Case Studies

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Below we share many inspiring examples of how health departments have concretely implemented the strategic practices to advance health equity — both internally within their departments and externally with communities and other government agencies. The case studies describe factors that enabled the work, what health departments did and their impacts, and advice for others wanting to replicate the work. Read more about how we identified case studies.

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Alameda County Advances Equitable Housing Policies

Working in collaboration with grassroots organizers, advocacy organizations, and other government partners, the Alameda County Public Health Department, California, helped change local policies and practices related to housing habitability, affordability, and access to eliminate housing and health inequities in low-income communities.

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Boston Builds Capacity to Address Racism and Achieve Health Equity

Building on a decade of anti-racism and health equity work within their organization, the Boston Public Health Commission, Massachusetts, is working to ensure that their workforce reflects the city’s population. This initiative has included developing an Anti-Racism Advisory Committee, requiring all staff to participate in racial justice and health equity training, and creating accountability mechanisms.

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Boston Uses Public Housing to Promote Healthy Birth Outcomes

The Boston Public Health Commission, Massachusetts, identified insecure housing as having a major impact on stress, birth outcomes, and maternal health. They worked with the Boston Housing Authority to develop a new policy and program to ensure public housing slots for housing-insecure pregnant women.

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Colorado Changes Data Narrative and Incorporates Equity Metrics

The Colorado Department of Public Health and Environment (CDPHE) is working to change the narrative and framing of population health data to emphasize the importance of structural inequities and social determinants of health. CDPHE is also working to incorporate equity metrics into program evaluations and performance monitoring and use boilerplate language regarding equity in CDPHE publications.

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Colorado Organizes Health Equity and Environmental Justice 101 Training

The Colorado Department of Public Health and Environment, along with partners, developed a Health Equity and Environmental Justice 101 training that all department staff are required to take. This training has opened the door for new collaborations across the department, increased awareness of health equity and environmental justice issues, and cultivated new discussions about how to embed equity in public health practice.

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Cook County Partners with Community to Tackle Structural Racism and Build Community Power

The Cook County Department of Public Health, Illinois, partnered with community organizers on worker and immigrant rights campaigns through its participation in the Collaborative for Health Equity. The Collaborative makes addressing structural racism and building community power an explicit element of its mission, with community organizers sitting on the Steering Committee and guiding Health Department work.

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Cuyahoga County Uses Health Improvement Process to Lift Up Equity and Racial Inclusion

The Cuyahoga County Board of Health, Ohio, worked with a multisectoral consortium to develop an equity-focused Community Health Improvement Plan (CHIP). Their CHIP identifies health equity as a guiding principle and tackling structural racism as 1 of 4 strategic priorities.

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Harris County Institutionalizes Health Equity through Organizational Transformation

The Harris County Public Health Department, Texas, created a department-wide health equity infrastructure, establishing overarching health equity policies, procedures, and staff training to infuse an equity lens into all divisions and programs.

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Kansas City Develops MOU and Shares Space with Community Organizers

The Kansas City, Missouri Health Department has developed a long-term close and synergistic relationship with Communities Creating Opportunity, a largely faith-based community organizing group. The relationship has enriched both organizations’ capacity to do meaningful community engagement and enact upstream policy change.

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Kansas City Organizes LifeX Summit

After data revealed place-based inequities in life expectancy in Kansas City, Missouri, the local health department advocated for the inclusion of life expectancy as a strategic objective in the City’s business plan. They also convened a summit of city staff to examine how to address these inequities across departments.

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King County Transforms County Practice to Advance Equity

Using a social determinants framework, King County, Washington, transformed its practice across all departments and agencies to advance equity throughout the jurisdiction. The countywide equity and social justice strategic plan is tied to the county’s biennial budget schedule, and departments and agencies set individual implementation plans to work toward shared equity goals.

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Lake County Builds Internal and External Bridges

The Lake County, Illinois, Health Department’s Health Equity Team facilitates relationships with community, agency, and business partners and builds internal and external awareness to improve the social conditions that determine health. Activities included taking the NACCHO Roots of Inequity Course, a bus reality tour for leadership, and piloting a social determinants of health assessment tool.

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Lake County Hosts Together Summit

The Lake County Health Department, Illinois, worked with county, business, and community leaders to host a countywide, multisector gathering — the “Together Summit” — to highlight strategic opportunities to work together, share accountability, and leverage investments to improve health for all.

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Long Beach Creates Office of Equity

The City of Long Beach, California, created an Office of Equity in their Health and Human Services Department to elevate conversations around equity and social justice, better align and coordinate existing equity-focused programs, and build racial and health equity capacity across city government.

