Over the last 20 years BARHII has published landmark reports, guides and briefs that have set standards for health equity and empower communities across the Bay Area
Resources
Most recent reports
Steady Hands, Strategic Choices: Leading with Equity in Times of Constraint
Leadership that Defends as it Builds: Five Equity Leadership Practices for the Moment
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Equity leaders in government are helping build a future we all deserve—one rooted in dignity, belonging, and collective well-being. That work has never been simple. Today, equity leaders are operating in a moment that is both familiar and newly complex.
This resource compiles insights from equity officers across the Bay Area about leadership in our new national moment. It surfaces effective strategies that equity officers have used to continue to advance long-term systems change inside public institutions. It also gives voice to the various roles that equity officers are often filling to forward their goals, including the bureau-strategist, network weaver, and more.
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Health equity champions in the Bay Area's public health departments are making strategic decisions about how to address new resource constraints while protecting critical programs and communities.
This guide highlights powerful strategies, tools, and mindsets that public health leaders can use right now to navigate the challenges of equitable resource allocation, showing how equity can remain at the center, even in constrained circumstances. It includes powerful budget equity approaches identified by BARHII's Executive Committee members, including budget equity assessment tools, community engagement approaches for complicated budgetary processes, and regional partnership opportunities.
Equity in the Response to Covid-19
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During the Covid-19 emergency, equity champions across the Bay Area delivered powerful innovations that saved lives and sustained families.
This report—“Equity in the Response to Covid-19: Successes and Areas of Opportunity for the Bay Area”—distills powerful lessons from the Bay Area’s pandemic response—and offers strategies that local governments and others can use to cultivate equitable approaches to future emergencies. This resource is built on the insights of public health staff, emergency managers, and community leaders who were directly involved in responding to the pandemic in our region.
We hope this resource inspires you to continue the critical work of safeguarding and advancing equity—preserving innovations, building on accomplishments, and strengthening local efforts in the face of new threats.
Practice Shift: A Playbook for Harnessing New Equity Roles to Drive Innovation in California's Local Public Health Departments
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It’s a transformational moment for the equity movement in California. Equity officers and equity leads are being appointed across all levels of government—from state agencies to local jurisdictions and departments. The California Department of Public Health (CDPH) recently invested $30 million in equity staff across our state’s local public health departments.
This resource supports our growing community of health equity practitioners in local government. Our report outlines five pathways that equity teams in public health departments can pursue to initiate or accelerate local health equity efforts, with exciting examples and tools. The report compiles key insights from the BARHII Action Lab’s 2023 California Equity All-Stars Series—a year-long training and skill building series for health equity leads and their colleagues across the state.
Reimagining Public Safety Report
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Police violence affects the entire Bay Area—from wealthy suburbs to core cities—disproportionately affecting the health of Black families and other communities of color. How will we address this health equity crisis and forge a path forward?
In the wake of a national cry for racial justice in policing, this guidebook demonstrates how police violence affects public health in the Bay Area and provides a roadmap for achieving healthier, safer communities for everyone, with inspiring solutions from across the region.
As our local governments face major questions about how to invest historic infusions of federal and state funds, we offer tools to help reimagine public safety through a public health lens, addressing structural inequities and institutional racism while improving the social and economic conditions that influence our health and safety.
Health Department Toolkits
Applying Social Determinants of Health Indicator Data for Advancing Health Equity
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The purpose of this step-by-step technical guide is to assist local public health departments and their community partners in the collection, analysis, and usage of priority living conditions data indicators for local community health assessments, program/policy development, and health equity advocacy.
Included in this guide are an introduction section with a Bay Area regional social gradient analysis using concentrated poverty, educational attainment, cause of death and life expectancy data; 15 “how to analyze” social determinants of health (SDOH) indicator chapters; a table of 72 priority SDOH indicators and their data sources; and technical data appendices.
State Health Department Organizational Self-Assessment For Achieving Health Equity
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The State Health Department Organizational Self-Assessment for Achieving Health Equity: (State Self-Assessment) provides public health leaders with tools and guidance to help identify the skills, organizational practices, and infrastructure necessary to achieve health equity.
