Welcome to the health equity website of the Public Health Services (PHS) department in the County of San Diego Health and Human Services Agency. This website provides a history of health equity in PHS, current health equity efforts, and additional health equity resources. 

Introduction

Since 2001, the Public Health Services (PHS) department in the County of San Diego Health and Human Services Agency (HHSA) has had a long history of focusing on social determinants of health and health disparities. In approximately the past 20 years, the County has made significant progress in addressing health disparities and committing to advancing health equity. In early 2000, the terms social determinants of health and health disparities were utilized; health equity was yet to be socialized. In 2008, HHSA made health equity a priority. This was followed by the health equity framework developed by the Public Health Officer.

PHS has dedicated significant resources toward these efforts. In 2001, the Reduce and Eliminate Health Disparities with Information (REHDI) Initiative was created. Currently, educational materials are posted on the PHS webpage in multiple languages. Following HHSA’s declaration of health equity as an Agency priority, in 2008, the Chronic Disease and Health Disparities Unit (later named the Chronic Disease and Health Equity Unit) was created, with its activities supporting the Building Better Health component of Live Well San Diego, focusing on nutrition, physical activity, and tobacco. In February 2010, PHS Public Health Officer created a health equity framework for the California Conference of Local Health Officers (CCLHO); it was used to integrate health equity into PHS to prepare for national public health accreditation. As part of this accreditation journey, in 2015, an Office of Health Equity was created (followed by including Climate Change in the name of the Unit in 2020); the Health Equity Working Group, also created in 2015, continues to meet every two months and to implement its internally focused health equity work plan; a departmental Health Equity Policy was also created. Lastly, PHS has developed Health Equity goals, which are part of the PHS Strategic Plan. Public Health Services' health equity efforts contribute to the overall County of San Diego and HHSA efforts to advance health equity.

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Vision, Mission, and Goal

PHS Timeline

• In 2001, Public Health Services (PHS) developed Reduce and Eliminate Health Disparities with Information (REHDI) Initiative to recognize health inequities across specific populations.
• In 2008, the Health and Human Services Agency made “health equity” an Agency priority.
• In Spring 2008, PHS established a Chronic Disease and Health Equity Unit devoted to the promotion of wellness and prevention of illness, disability, and premature death due to chronic diseases and health disparities. This unit focusses on policy, systems and environmental factors to advance health equity.
• In 2010, the County of San Diego Board of Supervisors adopted Live Well San Diego, a long-term initiative. Live Well San Diego includes three components: Building Better Health, Living Safely, and Thriving.
• In July 2010, the PHS Public Health Officer created the Health Equity Framework for CCLHO. A subsequent article was published promoting this effort.
• In 2010, PHS staff participated in the Public Health Institute (PHI) second cohort of the California/Hawaii Public Health Leadership Institute (CHPHLI), focused on health equity.
• In 2012, PHS was able to assess the County of San Diego Health and Human Services Agency (HHSA) 5,400 plus staff members on skills and organization practices and infrastructure needed to address health equity. The Health Equity Assessment was separated into three parts to provide information on which areas to target to ensure that staff is able to address health equity. This was the first BARHII survey for staff on health equity and cultural competency from the BARHII Toolkit. 
• In October 2014, the County of San Diego Board of Supervisors adopted the third component of Live Well San Diego, Thriving, which encompasses a broad range of areas that are interconnected and foundational to the quality-of-life for everyone in the region. The County of San Diego Public Health Services also became a member of Big Cities Health Coalition and participated on its health equity working group.
• In 2015, PHS hired its first Health Equity Coordinator, published its first ever Health Equity Plan (2015-2020), and created a Public Health Services Office of Health Equity (now named Office of Health Equity and Climate Change).
• In 2016, PHS undertook a series of tailored health equity workshops by branch to operationalize health equity and/or embed health equity into public health practice at the branch level.
• In 2017, PHS developed a series of mandatory Public Health 101 trainings for PHS staff including a Health Equity 101, History of Public Health 101, Concepts in Public Health 101, and Climate Change 101.
• In 2018, PHS leadership published a Health Equity article with Public Health Accreditation Board (PHAB) for the Journal of Public Health Management and Practice.
• Also in 2018, PHS undertook the second BARHII survey for staff on health equity and cultural competency from the BARHII Toolkit, and developed a Health Equity Tool for Programs to assist staff in operationalizing and embedding health equity in their public health practice.
• In the fall of 2019 achieved a 90+% completion rate of the mandatory health equity training for all staff.
• In 2019, Branch Health Equity goals were added to the Public Health Services Strategic Plan. 
• In 2020, produced the COVID-19 Health Equity Strategy.
• In 2021, San Diego County declared racism as a public health crisis and produced the second Health Equity Plan (July 1, 2021).
• In 2022, PHS expanded its cultural and social observance calendar and added minority health research as a regular feature of monthly cultural and social fliers, launched the Health Equity website, and updated the 101-training series, and the Health Equity Policy.

