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
Click on the areas of focus within the four domains below to see the associated strategies and sample actions.
Domain One: Outbreak and Emergency Response
- : Expand opportunities for testing in alternative sites and settings
- : Source and distribute self-collection kits to individuals and organizations to increase access to testing
- : Expand testing opportunities for people who are underserved
Community and Mobile Testing
Expand opportunities for testing in alternative sites and settings
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Expand test to treat locations to ensure access particularly in remote areas and in communities for people who are underserved
- Increase testing availability by providing services in the following sites and settings:
- Rural communities and Tribes
- Communities with populations disproportionately affected
- School and faith-based locations
- Resource Centers perform staff testing
- Foster care homes or residential group care facilities
- Congregate care settings
- Jails/detention facilities
- Border testing at pedestrian entrance
- Expand mobile and pop-up location testing to ensure access to populations in disproportionately impacted communities:
- Identify and purchase mobile outreach vans for testing
- Provide mobile testing “strike team” services via fire and emergency medical staff
Self-Collection Testing
Source and distribute self-collection kits to individuals and organizations to increase access to testing
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Partner with local government, school, healthcare, community partners, Tribes, and businesses to create a distribution plan for at-home antigen tests to increase access and reduce barriers to testing
- Make at-home tests available via outreach events, clinics, community-based organizations, faith-based partners, and Local Tribal Health to promote early detection
- Distribute self-collection test kits to target populations including but not limited to people with disabilities, people experiencing homelessness, and people who are homebound, agricultural/migrant seasonal farm workers, and rural communities
Testing Support for Special Populations
Expand testing opportunities for people who are underserved
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Develop a marketing plan that includes outreach and media campaigns in multiple languages with culturally relevant images, and expands opportunities and incentives for testing
- Provide onsite interpretation in Spanish, English, Indigenous and other Languages at testing sites
- Increase testing capacity and ensure access to people who are underserved, isolated older adults, and those populations with disproportionate case rates
- Expand testing for farmworkers and impacted industries
- Perform testing outreach to Indigenous communities and establish partnerships with Tribal nations for testing
- Engage in racial and ethnic minority group and LGBTQ+ community-focused testing
- Establish phone help line to provide testing access assistance for those without internet capabilities
- : Recruit and train a contract tracing workforce representative of communities served
- : Leverage contact tracing data to inform program, policy, and evaluation activities
- : Build partnerships with community-based organizations to support contact tracing
Investigation and Monitoring Workforce
Recruit and train a contract tracing workforce representative of communities served
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Case Investigation:
- Increase staffing of case investigation to reduce transmission
- Educate investigation staff to complete case consultation
- Establish a Case and Contact Interview Branch (CCIB) to interview, ensure isolation of every case, and identify who has been in close contact with people experiencing illness
Contact Tracing:
- Recruit part-time contact tracers to address gaps in staffing
- Train team to ensure language access and cultural competency in provision of contact tracing services to meet the needs of priority populations
- Utilize Promotores/Community Health Workers (CHW) to provide bilingual and bicultural services when performing outreach to identified close contacts
- Maximize contacts with individuals by increasing coordination between contact tracer, testing, and isolation support teams
Information Collection and Utilization
Leverage contact tracing data to inform program, policy, and evaluation activities
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Ensure collection of quality contact tracing demographic and clinical information
- Apply a racial and equity lens to contact tracing program and policy decisions to inform equitable provision of services across communities
- Utilize case investigation and contact tracing in skilled nursing facilities and congregate settings in the event of an outbreak
- Schools, businesses, congregate settings, and other entities can utilize the School and Shared Portal for Outbreak Tracking (SPOT) to report exposures and/or outbreaks (at their locations) to local health departments
Community Support and Coordination
Build partnerships with community-based organizations to support contact tracing
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Contact tracers Collaborate with community-based organizations and housing associations to:
- Engage in efforts to improve community responsiveness to contact tracing
- Refer people to resources such as food, medication, transportation, and housing
- Ensure contact tracers have resources to provide housing for isolation or quarantine
- : Utilize health education, promotion, and outreach to inform and reduce transmission, positivity rates, and exacerbation of underlying medical conditions
- : Deploy strategies and actions to prevent or reduce the transmission of communicable diseases
Outreach and Education
Utilize health education, promotion, and outreach to inform and reduce transmission, positivity rates, and exacerbation of underlying medical conditions
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Health Promotion and Prevention:
- Expand capacity to provide outreach, education, and prevention strategies that are culturally and linguistically responsive
- Leverage health education messaging campaigns via social media, television public service announcements, radio, streaming services, billboards, and websites
- Ensure health education outreach and materials include methods beyond electronic messaging (e.g., health fairs, appointment reminders, direct mailers, print ads, community bulletin boards, and door-to-door canvassing) to enable accessible communications for older adults, people with disabilities, and people with limited or no access to internet
- Provide ongoing mask distribution and encourage mitigation efforts (physical distancing, hand hygiene) to populations with disproportionate risk of infection
Collaboration and Technical Assistance:
- Provide technical assistance to educate partners on best practices of infection control (testing resources, contact tracing support, and prevention measures)
- Engage with community-based organizations to support advancement of health education, prevention, and mitigation efforts
- Partner with the County Office of Education and schools to provide outreach and share public health guidance to keep children in school safely
- Collaborate with First 5 and Promotores/Community Health Workers to conduct outreach and education on public health programs and services
- Integrate violence prevention measures, programs, and education into emergency response to reduce the incidence of domestic violence that may occur due to increased home confinement
- Establish a 24/7 mental health line to connect communities to immediate support
Mitigation Activities
Deploy strategies and actions to prevent or reduce the transmission of communicable diseases
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Risk Assessment and Communication:
- Assess differential distribution of risk across neighborhoods and workplaces, and focus prevention and mitigation efforts to areas and populations disproportionately affected
- Utilize risk communication, multiple media platforms, and health education and promotion to combat misinformation
- Develop and distribute educational materials about infectious disease transmission and ways to reduce transmission through improving environmental (e.g., indoor air quality) and social (e.g., physical distancing) factors
- Create educational resources about the risks associated with infectious diseases, and promote reducing exposure risk as the best form of prevention
- Support community and faith-based organizations’ efforts to connect with residents; engage in policy and practice changes; and share vital information on risks and opportunities for improved health outcomes
Guidance and Technical Assistance:
- Provide staff emergency preparedness and disaster prevention training and mitigation strategy guidance to support provision of informed technical assistance to communities in their language
- Train staff on their worker’s rights and safety protections (e.g., access to personal protective equipment and sick leave)
- Utilize Workers’ Centers to conduct education about infection control measures; empower workers to advocate for safety measures and report potential violations; and discuss strategies for increasing worksite safety compliance
- Convene Public Health Councils to increase adherence to legally enforceable directives in business sectors disproportionately impacted
- Establish school district reopening technical assistance teams utilizing health educators to provide guidance on K-12 school implementation in compliance with State and County infectious disease safety requirements and recommendations
- Collaborate with school nurses and district offices to ensure buildings have applicable filters and prevention infrastructure for the upcoming school year
Coordination and Outreach:
- Coordinate with community-based organizations to identify service gaps and establish community outreach and system navigation to support direct linkages to testing, vaccination, quarantine/isolation housing, and wraparound services
- Coordinate with healthcare providers regarding personal protective equipment in care settings where potentially infectious patients and ill people congregate
- Utilize Resource Centers to prevent infectious disease spread through dissemination of hand wash stations and personal protective equipment
- Leverage trusted messengers to increase prevention and guidance awareness
- Develop Farm Worker Outreach initiatives (e.g., task force) to address inequitable exposure and improve access to vaccines, testing, and housing options
- : Ensure vaccine strategies are in place to expand population knowledge and equitable access to minimize risk, disease burden, and health system impact
Services and Resources
Ensure vaccine strategies are in place to expand population knowledge and equitable access to minimize risk, disease burden, and health system impact
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Vaccine Access and Availability:
- Utilize epidemiologists to assess population health disparities by evaluating Healthy Places Index (HPI) quartiles and census track data; health status and risk factors; and demographics to inform decision making for equitable vaccine distribution and clinic placement
- Expand vaccine access by varying vaccination sites/points of dispensing sites (PODS) to include walk-up sites; larger drive-through mega PODS; smaller community PODS in parks and community centers; and offer test to treat options with additional programs and services at Federally Qualified Health Centers (FQHCs) and public health sponsored locations
- Collaborate with State partners to support delivery of vaccine services to reduce disparities particularly when limited resources impact service and equity for vulnerable populations
