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.
Who Took This On
Office of Equity and Social Justice, Office of the King County Executive, WA
Public Health – Seattle & King County, WA
Ways You Can Get Started
- Disaggregate health outcomes and social determinants of health by race, income, and place
- Adapt King County’s Community Engagement Guide, Equity Impact Review Tool, Language Access Resources and Policy, Implicit Bias Toolkit, or other tools to your local context
- Develop a shared analysis with other government agencies about the history and current context of social inequities in your jurisdiction
See Advice for Local Health Departments below for more ways to take action.
What Sparked This?
Disaggregating data reveals previously unacknowledged inequities
Historically, Seattle and the Pacific Northwest have been perceived by many as a fairly homogenous region with few inequities and as a great place to live, work, and play. In conjunction with the national trend of gathering data on the social determinants of health, Public Health – Seattle/King County (PHSKC) mapped and presented data on the environmental, social, and economic conditions impacting health. As PHSKC as well as other King County department staff disaggregated data by race, income, place, and other factors, they showed that contrary to this narrative, Seattle/King County inequities mirrored the national situation, and in some areas were even worse. For example, some majority White and wealthy communities were living over 90 years (higher than the national averages), but poorer communities and communities of color had much lower life expectancies.
Elected leaders support involvement in national place-based initiative to dig deeper into local inequities
Recognizing they needed to dig deeper into the connection between place, race, and health, the Health Department and the (county-level) Executive Office participated together as a founding cohort member of the National Collaborative for Health Equity (NCHE) (formerly known as Place Matters). Supported by the Joint Center for Political and Economic Studies and other NCHE cohort members, the King County team established community-based leadership to design and implement strategies to address the social conditions that lead to poor health. As noted by the King County Office of Equity and Social Justice (OESJ) Director, “Our National Collaborative for Health Equity work was and is our equity and social justice work. From racial equity to the social determinants, it is a fundamental process that is at the root of our current work and has informed many aspects of the way we do our work today.”
As part of NCHE and inspired by a Dellums Commission report looking at housing, criminal justice, health, education, and other conditions that impact young men of color’s life opportunities, the then County Executive requested that an interdepartmental team of county agencies create a similar analysis locally.
Growing focus on social determinants of equity
Around the same time, Unnatural Causes: Is Inequality Making Us Sick? was released, and PHSKC leveraged this opportunity to further conversations about the social determinants of equity throughout the county. Specifically, PHSKC staff trained 100 facilitators to do community engagement work and share the social determinants framework to start figuring out where and how the county government should engage. This community engagement work complemented the interdepartmental work to advance understanding of the social determinants framework across the county, not just inside the health department.
Language choices: “determinants of equity” instead of “health equity”
From the beginning, the Health Department intentionally talked about the “determinants of equity,” not of health equity, even though the determinants framework was rooted in public health theory. The language of equity was strategic to make sure everyone — transportation, criminal justice, housing, etc. — saw themselves reflected in the work.
Engaging communities in equity and social justice dialogues and actions
In 2008, King County staff and community partners involved in the Equity and Social Justice Initiative’s Community Engagement Team provided leadership to engage communities in dialogues and actions related to equity and social justice. The facilitators supported discussion and dialogues with over 100 groups across many sectors, including education, criminal justice, human services, public health, and youth and faith-based groups. Additionally, hundreds of King County residents attended 3 town hall meetings in 2008 — one led by the King County Executive, a second hosted by the King County Council, and a third focusing on neighborhoods and health.
Building relationships between county agencies and departments
In early 2008, led by the County Executive Office and PHSKC, King County launched the Equity and Social Justice Initiative. Through interdepartmental teamwork, PHSKC began to develop closer relationships with staff in other county departments to advance the work in the executive branch. As part of this work, King County developed a shared analysis and understanding of the historical roots of social inequities in the county, and began creating tools to promote institutional changes.
