Monterey County, California, has a population of 437,907. Agriculture in Monterey County has an estimated $8 billion annual impact on the local economy, and the surrounding Salinas Valley is known as the Salad Bowl of the World.” Overall, 55% of the population is Hispanic/Latino, 33% are White (not Hispanic), 6% are Asian, 3% are Black/African American, and the remaining 3% are Other with 53% of the population not speaking English at home. Monterey County has a 17% poverty rate, 1 in 3 residents are on Medi-Cal, and 1 in 10 of the county's public school children are homeless. Monterey County Health Department (MCHD) tackles diverse health issues reflective of its diverse population.
Health equity is a guiding priority and core value of the American Public Health Association. Health equity means everyone has the opportunity to attain their highest level of health. Inequities have led to disparities in key outcomes (from infant mortality to life expectancy) in the United States and these differences in health status by social and demographic factors have tended to grow larger over the past several decades rather than diminish. Health departments are at the forefront of work to reduce health inequitities. Yet often staff have not had opportunities to consider the history of health inequities in their jurisdiction, learn methods for reducing health inequities as part of their daily work, or provide input on how their health department addresses health inequities. A knowledgeable and engaged workforce is one that can shift systems thinking and work strategically with other sectors to address factors that influence health, from housing to food access.
MCHD's Health Equity Scholars Academy (HESA) seeks to help achieve health equity in Monterey County by transforming MCHD culture. HESA's goal is to build understanding and capacity to advance equity across MCHD's workforce and in the community. Objectives include enhancing the safety and quality of services through training staff in health equity principles; creating collaborative relationships across department sectors to address inequities; and improving staff leadership and their work done in the community at a systemic level to address health inequities. Through a learning environment, staff gain an awareness of one's culture and lived experience and how that affects health.
HESA was implemented in 2014 by the Health Director as part of the 2011-2016 Strategic Plan. HESA supports internal transformative processes through guided classroom dialogue about issues including social determinants of health, cultural inclusion, and structuralized racialization. HESA participants meet once a month over five months to learn about these issues in relation to Monterey County and discuss how to better serve in a culturally sensitive manner. Most importantly, participants brainstorm steps MCHD can take to reduce such inequities and build community capacity.
Given the goals and objectives, the HESA program has been quite successful. It is a voluntary training, resulting in 105 staff to date participating in a comprehensive five-module course of 20 hours total. Twenty-one percent of participating staff have been managers or supervisors and 79% have been front line staff. Over half of the participants come from MCHD's Public Health Bureau and there has been representation from all seven Bureaus over the four years that the training has been offered. Staff have appreciated the opportunity for dialogues and learning around equity, power, and oppression. HESA's goal of 80% of participants gaining knowledge in health equity has been surpassed for each cohort. In addition, knowledge gained by staff has disseminated across all staff. In a 2017 all staff survey, nearly 75% of MCHD staff members indicated that MCHD is committed to addressing upstream issues, including environmental, social, and economic conditions that affect health. Additionally, approximately three out of four respondents agreed that MCHD has expectations for how staff should work with community members.
In addition, this program at MCHD has facilitated more discussions around racial equity across county departments and HESA components have been incorporated into a new mandatory countywide training on implicit bias.
A number of factors have led to the success of the HESA program. These include championing of transformative change by senior leadership, building internal infrastructure to develop the training, allocating resources to advance equity, engaging with the community and truly committing to addressing the issues they raised around equity, and building alliances both within and outside the department to protect against naysayers and ensuring accountability.
HESA has impacted MCHD's public health practice as the majority of staff understand the importance of health equity as part of the department's work and department efforts have begun to impact systems change across the county.
Website for your program, or LHD
MCHD: www.mtyhd.org
HESA website: http://www.co.monterey.ca.us/government/departments-a-h/health/planning-evaluation-and-policy-pep/health-equity-scholars-academy