California Healthy Places Index & the State's Blueprint Health Equity Metric

October 1, 2020

Yesterday, the California Department of Public Health announced a new health equity metric that will be used as part of the State’s Blueprint for a Safer Economy, effective October 6. The State has created a metric that utilizes the Alliance’s California Healthy Places Index (HPI) to compare the overall test positivity rate in a county’s census tracts with the least opportunities for health compared to the threshold rate of the State’s Blueprint tiers. To our knowledge, this makes California the first state in the country to incorporate an equity metric into the COVID-19 response and recovery.

We are encouraged that the State is acknowledging the importance of addressing the disproportionate impact and toll this virus has taken on low-income and communities of color throughout California, particularly our Black, Latinx, Indigenous, and Native Hawaiian and Pacific Islander community members. The HPI has already been utilized by more than 100 government agencies, health care institutions, community groups and other sectors, and has been used to allocate almost half-a-billion dollars from state agencies and philanthropy, directing resources to communities most in need. This most recent application will support a more just COVID-19 response and recovery for the state’s most disproportionately impacted communities.

The State’s health equity metric acknowledges the importance of targeting investments in communities that are disproportionately impacted by this virus due to centuries of structural racism, disinvestment and discrimination. The HPI was developed with the intent to help guide prioritization of public and private investments, resources and programs to address structural inequities—inequities that require both short and long-term solutions. HPI can support our partners in working with the most impacted community members to develop equity-centered strategies and targeted investments that work to achieve a safe and just re-opening and recovery in communities across our State.

More information about the State’s guidance on the health equity metric is available here. You can also learn the latest about the HPI on our website, platform map and COVID-19 resource map.

Health Equity Matters in the Face of a Pandemic

COVID-19 has been described as the great equalizer. However, data show that low-income Californians and Californians of color are bearing the brunt of the effects of this pandemic. While the state's Census tracts with the least opportunities for health are home to 24% of Californians, they account for 40% of COVID-19 cases. Black, Latinx and Native Hawaiian and Pacific Islander Californians have been disproportionately impacted by this pandemic. Black residents represent approximately 6% of California’s total population, but close to 8% of all COVID-19 related deaths. While Latinx people represent approximately 39% of all Californians, they represent 61% of the cases and over 48% of all the deaths. This is nearly half of all COVID-19 related deaths in California. Data also reveal inequitable health outcomes that are especially stark for younger (ages 18-34) Black, Latinx and Native Hawaiian and other Pacific Islander (NHPI) Californians.

These disparate COVID-19 outcomes are rooted in and exacerbated by structural inequities that have long existed in our communities. In California, like the rest of our country, centuries of policies and practices have created barriers to stability and health. From Jim Crow, to redlining and predatory lending, Black, Latinx, Indigenous and other communities of color were pushed into under-resourced, highly segregated neighborhoods, and locked out of wealth building opportunities that were afforded to many white Americans. The effects of these policies are still felt today, as many of the same communities still disproportionately face worse economic, environmental, and health outcomes, including COVID-19.

Amid this pandemic, there are large differences in who can safely work from home. In California, more than half of low-wage workers are employed in front-line essential jobs, compared to only 39% of middle and high-wage workers. 55% of Latinx workers and 48% of Black workers are employed in front-line essential jobs, compared to only 35% of White workers. In addition, nearly half of immigrant workers are employed in front-line essential jobs. As a result, low-wage workers and Black, Latinx and other workers of color are at greatest risk of workplace exposure to COVID-19.

To protect the health of the most impacted communities during this pandemic, we must address inequities in outcomes in our response. The HPI can be used as a tool for better understanding the impact of inequitable community conditions on COVID-19 and other health outcomes. The HPI can also be used as a tool to positively support a community’s response to addressing the disproportionate impacts of COVID-19 and support the prioritization of critical short and long-term resources needed to keep communities safe and work to improve structural inequities in community conditions.

We Can Achieve Equity Together

Achieving equity during this unprecedented moment—in the short and long term—means prioritizing equity in our response and recovery. It requires centering the voices, expertise and leadership of those being most impacted by this pandemic. And it necessitates a fundamental shift in how we approach embedding equity in our emergency response structures and process.

In the short-term, it means focusing on strategies and policy changes that address the immediate drivers of COVID-19 disparities, such as:

  • Ensuring safe workplaces
  • High-quality PPE distribution for essential and frontline workers
  • Quarantine and isolation housing for individuals and their families (when needed)
  • Expanded paid sick and family leave and wage replacement.
  • Increased housing stability
  • Robust testing access

In the long-term, improving health outcomes will require investments and holistic strategies focused on structural inequities, including: expanding affordable and safe housing, increasing investments in local health department infrastructure and climate resiliency, and expanded, safe employment opportunities.

Achieving health equity in this moment means a proverbial linking of arms—local health departments, cross-sector government partners, healthcare providers, the business community, community partners and leaders, and ourselves as community members—to truly address the short and long-term barriers that continue to prohibit our state from achieving a just response and recovery during this crisis. Californians have a shared goal of ensuring that people are healthy and economically stable during COVID-19. That is why our collective commitment to equity and justice in its many forms, is more important than ever to ensure a safe recovery for all of us.

The Alliance’s COVID-19 Resources

The Alliance has been developing resources and tools to support local public health departments and other groups on the frontlines of the COVID-19 response and recovery since early on in the pandemic. In response to this announcement, the Alliance has developed a set of talking points to support our members and multi-sector partners in describing the key elements of the HPI and why the HPI is such a valuable tool for keeping equity at the forefront throughout the COVID-19 response and recovery process. You can check out all our COVID-19 resources here, including:

  • HPI COVID-19 Resource Map, an enhanced HPI data tool with more than 48 curated COVID-19 related indicators, organized in 6 categories, to support local response efforts and inform equitable resource allocation, program planning, and service delivery.
  • COVID-19 Policy Platform, developed to outline key priority areas where amplifying a regional voice around COVID-19 policy and investment priorities is essential.
  • Embedding Equity Into Emergency Operations Brief & Webinar, developed in partnership with the Bay Area Regional Health Inequities Initiative (BARHII) to outline steps jurisdictions can take to explicitly and intentionally embed equity staff and practices into their emergency operations structures and throughout the recovery process.
  • COVID-19 Equity Snapshots, designed to elevate critical equity concerns emerging throughout the COVID-19 pandemic.
  • Investing in Our Local Health Departments Brief & Resources, jam-packed with data, infographics, and key messaging around the history of public health funding cuts and a call to action for investing in a resilient and robust public health system.