November 18, 2022
San Joaquin Valley Public Health Consortium, CA

Introduction

For many years, public health departments have been forced to rely on limited, inconsistent, and narrowly focused funding sources to do their work, hampering their ability to reliably build the cross-cutting competencies and skills needed to address public health challenges and health inequities. By pooling resources and sharing staff, expertise, funds, and programs, local public health departments often accomplish more together than they could alone. When established by willing partners and developed in a thoughtful and comprehensive manner, cross-agency resource-sharing arrangements can improve the efficiency and effectiveness of programs and strategies. The 2019 Public Health Forward: Modernizing the U.S. Public Health System report recommends that health departments, as appropriate, explore resource sharing arrangements with neighboring departments to fill in gaps or increase effectiveness and efficiency of foundational public health services.

Context

The San Joaquin Valley Public Health Consortium (SJVPHC) comprises 11 counties in a mainly rural and agricultural region of central California. Its members include the county health directors and county health officers from participating counties. The counties tend to have very similar public health issues and for over 20 years, the SJVPHC has met to discuss respective and collective challenges, exchange ideas, share information, and otherwise support one another in informal ways. For the past several years, member dues supported a part-time coordinator to support meeting logistics. Although SJVPHC members have had many ideas about potential joint programs, they lacked the resources to bring them to fruition. Just before the pandemic struck, health equity emerged as a shared priority and catalyzed a decision to hire a director and develop a strategic plan to share resources to address this issue as a region. As it has since the consortium was established, the California State University-Fresno (CSU-Fresno) Foundation serves as a fiscal agent and provides office space for SJVPHC staff.

Key Actions

Agree on the goals and objectives of a sharing arrangement.
  • SJVPHC leaders decided to build collective capacity to understanding health inequities and developing strategies to address them as a region.
  • A leadership committee comprising the health director and health officer from each county provides oversight to the consortium’s efforts.
  • The committee is guided by a shared mission, vision, core values and formal operating principles that address the governance structure, dues, establishment of subcommittees, and decisionmaking processes.
  • SJVPHC began by hiring a full-time director to develop and manage an effort to advance health equity throughout the region. The director leads activities that the SJVPHC members value but do not have the capacity to do, including meeting logistics, developing programs, writing grants, hosting interns, and hiring and supervising additional staff.
  • The next planned hire is a data scientist. Epidemiology capacity in member health departments varies widely, ranging from full-time, to part-time, to no epidemiologists on staff. The shared data scientist will develop a regional assessment of health inequities and conduct other epidemiological studies to support planning and evaluation for health equity work. The studies will include both regional and county data and analyses to support public health efforts at the regional and county levels.
  • Additional hires for the near future include a communications specialist, health equity coordinator, and collaboration specialist.
    • The communications specialist will develop, implement and maintain a regional communication plan tailored to reach the valley’s diverse communities on health risks and health education.
    • The health equity coordinator will develop and implement strategies to advance health equity.
    • The collaboration specialist will support convenings and relationships between the health departments and people who have lived experience and the organizations that support them.
  • SJVPHC members have been paying dues since the group was established in 1999. Dues were increased moderately in 2020 to hire a director.
  • Dues are calculated on a per capita basis. The smallest health department, in Mariposa County, serves 17,000 people, and the largest health department, in Fresno County, serves one million; dues range from $750 to $32,000.
  • CSU-Fresno provides in-kind contributions such as office space, and additional funds come from other California-based foundations and the state health department. The state health department began providing funding to the consortium to assist with the region’s COVID-19 response.

Recommendations

Financial

Advocate for regional funding.
  • SJVPHC members work with the state health department as individual grantees and as a consortium. The SJVPHC director is included in strategic discussions with the state health department about funding opportunities for her input and to facilitate her grant writing.

Routinely connect consortium staff to potential funding resources, as staff may not receive the same funding notices as health departments.

  • State health department contracts obligate SJVPHC to serve all eleven counties, and the consortium does not pursue any funds that omit any of the counties (e.g., some local foundations do not serve all of them). This practice helps to ensure that the consortium serves all counties in an equitable fashion.

Workforce

Hire a lead staff member capable of making executive-level decisions.

The more independent the staff, the more efficiently work can proceed. It is important that all those involved in governing a consortium have a high level of trust in the senior staff person.

As consortium staff are hired, they will generate work that requires discussion, review, and approval by member health departments’ staff. Moreover, the goal of the consortium is to be of value to the health departments. Therefore, health departments should ensure that their staff dedicate time as needed to support the work of the consortium.

  • SJVPHC established subcommittees populated by program staff who provide subject matter expertise and approve deliverables that do not need executive-level feedback.

Encourage staff to contact other consortium members for input on individual county efforts and remind staff of the available expertise of consortium staff. Health department staff-level engagement with consortium members and consortium staff further solidifies a culture of a regional mindset, that in turn strengthens the value of the consortium.

Policy

Leverage the power of regional policy statements.
  • SJVPHC is developing processes to generate and disseminate regional policy statements. A regional approach may be an effective way to raise the visibility of public health issues that may not otherwise receive attention due to political opposition. Furthermore, the widespread support demonstrated by a region-wide statement can be persuasive to policymakers.
  • SJVPHC is developing regional statements on equity and racial justice and hopes these will provide a foundation for individual county efforts in addition to supporting regional work.

It is important that regional statements use language and concepts that are culturally competent and do not directly oppose decisionmakers’ stances or otherwise risk generating political backlash.

  • The COVID-19 response have left many in the San Joaquin Valley with lingering distrust and resentment of government “intrusion” into people’s private lives. This sentiment is more pronounced in some areas than others. The to-be-hired communications specialist will be instrumental in crafting language that is sensitive to these sentiments and helps to re-establish communities’ trust in public health departments.

Anticipated Impacts For Public Health Departments

An initial analysis surfaced some inequities and generated additional questions.

SJVPHC members’ staff worked with partners to complete an initial regional equity analysis that surfaced some health inequities and generated additional questions that the data scientist will address. The initial findings provided a solid foundation for planning the consortium’s first hires and starting to advance health equity at the regional level.

Potential Challenges To Implementation

Workforce shortages and high turnover rates.

When a SVJPHC member health department does not have a local health officer, as has been the case, their counties are not fully represented during leadership committee meetings. One option to addressing a leadership vacancy is to allow health departments to bring another staff member to meetings who is comfortable taking leadership in the department.

Sustainability

The expanded SJVPHC relies on grant funds and therefore, grant-writing is important.

Despite the support of CSU-Fresno and membership dues, the expanded SJVPHC relies on grant funds and, therefore, grant-writing is an important part of the director’s job. The decision to hire the director came shortly before the pandemic started; as a result, more funding than usual has been available to support SJVPHC. Within a few years, however, additional support will need to be secured. SJVPHC fully anticipates that the additional capacity afforded by the expanded staff will greatly enhance its ability to attract additional grants, as deliverables are generated and the value of the consortium in advancing health equity becomes more tangible.

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