- Expand vaccine access and availability through transportation support, incentives, mobile vaccine and pop-up clinics in rural, non-English speaking, and lower income communities
- Community Health Representatives (CHR) coordinate transportation and travel via mobile clinic bus to provide vaccine education and administration to Tribal members
- Collaborate with employers to set-up on site vaccination clinics to reduce barriers and improve vaccine access
- Partner with schools to make vaccinations available and increase the probability of avoiding school closure from outbreaks
Vaccine Outreach:
- Use engagement strategies such as community advisory committees and/or coordination with partners to integrate a racial equity lens in vaccine strategies, outreach, messaging, and training
- Host a vaccine clinic and/or place vaccine information booths in lowest health equity quartile communities (HPI neighborhoods of focus)
- Consider role of Supplemental Nutrition Assistance Program (SNAP) nurses rotating to historically underserved communities to provide vaccinations and education
- Perform door-to-door canvassing, mailers, phone calls, and radio announcements, to educate about the importance of vaccinations
- Consider role of public health nursing work force to provide in home vaccinations and guidance for older adults and people with disabilities, and people with immunocompromised conditions
- Provide vaccine information at youth gatherings and coordinate education presentations with community pediatric nurse practitioners with experience in trauma informed care
- : Dedicate staff to coordinate provision of quarantine and isolation support services
- : Educate and provide access to resources to support quarantine and isolation
- : Provide housing options and alternative settings for individuals to appropriately and safely quarantine and isolate
Staffing and Coordination
Dedicate staff to coordinate provision of quarantine and isolation support services
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Provide quarantine and isolation support and direct response resources, particularly through testing clinics, skilled nursing facilities, and providers for people experiencing homelessness
- Expand culturally competent and multilingual staff to support isolation and quarantine
- Utilize a Resource Coordinator to assist with quarantine and isolation support, including the provision of social support and healthcare services
Education, Services, and Resources
Educate and provide access to resources to support quarantine and isolation
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Educate priority populations and communities on how to isolate/quarantine and/or protect themselves from acquiring virus infection
- Provide access to case management services and financial and material resources to help people adhere to isolation/quarantine recommendations
- Provide food delivery, medication delivery, isolation care kits, and basic home healthcare support
- Coordinate with non-profits to identify and support isolation/quarantine needs for people experiencing homelessness or housing insecurity, undocumented immigrants, and geographically and culturally isolated communities
- Use of stipends to support compliance with self-isolation requirements
- Pilot a program to support people who may lose wages to reduce economic barriers that may inhibit isolation/quarantine compliance
- Ensure congregate settings (e.g., long-term care facilities) implement infection prevention and control measures and test screening for staff and residents
- Promote access to telehealth and grocery delivery or no-contact pickup and use of online educational instruction to minimize interaction in public settings
Housing and Alternative Settings
Provide housing options and alternative settings for individuals to appropriately and safely quarantine and isolate
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Partner with short-term residential therapeutic programs (STRTPS) to develop quarantine and isolation plans for foster children placed in residential settings
- Provide complimentary hotel rooms, congregate shelter or isolation trailers for people experiencing homelessness, people with lower incomes or people unable to safely isolate/quarantine at home due to living with a medically compromised person
- Provide educational resources to providers and community organizations that address relocation risks (e.g., exposures during travel, encountering new virus variants, challenges accessing health care or testing services)
- : Ensure adequate staffing capacity and operational resources to support emergency response and recovery activities
- : Plan and deploy activities and services to facilitate equitable recovery from public health emergencies
Responder Staffing and Resources
Ensure adequate staffing capacity and operational resources to support emergency response and recovery activities
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Staffing Capacity:
- Address key staff roles to respond to outbreaks:
- An epidemiologist, infection preventionist, and public health nurse
- Full-time equivalent staff, including a senior health education specialist, to prioritize an equitable response; provide support to people most impacted; and promote increased engagement and participation in recovery services
- A response coordinator to oversee contacts and case investigations
- Community Health Representatives (CHR) to provide health care, health promotion, disease prevention, and supportive services (including transportation) to Tribal communities
- Expand staffing capability to:
- Serve as a liaison for medical staff and emergency responders
- Establish an infection preventionist (expert stewardship) staff role or contract for case investigation, testing support, and infection control guidance for long term care facilities (skilled nursing facilities and residential care)
- Leverage community health advocates to develop outreach materials and events to improve utilization of recovery services
- Establish a nurse intern program that creates a career pathway; expands local hiring during emergency response; develops leadership; and equips and prepares extra staff for permanent roles within the department
Operational Resources and Support:
- Identify sustainable funding for emergency response particularly for logistical support and supplies for operational needs
- Put workforce development systems in place for staff to increase protective factors to sustain retention, boost morale, and reduce burnout especially in low resource communities
- Provide emergency preparedness and disaster prevention training for staff and communities in their language
- Provide a Community Health Worker (CHW)/Promotor(a) de Salud training curriculum on the basics of public health, emergency response, and CHW competencies
Equitable Response and Recovery Activities
Plan and deploy activities and services to facilitate equitable recovery from public health emergencies
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Preparedness and Response:
- Utilize an infection preventionist to build prevention and control strategies to respond to outbreaks
- Complete a Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP) to assist with focusing and prioritizing emergency response efforts with emphasis on populations disproportionately affected
- Create subcontracts with rural community-based organizations to implement containment and mitigation strategies for populations that are underserved
- Deploy mobile units to provide emergency response and care services to the agricultural workforce
- Establish a program of informal and formal leaders to establish and deploy emergency response services in their communities and disseminate information (e.g., “3,000 lives” program)
- Perform an after-action-report process and center equity in the retrospective analysis to inform future equitable emergency response and recovery activities
Recovery:
- Develop a Local Equity Recovery Plan to recommend priority services, outreach venues, evaluate progress, and address challenges in schools
- Coordinate with Office of Education and K-12 schools to provide guidance to develop and implement re-opening plans for outbreak mitigation, and identify strategies and partners to ensure equitable access to academic resources for communities with limited support
- Partner with city, county, regional agencies, Tribes, and impacted communities to champion an equitable recovery that addresses the needs and experiences of communities
- Collaborate with educators, healers and facilitators who focus on healing-centered practices (e.g., meditation, yoga, breath work, and rest)
- : Collect, analyze, and interpret communicable disease data on populations in a specified area
- : Provide official statistics on communicable disease data and share updates on emergency response
Public Health Data Collection and Analysis
Collect, analyze, and interpret communicable disease data on populations in a specified area
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Utilize syndromic surveillance to collect and analyze timely patient encounter data among populations, to detect symptoms of illness and identify disproportionately affected populations before cases are diagnosed or confirmed, especially in congregate settings
- Enhance epidemiological capability to perform testing, data collection, analysis, and genomic surveillance (genotyping) for variants, particularly for disproportionately affected populations
- Use of water waste surveillance testing to measure disease levels to gain a better understanding of disease prevalence
- Develop a school liaison team to assist with surveillance of schools, daycares, secondary schools, and higher education institutions case rates and outbreaks
- Task outbreak management teams with investigation and management of outbreaks in high-risk facilities
- Perform a geographical analysis of the infectious disease distribution in lower quartile areas to inform place-based (neighborhood) health equity disparities, resources, and response
- Compare the infectious disease case and communicable disease distribution to equity-defined geographies
Public Health Data Sharing
Provide official statistics on communicable disease data and share updates on emergency response
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Organize data and make information accessible to the public via media briefings; County Board of Supervisors meetings; sector-specific telebriefings; and community town halls
- Deploy data sharing process with local partners to improving tracking
- Utilize data dashboards to:
- Feature interactive maps and chart visualizations by place (city/community and county-level), sector, and demographic characteristics (age group, race and ethnicity, gender identity, and sex assigned at birth)
- Highlight community, city, and county-level trends and weekly and cumulative data across time (time series)
- Provide setting-specific (skilled nursing facility, schools, and youth programs) data for disproportionately affected populations to assist with prioritizing early alert indicators, prevention measures, and mitigation and preparedness actions
- Enable download of data tables for direct use or additional analyses
- : Enhance laboratory testing and reporting capacity
Services and Reporting Capacity
Enhance laboratory testing and reporting capacity
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Modernize laboratories to support novel advancements in analytical techniques to detect and track the spread of diseases and communicate information to the public in a timely manner
- Utilize lab data to conduct case investigations, contact tracing, and containment measures
- Increase lab capacity to detect variants of interest by polymerase chain reaction (PCR) and/or sequencing research, including gene sequencing
- Design and implement the usage requirements for lab information software and equipment related to managing increased test demand
- Collect and report comprehensive/disaggregated data on race and ethnicity, etc.
