Change Internal Policies and Practices

How public health departments can change and align internal policies and practices to advance health equity and racial justice

Internal organizational policies and practices influence all aspects of public health infrastructure and systems. They shape how health departments design, implement, and evaluate their essential services. Written policies and practices reflect the organization’s values and culture. Health departments need to clearly articulate equity and justice values and ensure they are reflected in policies and practices. Values-aligned policies and practices help staff feel a sense of belonging, facilitate more effective equity strategies and practices, and support other counter-cultural practices necessary for transformative change.

Health departments can use an equity lens to assess and change internal policies. Backbone operation support systems, such as finance, human resources, and community engagement, are an effective place to begin assessing and changing internal policies, as these systems cut across all organizational divisions and can have wide influence and impact.

Internal policy and practice change requires:

• Leaders with power to make an organizational commitment to upholding and sustaining equity and justice practices internally
• Regular assessment of policies and practices to ensure they reflect the organization’s values
• Transparent and consistent communication to support the diffusion of new policies and practices
• Staff capacity and a supportive infrastructure to engage in internal change strategies

Action Steps health departments can take to change internal policies and practices:

• Assess organizational accessibility to ensure all staff are able to fully participate in all organizational programs and processes, keeping in mind that not all access needs are visible or obvious
• Update hiring, promotion, and retention policies and practices to ensure equity, inclusion, and diversity among agency staff. Include policies that:
  • Foster fair employment and promotion opportunities for all staff
  • Build cultures of access and belonging for all staff
  • Prioritize building a diverse workforce along multiple dimensions of identity
• Update contracting processes to make submitting proposals and receiving funding easier for community organizations. Prioritize contracts with businesses owned by Black, Indigenous, and people of color, women, LGBTQIA+ community members, and people with disabilities
• Use an equity lens tool to assess internal policies and practices, and then identify changes that will more explicitly and effectively promote equity across the health department
• Implement community engagement practices and standards that center involvement of those most impacted by inequities; support deeper relationships and collaboration with community groups; and compensate community members for their participation
• Align budgets and funding streams with health equity priorities, allowing the health department to better support and amplify community efforts that aim to transform the social and economic conditions for health