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Madison-Dane County Embeds Health and Racial Equity Capacity

Public Health Madison & Dane County, Wisconsin, has worked to build collective understanding and capacity across the health department and with other government agencies and community organizations to address racial equity. This has resulted in development of an internal health and racial equity team; a strategic plan with explicit equity goals; and application of racial equity analyses to programs, policies, and plans.

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Maricopa County Builds Health Equity Cloud

The Maricopa County Department of Public Health (MCDPH), Arizona, leverages collaborations with public and private partners to protect and promote public health with very limited resources. To build health equity capacity, MCDPH conducted an internal assessment survey, piloted a lunch-and-learn series, partnered with consultants to provide trainings and support workplan development, and incorporated their work into the Department’s “cloud” structure.

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Minnesota Changes the Narrative around Health Equity

The Minnesota Department of Health is changing the narrative around health to focus on opportunities and what is needed to be healthy. Through extensive community engagement and partnerships, various publications, and the creation of the Center for Health Equity, the Department explicitly addresses the social determinants of health, acknowledges structural racism, and advances health equity across all sectors and policies.

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New York City Races to Justice

The New York City Department of Health and Mental Hygiene, New York, launched their Race to Justice initiative to reform internal policies, practices, and operations to advance racial equity and social justice across the Department. The initiative builds staff skills to address racism, implements policies to lessen the impact of structural oppression, and strengthens collaborations with communities across the city.

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Omaha Metro Develops the Common Quill Health Equity Cohort

The Douglas County Health Department and the Sarpy/Cass Department of Health & Wellness in Nebraska formed the Common Quill, a local cohort of mid-career public health leaders dedicated to advancing health equity. Common Quill members support each other from behind the scenes and in public settings to advance a health equity agenda in health department and cross-sector decision making.

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Rhode Island Braids Funding to Create Health Equity Zones

The Rhode Island Department of Health is leveraging various federal, state, and local sources of prevention, categorical disease, and population health funding to create place-based “Health Equity Zones,” geographic areas designed to achieve health equity by eliminating health disparities and promoting healthy communities.

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San Francisco Creates the Program on Health, Equity and Sustainability (2002-2011)

The San Francisco Department of Public Health, California, created the Program on Health, Equity and Sustainability (PHES) through increased staff efficiency, autonomy, and innovation with the goal of working in partnership with residents, public agencies, and private organizations to advance healthy environments and social justice.

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San Francisco Leverages Health Permits to Combat Wage Theft

Wage theft is a national epidemic that hurts workers, responsible employers, and the local economy. After learning through participatory research collaborations that wage theft impacts the health of many low-wage and immigrant workers, the San Francisco Department of Public Health, California, leveraged their restaurant health permitting process to hold employers accountable for wages stolen from employees.

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San Mateo County Funds Community Implementation Projects to Advance Equity

The San Mateo County, California, Health Policy and Planning Program (HPPP) developed a Community Implementation Fund to acknowledge the leadership of local nonprofit organizations in addressing the social determinants of health and understanding community needs. HPPP is shifting project funding from a focus on healthy eating and physical activity to policy-oriented projects that address housing, education, economic, and neighborhood conditions.

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San Mateo County Supports Youth Leadership and Capacity Building

The San Mateo, California, Youth Commission was created to facilitate youth leadership and capacity building and to inform policy. As the Youth Commission funder, San Mateo County Health System leveraged their contracting process to explicitly include equity metrics and requirements in the youth facilitator contract.

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Santa Clara Develops Infrastructure to Address Racial and Health Equity

Building on the results of health assessments and a revised strategic plan, the Santa Clara County Public Health Department, California, is developing internal infrastructure to advance racial and health equity. This includes hiring dedicated staff to lead department-wide efforts, developing a training program for its public health workforce, and pilot testing the application of racial equity tools.

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Solano County Leverages Internal Champions and External Experts to Advance Equity

The Public Health Division of Solano County, California, is leveraging the commitment of internal equity champions and the work of national organizations to address historically limited capacity and limited resources to focus on the social determinants of health. Together, the Public Health Division and its national partners are building internal capacity to advance equity in a county with urban, suburban, and rural areas.

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Tacoma Creates Tools to Advance Health in All Policies

An interdepartmental health equity team at the Tacoma-Pierce County Health Department, Washington, developed a Health Equity Assessment report, including numerous maps, and used various tools that have facilitated internal capacity building and external relationship building to advance Health in All Policies at the city and county level.

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