- Contract with a local health system to establish an in-county monoclonal antibody therapy site to address the burden of receiving services out-of-area
Domain Two: Health Impact and Outcomes
- : Prioritize research, education, and resources to address the maternal and infant mortality crisis
- : Provide programs and services with tailored strategies to meet the specific needs of populations that experience disparity in maternal and infant health outcomes
Outreach and Education
Prioritize research, education, and resources to address the maternal and infant mortality crisis
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Design multi-cultural and -linguistic outreach campaigns to promote the importance of pre- and post-natal care
- Educate individuals, families, and support networks about the warning signs of complications during pregnancy and the postpartum period
- Provide pregnant individuals with education and resources about the interconnectivity between physical, mental, and oral health and impacts on maternal and infant health
Access to Need-Based Services and Care
Provide programs and services with tailored strategies to meet the specific needs of populations that experience disparity in maternal and infant health outcomes
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Partner with healthcare providers and community health workers to ensure birthing people have access to pregnancy and postpartum care
- Promote resources and supports such as the Black Infant Health Program (BIP) and the IrthApp to improve health outcomes for Black infants and birthing people
- Ensure home visiting practices are delivered in a culturally and linguistically appropriate manner to respect birthing people and their families
- Provide no cost prenatal and newborn screenings
- Coordinate with homeless shelters and women’s shelters to provide birth control and other reproductive planning resources to support reproductive health and autonomy
- : Promote early childhood development, supports, screenings, and interventions
- : Educate parents, caregivers, practitioners, and communities about the impact of ACEs on health
- : Promote screening for ACEs to support detection and interventions that aim to improve quality of life and health outcomes
- : Advance solutions that build PCEs to drive healthy development and mitigate effects of ACEs
Early Childhood Development
Promote early childhood development, supports, screenings, and interventions
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Educate parents and caregivers about the importance of early brain development and provide activities and support resources to promote efforts such as the First 5’s Talk, Read, Sing Campaign
- Coordinate with community partners to promote routine well child visits and developmental screenings
Adverse Childhood Experiences (ACEs) Awareness
Educate parents, caregivers, practitioners, and communities about the impact of ACEs on health
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Conduct trainings for providers and stakeholders, including First 5 and county, on ACEs screening
- Develop a First 5 ad hoc committee to explore implementation of ACEs education for families with young children
- Increase ACEs awareness through a series of trainings on health equity, diverse populations, and cultural sensitivity presented by community organizations and health care providers
- Deploy an ACEs Aware public education campaign utilizing social media and print materials to educate the community
- Educate community partners and school districts on the importance of ACEs screenings and impact of ACEs on youth and adults
- Facilitate home visits to share educational information and resources about mental health and substances to support parents, youth, children, and families
ACEs Screening and Interventions
Promote screening for ACEs to support detection and interventions that aim to improve quality of life and health outcomes
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
ACEs Screening:
- Provide trauma transformed training sessions for staff to build capacity to identify ACEs risk factors and increase knowledge of resources and referral process to obtain supportive services
- Public Health Nurses in Home Visiting Program in collaboration with community-based organizations:
- Provide education to identify and prevent ACEs and build health resiliency
- Plan and implement ACEs screening
- Implement ACEs screening within other programs (e.g., Targeted Case Management program)
ACEs Interventions:
- Engage in ACEs program planning and implementation in collaboration with partners such as First 5, health services, and community partners
- Utilize a Therapeutic Child Care Center, with the support of a Clinical Psychologist and a Mental Health Therapist, to screen for ACEs to break the cycle for children ages 0-3 and families who have experienced ACEs
- Coordinate and integrate child serving systems, including regional centers, education, behavioral health, child welfare, and probation
- Collaborate with the Office of Education and Behavioral Health to establish a Wellness in Schools Program to coordinate and expand school based mental health services
- Create a Children’s Crisis Stabilization Unit (CSU) to provide community-based, mental health focused response and support without law enforcement intervention
- Partner an alcohol and drug prevention team with schools to review ACEs screenings data to develop youth programming and services
- Apply a Trauma Informed Approach for home visits by the Maternal Child Adolescent Health program
- Provide access to healing pathways therapeutic centers and sessions to apply a trauma informed approach to care delivery
Promote Positive Childhood Experiences (PCEs):
Advance solutions that build PCEs to drive healthy development and mitigate effects of ACEs
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Promote caring relationships with parents, teachers, counselors, or others actively involved in a child’s life
- Provide programs and services to build skills in practices such as mindfulness, goal setting, positive coping, and conflict resolution
- Support safe, stable, and nurturing relationships and environments
- : Utilize health promotion activities to improve awareness of mental and behavioral health care services and resources
- : Provide access to services and resources to address mental and behavioral health needs and build resilience
- : Provide prevention and intervention services for people experiencing harmful use and effects of alcohol and/or other substances
- : 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
Mental Health Awareness
Utilize health promotion activities to improve awareness of mental and behavioral health care services and resources
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Design campaigns and events featuring diverse and culturally competent providers and speakers to reduce the stigma of mental and behavioral health services
- Provide awareness and education around the health impact of collective trauma (e.g., pandemic, racism, violence, etc.) for communities
- Collaborate with mental health care partners to develop a comprehensive equity assessment of the local mental health system of care (services) to identify community needs and gaps for use in evidence-informed planning/assessment
- Increase school-based mental health awareness and services for youth by educating school staff, students, and parents of available behavioral health services for students
Services and Resources
Provide access to services and resources to address mental and behavioral health needs and build resilience
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Access to Services:
- Facilitate access to mental health services via navigation assistance and a resource outreach map and referral directory
- Support behavioral health services shift from face-to-face visits to telehealth care and deploy home-based portable telehealth equipment
- Establish a front porch program that provides culturally competent and population-specific mental and behavioral health services and resources
- Connect students and families to counselors, psychologists, and other staff that can assist with mental health development and general health education
- Provide financial assistance and incentives (vouchers, discounts, etc.) for residents to access mental health services
Therapeutic Services:
- Engage with community to practice trauma informed systems and healing circles by leveraging a train-the-trainer model and Promotores addressing health literacy
- Provide mental health therapy and art therapy sessions in partnership with County Behavioral Health Services and Mental Health Services
- Develop an application or online resources for self-help guides and videos for addressing mental health
- Consider key roles such as adding a mental health specialist to the nursing staff to:
- Facilitate minor to moderate mental health treatment
- Act as a liaison with the Behavioral Health department
- Coordinate with Maternal, Child and Adolescent Health (MCAH) Division to improve health and well-being
- Engage older adults to create a plan to address needs for social inclusion and belonging
Services Coordination:
- Utilize funding and community partnerships to support the mental and behavioral health needs of the population through a holistic and wrap-around approach that provides services and reduces stigma associated with treatment
- Co-design a Mental Wellness and Community Resiliency Project with partners to address mental health stigma, long-term disaster recovery and resiliency, and improve access to resources
- Promote cross-program solutions, such as collaborating with cross-sector and community partners to improve park access and safety in disadvantaged neighborhoods to improve mental health and chronic disease outcomes
Prevention and Intervention
Provide prevention and intervention services for people experiencing harmful use and effects of alcohol and/or other substances
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Data and Funding:
- Use surveillance data to advance insight into overdose incidence rates to inform the development and delivery of collaborative prevention efforts that address upstream conditions and risk factors contributing to substance use disorders and overdose
- Align multiple funding sources for alcohol, tobacco, and other drug services to support prevention, harm reduction and treatment
Access to Services:
- Provide comprehensive behavioral health prevention and early intervention services and ensure access to a 24-hour telephone hotline for alcohol or substance abuse support, referral, and resources
- Provide access to telehealth and/or virtual treatment and recovery programs
- Address behavioral health concerns through population specific interventions that provide services and reduce stigma associated with treatment
Tobacco Prevention:
- Deploy a Tobacco Prevention Program with emphasis on community education to empower civic engagement for policy change
- Facilitate a Tobacco Control Program to provide education and advocacy aimed at reducing the impact of tobacco and cannabis products on vulnerable populations
- Engage youth and schools in prevention efforts to support a tobacco free community
Substance Use:
- Coordinate across sectors to assess the risk factors associated with alcohol and other substance use, and relationship to demographics and mental health
- Create an Opioid Prevention/Mitigation Program that provides multilingual services and increases community awareness about Narcan, treatment services and prevention approaches
- Provide alcohol and substance use addiction prevention and intervention support groups and activities that engage communities outside of clinical care
- Coordinate syringe exchange programs (syringe services programs) to provide sterile syringes, collect used ones, and promote health education and care for people who inject drugs
- Increase youth awareness of harm and health impacts related to drug and alcohol use, misuse, and addiction
Crisis Response
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
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Develop a Specialized Care Unit to provide 24/7 mobile support and response to behavioral health crisis calls (mental health and substance use) without the assistance of law enforcement
- Establish a cross-department County Crisis Response Team to increase community capacity through Narcan distribution and building a system to respond to overdose and overdose cluster events
- : Provide outreach and resources to report and prevent child abuse and neglect
- : Provide access to resources and social networks to support people experiencing domestic or intimate partner violence and reduce the factors that place them at risk
- : Provide prevention and intervention services for those experiencing psychological and social factors that may lead to suicidal ideation
- : 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
- : 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
Child Maltreatment
Provide outreach and resources to report and prevent child abuse and neglect
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Partner with community-based organizations to provide child abuse and neglect prevention and outreach, particularly to populations experiencing poverty as well as children with physical or developmental disabilities
- Establish and/or expand secure hotlines, outreach centers, and virtual options to report abuse
- Develop options to reduce or bypass wait times to make a report of abuse or neglect, particularly for mandated reporters
- Utilize a multi-sector approach to integrate child maltreatment considerations into future disaster risk reduction and preparedness planning
- Partner with child welfare service organizations to develop an Emergency Preparedness Policy that describes steps for ensuring the health and safety of foster children, resource families, and child welfare staff https://www.cdc.gov/ncbddd/disabilityandsafety/child-safety.html
Domestic and Intimate Partner Violence
Provide access to resources and social networks to support people experiencing domestic or intimate partner violence and reduce the factors that place them at risk
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Extend reporting and assessment resources to support people who are living in shelters after experiencing domestic and intimate partner violence
- Partner with domestic violence organizations to deploy virtual and in-person classes to increase coping skills and resilience and reduce social isolation and/or dependence on alcohol or substance use or misuse
- Establish referral systems in which health care providers coordinate with social services to reduce social and economic burdens through dissemination of supportive and assistive resources
- Promote increased awareness of local and national telephone hotlines for reporting abuse
- Ensure domestic violence is integrated into response and recovery plans and emergency preparedness strategies
- Partner with domestic violence prevention and behavioral health organizations to deploy classes for people experiencing domestic or intimate partner violence, as well as those who initiate the violence
Suicide and Self Harm
Provide prevention and intervention services for those experiencing psychological and social factors that may lead to suicidal ideation
