What Sparked This?

Mobilizing Action through Planning and Partnerships process identifies health equity as priority

In 2011, the Lake County Health Department and Community Health Center (LCHD/CHC) chose to use the NACCHO Mobilizing Action through Planning and Partnerships (MAPP) process to develop their state-required Community Health Assessment (I-PLAN). Following MAPP guidelines, LCHD/CHC proposed and the Lake County Board of Health approved the formation of the Live Well Lake County Steering Committee (LWLCSC), which helped facilitate the MAPP process.

Together, LCHD/CHC and LWLCSC conducted surveys, focus groups, and interviews and had a much more robust community engagement process than in previous community health assessments. The community- and data-driven group selected 4 priorities, 1 of which was to reduce inequity and increase equity in Lake County.

Once health equity was included in the 2012 Community Health Assessment, Health Department staff began to grapple with what it would mean to invest in advancing equity. LCHD/CHC leadership made a commitment to establish new staff positions exclusively dedicated to advancing health equity internally in the Department and externally in the community through strategic coordination and capacity building.

Hiring process weighted toward capacity for multicultural bridging

By spring 2015, LCHD/CHC had created and posted 5 full-time health equity positions. The person who helped coordinate the MAPP process in 2011–2012 was hired as the first Health Equity Coordinator in June 2015, and by September 2015 LCHD/CHC had hired 4 additional staff in Community Health Specialist I and Community Health Specialist III positions. When they started the hiring process, they had 160 applicants from 11 different states. To ensure that there was a fair, equitable hiring process, the Health Equity Coordinator created a Grid for Candidate Assessment that weighted previous experience with historically vulnerable communities and capacity to do multicultural bridging in combination with employment history. The final candidates who were hired brought varied experiences working closely with the communities most impacted by health inequities in Lake County. From the beginning, relationship building was the highest priority for their team.

Program Description

Team builds a shared understanding of health equity

Once all 5 health equity positions were filled, the new staff took time to build a common understanding of the historical roots of health inequities, the current context, and the opportunities internally and externally to advance change.

One of their first activities as a team was to take the NACCHO Roots of Health Inequity course together to develop a strong foundational understanding around health equity, and to understand the historical context of health inequities in the United States. They also developed a collaborative partnership with the Health Department’s assessment and planning team, as well as other prevention team members, to leverage the Health Department’s data collection and analysis, planning, and other resources for health equity capacity building. As noted in the other Lake County case study, the relationship with the assessment and planning team was critical to bringing health and social determinants data to conversations with others in the Health Department, as well as to other government agencies, businesses, and community partners to increase awareness about the existence of health inequities and the importance of addressing them.

The team also drew on others’ work to help inform their internal capacity-building efforts, in particular drawing on resources from the Alameda County Public Health Department, the Robert Wood Johnson Foundation’s Culture of Health framework, NACCHO’s community engagement materials, and the Place Matters network. They did an exchange with colleagues at the Houston-area Harris County, TX, Health Department to understand how Harris County was advancing equity internally; they became a collaborative partner in Lake County’s internal policy change process. The coordinator emphasizes that from the beginning, the vision has been to build collective ownership of health equity and understanding of the importance of health equity in all communities countywide.

“We never imagined the five health equity staff to be the only ‘doers’ of health equity, but rather to be catalysts of health equity, who could help build capacity agencywide for owning the health equity messages and practice.”

Developing a social determinants of health assessment for clinical operations to “build bridges”

LCHD/CHC is 1 of 9 departments of public health in Illinois that are both a local health department and operate their county’s federally qualified health centers (FQHC). As a result, more than half of LCHD/CHC employees do clinical operations work, collectively seeing over 50,000 patients for primary care and behavioral health. They see the most vulnerable members of their community at FQHC — the undocumented, the uninsured, the unemployed, the very ill, and the severely mentally ill — so it is a key location to intervene to address health inequities.

The Health Equity Team is working with the LCHD/CHC Clinical Operations Team to develop a social determinants of health (SDOH) assessment to be used in patient interactions to “build strong bridges to warm connections to community opportunity, addressing root cause conditions.” Specifically, the Health Equity Team is helping to train and coach registered nurse care coordinators on how to build bridges with patients in a way that respects patient autonomy but also works to support their identified needs, such as housing, utility fees, more educational opportunities, or greater social engagement. LCHD/CHC is piloting the SDOH assessment in 1 of the 9 FQHC sites in Lake County and working to get all staff on board with “building strong bridges to warm connections.”

Expanding diversity and inclusion in community initiatives as part of internal work

The Health Equity Team has also been working to facilitate inclusion and broaden outreach within existing Health Department programs. For example, Lake County includes numerous walking paths near lakes, forests, savannas, and other natural areas that can facilitate physical activity and improved mental health. Historically, people of color have been underrepresented in community walking initiatives. The Health Equity Team is bringing a warmer invitation to participate in these initiatives to different neighborhoods and communities, and as a result is starting to see greater diversity in participation. Partnerships with community-based organizations and social service agencies have also helped extend these more inclusive invitations.

