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.
Who Took This On
Solano County, CA, Health & Social Services, Public Health Division
Ways You Can Get Started
- Connect to national networks advancing equity, such as GARE, Public Health Awakened, CityMatCH, and others to tap into their resources and knowledge
- Leverage existing and future chronic disease prevention work to focus on environment, policy, and systems change with an explicit focus on equity
See Advice for Local Health Departments below for more ways to take action.
What Sparked This?
Solano County connected to, but different from, neighboring Bay Area counties
Located in the San Francisco Bay Area, the Solano Public Health Division and its sister agencies are connected to various regional collaboratives, including the nationally recognized Bay Area Regional Health Inequities Initiative (BARHII). As BARHII members, Solano health leaders and staff both inform and are informed by the Initiative’s work, particularly their social determinants of health framework. As noted by one staff person, there are many inspiring examples from neighboring health departments, and it can be helpful to point to what others are doing and recommend that Solano also do the same. However, unlike some of the other more progressive Bay Area counties, Solano County is a mix of urban and rural communities with traditions and politics that are largely centrist, sometimes making Solano “chart its own course.”
CDC prevention grant used to promote environment, policy, and systems changes
In 2014, the Health Promotion & Community Wellness (HPCW) Bureau applied for and received a $3 million chronic disease prevention grant from CDC. The grant required that half of the funding be used in contracts to develop and support multisectoral coalitions and partnerships.
Using this funding, HPCW worked with community partners and other government agencies to undertake projects focused in low-resourced neighborhoods:
- Conduct healthy store makeovers
- Adopt and implement policies to increase access to water in parks and schools
- Improve clinical prevention referrals
- Introduce policies that address access and exposure to tobacco
The grant also funded communications and consulting to help HPCW rebrand their chronic disease work and dive deeper into health equity and meaningful community engagement. For example, HPCW launched Vibe Solano, a more interactive, more user-friendly and less bureaucratic website than the Solano County website, and which also maintains a social media presence on Facebook and Twitter. The Bureau also hired Human Impact Partners to support specific strategic community engagement activities and to increase understanding and capacity around health equity.
Solano strengthens partnerships with community organizations and agencies
Solano Public Health prioritized strengthening their ongoing work and collaborations with community partners to change policies to prevent chronic disease. Some of these partnerships include:
- Upstream chronic disease prevention: Focusing on policies, systems, and environmental changes, partners include city governments to change policies; local nonprofits and grassroots organizations to work with the private sector on smoke-free apartments and healthy store conversions; clinician champions to promote prevention referrals; and residents to inform effective ways to make these changes.
- Improved birth outcomes: To identify racial disparities and address their root causes, partners include local hospital and clinic staff to explain and change access to care in Solano County; local faith communities to help reach those with the highest burden of negative birth outcomes; home visiting staff to describe the conditions in which pre, post, and perinatal women live; local and regional funders to respond to the community’s needs; and residents to inform effective ways to make improvements.
- Tobacco prevention: To continue reducing second and thirdhand smoke exposure and youth access to tobacco, partners include school districts and the Solano County Office of Education to engage youth in these efforts; internal and external partners working on store makeovers to ensure tobacco ads and product placement are reduced; city governments to make policies reducing smoke exposure in public spaces; and residents to advocate for and inform the most effective ways to make these changes.
These and other Vibe Solano community partners have been instrumental in achieving the policy changes described below.
Solano forms a Government Alliance on Race and Equity Learning Cohort
In 2015, Solano’s Health Officer learned about the Government Alliance on Race and Equity (GARE) Learning Cohort opportunity and asked staff to explore participation. The Director of Health & Social Services authorized participation, as a way to help the Public Health Department achieve their health equity goals.
After the first session, participating staff realized that having a cohort team of just public health staff would be missing out on a huge opportunity to collaborate with other divisions and programs. They decided to invite several other Solano County departments to join them. Staff from the offices of Employment & Eligibility, Behavioral Health, Medical Services, Public Defender, and Solano Coalition for a Better Health joined public health staff on the Solano Race Equity Team to participate in the GARE learning year.
Solano Public Health leveraged existing resources to inform their internal capacity building, recognizing the strong interest and commitment to health equity but limited capacity of current staff. Solano Public Health worked to identify national best practices for incorporating health equity into their day-to-day work with the help of GARE, Human Impact Partners, and the National Organization of Urban Maternal and Child Health Leaders (CityMatCH). Each of these partnerships is described below.
Racial equity team develops training and pilots race equity analysis tool
Through their first training year in GARE’s Learning Cohort, Solano Public Health staff and other team members gained tools, direction, and confidence to begin normalizing conversations about race and inserting an equity lens into policy, program, and budget decisions.
