Promoting Health Equity in Los Angeles
The Department of Public Health (DPH) is facilitating Health Agency efforts to establish a Center for Health Equity. The Center’s mission is to ensure all individuals have access to the opportunities and resources needed for optimal health and well-being by advancing racial, social and environmental justice in partnership with committed organizations and residents.
The guiding principles for the Center include a belief in dismantling a system that assigns human value based on race, ethnicity, sexual orientation, gender identity, and/or religious affiliation; using data to drive action amplifying community voices through engagement in planning, implementation, analysis, and reporting; and building multi-sector partnerships that advance health equity.
The Center will initially invest in five key initiatives (Infant Mortality, Sexually Transmitted Infections, Environmental Justice, Health Neighborhoods, and Cultural & Linguistic Competency) with support from the Health Agency and external partners to expand cross-departmental efforts and community collaboration to achieve system, policy, and practice changes that lead to health equity. Core staff for the Center includes 4 full-time DPH positions and staff on loan from both the Department of Mental Health (DMH) and Department of Health Services (DHS).
The infant mortality rate is commonly used to measure the health and well-being of a population, and significant differences exist among communities throughout the nation based on income level, educational attainment, geographic location, and most significantly by race/ethnicity. In LA County, the infant mortality rate of Black babies is three times higher than the rate of white babies. Closing this gap will require developing innovative strategies to improve pre-conceptual, prenatal, inter-conceptual care.
Sexually Transmitted Infections
While STI rates remain lower in LA County than in many other large urban areas, rates have increased dramatically in recent years with a disproportionate number of cases among men of color, LGBTQ persons, and African American women. For example, the highest rates of gonorrhea are among young Black men and women, while the rate among Black women is over 11 times higher than the rate among white women and nearly six times higher than Latinas. Novel, coordinated action is needed to address the complex factors affecting STI rates countywide and placing some communities at higher risk.
Low-income communities and communities of color face a range of environmental hazards that contribute to poor health inequities. These include high-risk industry operating in close proximity to densely populated urban areas as well as poor quality infrastructure including lack of parks and trees, streets unsafe for walking, insufficient affordable housing, and degraded indoor environments. Addressing these conditions will require extensive collaboration across County departments and programs as well as ongoing community engagement to mitigate community-identified threats and support implementation of community identified solutions.
County residents with complex medical conditions often experience fragments and episodic care with few community supports, contributing to disproportionately poor outcomes and high levels of frustration. By linking population-based approaches with comprehensive service delivery models, it is possible to address gaps in services and offer a broad spectrum of interventions that both address determinants of ill health and ensure availability of effective treatment services for individuals with complex health needs. Health Neighborhoods (HN) builds on a vibrant effort led by DMH to establish neighborhood coalitions that include health care, mental health, and public health providers collaborating with community-based agencies, social service providers, and community members to refine and improve care coordination and consumer engagement. HN aims to: expand access to services; increase care coordination among providers; and enhance the health and well-being of the neighborhoods and communities they serve.
Cultural and Linguistic Competency
Cultural competence for health care providers often refers to skills, values, and principles that embrace understanding, appreciating and respecting the differing social, cultural, and linguistic needs of clients. When absent, communication and trust suffers, often leading to client dissatisfaction, decreased treatment adherence, lower utilization of health-promoting services, and ultimately poorer health outcomes. Providers may also be at risk of allowing implicit bias to adversely affect their behavior and clinical decision-making. A culturally competent health care system can help improve health outcomes and quality of care and can contribute to the elimination of health inequities. This specific initiative builds upon a 2015 Health Agency Strategic Priority and aims to establish the Health Agency Cultural Competency Institute (HACCI). HACCI will focus on ensuring culturally competent strategies are used across the Health Agency; community stakeholder involvement occurs at critical junctures; quality improvement is ongoing, and workforce development and training is available for staff involved in client care and community outreach.
To learn more, read the DPH Rx for Prevention article, “Achieving Optimal Health for All Angelenos: An Interview with