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PHS Health Equity Plan

Fiscal Years 23-26

The FY 23-26 Public Health Services Health Equity Plan includes a snapshot outlining how Public Health Services addresses equity through four domains: organizational, workforce, data, and community.

Public Health Services Health Equity Plan Snapshot
FY 23/24 to 25/26

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Health Equity Definitions

Health is a state of complete physical, social, and mental well-being, not merely the absence of disease or infirmity. Public Health refers to what we as a society do collectively to assure the conditions in which people can be healthy.

Health Disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.

Health Equity is when all groups in a population have fair and just opportunities to attain their full health, well-being, and quality of life.

Health Inequity is differences in population health status and mortality rates that are systemic, patterned, unfair, unjust, and actionable, as opposed to random or caused by those who become ill.

Public Health 3.0 refers to a major upgrade in public health practice that emphasizes cross-sector work to affect the social determinants of health and advance health equity. Public Health 3.0 challenges us to incorporate health into all areas of governance. It is led by the U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Health (OASH). It calls for us to boldly expand public health to address all aspects of life that promote health and well-being, including:

• Economic development
• Education
• Transportation
• Food
• Environment
• Housing
• Safe neighborhoods

Population Health refers to the health of a population as measured by health status indicators and as influenced by social, economic, and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development, and health services.

Health Equity Resources

Data Resources

The Community Health Statistics Unit (CHSU) provides health statistics that describe health behaviors, diseases, and injuries for specific populations, in addition to health trends and comparisons to national targets. View the Health Equity Dashboards.

Local and Regional Resources

• Collaboration with The Public Health Alliance of Southern California
  The Alliance strives to deepen its commitment to advancing health equity and racial justice through policy and institutional changes. 
• County of San Diego Diversity & Inclusion Fiscal Year 2020-2021 Report
  A report on Diversity, Equity and Inclusion in the County of San Diego.
• County of San Diego HHSA Chronic Disease and Health Equity (CDHE)
  CDHE's mission is to promote wellness and prevention of illness, disability, and premature death due to chronic diseases and health disparities.
• County of San Diego HHSA Community Health Statistics – Achieving Health Equity in San Diego
  The Community Health Statistics Unit developed key reports on the status of health equity in San Diego County (e.g., race/ethnicity, age, geography, gender, socio-economic status).
• Exploring Health Disparities in San Diego County: Executive Summary
  This executive summary highlights health disparities through five lenses of health equity including age, gender, geography, race/ethnicity, and socioeconomic status.
• Health and Human Services Agency Health Equity
  Overview of Health Equity efforts within Health and Human Services Agency so collective impact actions may be taken to ensure health and well-being for all San Diego County residents.
• Live Well Indicators
  The Top 10 Live Well San Diego Indicators define what it means to live well in San Diego. Measured across the lifespan among all residents, the Live Well San Diego Indicators capture the collective impact of programs, services and interventions provided by government and community partners striving to improve quality of life so that all San Diego County residents can be healthy, safe and thriving.
• Office of Equity and Racial Justice
  San Diego County's Office of Equity and Racial Justice partners with the community to co-create transformative, enduring, structural and systemic change in San Diego County government.
• Public Health Services Materials/Resources, Including Those in Multiple Languages
  The Public Health Services (PHS) Division, in the County of San Diego Health and Human Services Agency, provides health services and information in multiple languages, both online and at County Public Health Centers. This section of the PHS website is a listing of written materials, most of which were developed by the County of San Diego, State of California, or Federal agencies.