To bring their learning to their local jurisdiction, the Solano Race Equity Team conducted Advancing Racial Equity trainings for staff and adapted and piloted a Race Equity Tool. The Advancing Racial Equity training covers the following topics:
- US government’s legacy of creating and perpetuating racial inequities
- Individual, institutional, and structural racism, and explicit and implicit bias
- How government employees can undo the explicit and implicit racist practices of predecessors
In January 2017, the Director of Health & Social Services invited the Solano Race Equity Team to speak with all 30 Health & Social Services managers at their quarterly meeting. The training was well received, and the team was invited to present to staff all across the Health & Social Services departments. The Health & Social Services managers and Race Equity team decided that, for now, they did not want to make participation in Advancing Racial Equity trainings mandatory due to anti-mandate sentiments among many staff and managers. However, the Race Equity Team is exploring how to include the Advancing Racial Equity training as an optional Cultural Competency training, while simultaneously embedding the training throughout the department.
As of May 2017, the Race Equity Team organized 7 well-received trainings with teams from Health Promotion & Community Wellness, Employment and Eligibility, First Five (contractors), and Behavioral Health. Managers and staff in Child Support Services also have planned sessions. Staff observe that the reaction from County leadership, department heads, and partner organizations has been overwhelmingly positive. The team also organized a Racial Equity Open House with a GARE staff member as the invited speaker, which resulted in a partnership between Solano Health & Social Services and Human Resources to roll out the Advancing Racial Equity trainings across County agencies.
Digging deeper into health equity and community engagement
Using CDC chronic disease prevention funds, the Health Promotion & Community Wellness Bureau contracted Human Impact Partners (HIP) to help the bureau dive deeper into health equity and community engagement. With the Bureau’s 12–15 staff coming with different understandings of health equity, HIP developed and facilitated trainings about health equity rooted in examples of Solano’s work, shared tools to improve community engagement, and helped develop a collective understanding of why health equity is important for their work.
Following an all-day training and 2 half-day trainings with Bureau staff, HPCW contracted with HIP again to further support their community engagement activities. Specifically, HIP staff were contracted to:
- Support HPCW as they conducted a Health Impact Assessment
- Organize a consensus conference to help set priorities for the Bureau’s programs
- Conduct a phone survey of clients referred to chronic disease prevention programs
- Conduct focus groups in neighborhoods to assess the impacts of programmatic and policy changes (e.g., healthy store conversions, smoke-free multi-unit housing)
The intent was to help the Bureau think differently about their work, hear and consider community voices about the impacts of their work, and conduct pilot projects to illustrate how they can do their work differently.
Participating in CityMatCH
Another way that Solano Public Health has sought to leverage external resources to advance equity internally is through participation in the National Organization of Urban Maternal and Child Health Leaders (CityMatCH). As part of a CityMatCH cohort, Solano County receives technical assistance from the national initiative, which seeks to improve birth outcomes for African Americans in 3 years.
Currently completing their first year in a 3-year cycle, the Solano CityMatCH group has expanded to become a community group. Although many of the people participating are connected through their work, the majority of participants live and work in the communities that they are trying to reach and are bringing firsthand experience with poor birth outcomes.
During their first year, the Solano CityMatCH group has primarily focused on education, visioning, branding, and developing a project workplan. To develop a shared understanding of how racism and social inequities negatively impact birth outcomes and life opportunities, the CityMatCH cohort looked at Solano data, showed the Unnatural Causes video, and played race equity games. By the end of their first year, the team will identify a specific project to address inequitable birth outcomes over the next 2 years.
Outcomes and Impacts
Race Equity Team hosts “Safe and Welcoming Space” events
Following several killings in the summer of 2016, the Race Equity Team hosted events for Department staff to gather and support each other. Moved by Black coworkers describing how they have to explain these events to their children, and informed by health department efforts in nearby jurisdictions, team members decided this was important to do, despite initial resistance. A diverse group of staff planned and successfully hosted 4 “Safe and Welcoming Space” events in collaboration with Mental Health staff who were on hand during the events. As noted by one staff person, “These events helped move us forward in a way that is hard to document. But the event created a space for people to talk about race and how this impacts us personally. It helped embolden some staff to do more, new staff joined the Race Equity Team, and they have used the list of participants to help make more structural racism trainings happen across the department.”
Building staff capacity to conduct Advancing Racial Equity trainings
During their participation in the year-long regional GARE Learning Cohort, Solano Public Health staff received tools and skills to facilitate a 4-hour introductory training on structural racism. As of June 2017, 6 staff members have practiced and feel confident conducting the trainings across the county.
Positive and inspiring responses to Advancing Racial Equity trainings
Despite an initial hesitance to discuss racial inequities in the workplace, staff were exceptionally supportive and eager to gently challenge pre-conceived notions and beliefs. Staff were particularly excited about applying the racial equity framework and tools in their day-to-day tasks and activities, both at work and in their private lives.
