Why Racial and Health Equality Matters

Social determinants of public health gathered from the U.S. Department of Health and Human Services, Barhii Framework and Kaiser Family Foundation

“Health equity means that all people have equal opportunity to be healthy; to achieve health equity is to ensure equal access to opportunities for education, employment, housing, transportation, and healthcare,” says Maritza Rodriguez, Senior Manager overseeing the County’s Racial Health Equity Program. “Historical legacies, structures, and systems have excluded many groups, especially people of color and low-income communities, from full and equitable access to these fundamental building blocks for health. Thus, public health must work for racial equity to achieve health equity.”

Public health departments assess which communities are experiencing what health disparities, then evaluate the underlying social determinants that may be driving these disparities, and ultimately work to address the inequities to alleviate the disparate health outcomes. The County of Santa Clara Public Health Department (SCCPHD) created the Racial Health Equity Program to help organize this work.

The Racial Health Equity Program is rooted in the belief that everyone deserves the same opportunities to achieve optimal health, regardless of race. When people are allocated the resources, care, and opportunities they need to thrive, everyone can benefit, racial disparities can resolve, and health equity is achieved. This program manages several community-based initiatives that make an impact at the local level, including policy change, redistribution of resources and critical partnerships.

Violence Prevention

One key Racial and Health Equity initiative is SCCPHD’s partnership with the East San José PEACE (Prevention Efforts Advance Community Equity) program. The PEACE partnership is made up of East San Jose residents and organizations dedicated to building a healthy, peaceful, and empowered community by preventing and addressing violence and trauma.

SCCPHD’s Violence Prevention Program serves as the coordination and backbone team supporting PEACE’s community partners. Although she serves as PEACE’s Co-Chair, Public Health Officer Dr. Sara Cody notes that, in fidelity to the model of community-driven change, neither she nor the department are decision-making authorities.

“The Public Health Department provides strategy, guidance, and alignment to the group, but we take a back seat to the experience and expertise of community members and leaders who set the direction and emphasis,” Cody says. “We use what’s called a distributed leadership model to make sure that decisions are made across the partnership.”

Accordingly, residents serve in PEACE workgroups and make decisions on funding allocation and strategies they want to implement.

WHY RACIAL AND HEALTH EQUITY MATTERS

In East San José, residents experience more violence and trauma than elsewhere in Santa Clara County. The community, which is 55 percent Latinx and 33 percent Asian, struggles with higher rates of hospitalizations due to assaults and firearms and higher rates of violent crimes, such as intimate partner violence. Experiencing violence and trauma, especially multiple forms of violence over a long period of time, is a significant contributor to poor health and life outcomes, ranging from heart disease and diabetes to increased risk for eating disorders, substance abuse, depression, and anxiety.

To understand why residents of East San José experience higher levels of violence and associated poor health outcomes, one must understand the history of the community and the evolution of multiple social determinants of health. Social determinants are conditions in the environment where people are born, live, learn, work, play, worship, and age that affect a wide range of health and quality-of-life outcomes, either positively or negatively. Addressing the social determinants of health to achieve health equity is at the core of public health work -- and is also an enormous challenge.

“Health equity means that all people have equal opportunity to be healthy; to achieve health equity is to ensure equal access to opportunities for education, employment, housing, transportation, and healthcare,”

This community-based approach encourages the residents to be involved in decisions that meet their needs and improve their communities. Some of the community-led interventions include activities to address housing displacement, intimate partner violence, gun safety, resident-led peace-building, and youth leadership development.

The PEACE partnership is one of many programs that the County’s Public Health Department administers as part of its mission to eliminate the root causes of unequal health outcomes through focusing on racial and health equity. “It’s the moral responsibility of public health professionals to meet the needs of the community in a culturally responsive way,” says Rodriguez. The American Public Health Association has made health equity

one of its foundational principles. They argue that “obstacles to health must be removed, such as poverty, discrimination, and their consequences, such as powerlessness and lack of access to quality education. Failing to make progress harms us all.”

Equity During the COVID-19 Pandemic

Health inequities become dramatically apparent during health emergencies like the COVID-19 pandemic. The onset of the pandemic quickly magnified deep-rooted and systemic issues -- like high-density housing, high levels of service jobs, and poverty -- that perpetuated health disparities in communities like East San Jose and South County. SCCPHD’s Racial Health Equity team realized that they needed to act fast to rectify the inequities in these neighborhoods.

The team reached out to over 100 community partners to better understand the impacts of COVID and the shelter-in-place order. They discovered that multiple organizations in East San José were experiencing an influx of requests for resources and services from the community.

In response to the most impacted communities’ needs, the County internally reorganized and quickly began providing:

• Free COVID-19 testing at local community centers • Mobile testing teams that provided culturally and linguistically appropriate customer service • Drop-in vaccine clinics for those who had difficulty setting up a specific appointment time • Technological support and paper options for COVID testing in settings where residents did not have access to a computer or internet • Multiple language options for different populations and literacy levels. • Communication emphasizing that access to services did not depend on immigration status

“It’s the moral responsibility of public health professionals to meet the needs of the community in a culturally responsive way” “by centering racial health equity in our response, I believe that we were able to dramatically reduce unequal health outcomes in our most affected communities.”

“Like every other organization facing a once-in-a-lifetime pandemic, there are ways in which we could have improved our Public Health response to COVID,” said Deputy Director Michael Balliet. “But by centering racial health equity in our response, I believe that we were able to dramatically reduce unequal health outcomes in our most affected communities.”

Cost of Gun Violence in Santa Clara County

No issue better illustrates health inequities than the level of gun violence in communities of color. Gun violence is a public health crisis and has become a leading cause of premature death through suicide, domestic violence, and intra-community violence. However, through a public health approach, gunrelated injuries and death can significantly be reduced.

In August 2022, SCCPHD published the “Cost of Gun Violence in Santa Clara County” report. This report provides an economic analysis of direct costs associated with firearm injury and death across a continuum of public and private sectors, including healthcare, criminal justice, emergency response, mental health, and employers. Indirect costs such as victim loss of wages and lost quality of life are also included. To find other resources on injury and violence prevention, see the Health Data Reports section in SCCPHD’s website at publichealth.sccgov.org/healthinformation/health-data.

How Providers Can Play a Part in Achieving Racial Health Equity

What keeps people healthy extends much beyond clinical care. There are four ways providers can enhance patient care by utilizing a racial equity lens. First, providers have a unique role in promoting health equity by understanding and considering the social and economic determinants of health that impact the health of individuals, families, and communities. Second, providers can ensure that patients are seamlessly connected and linked to supportive community resources. Third, providers can engage in cultural humility training and institutional practices to better understand unconscious bias, stereotypes, and attitudes in caring for patients. And last, physicians have a position of power and can also serve as advocates and champions to hold society accountable for structural changes in the environment and social conditions that act as barriers to achieving health.

Source: County of Santa Clara Public Health Department (August 2022)

This map shows which parts of the County are most affected by poverty. If someone were to overlay a similar map showing incidences of diabetes, gun violence, poverty, or COVID on the same map, we would see the highest prevalence in all the same areas. These are also the same areas with fewer farmer’s markets and grocery stores, but an abundance of liquor stores and tobacco retail outlets.