The Self-Assessment document supplements the Local Health Department Organizational Self-Assessment for Addressing Health Inequities: Toolkit and Guide to Implementation developed by the Bay Area Regional Health Inequity Initiative (BARHII). The Self-Assessment can be a key component in strengthening the health department’s capacity to partner with communities, agencies and organizations to achieve health equity. The process requires commitment at all levels within the health department.
The State Self-Assessment is intended to help state health departments in the following ways:
Establish a baseline measure of capacity, skills, and areas for improvement to support health equity focused activities.
Inventory a set of research-based organizational and individual traits that support effective health equity focused work.
Provide information to guide strategic planning.
Serve as an ongoing set of tools to measure progress toward goals developed through the assessment process.
The Self-Assessment includes a compendium of six instruments and guidelines to support state health departments in addressing health inequities. The instruments are:
Staff Survey – An online tool designed for health department staff at all levels within the organization. The survey addresses most of the elements in the Matrix (see below).
Collaborating Partner Survey – An online tool to give other agencies, organizations, and groups working with the health department an opportunity to share feedback and insights regarding health equity work.
Staff Focus Groups – Facilitated group questions for in-depth discussions of the Matrix elements. The questions are meant to gather further information on specific issues from the staff survey.
Management Staff Interviews – Individual interviews with senior management allowing the department to get an in-depth sense of organizational strengths and areas for improvement related to addressing health inequities.
Internal Document Review Worksheet – A worksheet that can be used to summarize important data gathered during the Internal Document Review and Discussion phase of the self-assessment.
Management Focus Groups – Designed as an alternative to managers participating in both a focus group and a management interview. It combines questions from each instrument.
Local Health Department Organizational Self-Assessment
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The Organizational Self-Assessment (Self-Assessment) for Addressing Health Inequities Toolkit is designed to assist public health leaders in identifying the necessary skills, practices, and infrastructure to tackle health equity issues. It serves as a baseline measure of capacity and areas for improvement, guides strategic planning, and monitors progress towards established goals. The toolkit includes instruments such as staff surveys, collaborating partner surveys, staff focus groups, and management staff interviews. It also provides guidelines for reviewing internal documents and human resources data. Additionally, the toolkit offers an implementation guide to help organizations assess readiness, prepare for the self-assessment, and take action based on the results. We encourage widespread use of the toolkit and ask that you please credit BARHII if you use or present on the Toolkit.
Practice Shift: A Playbook for Harnessing New Equity Roles to Drive Innovation in California's Local Public Health Departments
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It’s a transformational moment for the equity movement in California. Equity officers and equity leads are being appointed across all levels of government—from state agencies to local jurisdictions and departments. The California Department of Public Health (CDPH) recently invested $30 million in equity staff across our state’s local public health departments.
This resource supports our growing community of health equity practitioners in local government. Our report outlines five pathways that equity teams in public health departments can pursue to initiate or accelerate local health equity efforts, with exciting examples and tools. The report compiles key insights from the BARHII Action Lab’s 2023 California Equity All-Stars Series—a year-long training and skill building series for health equity leads and their colleagues across the state.
Equitable Recovery
Equity in the Response to COVID-19
COVID-19 Equity Investment Guide | 2021
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We recently released the second edition of our “equity investment guide” and it's bigger and better! This powerful tool supports local government investment decisions for an equitable rolling recovery from COVID-19. The guide integrates the latest information on federal and state investment opportunities—with the American Rescue Plan Act (ARPA) and California’s historic 2021 state budget. It also includes guiding principles, our top ten priorities for local investment, and examples of promising practices from across the Bay Area.
It’s a great companion to the first edition of the guide from fall 2020, which provides a broad suite of policies and investments that local governments can adopt to advance equity.
Eight Essential Actions for the Bay Area | 2021
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The Bay Area should be a place where people of diverse incomes and backgrounds can live and thrive—with healthy, stable, and affordable housing.
By late 2020, California’s pandemic-related eviction protections had already prevented 186,000 COVID-19 cases and 6,000 deaths. Even though one million California adults are behind on rent, the statewide emergency eviction moratorium expires on September 30th, 2021, and foreclosure protections are also ending.
The Bay Area’s local governments and philanthropies must act quickly to support our communities. Many households—especially in Black, Indigenous, Latinx, and Pacific Islander communities—face a tenuous future as the pandemic continues to deepen existing racial injustices, claim lives, increase debts, and threaten livelihoods. Our solutions should advance racial justice and make everyone safer by prioritizing the people who have been hit hardest by the pandemic.
