Organizational Self-Assessment for Addressing Health Inequities: Tools, guidelines and resultant organizational changes at a local public health department

The Bay Area Regional Health Inequities Initiative (BARHII), a collaboration of the eleven public health departments in the San Francisco Bay Area, was formed to transform public health practice to achieve health equity and to build healthier communities. BARHII focuses on the underlying social conditions that contribute to health inequities and on the institutional policies and practices that shape those conditions. BARHII has developed the Organizational Self-Assessment for Addressing Health Inequities. It is presented in a toolkit complete with tools and guidelines that help identify skills, organizational practices and infrastructure needed to address health equity and facilitate local health departments taking steps to address the social determinants of health. It serves as the baseline measure of capacity, skills and areas for improvement to support health equity-focused activities; inventories the presence of a set of organizational and individual traits that support health equity-focused work; provides information to guide strategic planning processes; and serves as an ongoing tool to assess progress towards identified goals developed though the assessment process. The development of the self-assessment tools was informed by an extensive review of public health and organizational development literature, as well as a review of existing organizational and cultural competency assessment tools. The self-assessment was pilot-tested at the City of Berkeley Public Health Division and the tools were further refined based on the pilot experience. The toolkit, lessons learned from the tool development and piloting process, resultant organizational changes in the pilot site, and recommendations for adaptation will be shared.