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State Health Equity Planning

State Health Equity Planning2026-10-27T12:21:41-07:00

Advancing Equity in Community Health

The State Health Equity Plan (SHEP) process, supported by the California Equitable Recovery Initiative (CERI), brought together diverse partners to better understand the health equity landscape, align efforts, and establish a shared foundation for advancing equity across California.

This webpage memorializes the work that occurred during this collaborative effort, including a summary of the SHEP Framework and how this work continues through integration into California’s broader State Health Assessment (SHA) and State Health Improvement Plan (SHIP) process.

Framework Summary

The State Health Equity Plan (SHEP) Framework Summary serves as a tool to support ongoing communication, alignment, and equity planning while elevating opportunities to scale and replicate promising practices. The tool provides a thematic summary of research and partner contributions. Learn more about the and .

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

Emergency Preparedness and Response (EPR)

Area of Focus:

EPR-1 Emergency Operations Planning and Management

Strategies:

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

Area of Focus:

EPR-2 Readiness and Response Coordination

Strategies:

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

Area of Focus:

EPR-3 Laboratory, Data, and Investigation Capacity

Strategies:

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

Area of Focus:

EPR-4 Prevention and Mitigation

Strategies:

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

Area of Focus:

EPR-5 Community Preparedness and Recovery

Strategies:

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

Area of Focus:

EPR-6 Responder Safety and Health

Strategies:

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

Area of Focus:

EPR-7 Facilities and Support Structures

Strategies:

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

Area of Focus:

EPR-8 Climate and Environmental Resilience

Strategies:

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

Health Outcomes (H)

Area of Focus:

H-1 Maternal and Family Health

Strategies:

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

Area of Focus:

H-2 Early Childhood Development and Resiliency

Strategies:

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

Area of Focus:

H-3 Mental and Behavioral Health

Strategies:

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

Area of Focus:

H-4 Injury and Violence Prevention

Strategies:

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

Area of Focus:

H-5 Disease Prevention and Health Promotion

Strategies:

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

Area of Focus:

H-6 Communicable Disease Control

Strategies:

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

Area of Focus:

H-7 Sexually Transmitted Infections

Strategies:

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

Area of Focus:

H-8 Environmental Health

Strategies:

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

Structural and Social Determinants of Health (SDOH)

Area of Focus:

SDOH-1 Inclusive Economic Development

Strategies:

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

Area of Focus:

SDOH-2 Housing and Homelessness

Strategies:

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

Area of Focus:

SDOH-3 Food and Nutrition Security

Strategies:

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

Area of Focus:

SDOH-4 Access and Linkage to Services and Care

Strategies:

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

Area of Focus:

SDOH-5 Social Support, Inclusion and Non-Discrimination

Strategies:

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

Area of Focus:

SDOH-6 Equitable Learning Environments

Strategies:

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

Area of Focus:

SDOH-7 Natural and Built Environment

Strategies:

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

Area of Focus:

SDOH-8 Anti-Racism

Strategies:

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

Equity Infrastructure (EI)

Area of Focus:

EI-1 Workforce and Capacity Building

Strategies:

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

Area of Focus:

EI-2 Organizational Policies and Practices

Strategies:

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

Area of Focus:

EI-3 Accountability and Performance Management

Strategies:

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

Area of Focus:

EI-4 Governmental Policy and Planning

Strategies:

  1. : Incorporate equity principles in policy and planning

Area of Focus:

EI-5 Assessment and Surveillance

Strategies:

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

Area of Focus:

EI-6 Cross-Sector Partnerships for Health Improvement

Strategies:

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

Area of Focus:

EI-7 Community Power Building and Partnership

Strategies:

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

Area of Focus:

EI-8 Health Education, Communications, and Outreach

Strategies:

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

Frequently Asked Questions

The COVID-19 pandemic underscored how longstanding inequities contributed to disproportionate differences in health outcomes across California. In response, state and local public health leaders elevated equity as a strategic priority and launched the California Equitable Recovery Initiative (CERI)–California Department of Public Health’s (CDPH) implementation of the Centers for Disease Control and Prevention COVID-19 Health Disparities Grant–this multi-year investment was awarded in June 2021. Building on statewide COVID-19 equity efforts, including the COVID-19 Health Equity Playbook for Communities and Targeted Equity Investment Plans, CERI strengthened equity infrastructure across state and local public health systems and created new opportunities to address longstanding inequities that influence community health.