In 2021, BARHII convened an array of experts from across the region—including legal assistance and safety-net service providers, community organizers, philanthropic leaders, and public health experts—to develop solutions. Together, we created this powerful guide, which outlines eight essential actions that local governments and philanthropic leaders should take to prepare for the end of emergency housing protections. This new tool is endorsed by nearly 50 organizations and includes solutions that are already working in communities across the region.
Embedding Equity into Emergency Operations | 2020
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The COVID-19 pandemic has revealed stark inequities in the health and economic security of California’s communities, with particularly alarming disparities in health outcomes by race and ethnicity. These disparities are driven by current inequitable policies and practices and a legacy of historic discrimination that puts Black, Latinx and other communities most impacted by inequities in harm’s way. For example, the lack of adequate protective measures for many “essential workers”—a population that is disproportionately people of color—has fostered a racial divide between those who can “shelter in place” and those who cannot. As the crisis grows, there is an urgent need for Local Health Departments to work with community members, elected officials, and other departments and agencies to address these inequities through their emergency response and recovery processes.
Farther Together | 2021
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This guide lays out a path for transforming how public agencies engage communities in climate resilience planning and disaster response to foster a healthy, resilient future. The report identifies systemic reforms needed in our public investments, institutional structures, and public engagement mandates. It also provides detailed recommendations for centering communities impacted by inequities during our planning processes—from project budgeting tips to no-wrong-door approaches for gathering community-driven solutions.
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During the Covid-19 emergency, equity champions across the Bay Area delivered powerful innovations that saved lives and sustained families.
This report—“Equity in the Response to Covid-19: Successes and Areas of Opportunity for the Bay Area”—distills powerful lessons from the Bay Area’s pandemic response—and offers strategies that local governments and others can use to cultivate equitable approaches to future emergencies. This resource is built on the insights of public health staff, emergency managers, and community leaders who were directly involved in responding to the pandemic in our region.
We hope this resource inspires you to continue the critical work of safeguarding and advancing equity—preserving innovations, building on accomplishments, and strengthening local efforts in the face of new threats.
The Four R’s of COVID-19 Recovery
Making Equity Endemic In Solano County
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This report provides recommendations and strategies for how the Solano County Health Department and the County in its entirety can advance a health response and recovery from COVID-19, avoid future outbreaks, and build resilience to public health emergencies to achieve short-and long-term health equity. The recommendations and strategies included in this document specifically focus on supporting Black, Indigenous, and People of Color (BIPOC) communities in Solano County.
Lessons Learned from the Abundant Birth Project
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This brief offers lessons learned about how to protect recipient benefits, particularly in California, through the lens of the Abundant Birth Project (ABP), a pilot program aimed at reducing birth health disparities and improving birth outcomes for Black and Pacific Islander pregnant women in San Francisco by providing $1,000 per month for six months during pregnancy and six months post-partum.
Interest in guaranteed income programs providing continuous, unconditional cash transfers is surging, with more than 30 pilot programs in development or underway in the U.S. alone. Guaranteed income is a policy response to systemic poverty and rising inequality, particularly during a pandemic that has brutally exacerbated these problems, and differs from traditional safety net policies by providing a steady and predictable flow of cash that recipients can use without limitations. The amount of money provided by current U.S. pilots is not sufficient for participants to live on, so many low-income recipients will continue to depend on public benefit programs to help bridge the gap.
Safety net programs are effective in reducing poverty, especially deep poverty, and many benefit recipients rely on these programs to survive. However, the majority of these programs have restrictive, complex, and shifting eligibility requirements around household income and assets. People relying on benefits face a well-documented “benefits cliff” problem, where even small increases in earnings or assets can result in sudden and often unexpected reductions, or even total losses, in public benefits.
COVID-19 Emergency Rental Assistance Programs (ERAPs) | 2021
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The COVID-19 pandemic has hit low-income tenants in the Bay Area hard, exacerbating the region’s severe housing affordability crisis. Approximately 140,000 households are behind on rent, owing nearly half a billion dollars.
This has serious ramifications for health and well-being, especially for BIPOC households that have faced decades of inequitable housing and economic policies. Black, Latinx, and Pacific Islander communities in California currently face a 20% higher COVID-19 death rate than the statewide average, driven in part by unstable and crowded housing conditions. ii These same communities are more likely to be faced with choosing between paying for essential medical care, food, and rent.