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Develop media campaigns to promote mental/behavioral health and suicide prevention and support
- Provide resources about stress reduction techniques, including virtual and in-person support groups or workshops
- Perform outreach to people with a history of psychiatric disorders and those experiencing social isolation
- Integrate and coordinate mental health and suicide prevention activities into schools and provide access to counselors for teens who report chronic sad or hopeless feelings
- Ensure access to a 24-hour telephone hotline for speaking with a professional for suicide support, referral, and resources
Youth and School Violence
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
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Utilize approaches to improve the built environment via neighborhood upkeep and housing and school building maintenance to create a sense of community safety
- Develop and implement programs to transform the social environment in schools to create supportive and accepting spaces that promote social connectedness and belonging among students
Community Violence
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
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Develop a community violence reduction strategic plan informed by evidence-based practices, trauma- informed approaches, and equity focused frameworks
- Form a Community Wellness and Violence Prevention Program planning team inclusive of key partners, community members, and public health staff
- Support access to community spaces and activities to develop neighborhood relationships, promote social connectedness, and develop a sense of community belonging
- Deploy a Trauma Prevention Initiative (TPI) that elevates place-based community-driven violence prevention, intervention, and capacity-building strategy to:
- Identify, assess, and reduce the rate of violence in highest need populations
- Evaluate the root causes (such as inequitable access to resources and opportunities) of lack of neighborhood safety
- Create strategies and interventions that focus on addressing the underlying problems rather than solely focusing on policing to mitigate the effects of violence
- Invest in public safety solutions that center survivors, employ peer specialists, and engage community members in decision making about violence prevention and healing interventions
- Coordinate with school and community-based providers and organizations to develop wraparound services to build community support and increase access to community and domestic violence prevention services
- : Implement prevention strategies that address shared risk across multiple health conditions
- : Strengthen health care delivery system policies and infrastructure to support uninterrupted access to treatment for non-communicable diseases (heart disease, stroke, cancer, diabetes, and chronic lung disease) during times of emergency response/crisis
- : Assess population oral health needs and engage in education and outreach to promote preventive care to reduce incidence of oral disease
Advance Cross-Cutting Solutions
Implement prevention strategies that address shared risk across multiple health conditions
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Advance 3-4-50 Model: Prevent three (3) health risk behaviors (unhealthy diet, sedentary lifestyle, and tobacco use) to address four (4) key chronic conditions (cardiovascular disease, cancer, chronic lower respiratory disease, and diabetes) that lead to more than 50 percent (50%) of premature deaths
- Expand health promotion and community engagement activities to populations with high incidence of non-communicable diseases and other risk factors that inhibit access to health care
- Provide lifestyle management skills trainings, individual and group education, and coaching sessions to increase prevalence of healthy choices and habits
- Establish response and recovery plans that include policies to ensure access to improved nutrition and food security, particularly for those with underlying conditions or other factors
- Promote and reestablish pre-screenings and primary care visits
- Utilize the Tobacco Education Program to provide resources and education at schools and outreach events to prevent cardiovascular disease, stroke, emphysema and lung cancer
- Administer the CalFresh Healthy Living Program (Supplemental Nutrition Assistance Program; SNAP-Ed):
- Provide multilingual nutrition education and resources, in schools and other eligible sites, to promote healthy and active living strategies thereby reducing risk and increasing management of chronic disease
- Engage and mobilize community and stakeholders to reduce obesity and chronic disease among low-income populations
- Conduct a Communities of Excellence (CX) Needs Assessment to provide feedback on tobacco-related issues resulting in health impacts and chronic conditions and rating how well intervention activities are working
- Partner with community members and gain support of local decision-makers on policy measures to promote retailer compliance with federal, state, and local tobacco-related laws and decrease access of tobacco to underage youth (e.g., Tobacco Retail License ordinances)
Chronic Disease Management
Strengthen health care delivery system policies and infrastructure to support uninterrupted access to treatment for non-communicable diseases (heart disease, stroke, cancer, diabetes, and chronic lung disease) during times of emergency response/crisis
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Coordinate across sectors to establish and maintain prevention and treatment structures to control risk factors for non-communicable diseases that are preexisting or acquired as a result COVID-19 infection
- Expand health promotion and community engagement activities to target populations with high incidence of non-communicable diseases and other risk factors that inhibit access to health care
- Establish staff roles dedicated to chronic disease prevention to better address diseases that do not currently have a specific funding stream
- Hire staff dedicated to chronic disease prevention to better address diseases that do not currently have funding and investment
- Strengthen relationship with community-based organizations, as trusted messengers, to deliver health education information through capacity building and training of Community Health Workers
- Facilitate the California Children’s Services (CCS) program, which provides diagnostic services, case management benefits, and uninterrupted access to treatment for eligible children who meet requirements and health conditions
Oral Health
Assess population oral health needs and engage in education and outreach to promote preventive care to reduce incidence of oral disease
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Educate health care providers about the impact of oral health on health problems treated in medical settings (diabetes, heart disease, low birth weight) and advocate for integration of medical and dental care
- Collaborate with oral healthcare providers to develop a comprehensive assessment of local oral health to identify community needs and reduce disparities in oral health
- Focus on oral health education in schools to assist with maintaining overall health and wellbeing and keeping kids in school
- Expand oral health program educational outreach activities to include school visits
- Encourage Medi-Cal (Denti-Cal) providers to partner with schools to promote Denti-Cal benefit options, particularly in low-income eligibility service areas
- : Utilize resources to access health care practitioners for diagnostic needs and treatment of communicable diseases
- : 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)
Communicable Disease Management
Utilize resources to access health care practitioners for diagnostic needs and treatment of communicable diseases
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Digitalize communicable disease workflows where data can identify disparities in race and ethnicity
- Provide heath tools to provide access to needed health maintenance services and support patient management, and communicable disease screening and service linkages
- Expand funding and staffing capacity to:
- Support communicable disease prevention, investigation, and mitigation activities
- Ensure workforce cultivates and fosters community relationships with special populations (e.g., LGBTQ+ and justice-involved) disproportionately affected by emerging communicable diseases such as Mpox
- Provide vaccine support and educational materials about prevention in advance of exposure events (e.g., large community gatherings)
- Build workforce capacity to support continued administration of tuberculosis program activities and testing
- Establish a Communicable Disease Unit infrastructure that includes a specialized team for outbreaks and emerging infectious diseases, another team for other Title 17 diseases, and a pool of staff to call upon during a surge
- Coordinate with community-based organizations to provide education through information sharing and trusted messengers to reduce the risk of transmitting and contracting communicable diseases
- Utilize community health workers to provide insight into community needs and disseminate resources to those not able to access digital health tools for service
- Perform surveillance and contact tracing for Mpox and those at increased risk for other communicable diseases
- Use epidemiology reports for response planning and decision making and collaborate with healthcare partners to increase treatment access
COVID-19 Treatment and Post COVID and Long COVID Conditions
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)
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Deploy “Path to Zero” as a COVID-19 treatment strategy to reduce and eliminate “preventable” COVID-19 deaths by assessing positive individuals and prescribing treatment with particular focus on the most impacted populations
- Leverage the Medical Health Operational Area Coordinator (MHOAC) to support facilitating COVID-19 therapeutics used in clinical care pathways
- Collaborate with medical professionals to develop guidance and educational materials for healthcare providers and patients experiencing post-COVID conditions or long COVID
- Create and/or expand community-based partnerships to provide supplies, resources, education, and referrals to people who lack access to preventive care, treatment, pharmacies, and therapeutics
- Ensure equitable access to treatment by expanding and innovating test to treat options in underserved communities
- Train staff on the latest COVID-19 guidance, prevention, and mitigation strategies to support informed technical assistance, including interventions to address long COVID and promote indoor air quality
- : Provide resources and services for screening, testing, and treatment of sexually transmitted infections (STIs) to reduce risk and transmission
- : Provide services and resources to individuals diagnosed and living with HIV/AIDS
- : Provide services and resources to address sexually transmitted infection rates particularly in areas with high disease burden
Prevention and Treatment
Provide resources and services for screening, testing, and treatment of sexually transmitted infections (STIs) to reduce risk and transmission
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Utilize key staff roles such as a dedicated public health nursing/STI investigation workforce to address STIs and prevention-related activities in a culturally and linguistically competent manner responsive to community needs
- Ensure STI programs promote education and preventative behaviors to reduce the spread of STIs, while also offering resources for testing (including home testing kits), treatment, counseling, partner notification, and referrals for those diagnosed with STIs
- Collaborate with medical providers, clinics, government, and community-based agencies to create guidance that supports:
- Maximizing STI treatment options (e.g., telehealth services) during disruptions to the health care system when in-person visits are not permissible
- Establishing partnerships with other clinics to cover patient overflow in the event of clinic closure, reduced staffing, or limited appointment availability
- Prioritizing patients that may experience complications and populations disproportionately affected by STI infection or outbreaks
Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS)
Provide services and resources to individuals diagnosed and living with HIV/AIDS
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Provide HIV testing (at no cost) and treatment to people experiencing unstable housing
- Provide housing, food assistance, and support services for individuals and families living with HIV/AIDS
- Utilize multi-county regional HIV care and treatment program approaches focused on support for community members experiencing higher risk, including injection drug users
- Utilize an HIV specialist to perform outreach and provide HIV specialty care and monitoring for co-infections for residents
- Implement a Linkage and Re-engagement Program (LRP) to identify, locate, and re-engage clients living with HIV and unable to access treatment or care on their own:
- Utilize health navigators and Clinical Social Workers to facilitate locating and following up with clients with challenges accessing HIV medical care
- Train staff in motivational interviewing techniques to reengage clients facing barriers and/or lack of responsiveness to service providers or medical care
- Facilitate a warm hand-off to clinics and Medical Care Coordination teams to meet a client’s complex needs
- Provide access to services and resources to recently diagnosed and those living with HIV/AIDs or sexually transmitted infections to address mental and behavioral health needs and build resilience
Other Sexually Transmitted Infections (STIs)
Provide services and resources to address sexually transmitted infection rates particularly in areas with high disease burden
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Establish and deploy a mobile unit to increase access to STI testing and services throughout areas with high prevalence of disease transmission
- Address incidence of syphilis and gonorrhea, especially in communities experiencing high rates of illness and disparities
- Ensure pregnant women, diagnosed with congenital syphilis, are treated and receive newborn monitoring
- Collaborate with the California Department of Public health and local clinics on congenital syphilis prevention serving pregnant women who have not accessed prenatal care
- : Collaborate across partners to address complex health challenges that impact animals, humans, and the environment
Support a One Health Approach
Collaborate across partners to address complex health challenges that impact animals, humans, and the environment
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Build and strengthen collaborative working relationships between human, animal, and environmental health partners to identify and address emerging, re-emerging, and endemic zoonotic diseases, neglected tropical diseases, vector-borne diseases, antimicrobial resistance, food safety and food security, environmental contamination, climate change and other health threats shared by people, animals, and the environment
