What Sparked This?

Grants built capacity to do upstream work

Over the past decade, the Douglas County Health Department (DCHD) sought and received grant funding from the Robert Wood Johnson Foundation, CDC’s Healthy Community Design Initiative, and the Health Impact Project to support Policy, System, and Environmental (PSE) change and Health Impact Assessment (HIA) work. The grants helped DCHD leadership — the Board of Health, Health Director, and division chiefs — to intentionally focus upstream on root causes and health equity on top of building internal capacity for data collection and analysis on the social determinants of health and community engagement. During this process, they utilized the BARHII Framework on Social Inequities and Health and the growing number of social determinants of health resources to support their capacity-building efforts.

Participating in the Public Health and Equity Cohort

In 2014, a Community Health Planner at DCHD participated in Human Impact Partners’ first Public Health and Equity Cohort (PHEC) (now called the Health Equity Awakened Leadership Institute). The Community Health Planner was selected for his prior work incorporating strong neighborhood engagement in his agency’s HIAs and was wholeheartedly supported by DCHD leadership.

“[The cohort experience] helped members learn both inside and outside strategies for advancing health equity at a local health department, but even more importantly, the relationships created and deep reflection sparked by PHEC challenged us to go from being supporters of health equity to being champions of health equity.”

Health departments’ leadership supported creation of local cohort

Following his participation in PHEC, the Community Health Planner proposed developing a local cohort of public health professionals committed to health equity. After receiving support from department leadership, the Community Health Planner called the Health Director for the Sarpy/Cass Department of Health & Wellness to seek their participation as well. The Director was instrumental in encouraging the idea of forming a local cohort and helping to identify mid-career public health leaders from around Omaha to participate in the cohort.

Program Description

“Through Common Quill, we are cultivating and supporting local champions of health equity — where health equity is a front-burner issue for each of us (personally and organizationally) and where we are willing to use our power and standing to find solutions, even in the face of risk and challenges.”

After a series of phone calls and lunches, a dozen people committed to participate, to support each other in their individual health equity work, and to work together to change the narrative around what creates disproportionate health outcomes in the Omaha metro area. After their first day-long retreat, they chose a name — Common Quill — to reflect their focus on changing the health narrative.

Common Quill focuses on mid-career professionals, so members bring key skills and experiences and are likely to be in positions of influence for many years to come.

Common Quill has created a new space for collaboration and communication. Although many of the individuals knew each other prior to Common Quill, they felt siloed in their individual organizations and divisions. The group meets twice a month — one meeting to discuss action steps and getting work done, and the other meeting to build relationships, have fun with each other, and decompress and debrief from the daily struggles of their work.

The group uses a shared leadership approach for their work. This approach has been very helpful for avoiding turf issues and agency politics, as well as helping people be more candid with each other. No single organization or individual “owns” this work:

• They host meetings in a range of locations rather than at a single agency
• They use facilitated processes to make sure everyone’s voice is included
• Everyone is participating as a fellow public health professional, not on behalf of their organization or agency

Outcomes and Impacts

• Raising health equity in large stakeholder meetings:

  One of Common Quill’s members is the Executive Director of Live Well Omaha, a key partner for various multi-sector health initiatives including the Douglas County/Omaha Community Health Improvement Plan and Partners for Healthy Schools. In 2016, Live Well Omaha and DCHD brought over 100 stakeholders together from health care, education, faith-based organizations, government, Fortune 500 businesses, small startups, and social service agencies for a process called a Decision Accelerator. The Live Well Omaha ED reached out to her Common Quill colleagues to make sure they were in the room to champion health equity during discussions about Omaha’s Accountable Health Community model.

• Incorporating the health equity frame into business discussions:

  As a result of the Decision Accelerator gathering, the elimination of health inequities is a clear commitment of Live Well Omaha’s updated vision. This means that Live Well Omaha brings a health equity frame to all of its discussions with Omaha business leaders who make up its membership.

• Reframing health department work to prioritize health equity:

  External work by Common Quill is being incorporated into both local health departments. Douglas County’s Health Equity Team recently completed a reworking of its purpose statement to take a much stronger stand on the importance of health equity and how it aligns across the entire department. At Sarpy/Cass, health equity is now built into its mission, vision, and organizational values.

Future Steps

“Utterly unapologetic yet deeply constructive champions for health equity”

In January 2017, Common Quill members met for their second all-day retreat to set priorities for their work for the upcoming year. The group decided that Common Quill will focus on ensuring that local public health efforts reframe health to include equity while building a base of support that goes beyond public health to include a critical mass of decision makers and diverse community members.

Advice for Local Health Departments

• Start by connecting with others informally:

  Start by talking with people to see if they are interested in an informal cohort. Many people welcome the opportunity to focus on the upstream work that is critically important — especially without the weight of funding requirements, grant deadlines, or agency politics attached. For the price of a couple of cups of coffee and a few lunches, you might find the makings of a new base of health equity champions.

• Invite people to participate as health professionals, not organizational representatives:

  Everyone who is part of Common Quill was invited as a fellow public health professional and not because of their title or job position. That has helped to minimize turf issues and power differentials in the group. Members are able to be very candid with each other in ways that would be less possible if they had to represent their agencies explicitly.

• Make time and space for fun:

  Health equity work is often heavy, and people need time to reboot and know that they aren’t alone in their struggles. Creating time for informal socializing is critically important for building the trust and understanding that allows Common Quill members to work together in meaningful ways.

Strategic practices leveraged in this case study

Develop Leadership and Support Innovation

Build a Health Equity Movement

Prioritize Upstream Policy Change

Build Organizational Capacity

Allocate Resources

Additional Resources

• HIP Public Health and Equity Emerging Leaders Cohort (now called Health Equity Awakened)
• TED Talk: Jonathan Haidt on the Moral Roots of Liberals and Conservatives
• Democracy Article: Of Freedom and Fairness by Jonathan Haidt