UC Berkeley

AbstractHealth Equity at the Local Level by Elizabeth Ambriz Doctor of Public Health University of California, Berkeley Professor Jason Corburn, Chair

This dissertation provides insight into Local Health Department (LHD) and county practice to engage in a health equity practice. The persistent health inequities pattered by race, class, and gender in the US call for a paradigm shift in public health practice with renewed approaches and skills. The more than 3,000 LHDs nationwide can play a central role in reducing health inequities by engaging in an intentional health equity practice that addresses the social, economic, and historical drivers of health inequities.

In the first paper, Transforming LHD Practice to Address Health Inequities: A Systematic Review, I characterize the practices that comprise a LHD health equity practice to help LHDs gain a better understanding of LHD approaches to more effectively address health inequities. This paper identifies six practices that comprise a LHD health equity practice including (1) authentically engage communities and build their power, (2) address the social determinants of health (SDOH) through collaboration across sectors, (3) assess and influence the policy context, (4) build organizational and staff capacity, (5) demonstrate leadership, and (6) change the narrative.

In the second paper, One LHD’s Journey Towards Health Equity, I critically analyze how one suburban LHD with large areas of rural farmland, the Monterey County Health Department (MCHD), is engaging in a health equity practice and the challenges they face. The MCHD is building community power through its Leadership and Civic Engagement Academy (EnLACE), building Staff capacity through its Health Equity Scholars Academy (HESA) and Government Alliance for Racial Equity (GARE) trainings, and collaborating across multiple sectors to address social determinants of health (SDOH) through its Health in All Policies (HiAP) initiative. However, the MCHD experiences barriers to implementing a health equity practice including funding cuts and inflexible funding, conflicting agendas and interests, a lack of a systemic approach to addressing inequities, and an intentional focus on vulnerable and highest need groups and places in MC.

Finally, in the third paper, Monterey County’s COVID-19 Response Through a Health Equity Lens, I focus on analyzing the context in which the MCHD operates by examining Monterey County’s COVID-19 response through a health equity lens. This study found that MC is addressing the immediate crisis and aims to implement a long-term approach to addressing inequities in the SDOH. However, it is imperative that MC shares decision making power with the communities most impacted by inequities.