Domain Three: Structural and Social Determinants of Health
- : Leverage and strengthen the social safety net to provide access to benefits and financial support to individuals and families experiencing economic burden and poverty
- : 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
- : 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
Supplemental Funding and Resources
Leverage and strengthen the social safety net to provide access to benefits and financial support to individuals and families experiencing economic burden and poverty
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Utilize supplemental payments and gift cards for gas and food to help families in need overcome economic burden
- Utilize Guaranteed Basic Income Programs for groups that have been marginalized as a means to support the basic needs of recipients, develop self-efficacy of individuals/families, and improve health and wellness outcomes
- Evaluate the unemployment application system and benefits to improve processing and coverage during extended periods of job loss and economic crisis
- Promote expansion of paid sick and family leave benefits
- Provide childcare vouchers for essential workers and vulnerable and low-income populations
- Extend access to assistance services that address people experiencing greater burden of job losses, income reductions, and increased unpaid care work
- Promote health and policy protections (e.g., portable benefits) for those working in temporary employment, contract, and gig workers, including domestic workers, by partnering with community organizations
- Provide financial literacy training and connect individuals and families to local Community Development Financial Institutions (CDFIs) to support financial development
Employment and Job Development
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
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Job and Pay Analysis:
- Conduct pay equity studies on positions to identify disparities in compensation
- Collaborate with partners (e.g., state agencies, community organizations, business leaders, unions and worker organizations, and researchers) to create a range of policy tools and resources to improve job quality (e.g., California Job Quality Index (JQI) and California Job Quality Incubator)
Workforce Development:
- Develop, contract or partner with a homeless center job development program to provide jobs to reintegrate people experiencing homelessness into the workplace
- Develop a Youth Pipeline job program to develop work skills and career goals to expand opportunities for employment
- Engage in youth workforce and capacity building by putting youth in leadership positions and boomerang models (go to college and come back to live and work) to add value to their communities
Workers’ Rights and Protections:
- Partner with organizations and coalitions to:
- Address racial and gender equity to support and expand essential workers equitable access to jobs that pay living wages in a safe and healthy work environment
- Create supports and structures to ensure working conditions that promote health and safety (e.g., unions and associations)
Community Health Investment
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
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Coordinate economic investment opportunities that incorporate public, private, non-profit, and health system partners to identify community health needs and address resource gaps to ensure equitable access to health services and resources
- Utilize zip codes to identify health innovation zones where disparities are prevalent, and identify strategic interventions to address place-based disparities and inequities
- Identify and develop sustainable funding for community-driven health education, outreach, and engagement that leverages innovative approaches beyond traditional funding mechanisms
- Develop and deploy community development strategies and interventions to address the impact of socioeconomic factors on communities in geographic areas (e.g., rural) experiencing barriers impeding achievement of optimal health and wellness
- Allocate resources (staffing, testing, education, and funding) to communities experiencing disadvantage (e.g., limited access to health services, food insecurity)
- : Expand and/or provide housing support for people experiencing housing related economic burden
- : Expand and/or provide housing options for people experiencing chronic homelessness
- : Provide education, supplies, and services to support the basic needs of people experiencing chronic homelessness
Housing Assistance, Affordability, Rights, and Protections
Expand and/or provide housing support for people experiencing housing related economic burden
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Utilize Eviction Protection Program approaches for those on the verge of experiencing homelessness or housing insecurity
- Provide case management and housing navigation services to support moving people who are not securely housed to permanent housing
- Provide rental and utility assistance to eligible people with lower incomes and people experiencing unstable housing
- Promote programs such as UndocuSupport to provide economic relief for undocumented immigrants and other immigrant families, such as rental assistance, utility payments, transportation, groceries, and health need to provide economic relief
- Incorporate a public health awareness into the City General Plan to include how public health intersects with housing policy and homelessness
- Implement a Continuum of Care (CoC) Program as a collaborative effort in which multiple partners and funding sources come together to address housing and homelessness
Housing Support for People Experiencing Homelessness
Expand and/or provide housing options for people experiencing chronic homelessness
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Leverage non-congregate shelter options available such as Project RoomKey and Project HomeKey to support leases, operational costs, and cleaning
- Research current capacity and explore expansion of congregate shelter capacity to provide alternative housing models for people experiencing unstable housing
- Provide case management and housing navigation supportive services to move people who are not securely housed to permanent housing
- Provide transitional and supportive housing, and other resources to people who were incarcerated
- Participate in housing partnerships with the health department, local government, and community-based organizations to provide more housing options, including affordable housing residences for older adults
Outreach and Resources
Provide education, supplies, and services to support the basic needs of people experiencing chronic homelessness
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Utilize a collective impact approach to addressing health and economic disparities for people who are not securely housed:
- Establish and implement a closed loop referral system to address unmet needs for medical, mental health, food insecurities, housing, etc.
- Partner with the city and others to administer public health services for medical screening, infection control, and disease management, and mental health support
- Deploy Homeless Outreach Teams into the streets to provide hygiene supplies and provide supportive education on how to prevent the spread of infectious diseases
- Communicate with local homeless service partners to identify priorities and incorporate California Advancing and Innovating Medi-Cal (CalAIM) process for Enhanced Care Management and Community Supports
- Partner with CalWorks and a homeless services program on Guaranteed Income Initiative strategies
- Leverage local Coordinated Entry System Outreach Team models, local advisory boards, and peer health educators to prioritize outreach venues and services to ensure equitable access for people experiencing homelessness
- : Improve access to nutritious foods to promote healthy eating for those demonstrating medical need, economic disparities, and/or isolation
- : 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
Access to Healthy Food
Improve access to nutritious foods to promote healthy eating for those demonstrating medical need, economic disparities, and/or isolation
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Engage and align with existing food systems’ groups and organizations to increase access to healthy food options and retailers
- Include access to more community farm fresh outlets through CalFresh Program (Supplemental Nutrition Assistance Program; SNAP-Ed)
- Provide meals and support programs based on specific dietary needs or restrictions, cultural practices, and/or medical need
- Establish a food security coalition that coordinates summer lunch programs and food pantry implementation and restocking and provides education in areas impacted by food deserts
- Provide a sustainable means to bring fresh produce to outlying areas with limited food resources and healthy options
- Collaborate with homeless shelters, schools, and churches to redistribute wholesome and healthy food that would otherwise be thrown away
- Create collaboratives between the county’s Cal-Fresh Healthy Living, Women, Infants, and Children’s programs and Family Resource Centers to provide access to healthier foods and meal options to individuals and families
Food Assistance
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
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Increase utilization, quantity and/or frequency of home delivered meals, for people with lower incomes and older adults
- Identify opportunities to transition congregate meal clients to be served through a to-go or home delivery food service
- Implement approaches such as a Vouchers 4 Veggies Program (V4V) and/or Produce Prescription Project (PPR) to support lower income families’ consumption and purchase of fresh fruits and vegetables at participating grocery stores
- Partner with local farms to get “Farmbuck” which gives CalFresh participants additional funding to obtain local grown nutritious food
- Offer free cooking classes with healthy meal recipes for communities with lower incomes
- Coordinate local food bank efforts to identify and educate communities on food support options
- Coordinate with shelters and local food banks to promote improved access to formula
- Provide nutritional guidance and health education support for Women, Infants, and Children (WIC) recipients that aligns with the family’s feeding practices (breastfeeding or formula feeding)
- Increase CalFresh utilization and participation in education and outreach events via the following strategies:
- Promote CalFresh awareness to increase food security
- Work with CalFresh Alliance to reach out to Medi-Cal recipients not enrolled in CalFresh
- Review “My Benefits CalWin” data on approvals and denials to troubleshoot barriers to online application process
- Work with community-based organizations to integrate GetCalFresh.org as an alternate application method
- Work with local school districts and colleges to promote CalFresh enrollment for families and students
- : Provide access and referrals to housing, financial, medical, dental, and mental and behavioral health services
- : Provide access to health care providers and models of care beyond the traditional health care delivery system
Wraparound Services
Provide access and referrals to housing, financial, medical, dental, and mental and behavioral health services
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Develop or leverage a 24-hour free call center and online support that disseminates information and referrals to housing, financial assistance, food, clothing, behavioral and medical care, etc.
- Implement a Systems of Care (SOC) to provide wraparound access to services which includes housing, health referrals, dental, oral health, tobacco cessation, substance use treatment, and mental health services
- Partner and collaborate across sectors to bring medical and mental health services and supplies to populations to meet the emerging and ongoing needs of communities
- Coordinate with multi-sector partners to provide resources and education to assist with navigating “safety net” systems (such as Supplemental Security Income, general assistance, Medi-Cal, and CalFresh) that support basic needs
- Develop or leverage virtual platform tools for appointments and medical care to make resources and treatment, care coordination and continuity of care services accessible, particularly for medical care, social needs, and behavioral health clients enrolled in the Women, Infants, and Children (WIC) and California Children’s Services (CCS) programs
- Engage the community and Tribes in co-designing Community Information Data Exchange systems (Health Insurance Portability and Accountability Act (HIPAA) compliant-based platform) that integrate data across sectors such as health care and social services to enable providers to coordinate services and share information to improve health and wellness for underserved communities
- Utilize a standardized screening tool, such as the Center for Medicare and Medicaid Services (CMS) Accountable Health Communities (AHC) Health-Related Social Needs Screening Tool, to identify health-related social needs that can be addressed by treatment planning and/or referral to community services
Expand Health Care Access
Provide access to health care providers and models of care beyond the traditional health care delivery system
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Leverage mobile health unit approaches to increase access to health care and mental health services to older adults and residents with limited resources, geographic isolation, illness and/or mobility challenges
- Increase awareness of financial assistance services provided by hospitals to reduce financial barriers to seeking medical treatment
- Connect people with lower incomes to Federally Qualified Health Centers (FQHCs)
- Continue existing telehealth programs and expand telehealth options to increase access and reduce costs associated with services
- Utilize a mobile health van to provide oral health screenings, physical health care, immunizations, and other services to people who are underserved and remote areas of the county
- Build workforce capacity informed by local community experience (e.g., hire community members to promote health education and support mobile clinic operations with key populations in lowest-Healthy Places Index areas of focus)
- : Provide direct care to children, older adults or people living with a short- or long-term condition that requires support and assistance
- : Develop and implement strategies to address inequitable health outcomes for groups of people with common risks and unique needs that require special consideration
Caregivers and Supports
Provide direct care to children, older adults or people living with a short- or long-term condition that requires support and assistance
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Leverage and maintain assistance services that address inequality of caregivers experiencing higher risks of job losses, income reductions, and increased unpaid care work
- Address support needs of caregivers who have not experienced job loss but are still in need of flexibility for caregiving support (flexible work hours, additional paid leave, supportive work environment/policies, etc.)
