Holding a north star for equity in public health institutions

Public health workers come to their work in California wearing such diverse hats — epidemiologists, community organizers, infectious disease specialists, budget experts, racial equity advocates, and social workers. It’s one of the strengths of the field — that it draws on the wisdom of so many areas in the quest to ensure that everyone can live healthy, fulfilling lives. No matter the role, being visionary is part of the work. All of us, including funders, should ask: what do we want to achieve, and what does equity within public health systems look like in practice today, and in the future?

While the context we are working in has changed, the need for this vision has not, and in many ways, it is even more critical in this moment. Public health practitioners across California are under real strain. Federal funding cuts and delays are forcing difficult decisions; departments are reorganizing, and initiatives that explicitly focus on equity are facing increased scrutiny and backlash. Naming this moment matters, but it does not have to be where the story ends. In moments like this, public health must hold a clear north star: a system that is trusted, equitable, and effective, one that is structurally designed with partnerships and power-sharing to ensure community defined needs are at the center of the work. This way, community assets and strengths are brought to the table to improve health outcomes for those most impacted by inequities and address the underlying causes that create these inequities.

Over the past several years, local health departments across California have invested in institutionalizing equity roles to strengthen public health’s ability to meet this north star. A combination of state, philanthropic, and local health department funding created these roles in response to longstanding health inequities, and they were further shaped by lessons from the COVID19 pandemic. These roles were designed not as addons, but as deep changes to internal structure that embed equity into decision-making, elevate community voice, and align programs and policies with community priorities.

In partnership with the Bay Area Regional Health Inequities Initiative, Central California Public Health Consortium, the Public Health Alliance of Southern California, and the Berkeley Media Studies Group, Bright Research Group conducted an evaluation to understand the contributions of equity positions to community health as well as document how and why these positions lead to outcomes and long-term impact. The findings affirmed what many health jurisdictions have experienced firsthand: equity roles are effective. Across counties, they have contributed to more responsive public health approaches and improved access to services for communities most harmed by our current systems and structures.

In moments like this, when equity work is politically contested, resources are constrained, and public health institutions are restructuring. It can be tempting to narrow the scope of what feels possible and lose sight of our north star. Acknowledging today’s challenges while continuing to believe we can reach our north star is fundamental.

In the midst of our current challenges, we can still reimagine our public health institutions and lay the foundation for how we want to rebuild them. When that moment comes, approaches that work, like equity roles, will be vital architects of what comes next. This is why documenting and learning from what works matters, even amid uncertainty. The California Public Health Equity Position Theory of Change offers a practical and strategic tool that can be used to sustain or rebuild an infrastructure that will get us closer to our north star.

At Blue Shield of California Foundation, we are proud partners and funders of all the organizations that participated in this evaluation. And our commitment to supporting public health in our state is unwavering.