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.
Who Took This On
City of Long Beach, CA, Department of Health and Human Services, Office of Equity
Ways You Can Get Started
- Develop and disseminate presentations about inequities in life expectancy and neighborhood conditions widely to health department and other agency staff and community organizations
- Work with decision makers to identify opportunities to advance health equity in existing work to address violence prevention, mental health, language access, and other equity issues
See Advice for Local Health Departments below for more ways to take action.
What Sparked This?
New Health Director mobilizes data to encourage action on social determinants of health
In 2013, the Long Beach Department of Health and Human Services (DHHS) hired a new director who had a strong vision for having the city health department collaborate with education, economic, and social service partners to address the social determinants of health. Using the city’s Community Health Assessment, the Director presented to “anyone who would listen” — community groups, city staff, directors, and others about the inequities between neighborhoods within Long Beach, particularly between neighboring zip codes 90803 and 90813. These presentations began to raise awareness about the 7-year difference in life expectancy between neighborhoods and the value of a health equity framework. Under the new Director’s leadership, the health department began to plan efforts for Long Beach to become a trauma-informed city, engage in the Safe Long Beach Violence Prevention Plan, and lead mental health diversion from incarceration efforts.
Participation in Government Alliance on Race and Equity builds framework and interdepartmental collaboration
Starting in 2015, under the leadership of the new Director of Health, the City of Long Beach began working with the Government Alliance on Race and Equity (GARE), initially with 8 city staff who went through the GARE training and later with strong representation from 12 of the 18 city departments. Work with GARE provided a framework for discussing racial equity and facilitated communication between staff across the city through their monthly convenings and regular communication via email and in person.
City Council allocates funds for equity work, citing health statistics
In July 2016, the Vice Mayor of Long Beach recommended that the City Manager explore the feasibility and benefits of establishing an Office of Equity, Access, and Prevention that would realign violence prevention, language access, and human dignity programs into the Department of Health and Human Services. In the presentation to the Mayor and the City Council, the Vice Mayor cited statistics about life expectancy gaps and stated that “there is nothing more important than the health and safety of our communities.” In August 2016, the city’s Board of Health and Human Services submitted a letter of support and the Director of Health sent a memorandum to the City Council outlining the feasibility and benefits of the creation of the office. In September 2016, the city’s budget allocated a position for fiscal year 2019, and grant funding was leveraged to launch the Office of Equity in January 2017.
Long Beach receives health equity grant
In 2016, the California Endowment awarded the Long Beach Department of Health and Human Services a grant of $200,000 over 2 years to build a health equity framework within their local health department. The funding is being used for the GARE trainings, implementation of a health and racial equity assessment tool, developing workshops for DHHS staff, and integrating health equity into the Department’s strategic plan. The funding was also used to hire the new Office of Equity Manager, who is helping implement all of the above activities. Although the position is currently grant funded, the longer-term vision is that the Equity Manager will be funded using general funds.
Building on this growing commitment across the city to advance equity, the Office of Equity was formally established in January 2017. The Office of Equity is intended to accelerate the city’s vision to end health, social, and racial disparities by working to normalize, operationalize, and institutionalize policies and practices that can reduce or eliminate disparate outcomes.
What programs were consolidated into the Office of Equity?
Equity programs that were previously housed in the Development Services Department, including the Language Access Program, My Brother’s Keeper, and the Human Relations Commission, were transitioned over to the Long Beach Department of Health and Human Services’ new Office of Equity.
On a day-to-day basis, the Equity Manager directly supervises the coordination of the Language Access Program and is involved with the other programmatic efforts that are currently managed in other bureaus. Specifically, although the Language Access Program handles a high volume of administrative work, including requests and invoicing for interpreters and translations, the Equity Manager is helping pull the Language Access Program staff into higher-level communications discussions about how to disseminate information about language access in social media, presentations, and city communications efforts. At the same time, the equity manager is working to build a stronger relationship with the Language Access Coalition, a coalition of community advocates that advocated for the program — to ensure greater transparency and a closer working relationship to facilitate continuous quality improvement of the program.
The My Brother’s Keeper (MBK) initiative has helped ensure young boys and men of color are being held up as a priority for the city. Building on the extensive involvement of community members in the MBK planning process, the Office of Equity is working to support the transition of MBK to the health department, including rethinking how the health department can support planning, data collection, data sharing, collaboration, and communications work.
