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The 1990s: A Salon on Health Equity

In the mid-1990s, a small group of public health directors and health officers from Alameda, Contra Costa and San Francisco counties, who had been working in the field for decades, got together to see how they might benefit from each other’s counsel. Although they began with familiar topics, such as whether it might make sense to regionalize public health laboratories, they soon concluded that the real potential of regional collaboration was in re-thinking the larger vision for public health. In particular, each was troubled by the fact that preventable illness and death seemed to reflect patterns of social inequalities, but public health programs were not designed to deal with these underlying causes. Even though the imagery that guides public health talks about going “upstream,” its programmatic base only went part of the way.

The informal conversations were sufficiently interesting that the group decided to meet monthly to see what they could come up with together. Although the focus was not yet sharp, the intent was compelling enough to draw in colleagues from public health departments in the City of Berkeley and San Mateo County, who had been struggling with similar concerns. One of the original participants, who is now employed by the Public Health Institute, was able to provide minimal support in the form of scheduling meetings, putting together agendas and taking notes. Over time, the public health officials also brought senior managers who were in the best positions to represent the programs and strategic directions of their respective health departments.

As is common in such amorphous groups, much of the discussion consisted of trying to recall what was decided at the last meeting, interrupted occasionally by questions about whether the group was merely a chatting salon or something to be taken seriously. After months of these wranglings had reached a low point, when some questioned whether it was worth continuing, one spoke up to say, “I know why I am here, it is to transform public health practice.” Not unlike a jazz improvisation, others added riffs that became not only BARHII’s name, but it’s mission “. . . to transform public health practice for the purpose of eliminating health inequities using a broad spectrum of approaches that create healthy communities.”

2002: Becoming an Organization

BARHII formally became an organization in 2002. BARHII asked the community foundations to each commit relatively small amounts of money to provide basic infrastructure support over several years to enable it to build a programmatic base and a long-term funding plan. The Peninsula Community Foundation (since reconstituted as the Silicon Valley Community Foundation), the San Francisco Foundation and East Bay Community Foundation awarded grants to hire a staff person and create a data and communications infrastructure. Subsequently, The California Endowment awarded BARHII a three-year grant to provide operational support and capacity for media issues. Since BARHII had no formal legal status, it was decided to ask the Public Health Institute, an Oakland-based non-profit, to serve as grantee and fiscal agent.

In the original grant applications, BARHII proposed to focus on nutrition and physical activity in low-income communities of color, in part because the growing movement around obesity prevention afforded public health departments an opportunity to demonstrate their contributions, and because the related practice focused on changing physical and social environments had implications for work on other diseases and risk factors. Subsequently, however, BARHII concluded that public health department categorical programs are often a source of limitation when working with communities where a host of neighborhood conditions contribute to poor health, and that having a single focus, no matter how important from a public health perspective, violates one of the first premises of working with communities that requires collaborative decision-making on priorities.

Accordingly, BARHII amended its focus to a broader interest in community engagement and capacity building, and corollary strategies to target institutions whose decisions have major implications for community health and well-being. A contract was executed with the Berkeley Media Studies Group to help craft approaches to media and policy issues that could supplement and support the work with communities and institutions. BARHII began ground breaking work on improving the community conditions that impact health.

BARHII’s Second Decade: 2012-Beyond

Since 2003, membership has grown from six to eleven health departments. As a result of the decision to focus more broadly than nutrition and physical activity, BARHII decided to organize its activities within the framework of two standing committees: Practice and Internal Capacity. The Practice Committee would develop new approaches to public health departments’ work with communities and other public and private entities. The Practice Committee subsequently spawned work groups focused on data, the built environment and communities. The Internal Capacity Committee would develop member health department capacity to carry out that work by conducting trainings, peer consultations, forums and other processes to increase the understanding of the link between public health and social justice, and to change the organization and culture of public health departments to better address the root causes of health inequities. BARHII continues to focus on improving expanding health practice to focus on the root causes of social inequity and on the internal capacity of public health departments BARHII has also joined with the National Association of County and City Health Officials (NACCHO) Social Justice Committee to work with other local health departments in California and the nation to re-focus practice and internal capacity toward the intersection of public health and social justice.