The Health Equity Team sees this as an example of how they are trying to build internal capacity within the Health Department. They “come alongside” an existing program, provide a spark and inspiration for doing the work differently, offer support for including more people, and then “give over the baton” as the existing program staff make advancements and engage more groups.

Bus reality tour for health leadership

When asked to speak with the LCHD/CHC executive/senior leadership team about health equity, the Health Equity Coordinator organized a community tour to do field observation and on-the-ground orientation to health equity. Before the tour, the Health Equity Coordinator introduced the concepts of health equity, social determinants of health, built environment, and primary prevention to the leadership team. Following the tour, the team looked at pictures they had taken together on the tour, and the Coordinator facilitated discussion about how community conditions impacted individual health and how the leaders could help lead the Department toward more equity-oriented initiatives and programs. The Coordinator notes that this was a helpful and eye-opening experience for their executive/senior team members, who still talk about this trip 2 years later. Since that tour, the executive/senior leadership team has been continuously supportive of internal health equity work and capacity building.

Outcomes and Impacts

• Developed the ABCs of building community partnerships

  Through this initial work, the Health Equity Coordinator developed a simple reference tool, referred to as the ABCs of Building Community Partnerships, to help remind the Health Equity Team of how to build authentic and affirming relationships with diverse community partners. This framework is a helpful tool for conducting outreach to leaders throughout the county in developing the Together Summit and in engaging community partners and municipalities to address obesity, tobacco control, mental health, and other pressing health issues.

• Launch of Health Equity 101 e-learning module

  The Health Equity Team is developing a 30–40 minute e-learning module for all LCHD-CHC staff to: 1) understand the concepts of health equity and social determinants of health, 2) share Lake County–specific data, and 3) advance the message that everyone — no matter what their role is within the Department, whether animal care and control worker, receptionist, or HIV/AIDS nurse — fits into the health equity vision that “Everyone in Lake County, no matter who you are, where you live, how much money you make, or your family heritage, has the opportunity to live in a healthy environment and to lead a healthful, fulfilling, and productive life.”

• Together Summit builds momentum toward addressing chronic disease

  Described in the Together Summit case study, the Health Equity Team organized a summit of over 200 diverse stakeholders in January 2017 to discuss how place matters, the importance of “investing in communities across communities,” and how “all of Lake County cares about all of Lake County.” The Together Summit advanced 3 community health initiatives that have significant policy, systems, and environmental change implications for Lake County, both at the county level and in numerous municipalities.

• Strategic plan highlights SDOH and health equity as core to future work

  The LCHD/CHC 2017–2019 Strategic Plan illustrates Lake County’s growing commitment to health equity. Specifically, the Health Department intends to “work with community partners to address the social, economic, and environmental causes of health inequity. They are using data to verify they are doing the right things, maximizing their resources, and providing quality care and services. They are working with their local, state, and federal policy, system, and environmental leaders to advocate for the healthiest Lake County.” The strategic plan outlines a clear plan for how to impact health in 3 years.

Future Steps

Building on the Together Summit momentum, the Health Equity Team is continuing to advance community partnerships at the county level and within individual municipalities. Momentum is expanding throughout the county, and all 52 municipalities in Lake County will have the opportunity to develop a walking campaign based on the GO Lake County Initiative to help communities be as healthy and active as they can be. Through this work, the Health Equity Team is exploring ways to leverage investments and resources across communities to address the county’s health inequities.

After they complete the internal Health Equity 101 e-learning module, the Health Equity Team will launch a similar training for the community to raise broader community awareness about how everyone can be involved in addressing unequal burdens and improving health and well-being for all.

Advice for Local Health Departments

• Listening is critically important

  One of the most important aspects of building trust with others — whether the CEO of a major corporation or the sick grandmother living in public housing — is listening. Making sure that everyone’s voice is heard and reflected in the dialogue moving forward is a critically important part of building a sense of trust and honor across the community. 

• Make community relationship building a priority

  The Health Equity Team prioritized using staff work time to go out and get to know different sectors of the community. For example, one staff member regularly attends a monthly Latino coalition meeting to support their efforts to improve the quality of life for the Latino community. This relationship building is important for being known, developing trust, and understanding what the priorities and issues are for the community.

• Inventory assets and existing resources

  Your staff aren’t the only ones working to advance equity. There are a lot of champions in every community — in the libraries leading literacy and citizenship programs, in the local housing authority, in SNAP programs and local food pantries, etc. — that are impacting health inequities. Often local health departments don’t think about what non-traditional conversations about health and health resources might look like, but almost all sectors in a community can be connected to health in some way.

Strategic practices leveraged in this case study

Build Organizational Capacity

Change Internal Practices and Processes

Prioritize Upstream Policy Change

Build Community Alliances

Additional Resources

• Harris County’s Health Equity Work
• NACCHO Mobilizing for Action through Planning and Partnerships (MAPP)
• RWJF Culture of Health Framework – From Vision to Action