The Human Relations Commission is a mayor-appointed body that has generally focused on issues of diversity and cultural inclusion. Under the Office of Equity, the Commission is conducting strategic planning that will help to narrow its focus, develop its capacity to use an equity lens in its work, be proactive rather than reactive to City Council requests, and better represent marginalized and underrepresented communities, rather than working on anything related to diversity generally.
Outcomes and Impacts
Changing the narrative about health inequities
Through frequent and consistent communication from the director to department staff, city leadership, community-based organizations, hospital leadership, and others, DHHS has begun to change the narrative about what leads to health and health inequities. This process was already underway prior to the creation of the Office of Equity, as illustrated by City Council members’ citing life expectancy and other health statistics and justifications for analyzing equity. The hope is that the creation of the Office of Equity will serve to further deepen and broaden these conversations.
Office of Equity involvement in Economic Blueprint development
The Office of Equity was invited to participate in the city’s development of an Economic Blueprint for the next 10 years. Although the Office got involved a little late in the process, they were able to help reframe and draw attention to the issue of economic inclusion. Specifically, DHHS provided feedback that groups being called “emerging communities” were actually not new, but had been a part of Long Beach for many years — they had just been marginalized. Through subsequent discussions, the section was renamed “economic inclusion,” and additional strategies to achieve economic inclusion were added to the blueprint. The Economic and Property Development Department also began engaging in GARE as a result of the mutual interest in economic inclusion. The departments are also seeking funding and other opportunities to implement equity on a day-to-day basis and to identify areas where equity assessment tools can be used to close the wealth gap in Long Beach.
Health department is a safe space for equity work to grow
To date, Long Beach staff have found that the health department has been a relatively safe space for health and racial equity work to grow. The newly formed Equity Workgroup is driving an organizational assessment and integrating equity goals into the department’s strategic plan. DHHS staff are open to doing the work — they bring valuable and relevant data that highlights the importance of equity on health outcomes, and staff bring relevant facilitation skills. However, the Equity Manager notes that being housed in the health department does not provide a bird’s-eye view of what is happening across the city in the same way that can happen in City Hall.
City of Long Beach received statewide award
In February 2017, the City of Long Beach received the Award for the Advancement of Diverse Communities from the League of California Cities. The city press release highlighting the award noted, “City leadership has undergone a cultural shift from implementing isolated programs to taking a systemic and collaborative approach to addressing economic and health disparities throughout Long Beach,” and specifically noted that the new Office of Equity is “working with community leaders, city leadership, and private sector partners to examine how Long Beach can systematically address equity issues and build on efforts to increase opportunities and improve outcomes for the diverse communities of Long Beach.”
The Office of Equity will continue working with the programs under its jurisdiction to refine and enhance communications, data collection and dissemination, and collaborations with community partners. They hope to implement an implicit bias curriculum and other racial equity trainings for staff and to obtain additional funds to hire more staff and expand their work across the city.
The Office of Equity will also develop an equity assessment to bring an equity lens to policies and programs and to build citywide awareness, focus, and engagement of equity. Three departments that will pilot the use of a racial equity lens include the Department of Health and Human Services, Civil Service, and the Economic and Property Development Department.
Advice for Local Health Departments
Know your political landscape
It is vitally important to understand the political landscape that you are working in and develop relationships both within the health department and with other city departments. Knowing the political dynamics, level of trust (or distrust) between city and community, history of previous equity work, who is truly open to advancing racial equity (and who is not), and potential allies and opposition are critical for being successful in the work.
Work with GARE if you can
GARE is an incredible resource for learning what other jurisdictions are doing, how they do the work, troubleshooting challenges in your local work, and being able to have one-on-one attention. At the same time, the GARE process can help facilitate conversations with and get buy-in from other city and local agencies that are not health oriented.
Messages that work for some will turn others away
Understand the messages you are giving and their impact on different communities within the city. Engage those who understand the topic the least or who feel there is something that may be lost by advancing equity in crafting, or at least reviewing, the message to ensure connection.
Seek and build on political energy
The equity movement was quietly in motion, and planned for and expected a quiet rollout focused in the health department. This work led to positive political interest and energy, which brought the work quickly to the forefront and garnered greater support.
Build on and strengthen existing collaborative efforts
It is key to develop and support an external community engagement strategy to undertake equity-related systems work. This work leads to greater involvement and empowerment of residents and community-based organizations as partners of a larger systems change approach and will result in more sustainable practices in the long run.