Support the Needs of Special Populations
Develop and implement strategies to address inequitable health outcomes for groups of people with common risks and unique needs that require special consideration
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Conduct analyses and implement interventions to identify and address the unique needs of populations experiencing long-standing disparities and inequities
- Follow case management protocols with focus on populations facing the greatest impacts
- Provide access to culturally competent services to populations including but not limited to the following activities:
- Work with disability advocacy groups for people with disabilities to access care and support service needs
- Ensure bilingual points of contact are available for questions from the public
- Leverage funding to support the development and sustainability of public health programs, services, and dedicated staffing for special populations such as people of color, LGBTQ+, older adults, and people with disabilities
- Develop focused outreach and interventions for Indigenous Mexican communities and provide Mixtec Cultural Awareness training and interpretation services for Mixteco and Zapotec languages
- Coordinate with local Community-Based Organizations (CBOs) to address the unique needs (language, culture, geographic, economic, and access) of the food and agriculture industry and communities
- Collaborate with local partners and CBOs (trusted messengers) to educate about special populations via capacity-building equity trainings that increase awareness and access to services
- Work with community organizers to engage special populations to increase capacity for civic participation
- Utilize Promotores/Community Health Workers (CHW) to identify and address the needs of special populations, such as people experiencing homeless, LGTBQ+, people with disabilities, and/or older adult communities
- Engage in efforts to improve social determinants to promote healthy living by identifying population characteristics among people experiencing homelessness, displaced veterans, Black, Indigenous, and people of color (BIPOC), and LGBTQ+ communities
- Promote the rights of individuals in special populations who are most vulnerable (older adults, individuals with disabilities)
- Develop educational resources and communications to promote awareness of and mitigate discrimination against people with disabilities, and older adult populations
- Address the unique needs of justice-involved individuals to maintain continuity of care during transitions into incarceration and later release
- Address the needs of people who have Limited English Proficiency (LEP), are hard-of-hearing/deaf, and those who are visually impaired/blind through activities such as:
- Conduct an environmental scan to determine LEP populations to provide language assistance services and resources
- Develop and ensure the organization’s Language Access Plan and Policy is inclusive of the needs of the LEP population
- Prioritize efforts to address needs of LEP groups disproportionately impacted by COVID-19 and related socioeconomic consequences of the pandemic
- Address key staff roles such as a full-time interpreter and translator to provide language assistance services
- : Support efforts to embed equity in the policies and practices of learning environments.
- : Promote programs and resources to support whole child wellness in learning environments
Equity in Policies and Practices
Support efforts to embed equity in the policies and practices of learning environments.
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Promote diversity, equity, and inclusion in the educator workforce
- Provide training and resources to support capacity building on diversity, equity, and inclusion principles, including: building awareness of implicit bias, strengthening cultural competence, non-exclusionary discipline strategies, and inclusive teaching approaches
Integrated Services and Supports
Promote programs and resources to support whole child wellness in learning environments
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Social Supports and Resources:
- Ensure meal availability and access to healthy food for children through in-school, to-go, and home delivery options during school hours and summer programs
- CalFresh Healthy Living Program coordination with school wellness committees to:
- Strengthen the wellness policy and its implementation
- Guarantee nutritious food availability in early childhood and student education settings
- Coordinate with schools and childcare programs to provide resources and education through programs such as CalFresh Healthy Living, California Tobacco Control Program, Oral Health, Maternal, Child, and Adolescent Health, First 5, Safe Routes to School, and substance abuse block grants, etc.
Economic Resources:
- Leverage Childcare Provider Income Program approaches to support childcare providers offering essential services to local families during emergency response
- Partner with childcare workers and early childcare organizations to increase availability of affordable, accessible early childhood care, preschool, and after school programming for people with lower- and middle-wage incomes
- Identify opportunities and resources to support improving indoor air quality in schools (e.g., improvements to HVAC systems, use of portable air filters) to reduce exposure to airborne pathogens and pollutants
- Identify strategies and resources to provide infection prevention supplies to smaller school districts
- Leverage supplemental payment models to support short-term residential therapeutic program (STRTPS) providers that support childcare, distance learning, and foster youth
Education and Mentor Support:
- Provide programming related to college and career resources for youth to expand equitable access to educational and economic opportunities
- Leverage existing school programs and community and business leaders to mentor youth to connect with opportunities to improve outcomes
- : Assess risks and vulnerabilities of the built environment (homes, workplaces, and public spaces), and incorporate equity concepts into activities to address environmental needs
- : Embed health equity considerations into climate change mitigation activities and adaptation policies and plans to address inequitable impacts on communities and enhance resilience to environmental threats and conditions
- : Promote programs and interventions that increase technology and internet access and availability to support equitable access to education, outreach, and services
Access to Healthy Built Environments
Assess risks and vulnerabilities of the built environment (homes, workplaces, and public spaces), and incorporate equity concepts into activities to address environmental needs
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Policy and Planning:
- Coordinate a Healthy Communities Work Group to incorporate equity concepts into the built environment to make health-related evidence-based recommendations to inform policy and planning
Neighborhood Health and Safety:
- Evaluate neighborhoods’ built environment and apply environmental justice strategies to improve safe and equitable community access to outdoor places (green spaces and parks), affordable transportation, protected bike lanes, grocery stores
- Build a coalition of partners to address food desert areas in vulnerable communities by recovering and redistributing surplus food thereby increasing equitable access to affordable and nutritious food
- Develop or leverage urban forestry programs that focus on hosting neighborhood and park tree planting events to ensure the creation of a green canopy for urban spaces
Housing:
- Encourage housing development models that create more walkable and socially connected communities
- Evaluate communities’ housing composition (apartments, constructed houses, manufactured houses, mobile homes, etc.) and heating/cooling systems to identify those most vulnerable to extreme weather events to build capacity and resiliency
Transportation:
- Engage older adults and rural community members to create a workplan to address transportation needs and challenges to reduce social isolation
- Reduce transportation barriers by promoting access to affordable and convenient public transit, encouraging workplace and neighborhood carpooling, and affordable rideshare service through partnerships with local government
Environmental Health:
- Partner with local environmental organizations to engage community members in stewardship activities to address the potential health impacts on communities by:
- Monitoring environmental quality to improve air, water (including water fluoridation), soil, and building materials
- Identifying environmental hazards to reduce pollutant exposure and increase access and utilization of affordable renewable energy
- Make potable water and additional support services available for residents impacted by drought and loss of water access in homes
Climate Change
Embed health equity considerations into climate change mitigation activities and adaptation policies and plans to address inequitable impacts on communities and enhance resilience to environmental threats and conditions
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Appoint a dedicated climate change policy leader to guide the jurisdiction efforts to better prepare and protect residents from the health impacts and effects of climate change
- Assess climate vulnerabilities, impacts, and resources through a health equity and environmental justice lens to ensure the adaptation policies and plans are responsive to diverse needs and changing environmental conditions
- Contribute to the County’s General Plan by reviewing and providing input into policies, goals, and actions that address climate change and develop a county climate policy that incorporates community participation
- Develop extreme heat and wildfire smoke response plans that include well-ventilated and accessible cooling centers
- Provide assistance and resources to support recovery, response, and rebuilding efforts following climate disasters
- Participate in regional workgroups to leverage climate preparedness funding including Strategic Growth Council’s Regional Climate Collaborative grant
Digital Equity
Promote programs and interventions that increase technology and internet access and availability to support equitable access to education, outreach, and services
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Technology Infrastructure:
- Address technology infrastructure disparities by developing strategies for increased investment and creating partnerships with businesses and non-profits to provide equipment in under resourced populations, localities, and education systems that lack full participation in the digital landscape
- Partner with the California Emerging Technology Fund (CETF) and California Department of Technology (CDT) to reduce digital divides in broadband for rural and remote areas, urban disadvantaged communities, and people with disabilities
Technology and Internet Access:
- Promote awareness of the Affordable Connectivity Program (ACP) to subsidize internet and internet-connected device costs for people with lower incomes and households with incomes below the federal poverty level
- Increase computer, digital device, and internet access to support and expand opportunities for social engagement, digital information, remote education and work, telehealth, and utilization of electronic related healthcare and social services systems
- Increase access to assistive technologies to support people with diverse learning styles and people with developmental and/or physical disabilities
- Collaborate with local leaders and public health practitioners to determine the health impacts of lack of broad band service
- Coordinate with libraries and local governments to protect internet access in public spaces for people without access to personal computers or internet, including people experiencing homelessness
Support and Technical Assistance:
- Provide culturally responsive and linguistically appropriate digital literacy skills training through peer Digital Navigator programs to older adults, justice-involved populations, and groups that have been marginalized
- Provide technical support and resources to bridge youth and intergenerational households by encouraging youth to teach older adults how to utilize technology