As equity infrastructure expanded, state and local leaders recognized the need for a shared strategy to guide and align ongoing equity efforts across state and local partners. Early discussions identified opportunities to:

• Strengthen statewide equity infrastructure and capacity to maximize collective impact.
• Align equity efforts across jurisdictions, programs, and funding streams to advance shared priorities.
• Leverage lessons from COVID-19 response and recovery to inform long-term, evidence-informed equity planning and investment.

To address this need, CDPH launched the State Health Equity Plan (SHEP) process as a statewide collaborative effort involving local health jurisdictions (LHJs), state programs, community-based organizations, and other key partners.

The State Health Equity Plan (SHEP) was designed to assess California’s health equity landscape, identify existing efforts and opportunities for alignment, establish shared priorities, and support coordinated statewide planning and action.

From the outset, the SHEP was intended to serve as the shared equity strategy and implementation approach for Let’s Get Healthy California—the State Health Improvement Plan (SHIP). Together, these efforts were designed to collectively advance health equity and improve community health, particularly for populations experiencing disproportionate barriers and disparities in health outcomes.

The SHEP approach was designed around several interconnected components:

• SHEP Framework: A tool for organizing, communicating, and aligning equity-focused activities and elevating promising practices.

• Shared Action Plans: Collaborative plans developed with partners to establish shared population results (statewide goals), population indicators (measures), and evidence-informed strategies for selected priority areas.

The SHEP approach also envisioned additional tools to support implementation and accountability, including Aligned Implementation Plans and Statewide Results-Based Accountability Scorecards. As the work evolved, CDPH identified an opportunity to further embed the products, partnerships, and approaches developed through SHEP into the State Health Assessment and State Health Improvement Plan process, where this work could continue as part of California’s broader commitment to advancing health equity through statewide health improvement planning.

The State Health Equity Plan (SHEP) process accomplished key activities to support California’s ongoing statewide equity work. Through comprehensive research and engagement, iterative framework development, and collaborative shared action planning, the process established a strong foundation for advancing health equity across California.

The SHEP was always intended to support and strengthen California’s broader State Health Assessment (SHA) and State Health Improvement Plan (SHIP). As the work progressed, California recognized an opportunity to further integrate these efforts and move from parallel planning processes toward a unified, equity-centered framework for statewide health improvement.

Building on the work completed through the SHEP process, California made the strategic decision to integrate the key components of the SHEP into the SHA and SHIP rather than create a separate standalone plan. This shift maintains what matters most—health equity remains the north star and partner expertise, experience, and engagement will continue to guide this work—while streamlining the process into one coordinated structure.

Through this integration:

• Key insights and themes from the SHEP research and engagement process inform the State Health Assessment.
• Priorities identified through SHEP shared action planning advance as priorities within the State Health Improvement Plan.
• Strategies and sample actions developed through the SHEP Framework guide SHIP implementation efforts.
• Ongoing implementation, monitoring, accountability, and continuous improvement occur through the established SHA/SHIP lifecycle.

This evolution reflects a maturing approach to advancing equity in public health. Rather than treating equity as a separate initiative, California is embedding equity directly into the core processes that guide assessment, priority setting, strategy development, implementation, and accountability. Integrating the SHEP into the SHA and SHIP strengthens sustainability, maximizes available resources, and supports a more coordinated approach to improving health outcomes across communities.

Gratitude to Our Partners

We want to acknowledge and thank our partners for your continued commitment to this important work and ongoing efforts to advance health equity across California.

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