Fair and Just Ordinance Passed
In 2010, after adopting King County’s first strategic plan, the King County Executive and County Council wrote and approved the Fair and Just Ordinance, which mandated that equity be incorporated across all of King County’s agencies and departments, not just the executive branch. Building on the adopted 2010–2014 Countywide Strategic Plan, the ordinance established the county’s definitions of equity and determinants of equity, and laid out a vision for how the county would advance equity work across all agencies and elected positions — including the Assessor’s Office, Prosecuting Attorney’s Office, Superior and District Courts, and others.
The ordinance also transformed the interdepartmental team into a formal interbranch team. The Equity and Social Justice Interbranch Team “is a catalyst for change in county government and the community by increasing focus on the determinants of equity and intentionally embedding an equity lens in the county’s policies and decision making, organizational practices, and community engagement and communications.”
With this mandate, equity and social justice work was no longer an “initiative,” and institutionalizing equity became part of everybody’s charge. King County developed more tools to facilitate equity considerations in the budget process, in community engagement and outreach, in hiring and workforce development practices, and in other areas both internal and external to the agencies’ work.
Office of Equity and Social Justice Created
In 2014, the King County Executive and Council agreed to allocate more resources to equity and social justice. Specifically, starting in the 2015–2016 budget, King County committed to funding 3 staff positions in a new Office of Equity and Social Justice (OESJ). As part of the Executive Office, OESJ is not housed in any one specific agency or department, but rather reflects its nature of supporting equity across all county work.
Since its creation, the Office of Equity and Social Justice has continued to expand and now includes an immigrant and refugee policy advisor and staff supporting the ESJ strategic plan implementation. The Office of Civil Rights has also been incorporated into OESJ. The OESJ Director emphasizes that they are not the only ones doing this work — to achieve the transformation they are heading toward, everyone has to be involved, and equity must be integrated throughout all the county’s work.
As a result of the gradual capacity building and legal mandate, every county-level department and agency in King County is participating in OESJ’s work by having senior-level staff participate in the OESJ interbranch team and by developing department and agency-specific work plans of how they will achieve equity. Nearly all departments and agencies have created equity and social justice teams to support their implementation.
OESJ provides centralized support to all of the departments and agencies by: providing technical assistance, trainings, and capacity building; supporting the application of their equity tools (such as working with budget analyses to apply the Equity Impact Review Tool) and ensuring that equity is central to policies, programs, and initiatives; and facilitating the countywide equity strategic planning process, supporting strategic plan implementation, and working closely with the community.
Strategic plan creates blueprint for change
Recognizing that there was some unevenness among the different county departments and agencies in how deeply they were engaging with equity, and given that King County had identified promising equity strategies and areas for improvements, OESJ initiated a strategic planning process in 2015 to establish a shared vision for where they are headed, create minimum standards for equity work, and elevate examples of good work being done across the county. In total more than 600 County employees and 100 local organizations participated in the strategic planning process to share their insights and expertise on the county’s progress, challenges, and solutions to achieve equity.
The ESJ strategic plan is a “blueprint for change, mutually created by King County employees and community partners.” King County’s end goal is clearly defined as “full and equal access to opportunities, power and resources so all people may achieve their full potential.”
Importantly, the plan notes that “the process of advancing toward equity will be disruptive and demands vigilance. Being ‘pro-equity’ requires us to dismantle deeply entrenched systems of privilege and oppression that have led to inequitable decision-making processes and the uneven distribution of benefits and burdens in our communities. Similarly, we must focus on those people and places where needs are greatest to ensure that our decisions, policies and practices produce gains for all.” As a result, the county is leading with racial justice as the first step in the plan implementation.
The ESJ strategic plan lays out an aspirational vision and specific goals for how King County wants to progress in the next 6 years. The goals are grouped into 6 areas: (1) leadership, operations, and services; (2) plans, policies, and budgets; (3) workplace and workforce; (4) community partnerships; (5) communication and education; and (6) facility and system improvements. The countywide ESJ implementation plan and each department and agency’s individual ESJ implementation plan will be updated every 2 years as the county grows, learns, and makes progress toward their objectives.
Additionally, the ESJ strategic plan has a policy agenda consisting of 8 areas: (1) child and youth development; (2) economic development and jobs; (3) environment and climate; (4) health and human services; (5) housing; (6) information and technology; (7) justice system; and (8) transportation and mobility. King County has also committed to a Regional Equity Collaborative to work with different sectors to advance equity in the region.