- Support access for older adults to technology equipment and/or training to access Telehealth services from remote and rural locations
- Partner with community organizations and trusted local messengers to provide technical assistance to program participants to support transitions from in-person to online service delivery
- : Declare racism as a public health crisis and address the impact of race-based inequity
Elevate Racism as a Public Health Priority
Declare racism as a public health crisis and address the impact of race-based inequity
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Policy and Planning:
- Leverage policy and communication approaches, such as a resolution to be adopted by local policymakers (e.g., Board of Supervisors), declaring racism as a public health crisis
- Develop and implement a department-wide racial equity strategic plan to drive institutional and structural change
- Include people of color in strategic goal planning, data collection, strategy development, and health status reporting
Organizational Capacity:
- Strengthen organizational capacity to better understand racism, how it intersects with other health inequities and can be at the forefront of trauma for families and populations
- Ensure anti-racist results-based accountability (RBA) work includes equity-centered principles to reframe impact through an equity lens to overcome structural barriers
- Participate in the Government Alliance for Racial Equity (GARE) initiative and have a leadership-level workgroup to address racial equity issues
- Establish a workgroup to review and collect data to identify potential racial equity implications of organizational hiring practices
Staff Training and Development:
- Utilize trainings to explain the organization’s equity vision and broaden staff capacity to support systematic and structural change to advance racial equity
- Facilitate implicit bias, anti-racism, and bystander intervention trainings for health care workers to mitigate systemic racism in medical settings
- Facilitate staff meetings to provide a space to identify strategies on how public health can address systemic racism and discuss opportunities for action
- Establish a Diversity, Equity, and Inclusion (DEI) Team and assemble staff affinity groups to increase fairness, justice, and equitable programs and practices within the workplace
Domain Four: Equity Infrastructure
Workforce and Capacity Building
Organizational Policies and Practices
Accountability and Performance Management
Governmental Policy and Planning
Assessment and Surveillance
Cross-Sector Partnerships for Health Improvement
Community Power Building and Partnership
Health Education, Communications, and Outreach
- : Recruit, hire, and retain a workforce that reflects the populations served
- : Establish an Equity Lead and/or other staff positions dedicated to advancing equity throughout the organization via capacity building initiatives and activities
- : Provide equity-focused training, development, and support to cultivate an inclusive workplace culture
Diverse and Inclusive Workforce
Recruit, hire, and retain a workforce that reflects the populations served
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Recruitment and Hiring:
- Incorporate a diversity, equity, and inclusion statement on job descriptions to demonstrate the importance of this organizational core value
- Expand reach of job postings by advertising on multiple platforms (mailing lists, websites, etc.) to broaden reach to a diverse applicant pool
- Improve hiring processes to reduce the administrative burden (redundancies and lengthy procedures) associated with the job application process
- Provide staff with guidance and resources about biases to ensure equitable practices occur throughout the hiring process
- Hire dedicated community health assessment and improvement plan staff to identify and prioritize population health needs
Onboarding and Retention:
- Streamline new employee onboarding processes to reduce barriers and include equity building concepts and terminology
- Promote accountability and transparency using a data dashboard to show the demographic characteristics of the organization’s staff
- Expand organizational capacity to support an inclusive workforce with capability to respond to public health emergencies with cultural sensitivity and humility across diverse communities
- Establish an upward mobility program to support promotion and career advancement opportunities for entry level positions
Dedicated Equity Staffing and Capacity
Establish an Equity Lead and/or other staff positions dedicated to advancing equity throughout the organization via capacity building initiatives and activities
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Hire a designated Equity Officer or Equity Lead with authority to ensure equity is prioritized and meaningfully carried out throughout the organization
- Establish offices or programs to set equity goals, monitor progress, identify successes and barriers, and advocate for/allocate resources responsive to equity needs
- Create Equity Liaison roles across the organization to promote alignment, coordination, and integration of equity principles across policies, programs, and services
- Identify sustainability resources to retain staff trained in health equity to address organizational inequities through equity goals and action plans
- Establish a Health Equity Fellowship that recognizes lived experience as qualifying expertise
- Establish and/or expand the scope of an Equity Action Team or Health Equity Workgroup to provide input/insight into community social determinant of health issues
Training and Development
Provide equity-focused training, development, and support to cultivate an inclusive workplace culture
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Hire a training officer to ensure equity trainings are delivered to advance staff equity knowledge and understanding
- Build an inclusive and trauma informed workplace culture that is responsive to staff needs and includes input from employee affinity and resource groups
- Provide equity-focused webinars, resources, and training for leadership, staff, Promotores, and community-based organizations
- Provide staff opportunities to engage in structured dialogue and peer learning sessions that support reflection, discussion, and normalization of equity-related content
- Provide workforce development opportunities for public health staff to further develop capacity to deliver equitable services
- Participate in equity-focused initiatives such as an Equity Task Force, Government Alliance on Race and Equity (GARE), and Justice, Equity, Diversity and Inclusion (JEDI) committee to prioritize racism and health equity within the organization
- : Assess organizational equity capacity by identifying and evaluating the level of equity integration into the organization’s infrastructure, culture, and communication
- : Establish an infrastructure and culture that values diversity of thought and supports equal opportunities to provide feedback and participate in decision making
- : Assess barriers to funding and resource allocations and implement solutions that support and advance diversity, equity, and inclusion
Organizational Equity Assessment
Assess organizational equity capacity by identifying and evaluating the level of equity integration into the organization’s infrastructure, culture, and communication
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Administer the California Department of Public Health Organizational Assessment for Equity Infrastructure
- Conduct an organization wide equity assessment including listening sessions (staff and community partners), focus groups, and interviews to determine priorities to address within strategic planning and organizational policies and practices
- Conduct Root Cause Map Analysis (e.g., 5 WHYS) on health equity with local health department leadership
- Co-develop health and equity analysis tools with staff and community partners
- Perform environmental scan of organization’s use of Promotores/Community Health Workers to support health education and prevention efforts in communities
- Collect feedback on community satisfaction with organizational equity efforts and utilize recommendations to inform policies and practices
Inclusive Decision Making
Establish an infrastructure and culture that values diversity of thought and supports equal opportunities to provide feedback and participate in decision making
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Apply a health equity lens and promote and support transparency and inclusion in decision making by:
- Distributing communications about plans, explaining policy changes, and soliciting input from impacted staff
- Establishing organizational commitment and leadership buy-in to reduce structural, institutional, and systemic barriers to equity
- Build safeguards into decision making processes to:
- Protect against institutional inertia influencing decisions (e.g., maintain status quo)
- Orient decision making toward systems-level change
- Create safe and protected spaces for staff to provide feedback about policies and practices without reprisal
Funding and Resource Allocation
Assess barriers to funding and resource allocations and implement solutions that support and advance diversity, equity, and inclusion
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Funding Methodology and Distribution
- Ensure departmental and programmatic financial analysis and budgeting incorporates an equity lens to determine impact of fiscal decisions on communities served, particularly for populations experiencing disparities and inequities
- Conduct an equity analysis of resource utilization and planning to identify key issues such as:
- Adjust funding allocations in response to inflation
- Sustainability planning to stabilize resource streams that support community-based organizations with capability to address specialized needs (e.g., engagement and services lowest quartile Healthy Places Index equity zip codes)
- Assess the role of direct assistance grant programs during emergencies or to address ongoing social determinant conditions, financial assistance support for rural and farmworker families to reduce health disparities; assistance grants for local and small businesses
- Planning for costs incurred by partners in key sectors engaged to address health needs (e.g., domestic violence providers, agency needs and costs incurred for health-related expenses; medical sheltering sites leases and operational costs)
- Analysis of funding levels for population health issues in comparison with highest community burdens and disparities
- Identify opportunities to simplify, clarify, and reduce the administrative burden of contracting and grantmaking processes, and implement solutions to address barriers
- Provide training, technical assistance, and support to underrepresented applicants who are new to contracting and grantmaking processes
- Leverage fiscal intermediaries where appropriate to handle administrative tasks associated with contracting to reduce the workload for local partners
- Develop and share strategies to obtain stable and consistent funding to ensure continuity of equity work
- Build mechanisms into contracts and grants to compensate individual community members for time and expertise
- Expand and enhance contracting strategies to support increasing the diversity of agencies participating in the contracting process
- Contract with non-profits to support partner collaborations for underserved populations
- Enforce vendor and contractor adherence to same equity practices/policies of the organization
- : Integrate equity principles into the organization’s plans, policies, and programs
Embed Equity Principles
Integrate equity principles into the organization’s plans, policies, and programs
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Ground equity work in the 10 Essential Public Health Services, Foundational Public Health Services – Foundational Capabilities, and Public Health Accreditation Board (PHAB) standards and measures to sustain equity efforts as a fundamental tenet of public health practice
- Ensure equity principles are reflected in policies, procedures, and resources relevant to all staff (employee handbook, onboarding trainings, etc.)