Fortunately, new rental assistance resources have recently been approved, providing a critical down payment toward the full scope of what is needed to stabilize the communities hit hardest by the pandemic. In December 2020, the federal government approved $2.6 billion to California for rental relief as part of the Emergency Rental Assistance Program (ERAP). In January 2021, California enacted SB 91, which among other things, provided local jurisdictions with populations over 200,000 three options for utilizing their portion of these federal funds
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In summer 2020, we laid out four major categories to guide response efforts to protect the health of those disproportionately affected by COVID-19: requiring basic health protections for workers; rebuilding financial stability for families, small businesses, and social enterprises; reconnecting communities and protecting mental health; and revolutionizing the status quo to protect people of color. Here, we describe the four categories, including key implementation actions and desired outcomes. This foundational tool incorporates expertise from over 1,000 government leaders, public health professionals, and community members.
Community Safety
Reimagining Public Safety Report
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Police violence affects the entire Bay Area—from wealthy suburbs to core cities—disproportionately affecting the health of Black families and other communities of color. How will we address this health equity crisis and forge a path forward?
In the wake of a national cry for racial justice in policing, this guidebook demonstrates how police violence affects public health in the Bay Area and provides a roadmap for achieving healthier, safer communities for everyone, with inspiring solutions from across the region.
As our local governments face major questions about how to invest historic infusions of federal and state funds, we offer tools to help reimagine public safety through a public health lens, addressing structural inequities and institutional racism while improving the social and economic conditions that influence our health and safety.
Housing and Land Use
Connecting housing justice, health, and journalism: A guide for Bay Area news reporters
Healthy Development and Land Use Guide
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The Healthy Planning Guide is intended to help public health and planning departments collaborate on strategies to promote healthier communities. Each page links health risks to aspects of the built environment, outlining ways to ensure that neighborhoods are designed to support health equity and community well-being.
Growing evidence demonstrates a strong relationship between our health and the environments in which we live. The way our neighborhoods, streets, and homes are designed affects whether children can play outside and walk to school, whether families can access basic goods and services, and even whether neighbors can socialize and look out for one another.
Housing Displacement Brief
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In February of 2016, BARHII dove deep into the housing issues that are re-shaping the Bay Area. We created BARHII’s first brief on Housing Affordability, Displacement, and Health with the goal of shaping a housing future that promotes health equity. When housing costs require increasingly high percentages of a family’s budget, families are forced to make choices that create unhealthy tradeoffs.
Families forego medical care or prescriptions, live in substandard or overcrowded housing, or move farther and farther away from the Bay Area’s job centers. More information about all the mental and physical health impacts of long commutes, financial stress, and displacement are included in the brief itself.
Housing Stability and Family Health Brief | 2016
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We often think of children as blank slates—that their futures are yet to be written—but several decades of public health research have shown that conditions during pregnancy and early childhood are some of the most important factors influencing lifetime health, and these years are a crucial window of opportunity to improve public health. Although a child’s choices will play a role in their future, the past can have reverberating impacts.
The homes and neighborhoods parents lived in when their baby was born, the policies and practices that shaped the conditions of those neighborhoods, and the opportunities and experiences that influenced their health before and during pregnancy all play a role in their baby’s health at birth.
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News reporting on the racial and health equity underpinnings of our housing crisis is essential for advancing solutions. Read more on how journalists can uncover the roots of housing and health inequities and elevate solutions for social justice in this new guide from BARHII, the Council of Community Housing Organizations, and Berkeley Media Studies Group (BMSG).
BMSG’s detailed news analysis of the San Francisco Bay Area shows that a critical aspect of housing has largely escaped journalists’ attention: The Black experience. The guide includes a case study exploring what’s lost when Black voice is missing from housing coverage. It also describes BARHII’s first-in-the-nation campaign focused on the housing needs of Black Californians.
Climate Justice
Taking Action on Climate Change for Health Guide 1
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To support the capacity-building of local health departments, BARHII’s Built Environment Committee (BEC) has completed the development of a series of five short guides which include information on why climate change is a public health and equity issue, the environmental and health co-benefits of climate change action, how to get involved in climate change action planning, and tangible steps to address climate change.