Outcomes and Impacts
Efforts started in Health Department and County Executive Office now impact all 14,000 King County employees
Over a decade ago, the Health Department, with the Executive Office, began working to develop a social determinants framework for their work and their 1,500 employees. Since then, this work has grown tremendously, is intentionally and strategically based out of the County Executive Office, and is now being integrated into the work of and impacting all 14,000 King County employees and all county residents.
Strategic plan provides guidance for individual department and agency plans
Building on the guidance provided by the county strategic plan, all county-level departments and agencies are developing 2-year implementation action plans for how they will achieve the ESJ strategic plan objectives. This planning process coincides with the county’s biennial budget, so there is an expectation that agency plans and budgets increasingly reflect the ESJ priorities.
Best Starts for Kids
In 2015, King County voters approved a property tax increase to fund “Best Start for Kids.” Informed by an advisory group that has a strong equity lens, “Best Starts for Kids” uses a collective impact approach on 3 specific areas — early childhood development, investments in youth, and place-based initiatives to address health, economic development, and housing — to make sure that every child gets the opportunity to be positioned for success.
OESJ expands to include work on immigrants and refugees
In response to rising concern for the safety and well-being of immigrants and refugees, King County developed strategies and a fund to support and protect immigrants and refugees and create an Immigrant and Refugee Commission, which will act as a hub for immigrant and refugee services and align efforts by governments and nonprofits. The new commission will be staffed in OESJ.
Regional partners talking about equity
As noted by the PHSKC Environmental Health Director, “When we started this work a decade ago, equity was rarely discussed at the regional and state level. It is exciting to see that the equity conversation is happening far more than it used to.”
NCHE work has informed national health equity work
The PHSKC Environmental Health Director also notes, “We are proud to have been part of that first National Collaborative for Health Equity cohort and to see how the lessons learned from our experiences and that of the other teams are informing subsequent equity discussions and work across the nation.”
OESJ plans to continue to advance equity across King County by implementing the ESJ strategic plan objectives and continuing to create dialogue with community members and across government about transforming government practice.
“This plan is designed to move the County from these occasional [community engagement] interactions to strategic investment in community partnerships that will inform the County’s programming, service delivery and budgeting and provide equitable opportunity for all residents to advocate in their own behalf and influence the decisions that impact their lives. This strategy is rooted in the principle that those affected have the right to define decisions.”
The OESJ Director and PHSKC Environmental Health Director both acknowledge that they still have a long way to go, both internally and with the community, and that since this work has started, some equity indicators, such as income inequality, have actually gotten worse. The OESJ Director stated that this reflected a need for the county to do more to support workforce and workplace changes — “to get our house in order” internally by being racially diverse at all levels and changing work culture — in order to more effectively work with the community to deliver programs and services that actually change conditions.
Advice for Local Health Departments
Have ongoing “difficult conversations” about racism
In order to fundamentally change a system, you must deeply understand why inequities in health and other outcomes exist. To sustain these efforts long term, staff and community have to truly understand why they are doing this work and look at policies and programs with a racial equity lens to ask whether they are delivering the right results. Even though some people at OESJ have been doing this work for more than a decade, there’s still much more to do.
Particularly in health departments, staff can assume they have the answers and know what the community needs. Yet in King County, for many community members things were getting worse, despite years of dedicated work. By working with people, rather than just providing services to them, you can define problems and identify solutions together. Make yourself vulnerable and open to critique and feedback. Community participation is central to success and progress.
Set a goal of creating more inclusive ways of governing
One of OESJ’s ultimate goals is to transform the existing system of government so that those who have been historically excluded from power are given a seat at the table and supported so that they have an active voice and power to develop and inform the policy decisions that affect their lives.
Leadership is key
OESJ had early and sustained buy-in from leadership. In many communities that have achieved success in equity work, the common denominator is having a leader who is willing to embrace and champion equity and take risks. If leadership is not fully committed, the work will not have the same transformative impacts that it does in other environments.