners. The framework will be evaluated from a policy, systems, and environmental (PSE) approach by focusing on the intent and/or implications of factors and conditions.

  • Emergency Preparedness and Response: This domain has been broadened to include preparedness and response for all types of public health emergencies and hazards. It will continue to be refined to incorporate equitable response and recovery activities that promote community resilience. Intersectionality between this domain and the others will continue to be explored as it is further refined.
  • Health Outcomes: Identify and elevate policy, systems, and environmental (PSE) and equity-focused strategies to address the implications that systems, structures, and/or social and built environments have on any particular health outcome (consider disproportional impacts to populations and communities).
  • Structural and Social Determinants of Health: Identify and elevate strategies for how public health can influence improvements in the structures, systems, and/or social and built environments related to factors that influence health (in collaboration w/ cross-sector partners).
  • Equity Infrastructure: Assets and Capacity Building: Identify and elevate strategies for building and sustaining organizational infrastructure to support equitable policies, programs, and practices that are responsive to the organization’s mission, workforce, and communities served.

Example of Applying Intersectionality Across Domains:

Healthy Nutrition in Workplace and School Settings: If an example is focused on advancing policies to ensure healthy food options within workplace and school settings, the intent is to improve health behaviors and outcomes and the example should be placed under the Health Outcomes domain. If an example is focused on improving equitable access to work and educational opportunities or on advancing diversity, equity, and inclusion within the work and educational environments, the intent is to improve systems and the sample action should be placed under the Structural and Social Determinants of Health. The SHEP Framework will continue to be strengthened and refined to elevate policy, systems, and environmental (PSE) strategies and sample actions within the Health Outcomes domain and further build out opportunities for advancing equity in the Structural and Social Determinants of Health domain.

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