Promoting Health Equity in California: A Comprehensive Assessment

A discussion about accountability with Cary Sanders of the California Pan-Ethnic Health Network

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Cary Sanders, senior policy director of the California Pan-ethnic Health Network
Cary Sanders, senior policy director of the California Pan-Ethnic Health Network. Photo: Paige Ricks

For all Californians to truly thrive, California — one of the most racially diverse states in the nation — must hold itself accountable for achieving health equity. Glaring health disparities among Black, Latino/x, and other racial/ethnic communities, as well as the LGBTQ+ and disability communities, reflect the state’s long history of discrimination embodied in contracts, laws, and practices of businesses and civic agencies.

When the COVID-19 pandemic underscored the impact of systemic racism on health and the killing of George Floyd fueled racial justice protests, California state agencies and departments, the legislature, and the governor’s office responded by launching new health equity initiatives.

From August 2022 to July 2023, the California Pan-Ethnic Health Network (CPEHN), with funding from CHCF, conducted a landscape assessment of state government activities and programs related to health equity. This led to a report published by CPEHN and a shorter issue brief published by CHCF.

I recently sat down with Cary Sanders, MPP, senior policy director at CPEHN, to talk about the findings and CPEHN’s vision for the future of health equity work in California. Our conversation has been edited for length and clarity.

Q: Your organization spent a year looking at how state government is doing in its efforts to improve health equity for all Californians. What’s going well?

A: It was great to see increased interest and significant activities by the California Health and Human Services Agency (CalHHS) and other elements of state government to make equity a strategic priority. They have been strengthening agency and department leadership and staffing while supporting more equitable hiring practices by state agencies, departments, and outside contractors. Within the departments of CalHHS, we have seen the creation of the chief equity officer position and the use of tools designed to help the state promote health equity. In the Medi-Cal arena, CalHHS agencies expanded eligibility for all regardless of documentation status and adopted policy changes to enable more equitable distribution of the COVID-19 vaccine.

We applaud the Department of Health Care Services’ (DHCS) strategy to bring together and actively listen to and engage with users of Medi-Cal — including enrollees, community representatives, and advocates — to advance equity using the promising cross-cutting Medi-Cal Member Advisory Committee.

We were also delighted to see multiple agencies, including Covered California, the Department of Managed Health Care, DHCS, and the California Public Employees’ Retirement System adopt similar health plan quality measures stratified by race, ethnicity, language, and other health plan member demographic data to drive improvements.

Q: Do all the California government agencies agree on the meaning of the term “health equity”?

A: No, and that is a significant concern for CPEHN. Our assessment uncovered a lack of uniform definition for equity and racial equity, which threatens to dilute the power of many of the interventions intended to right historic wrongs. It also undermines progress the state is making toward meeting some of these aspirational goals. That’s why definitions of health equity should explicitly include racial equity and define it in a way that is actionable rather than aspirational.

At the national level, we’ve seen a prioritized focus on advancing equity generally and racial equity specifically. CPEHN’s report examined President Biden’s Inauguration Day executive order advancing racial equity, which calls out the need for racial equity while recognizing other underserved communities. We also can learn from sister states like Oregon and Washington. For example, the Oregon Health Authority’s definition of health equity is notable because it calls for the redistribution of both decisionmaking power and resources to communities of color. That can be done in California.

Q: Chief equity officers are relatively new in state government. What do you hope to see from them?

A: Through the Capitol Collaborative on Race & Equity (CCORE), participating staff at multiple agencies are receiving training, support, and racial equity tools to apply to policy decisionmaking, program planning, and budgeting. They are also developing racial equity action plans.

However, a lot of this work is still voluntary and not supported by a centralized, coordinated, or sustained budget. Most of the departments’ racial equity action plans are not public. We would love to see the incoming chief equity officers establish clear expectations for these racial equity action plans to be made public and serve as not only internal road maps but also external public accountability tools. The chief equity officers should regularly update them and report on their progress toward meeting the goals outlined in their action plans. CPEHN favors more transparency around how agencies and departments are working to advance health and racial equity.

Q: What else could the state do to ensure that California is moving toward a system that is focused on racial equity?

A: The governor is requiring state agencies to update their strategic plans to include equity more directly. This is an opportunity for state agencies to go into communities, talk to community members and the users of their programs, and gather input for whatever final definition of health equity the state may land on to address racial inequities.

CPEHN is focused on data collection and reporting. While the data exchange framework is an important innovation that brings together cross-agency granular data on Californians, it is important to share with the community how the data is being used to improve and advance more equitable health outcomes.

Traditionally, we tend to think of the state as providing services to those in need. But that is only part of the story. One of CPEHN’s goals is a model where the state partners with Californians who have not been well served and collaborates on designing and implementing services that will address the root causes of their needs. Instead of just focusing on how to better serve the growing number of Medi-Cal enrollees, we envision a system that addresses the quality of and access to services for all eligible Californians, including those not yet engaged with our systems of care. Not until we achieve that have we really achieved success.

Paige Ricks

Paige Ricks is a photographer based in Oakland, California. With her background in journalism, storytelling is integral to her photography. While studying at UC Berkeley Graduate School of Journalism, she quickly gravitated towards her camera, blending writing with visual narratives. Her photography is bold, expressive, and optimistic, often utilizing a saturated color palette to highlight her subjects’ vibrant energy. Read More

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