Turning ships, shaping cultures: Incremental organizational steps to address evolving public health challenges

Spurred by national research and local experience, the San Mateo County Board of Supervisors convened a 2004 summit on health disparities. The Health Department invited expertise across multiple disciplines and sectors to shape this effort. Three areas were identified for initial focus – prevention of childhood obesity, substance abuse prevention, and linguistic access to health care. Subsequently, the Department considered the internal organizational structure needed to support this work in partnership with the community.

Internal resources were redirected to create a Health Policy, Planning and Promotion unit with expertise in community planning, health promotion and policy analysis to act as partners to community coalitions in influencing the root causes of health disparities. A decision for the unit to report directly to the Health Director provided leadership access and visibility. A dotted line reporting relationship to the Health Officer institutionalized the importance of the long-term population health agenda.

Learnings to date reflect successes and challenges. It is clear that trust-building will be incremental, requiring relationship-building at the individual and organizational levels, internally and in the community. The challenges of evaluation and interim milestones are central in balancing short- and long-term time horizons in improving community health. New human resources practices are evolving to involve the diverse perspectives needed to eliminate health disparities.