Sonoma Aims for Healthiest County in Calif. By Addressing Education, Poverty: Q&A with Peter Rumble
In 2011, Sonoma County in California established the division of Health Policy, Planning and Evaluation (HPPE) in an effort to move the county up in the County Health Rankings, toward a goal of becoming the healthiest in the state by 2020. As the director of the division, Peter Rumble, MPA, has played a critical role in the development of numerous programs and policy efforts to help create opportunities for everyone in Sonoma County to be healthy. Rumble has worked on programs and policies that go beyond traditional public health activities and aim to address the root causes of poor health, including the local food system, education and poverty.
Following his presentation at the International Making Cities Livable Conference, NewPublicHealth was able to speak with Rumble about the ways in which his work with HPPE is pushing to achieve health equity in Sonoma County. Rumble will soon move into a position as Deputy County Administrator of Community and Government Affairs for the County of Sonoma, where he plans to continue his commitment to a vision of health and quality of life for the county.
NewPublicHealth: Sonoma is making a concerted effort to help address the root causes of poor health, like poverty and lack of education. Tell us about some of those efforts.
Peter Rumble: Health Action is our real heartbeat of addressing social determinants of health, and it’s a roadmap for our vision of being the healthiest county in California by 2020. Health Action is a community council that advises the Board of Supervisors. There are 45 seats on the council, including elected officials, individual community leaders, nonprofit leaders, and representative from the business, financial, labor, media, transportation and environmental sectors. If you pick a name out of the hat for all of the sectors in the community, we’ve got somebody who either directly or tangentially represents that sector. That group began talking about needing to do something around health in 2007.
If we’re going to be the healthiest county in California by 2020, what do we need to do to achieve our ten goals based on the best evidence available? We certainly have goals associated with the health system, but predominantly, we’re focused on influencing the determinants of health. Our first goal is related to education. We want all of our children to graduate from high school on time and ready to either enter a thriving workforce or go into college or a technical career academy.
We started with some grassroots initiatives. Being a real strong agricultural community, iGROW was a good place to start. It was a movement to develop community gardens—for people to tear up their front lawns and plant a garden there, and increasing access to healthy food. That was a huge hit. We set a goal of a few hundred community gardens, and we’re up to a thousand now—it’s just caught fire.
That was all great, but a community garden is not going to make us the healthiest county in California, right? You can see the beautiful posters out on shop windows, you can see your neighbor tore up their front lawn and is growing this beautiful zucchini and has an edible lawn now and all that’s wonderful, but we only have a graduation rate of 70 percent. We’ve got nearly one in four kids living in poverty by the federal poverty standards and if you look at what actually it takes to raise a family in Sonoma County, about half of all families can’t make ends meet.
NPH: Does that surprise people to hear about Sonoma?
Peter Rumble: Absolutely. If I just ask you what do you think about Sonoma County, you go to this kind of natural abundance of beautiful landscapes, of fantastic wineries, of great food in restaurants, of this vibrant community where we host big bicycle events and you can go into a hot air balloon and float around. So you absolutely don’t think of those things, but they’re very real and so even in Health Action, it was a hard conversation to have.
NPH: Why did you start by focusing on education, and what did you do about it?
Peter Rumble: We focused on education first in part because it’s one of the primary determinants of health, but also in part because it’s an easy one to get behind. We ultimately developed what’s called Cradle to Career and that’s a community-wide initiative to focus on this pipeline to ensure success not only in the classroom, but with support outside of the classroom.
We need to focus on maternal health, we need to focus on preschool, we need to focus on what happens outside of school because the bulk of a child’s time is outside of the classroom.
NPH: How are you engaging kids and helping to provide a better environment outside of schools?
Peter Rumble: Parents are the first teacher early on, so we need them to be engaged. Preschool is also critical, and then you might have significant amount of time outside of high school before somebody’s ready to enter the work force. So we want to look at all of that and make sure that that pipeline, so to speak, is really intact.
We’ve been able to marshal a lot of resources—not just governmental resources, but foundations, private philanthropies and other organizational resources like the United Way, and begin to direct those resources at proven strategies. We’ve invested in preschool scholarships, we’ve invested in work site literacy programs for families, where English might be the second language… United Way Schools of Hope is a program that allows employees to take work time, not vacation or sick time, but work time to go into the classroom and provide tutoring and mentoring.
NPH: And what are you doing to address income and poverty?
Peter Rumble: We’re looking at it through the lens now of asset development rather than poverty or income seeing that is a tie directly to the inter-generational poverty issue. How can we really find a way to have individuals build their individual assets rather than trying to say we’re going to raise the minimum wage for everybody? This is still under development.
NPH: Tell us how you’re collaborating with the Planning Department.
Peter Rumble: I think our greatest collaboration with them began a handful of years ago with the development of Healthy by Design, which is a planning tool kit and resource guide for how to design and build healthy communities. That involved the County Planning Department and it also involved all of the city’s planning departments as well… That was a really great collaborative, and I think it solidified a certain level of partnership that might not have been there in the past. The Healthy by Design toolkit won an award from the California Chapter of the National Architect’s Association.
We’re also opening up conversations around housing and building in a health lens for that. We’re at the very early stages of talking about how do we prioritize healthy housing designs, much in same way as we’re already prioritize high LEED standards. Right now, environmentally sound designs that come in for approval, jump the queue and get priority, so it makes it actually financially beneficial and more efficient for a builder to come in with high LEED standards in their design because they get priority through that process and for those kind of projects. Time is very real money to them. And so we’re trying to open that conversation for healthy standards as well.