State Resources

• California Conference of Local Health Officers (CCLHO)
  The mission is to mission of CCLHO is to prevent disease and improve the health of all California residents.
• California Department of Public Health, California Office of Binational and Border Health (COBBH)
  COBBH was created “to facilitate cooperation between health officials and health professionals in California and Mexico, to reduce the risk of disease in the California border region and in those areas directly affected by border health conditions”.
• California Department of Public Health, Climate Change & Health Equity Section (CCHES)
  The Climate Change and Health Equity Section (CCHES) embeds health and equity in California climate change planning and embeds climate change and equity in public health planning.
• California Department of Public Health, Office of Health Equity (OHE)
  OHE works with community-based organizations and local governmental agencies to ensure that community perspectives and input help to shape a health equity lens in policies and strategic plans, recommendations, and implementation activities.
• California Reducing Disparities Project (CRDP)
  The goal of the CRDP is to simultaneously demonstrate that community derived mental health practices reduce mental health disparities across the five unserved, underserved, and inappropriately served population groups (African American; Latino/x; Asian and Pacific Islander; Native American; and LGBTQ+) as opposed to traditionally funded mental health services based on Western clinical models.
• Gender Health Equity Unit (GHEU)
  As part of the California Department of Public Health’s Office of Health Equity, the Gender Health Equity Unit (GHEU) plays a leadership role in the development of programs and policies intended to eliminate gender-based health disparities in California. 
• Health Equity Research and Statistics Section (HERSS)
  HERSS is a leading state section in collecting data and disseminating information about health and mental health disparities and inequities in California.
• Health in All Policies Initiative
  Health in All Policies is a collaborative approach to improving the health of all people by incorporating health considerations into decision-making across sectors and policy areas.

National and Federal Resources

• American Medical Association
  The American Medical Association is committed to addressing racial and ethnic health care disparities, through the Minority Affairs Section, the Health Care Disparities Program, and other initiatives.
• American Public Health Association (APHA): Health Equity
  Creating health equity is a guiding priority and core value of APHA. APHA works with other sectors to address the factors that influence health, including employment, housing, education, health care, public safety and food.
• CDC – Social Determinants of Health
  The CDC recognizes the impact of social determinants of health throughout its programs and provides data and resources to identify and address health inequities caused by unhealthy social environments.
• CDC COVID-19 Response Health Equity Strategy
  Progress Towards Reducing COVID-19 Disparities and Achieving Health Equity.
• CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) – Health Equity
  NCCDPHP addresses health equity through its programs, research, tools and resources and leadership access.
• CDC’s Office of Minority Health & Health Equity (OMHHE)
  The mission of OMHHE is to increase CDC’s ability to achieve health equity and women’s health issues across the nation through science and programs.
• Collaboration with Big Cities Health Coalition Working Group on Health Equity
  The Big Cities Health Coalition collaborates to advance equity and health for present and future generations.
• Health Equity Guide
  This website is structured around a set of strategic practices that health departments can apply to more meaningfully and comprehensively advance health equity. 
• Office of Climate Change and Health Equity (OCCHE)
  The Office of Climate Change and Health Equity addresses the impact of climate change on the health of the American people. Exercising powers of convening, coordination and collaboration, the Office serves as a department-wide hub for climate change and health policy, programming, and analysis, in pursuit of environmental justice and equitable health outcomes.
• The National Association of County and Community Health Officials (NACCHO): Health Equity and Social Justice
  The goal of NACCHO's Health Equity and Social Justice Program is to advance the capacity of local health departments to confront the root causes of inequities in the distribution of disease and illness through public health practice and their organizational structure. The program's initiatives explore why certain populations bear a disproportionate burden of disease and mortality and what social arrangements and institutions generate those inequities, to design strategy to eliminate them.
• The National Institute on Minority Health and Disparities (NIMHD)
  The mission of NIMHD is to lead scientific research to improve minority health and eliminate health disparities.
• U.S. Department of Health and Human Services: Office of Minority Health (OMH)
  OMH is dedicated to improving the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities.

Global Resources

• Sustainable Development Goals
  17 Sustainable Development Goals (SDGs) were created as an urgent call for action by all countries - developed and developing - in a global partnership. It is recognized that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth – all while tackling climate change and working to preserve our oceans and forests. For more information, view the 2023 Agenda for Sustainable Development. 
• The World Health Organization (WHO) - Global Health Observatory Data, Health Equity Monitor
  Data are presented according to social, demographic, economic or geographical factors helping to identify vulnerable populations and target health policies, programs, and practices.
• The World Health Organization (WHO) – Social Determinants of Health Unit
  The WHO is a global champion for addressing social determinants of health guiding research and policy to support countries in taking action to address health inequities.
• Universal Declaration of Human Rights
  The Universal Declaration of Human Rights (UDHR) is a milestone document in the history of human rights. The UDHR was adopted by the UN General Assembly in 1948 and was the result of the experience of the Second World War. 

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