- Establish processes, such as a health equity checklist, for integrating equity principles into programmatic policies
- Develop an agency wide Workforce Development Plan dedicated to building equity capacity by strengthening workforce policies and practices
- Develop and operationalize a Health and Racial Equity Action Plan to improve systems and alignment of health equity assessment and strategic planning
- Implement a Policy Review Committee to engage in analysis when updating and embedding equity into organizational plans, policies, and procedures
- Maintain a current Strategic Plan and Community Health Assessment and Improvement Plan (CHA/CHIP) with particular focus on integrating health equity:
- Facilitate a community and partner-led CHIP to address root causes of health, economic, and racial inequities, and drive activities around health equity
- Update the CHIP to:
- Reflect pandemic impacts
- Apply a health equity lens to identify and prioritize community needs
- Ensure goals, objectives, and strategies address disparities identified throughout the pandemic
- Develop and implement an Equitable Recovery and Resilience Plan
- : Incorporate equity principles in policy and planning
Effective Public Health Policy
Incorporate equity principles in policy and planning
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Develop shared policy agendas comprised of mutually selected policies, practices, and/or programs that address high priority public health issues
- Work with cities to include public health considerations in Master Plans
- Form planning structures (e.g., Justice, Equity, Diversity, and Inclusion Commission) to guide efforts to examine existing and new policies and actions with equity and public health lenses
- Promote awareness of the social determinants of health among policymakers and emphasize the importance of addressing upstream factors to advance health equity
- Build on Health in All Policies work, across sectors, particularly in the context of emerging opportunities and challenges (e.g., climate change)
- : 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
- : Embed equity in data use, research, and reporting, and develop and utilize tools to test data for bias
- : Improve monitoring and reporting on social determinants of health to inform upstream approaches and interventions and increase opportunities to achieve equitable health outcomes
Community Health Assessment
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
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Conduct a county-wide equity-focused Community Health Assessment (CHA) to:
- Evaluate population needs, and capacity related to improving health equity for groups that have been marginalized
- Highlight health disparities and inform development of strategies to improve health outcomes
- Dedicate a data and analysis section (or addendum) of the CHA to pandemic impacts on health disparities and outcomes
- Utilize a collaborative framework of multi-sector teams and community partners to implement Community Health Improvement Plan strategies to reduce health disparities
- Utilize data from the Community Health Assessment (CHA) process to develop a plan that addresses root causes of inequities across the county
Embed Data Equity in Research and Analysis
Embed equity in data use, research, and reporting, and develop and utilize tools to test data for bias
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Data Equity Strategy:
- Promote data standards that support integration of equity into public health policies, programs, and practices
- Develop goals and metrics to address community health disparities and advance equitable health outcomes
- Monitoring health equity data through a dashboard that includes health domains, indicators, and performance measures using models such as Results-Based Accountability (RBA) or other results-based approaches
- Collaborate with partners and communities to use data to inform health promotion guidance and drive upstream approaches to reduce health disparities and inequities
Data Standards of Practice:
- Develop and update Standards of Practice for the collection and reporting of disaggregated data based on demographic characteristics (race and ethnicity, disabilities, and sexual orientation and gender identity)
- Obtain input from internal programs, other county departments, community partners, community-based organizations, advocacy groups, and research institutions
- Ensure privacy protections are in place to prevent reidentification of individuals within data
Data Sharing:
- Create a data sharing process with local partners to track and analyze collective qualitative data and develop shared metrics
- Include qualitative community stories to provide context with quantitative data in reports and dashboards
- Establish partnerships with academic institutions to increase research and data analysis capacity of rural counties
- Engage with regional partners to share data and professional resources
Social Determinants of Health Data
Improve monitoring and reporting on social determinants of health to inform upstream approaches and interventions and increase opportunities to achieve equitable health outcomes
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
Data Tracking and Reporting:
- Identify populations disproportionately affected by health inequities and make disparities more visible and actionable
- Establish tracking and reporting mechanisms that align with funding requirements and best practices in health equity
- Compile data on social determinants for Medi-Cal beneficiaries as part of planning for integrating equity into California Advancing and Innovating Medi-Cal (CalAIM) implementation
Data Informs Decision Making:
- Prioritize and maintain epidemiological capacity and cohesive data collection and analysis to inform staff, partners, and decision making
- Disaggregate data by race and ethnicity and socioeconomic factors to tailor resources and inform program interventions to ensure disproportionately affected populations are served
Data Sources and Platforms:
- Access the Healthy Places Index (HPI) or other compiled data sources (e.g., Let’s Get Healthy California, California Community Burden of Disease Engine, Healthy Communities Indicators, Healthy Places Index, etc.) to provide county-specific visualizations of health burden to aid in determining community needs, priorities, and investments to advance health equity
- Utilize Geographical Information Systems (GIS) to provide visualization and analysis of the State Health Equity Plan Framework’s structural and social determinants of health’s areas of focus to gain insights on place-based disparities
- : Conduct shared analysis and planning to explore root causes of problems and co-develop strategies and solutions
- : 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)
Shared Analysis and Integrated Planning
Conduct shared analysis and planning to explore root causes of problems and co-develop strategies and solutions
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Train and educate community partners and local government to view data and decision making through an equity lens to identify root causes and culturally competent solutions
- Partner with other departments and sectors to pursue collective goals that focus on drivers of health challenges and derive and implement strategies and actions to improve population health outcomes
- Address underlying structural issues and social determinants of health by engaging impacted communities in planning and decision making to ensure initiatives and solutions are relevant and realistic
- Engage advisory groups to recommend priority services, outreach venues, and evaluate progress
Cross-Sector Collaboration
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)
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Build capacity among local stakeholder groups, community-based organizations, and government to identify health and racial equity priorities and implement Health in all Policies in decision and policy making to address persistent inequities
- Establish multi-sector teams to elevate environmental, social, and economic issues, engage in solution-oriented planning, and evaluate impact in disproportionately impacted communities
- Consider diverse partners (hospitals/systems, First 5 California, behavioral health, housing, mental health, social services, Tribal organizations, and more) as champions to support and/or contribute to efforts to advance equity and systems change transformation
- : Establish structures, venues, and forums that develop and support meaningful community partnership and engagement opportunities
- : Build trust with the community/residents through transparent and inclusive communication, respectful co-learning, and leveraging community expertise to inform equitable practices
- : Strengthen partnerships with Tribal entities to support health planning
Community Partnerships
Establish structures, venues, and forums that develop and support meaningful community partnership and engagement opportunities
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Foster community relationships built during pandemic response into partnerships to establish mutually reinforcing goals to serve communities most impacted by inequities
- Develop a Community Engagement and Empowerment Action Plan to create and implement community health action plan projects
- Adopt or expand a community engagement framework utilizing a participatory collective impact approach to produce incremental and sustainable, and solutions-oriented change in the community
- Develop a model for civic engagement groups to increase civic participation and center community voice for an equitable recovery
- Ensure inclusive community representation to understand context and recognize gaps and opportunities for improvement
- Convene town hall meetings and coordinate events at local cultural and resource centers that share information about community resources and services
- Leverage shared resources, qualitative community data, and community expertise to increase participation and project buy-in and compensate community for time dedicated in collaborative activities
- Link Equity Action Team efforts to Community Response Teams to ensure alignment and collective impact to address community needs
- Design a series of community trainings and activities for leadership development and to build capacity for systems change and advancing racial equity
Foster Community Relationships and Resilience
Build trust with the community/residents through transparent and inclusive communication, respectful co-learning, and leveraging community expertise to inform equitable practices
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Acknowledge the historical harms from government and health care institutions that have impacted groups that have been marginalized
- Share power and engage in inclusive decision making to build trust and establish authentic relationships between the local health department and disproportionately impacted communities
- Hold public facing meetings that provide opportunities for community leaders and representatives to provide input on plans and feedback directly to health director, health officer, and equity staff
- Build community coalitions that facilitate engagement, increase cultural competency, and establish partnerships that message the impact of health inequities to departmental health equity staff and program equity champions
- Convene culturally responsive discussion groups in coordination with trusted messengers to gain community input on sensitive topics and identify and elevate community-defined, evidence-based best practices
- Leverage or establish key staff roles (e.g., Health Education Coordinator) to attend community events to gather input for the Community Health Assessment and offer education and resources for public health programs
- Hire community members with lived experience and diverse cultural backgrounds to build trust and lead engagement as an ambassador
Tribal Relations
Strengthen partnerships with Tribal entities to support health planning
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Develop a Tribal Consultation Policy to support meaningful and transparent dialogue, information sharing, and informed decision making between State, Local, and Tribal governments
- Establish Memorandum of Agreements (MOAs) with Tribal nations to:
- Recognize sovereignty of Tribal nations and their authority over Tribal public health practice
- Allow for open communication relating to testing, pandemics, epidemics, outbreaks, and other communicable diseases
- Consider governance, data sovereignty, and development of an equity statement when:
- Exchanging community information with Tribes and Tribal organizations
- Engaging Tribal leaders and communities through regional coalitions
- : Formulate an equity communication plan, strategy, and/or messaging that is inclusive and responsive to diverse populations
- : Create language access policies, plans, and/or procedures to make information accessible to diverse audiences
- : Increase knowledge of health equity principles to build awareness of health disparities and inequities in impacted communities
Equitable Communication
Formulate an equity communication plan, strategy, and/or messaging that is inclusive and responsive to diverse populations
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Develop guidelines and best practices for equitable communication that address:
- Messaging and scope to ensure information and dialogue is transparent, clear, regular, relevant, and respectful
- Materials and services in languages predominantly spoken in the communities served
- Accessibility for people with disabilities
- Streamlined review and approval processes for media communications to ensure health information reaches audiences in a timely manner
- Develop health literacy toolkits for providers to share with patients and promote health education
- Integrate multiple data sources to develop messaging tools that tell the story of health disparities and structural barriers for people who are underserved
- Coordinate with resource centers and community-based organizations to develop and disseminate health promotion, prevention, and education information that is culturally competent with sensitivity and awareness of diverse populations
Language Access and Cultural Competency
Create language access policies, plans, and/or procedures to make information accessible to diverse audiences
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Create a Language Access Plan and Services Policy that:
- Supports inclusive communication of internal processes and encourages organizational commitment to diverse communication practices
- Standardizes the process for sharing information via development of a style guide to support communication and messaging
- Utilizes innovative and culturally competent approaches to inform diverse communities and partners about public health programs and interventions
- Ensures public health information, communications, and websites are accessible to people with disabilities and meet the language and literacy needs of diverse populations
- Provide language access and cultural competency services via certified translators and interpreters and dual language employees
- Connect individuals with culturally and linguistically appropriate services to develop adult literacy skills
Health Equity Awareness
Increase knowledge of health equity principles to build awareness of health disparities and inequities in impacted communities
Sample Actions
These sample actions have been compiled from the first phases of research and engagement and will continue to be refined with partners. They are meant to provide examples for how a strategy can be, and often have been, implemented at the state, local, and community levels.
- Use issue framing strategies to develop public-facing messaging tools that:
- Focus on solutions, shared risk, and protective factors and strengthen shared buy-in around equity approaches
- Change the narrative around health outcomes from a limited focus only on individual behaviors to a broader frame with an emphasis on upstream factors
- Establish structures to promote shared decision making and information exchange (e.g., community engagement teams, public-private partnerships)
- Conduct health equity trainings that:
- Use local data and community insights to elevate community awareness about health disparities
- Engage partners in effective communication and emerging best practices in health outreach and education
- Utilize key staff roles (e.g., Health Educator) for community outreach to disseminate health related information and resources
- Develop a Service Navigation Pilot to include collaboration with other agencies to:
- Create a package of resources, outreach materials, and events
- Provision of incentives for volunteer support to expand the reach through trusted partners
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 upcoming phase of this effort (beginning early next year), 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:
- Review of existing equity-related efforts and investments.
- Evaluation, reflection, and alignment with state and local priorities.
- 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. Four SHEP domains:
- Outbreak and Emergency Response Domain: Activities to prevent, detect, and manage outbreaks, preparedness, and response. This domain was previously the Covid-19 Outcomes domain and has been broadened to emergency preparedness. This domain will continue to be refined to incorporate equitable response and recovery activities that promote community resilience.
- Health Impact and Outcomes Domain: Key health issues [or groups of issues] that have emerging or long-standing disparities and require focused efforts to support equitable outcomes.
- Structural and Social Determinants of Health Domain: Focus on upstream factors and conditions, particularly amongst populations at highest risk and underserved.
- Equity Infrastructure – Asset and Capacity Building 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.
- 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 Impact and Outcomes and Structural and Social Determinants of Health domains.
- Foundational Public Health Services – Foundational Areas are aligned with the Health Impact and 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.
- Outbreak and Emergency Response: This domain was previously the Covid-19 Outcomes domain and has been broadened to emergency preparedness. This domain 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 Impact and 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 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: Asset 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 Impact and 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 Impact and Outcomes domain and further build out opportunities for advancing equity in the Structural and Social Determinants of Health domain.
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