Taking Action on Climate Change for Health Guide 2
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To support the capacity-building of local health departments, BARHII’s Built Environment Committee (BEC) has completed the development of a series of five short guides which include information on why climate change is a public health and equity issue, the environmental and health co-benefits of climate change action, how to get involved in climate change action planning, and tangible steps to address climate change.
Local Health Departments Address Climate Change Readiness
Taking Action on Climate Change for Health Guide 3
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To support the capacity-building of local health departments, BARHII’s Built Environment Committee (BEC) has completed the development of a series of five short guides which include information on why climate change is a public health and equity issue, the environmental and health co-benefits of climate change action, how to get involved in climate change action planning, and tangible steps to address climate change.
Taking Action on Climate Change for Health Guide 4
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To support the capacity-building of local health departments, BARHII’s Built Environment Committee (BEC) has completed the development of a series of five short guides which include information on why climate change is a public health and equity issue, the environmental and health co-benefits of climate change action, how to get involved in climate change action planning, and tangible steps to address climate change.
Taking Action on Climate Change for Health Guide 5
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To support the capacity-building of local health departments, BARHII’s Built Environment Committee (BEC) has completed the development of a series of five short guides which include information on why climate change is a public health and equity issue, the environmental and health co-benefits of climate change action, how to get involved in climate change action planning, and tangible steps to address climate change.
Health Equity in the North Bay Fires Recovery Process
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Natural disasters intensified by climate change do not discriminate, but our responses to them can. The neighborhood we are from, the languages we speak, our class, race, disability, age, existing health conditions, and immigration status all shape how we are impacted by disasters, and the resources our families and communities have to recover. Keeping equity at the forefront of the recovery process and ensuring the participation of communities who have been marginalized will ensure more effective recovery for all. This document presents key findings and recommendations to assist public health departments and other local government staff improve equity in recovery, with a focus on low-income and immigrant communities.
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In California, wildfires, heatwaves, and other climate-driven disasters are creating unprecedented challenges to human health and well-being—particularly for communities that experience health inequities. California’s local health departments (LHDs) have an essential leadership role to play in our new era of climate-related emergencies. However, as our findings show, while LHD leaders across California see an urgent need for public health departments to engage in climate action to safeguard those most at risk, these departments do not receive adequate resources to address this public health crisis. This report, developed in partnership with the Public Health Alliance of Southern California, shows the way forward to ensure LHDs can foster a more equitable, healthy, and resilient California.
Economic Justice
New Partnerships for Healthier Neighborhoods | 2009
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In 2009, BARHII and Planning for Healthy Places convened a roundtable of redevelopment and public health departments in the San Francisco Bay Area to discuss how health-promoting strategies can be incorporated into the process of rebuilding low-income or “blighted” neighborhoods. This report explores the potential for collaboration between these agencies and shows how both can overcome their own institutional challenges to create a strong partnership to improve community health.
Preventing an Eviction and Debt Epidemic
Minimum Wage and Health: A Bay Area Analysis | 2014
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The Minimum Wage and Health: A Bay Area Analysis demonstrates that a Bay Area-wide minimum wage increase would benefit the health and well-being of nearly 1 million low-wage earners. A large body of research literature on wage, income, and health demonstrates that public policy interventions that aim to increase the incomes of low income populations will increase income equality and economic security as well as lower mortality rates, improve overall health status in the population, decrease health inequity, and lower overall healthcare costs.
More than a decade of wage stagnation and erosion for the great majority of American workers has prompted a public health need to address economic policy. Virtually all low- and mid-wage workers in California earn less today than they did three decades ago, with the bottom 20 percent of the wage distribution experiencing a 12.2 percent loss in inflation-adjusted wages between 1979 and 2013. Meanwhile income among the top wage earners has increased, thus increasing income inequality. Studies of populations with high and rising income inequality are associated with lower life expectancy, higher rates of infant mortality, obesity, mental illness, homicide, and other measures compared to populations with a more equitable income distribution.
There are significant health consequences of low wages and poverty. Analysis of California Health Interview Survey data shows that minimum wage workers are more likely to report “fair” or “poor” health, depression and a condition that limits physical activity.