Use of Race Equity Tool
Adapted from a number of other equity tools in the GARE national network, Solano’s Racial Equity Tool integrates an explicit consideration of racial equity into policy, program, and budget decisions.
Highlighting emphasis on upstream work to address equity
Solano Public Health staff have worked with internal government partners, elected officials, and policy makers, as well as youth and community members, to emphasize their focus on upstream policy, environmental, and systems change. For example:
- Through their website and social media accounts, Solano Public Health has conveyed clear messages about systems changes in which partners and residents can have a role.
- At the Race Equity Open House event, staff introduced social determinants and racial equity data and frameworks, and participating government employees and elected officials expressed an eagerness to adopt equity frameworks and tools into their work.
- Staff and partners were encouraged to look upstream in the accreditation process, through the BARHII model, leading to the top 5 priorities for the Community Health Improvement Plan (CHIP) focused on poverty, homelessness, unemployment, lack of affordable housing, and inequitable education instead of individual behavior change.
Upstream policy and environment changes implemented
Solano Public Health worked with cross-sector collaborators to mobilize data, move conversations upstream, and make concrete policy change. Specifically, Solano Public Health increased access to water and smoke-free spaces for thousands of people by supporting the following changes:
- 2 city park systems and 3 school districts updated their policies to ensure access to drinking water.
- With a grant from CDC, 33 new water bottle–filling stations were installed in Solano’s highest-need parks and 40 water stations were installed in the highest-need schools.
- The County and 3 cities updated park policies to provide smoke-free parks and campgrounds in their respective jurisdictions, impacting 2 campgrounds, 5 community centers, and 84 parks.
Ability to discuss health equity in new ways
Staff state that doing this work opened the door to discuss health equity with partners in new ways. For example, thoughtful discussions about how to prioritize locations for new water stations and how to protect the homeless from being targeted for smoking in parks are helping move equity discussions into the open and be regularly considered in decision making.
As its grants wrap up or move into new phases, Solano Public Health is exploring how to continue the momentum and advances achieved over the past few years.
Solano Public Health hopes to continue chronic disease prevention work following the end of the CDC grant, but with greater community engagement. By doing more community-based and community-listening activities with HIP, HPCW is hoping to build deeper relationships with specific communities and see where those relationships take them. And by piloting health impact assessment and consensus conference techniques, the Bureau will learn how to apply these and other related community engagement techniques.
The CityMatCH project does not have external funding but has a very committed team of people involved, and will have increased momentum with community members once a birth outcomes inequities project is identified.
Solano Public Health will remain involved in GARE, and will focus their second year on expanding their internal trainings across the county and broadening use of the Racial Equity Tool. Staff are also discussing the idea of a Health Equity Officer to normalize and operationalize potential changes to internal practices that advance health equity.
Advice for Local Health Departments
When discussing racial injustices, foster a sense of responsibility for the present, without diverting blame for the past
Through the GARE Learning Cohort, Solano Public Health Division staff learned that some marginalized and oppressed populations in the county may only see government when the systems aren’t working for them. Although the individuals they partner with today may not be the individuals who created the systems, that distinction doesn’t always matter. The Advancing Racial Equity training confronts the explicitly racist past of US government entities, including local ones, and for some participants, this is new information. Training facilitators make sure to steer the conversation toward what current government employees can do to change the systems for which they work, while always taking into consideration the ways in which burdens were intentionally or unintentionally created in the past to ensure they are not exacerbated in the future.
Leverage inside champions and outside experts/networks in low-resourced departments
To advance health equity, you need inside champions and outside experts who are experienced and can help jumpstart your efforts. Solano Public Health didn’t have the resources to be the first to do new things, but they took advantage of existing networks and learned from other agencies and national groups to identify best practices. For example, participation with GARE has provided not just tools and trainings, but also networking and relationship-building opportunities.
Find your allies in the health department
It is critical to find other people who share a similar vision and values for advancing health equity. This work can be difficult, and sometimes simply going out to lunch or having someone else to bounce ideas off of or express frustrations to can help you keep moving forward.
Know what’s happening across the health department
Although many Solano Public Health staff were aware of equity-based initiatives happening elsewhere in the Division, many activities overlapped. Ideally department leadership will encourage program staff to talk to each other and/or have a consistent means of disseminating information about what’s happening across the department. However, staff may need to take their own initiative to ensure this information is being shared effectively.
Get out of your office, stand on the corner, and listen
To understand what’s happening in your communities, it’s important to get out of the office, talk to people, and be a good listener. By reaching out to people in neighboring county health departments, community and advocacy groups, and schools, you can build real relationships and understanding.