Achieving health equity and social justice: Mechanisms for organizational transformation at a local public health department

The Boston Public Health Commission (BPHC), the city's health department, is undergoing an organizational transformation to become an explicit social justice organization based on anti-racism and health equity principles and practice. BPHC employs several mechanisms that develop both its infrastructure and capacity to advance anti-racism and health equity throughout all programs and services. Structurally, BPHC has established a Center for Health Equity and Social Justice in the Executive Office and an intra-agency Anti-Racism Advisory Committee (ARAC). The Center, launched in October 2008, combines two Commission offices to expand efforts to eliminate racial and ethnic health inequities among city residents: the REACH US Center of Excellence in the Elimination of Disparities (CEED) and the Office of Health Equity. The Center works to develop a comprehensive health equity agenda for BPHC's programs and partnerships that focuses on organizational change, policy development, community coalitions, community engagement, and sustainability. ARAC consists of 22 staff members from across BPHC and works to shape the organization's anti-racism strategies and identity. These entities are working together to build organizational capacity by developing an integrated training curriculum for all staff. The training will link health equity and racial justice theories to public health practice. It will also support changes in program planning, implementation, and evaluation, including development of specific indicators and benchmarks, in order to track progress towards achieving health equity. BPHC's strong leadership has been essential to the Commission's transformation. The model presented will be valuable for public health departments aiming to establish similar approaches.