They are also more likely to report being unable to afford balanced meals and less likely to receive a flu shot. Bay Area adults living under 200 percent of the federal poverty level (FPL) have a higher percentage of diagnosed diabetes, high blood pressure, and psychological distress compared to those living over 200 percent FPL.
Bay Area children living below 300 percent FPL were more likely to have abnormal child development and Bay Area teens living below 300 percent FPL were more likely to have poor dental health. The impact of a higher disease burden in low-wage populations contributes to a shortened life expectancy.
On average, a child who is born and lives in a census tract with more than 30 percent of individuals living in poverty can expect to live seven years less than a child born in a census tract with fewer than 10 percent of people living in poverty.
In conclusion, this analysis demonstrates that policies that reduce poverty and raise the wages of low-income people can be expected to significantly improve overall health and reduce health inequities.
This report was prepared with the University of California Berkeley Center for Labor Research and Education. This report was made possible by support from The California Endowment.
Economic Opportunity Brief
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An inclusive local economy promotes everyone’s health by allowing households to meet basic needs and plan for a healthy future. Many working and middle-class residents have been left behind—facing low wages, spiraling debt, disinvested neighborhoods, and shrinking social supports. These preventable conditions are associated with preventable diseases, injury, and ultimately lower life expectancy. This brief explores the impacts of Economic Opportunity on Individual and Community Health as well as concrete strategies to bolster health through economic policies.
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With California’s eviction moratorium scheduled to expire on June 30, more than 700,000 California households behind on rent, and less than half of one percent of our state’s total federal emergency pandemic rental assistance funds paid out, California faces an eviction epidemic. Legislators have just one month to fix SB 91, the law governing eviction protections and rent relief, to prevent a wave of evictions that would be a humanitarian crisis and an economic and public health disaster. Across the state, tenants and organizations providing aid have reported households who need assistance but are saddled with debt because they are ineligible or facing hurdles in applying. Organizations across California have reported tenants facing eviction, becoming unhoused, and choosing between paying for essential medical care, food, utilities, and rent. To better understand the best ways to fix SB 91, BARHII, Housing Now!, and PolicyLink surveyed 177 people who understand the program the best: those conducting intake and outreach for state and local emergency rental assistance programs.
Health Equity: The Early Years
Health Inequities in the Bay Area
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The Health Inequities in the Bay Area report is an attempt to show how a large set of factors influences health in the nine-county Bay Area, and also to suggest the kinds of policy initiatives and activities that will be crucial for both reducing the disparities and improving overall health.
Partners for Public Health
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Partners for Public Health provides a broad overview of the many public agencies that make policy decisions affecting aspects of the built environment, and outlines the structure and decision-making process for each agency (at the local, regional, state, and federal level), pointing public health professionals toward opportunities for engagement.
BARHII and Planning for Healthy Places developed this publication as a companion resource to the Healthy Planning Guide, which links key health risks to aspects of the built environment, outlining policies to consider in the planning process and ways for public health professionals to get involved.
Health Equity and Community Engagement Report | 2011
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From 2009-2011, the BARHII Community Committee conducted qualitative assessments in seven local health jurisdictions to explore local priorities in health inequities and social conditions as well as highlight best practices and lessons learned related to (1) public health department and community agency collaborations and (2) how health inequity concerns are being addressed by both health departments and community agencies in the Bay Area.
The following reports summarize the 39 focus groups conducted and describe the perspectives of both health department and community agency staff on the following key themes that emerged:
Relationship building
Community engagement
Community capacity-building
Data collection and sharing
Partnership and collaboration development
Accessible community-based services
Upstream practices and policy change
Role of public health
Leadership support for health equity efforts
The findings in these reports can assist local health departments and community agencies in working together to implement common-goal strategies to improve health equity and the quality of life of all their residents.
Local Control Funding Formula Fact Sheet
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BARHII has developed a new resource to assist staff at all of our member local health departments, and in particular those participating in BARHII’s iREACH (impacting Regional Educational Achievement to Change Health) Initiative, in continuing to address educational attainment in the communities we serve. California’s new public education funding formula can help improve health equity by investing much needed resources in the communities that need them the most.
BARHII has developed a fact sheet to provide you with a quick overview on how LCFF works, opportunities for local involvement, and suggestions on ways that local health departments can get involved. Please share this information with your health department leaders and colleagues. This information may also be shared with clients so that they can be supported in getting involved in local engagement activities.