When we started organizing the Advancing Health Equity in Health Departments webinar series last fall, we were excited to bring together an amazing lineup of speakers to share their experiences in advancing health equity in their local health departments. We were blown away by the innovative and transformative approaches they’ve taken. We’re hopeful the 2,000+ folks who participated in the series felt the same degree of excitement and potential!
Speakers laid out why it’s so important to address the root causes of health inequities in health departments, with community and across government:
- Government has played a key role in creating inequities.
- Half of health is determined by social, economic and environmental conditions. Those conditions are usually governed by other agencies and decision-making bodies.
- Public health can’t make these changes alone.
To make it more concrete, we’ve pulled out 6 choice quotes from the health equity champions who spoke on the webinars to give you a taste of their thinking.
1. “Sometimes [health equity] work can start with finding someone who does similar work to you in another department and having coffee with them”
— Jordan Bingham, Public Health Madison/Dane County (Wisconsin)
All webinar speakers spoke to the importance of equity being something that should be embedded throughout the health department, and not just the responsibility of one person or a small team of employees. Although every health department has different staffing, leadership, resources, political context and relationships, there are opportunities at every level of management and government to advance equity.
As illustrated by the transformative work in King County, New York City, Madison-Dane County and others, getting leadership on board to do equity work can dramatically impact work across the department and/or whole county government. But responsibility for advancing equity doesn’t just lie in the hands of leadership.
Frontline staff, program coordinators, middle managers, and others can help support transformative systems change work by practicing inclusion and engagement, building equity skills and practices, helping identify equity goals and plans, and reaching out to others. Building shared responsibility and accountability for advancing health equity often begins in relationship building.
2. “Doing health equity work is about changing the way we do our work, not just adding new work.”
— Dr. Linda Rae Murray, former Cook County Health Officer and former APHA president
Changing the way we do our work can happen everywhere, in small or rural health departments as well as large metro ones, and in the work of epidemiologists, public health nurses, health educators to administrators and Health Officers.
Examples of how to change the way we do our work includes:
- Use a health equity lens for every funding application, initiative and evaluation
- Invest in equity-focused assessments, trainings and partnerships
- Prioritize analysis of data that’s useful for the community
- Include questions about social determinants of health and equity on existing surveys and client forms
- Invite new stakeholders and community members to community health assessment and planning work
- Speak up in staff and community meetings about equity, power and oppression
3. “It’s important to repeat again and again what drives inequities — with staff, with elected officials, with the public — to help change the narrative”
— Sandi Galvez, Alameda County Public Health Department
Several speakers emphasized the importance of changing the narrative around health to advance equity. As happened in Minnesota and Alameda County, we shifted from talking about how sick we are to what’s needed to be healthy. This shift resulted in different stakeholders being engaged at the table, different goals, priorities and solutions to addressing health inequalities.
At the same time, health departments, such as those in metro Omaha, Minnesota, and Rhode Island, acknowledged that it’s important to translate equity and the social determinants of health work across the political spectrum, using concepts and terms that motivate elected officials and others to be engaged, but yet still being an unapologetic champion for health equity.
4. “We have to be explicit about racism because racial inequities persist in every system and in every jurisdiction, and they have historically been perpetuated by government.”
— Jonathan Heller, Human Impact Partners
To begin normalizing conversations about racism in the workplace, Shawna Davie of the Government Alliance on Race and Equity (GARE) recommended sharing articles on racism and health like The Gardener’s Tale and screening documentaries like Race: The Power of an Illusion or Unnatural Causes: Is Inequality Making Us Sick?.
Other speakers described that partnering with national organizations like GARE, HIP, and CityMAtCH, and/or building internal staff capacity to facilitate conversations about racism and power, concretely supported individual and department-wide conversations on these important yet challenging topics.
5. “It’s practically malpractice NOT to work with community organizers.”
— Dr. Rex Archer, Kansas City, Missouri, Health Department
Speakers acknowledged that public health doesn’t not have the power to make change on its own, particularly around the social, economic and environmental determinants of health. Community organizers build agency and power, focus on the determinants of health (even if they don’t use those terms), and have relationships with and an understanding of communities suffering from inequities.
Kansas City and Alameda County specifically discussed partnering with community organizing groups to to win policy change on social determinants, including promoting a livable wage, providing paid parental leave, banning the box on employment and SNAP applications, capping rent increases, expanding just-cause eviction protections for tenants and including life expectancy in the City’s Business Plan.
These and other speakers encouraged webinar participants to get their health department involved in local social movements and to:
- Recognize community organizers won’t necessarily see public health people as natural allies, but to stay persistent
- Provide in-kind support to organizers, e.g. meeting space, data to help push campaigns, facilitation or evaluation support — to build trusting relationships
- Recognize that a lot of organizing work happens outside a 9–5 work day, and therefore adjusting their ideas around when “the work” happens — for example, taking a vacation day to participate in a march or other community mobilization
- Self disclose your own barriers and your own agency’s role in creating and perpetuating inequities
- Work with a shared purpose, even though approaches between health departments and community organizers may be different
- Recognize that we need to organize people, resources and narrative to build power for change
6. “We need to be more courageous and be clear about the consequences of inaction”
— Lili Farhang, Human Impact Partners
A final lesson was about risk taking and leadership to change the status quo. Most equity work is happening because there are active efforts to change the status quo, recognizing that the status quo traditionally benefits those with power and privilege.
As noted by HIP’s Lili Farhang, we often overestimate the probability and consequences of something going wrong and under-estimate our ability to handle the consequences of risk or impacts of inaction. She emphasized that being more courageous, addressing our fear of failure, and being clear about the consequences of inaction can help staff at all levels of management speak up and take action to advance health equity.
Many thanks again to all of our webinar presenters (Andy, Deb, Evonda, Jeanne, Jonathan, Jordan, Lili, Linda, Matias, Rebekah, Rex, Sandi, and Shawna) for their valuable insights and inspiring stories! Thanks also to our webinar co-sponsors the Government Alliance on Race and Equity, The National Collaborative for Health Equity, and NACCHO’s Health Equity and Social Justice Committee — and to The California Endowment for their financial support of the webinars and the Health Equity Guide.
We encourage anyone interested in advancing health equity to check out the inspiring examples of health departments doing this work in our Health Equity Guide, along with many actions and resources to get started.
And please leave us any comments or suggestions about your experiences advancing health equity and/or other resources needed to support your organization’s transformative change!
Megan Gaydos works as a part-time consultant with Human Impact Partners, managing the Health Equity Guide website and related programming and supporting various research projects. A former epidemiologist, she is incredibly inspired by the work that health departments are doing to advance health equity around the US.