Maricopa County, Arizona

Located in southwest Arizona in the Sonoran Desert, Maricopa County is home to 25 cities and towns, as well as five American Indian reservations.

Prior to European settlement, the area was inhabited by several bands of American Indians, including the Apache, Maricopa, Gila River, and Pima tribes. Since the first European settlers arrived in the late 1800s, the county has experienced rapid population growth; in the last 24 years, the population has almost doubled. The “Five Cs” (copper, cotton, climate, citrus, and cattle) have historically made up most of Arizona and Maricopa County’s economy. However, by the mid-20th century, the influx of technology companies and the establishment of military air bases and training facilities led to a population and technology boom. Currently, less than half of a percent of Maricopa County’s workforce is employed in agriculture.

The Maricopa County Department of Public Health is charged with providing a wide range of health services to this large, diverse, and continually growing population. However, a lack of local funding for public health has forced public health leaders to rely on public-private partnerships and cross-sector collaboration to implement preventive health programs and to address a variety of issues, such as child safety, access to health care, and teen pregnancy.

Overview

Population and Demographics

Population: 4,087,191

SOURCES:
U.S. Census Bureau; photography courtesy Flickr user Sharon Mollerus, CC BY 2.0.

Context and Actions

Community Context and Challenges

Significant disparities exist in income, education, employment, insurance coverage, and health; Hispanic residents, in particular, are the least educated and most impoverished.
Controversial immigration policies targeting the Hispanic population and federal policies that limit immigrant access to health care present significant challenges to health equity.
The state has cut funding for community colleges, which have traditionally played an important role in providing advanced skills and job training for many Hispanic residents.
Minority groups lack access to health care coverage and are less likely to seek medical care; 43% of Hispanics have not seen a doctor in the past 12 months, followed by 35% of Black, 30% of American Indian, and 17% of white residents.

SOURCES:
Maricopa County Department of Public Health (2012). Maricopa County Community Health Status Assessment.

Taking Action

To overcome its lack of dependable financial resources, Maricopa County’s health department strategically fosters collaboration and helps coordinate initiatives.

This approach was emphasized as part of the 2012 Maricopa County Community Health Assessment. The assessment identified several public health priorities, including: obesity, diabetes, cardiovascular disease, lung cancer, and access to health care. The assessment also noted that “as our population continuously grows in numbers and diversity, the Department will not be able to meet its needs alone, but through partnerships and collaboration.”

NOTE:
These baseline reports, created in 2016, track community programs and initiatives in their early stages and measure initial progress only. Future reports will provide more in-depth insights and analysis into this community's efforts to build a Culture of Health.

Underrepresented Populations

Fear resulting from anti-immigrant policies could inhibit Hispanic residents from participating in initiatives geared to promote health and well-being and to undercounting of the population in the U.S. Census.

Health Improvement Partnership of Maricopa County

In response to the needs identified in the health assessment and the call for collaboration, the health department and other public and private organizations formed the Health Improvement Partnership of Maricopa County, a collaborative effort of more than 105 organizations, to address priorities through the 2012-2017 Community Health Improvement Plan. The partnership includes four sectors: community, worksite, education and health care.

BreatheEasy

BreatheEasy is a collaboration between the health department and the Maricopa County Community College District students to prohibit use of tobacco products on college campuses and in the 10.5 million square feet of office space owned or leased by the county, excluding sidewalks and parks.

Preventive Health Collaborative

The Preventive Health Collaborative works to streamline preventive health services and care for children from birth to age 5 and their families. The collaborative has more than 70 partners in Phoenix and is expanding its network to other Maricopa County communities.

Going Forward

Questions for Consideration

Maricopa County’s health department is leveraging its limited resources by mobilizing people and organizations to create robust partnerships and providing high-level coordination services such as strategic planning, networking opportunities, and other forms of technical assistance. Nevertheless, the department faces significant limitations due to the lack of funding for public health. It also faces the challenge of addressing racial and ethnic disparities within a political environment fraught with anti-immigrant sentiment and other policies that affect access to health services for the largely Hispanic immigrant population.

Additional surveillance, data and information gathering, analysis, and reporting will examine the following questions in further detail:

To what extent, and for what population groups, have cross-sector collaborations improved the health and well-being of the county residents? For example, how has the 2012−2017 Community Health Improvement Plan progressed in addressing the five health assessment priorities: obesity, diabetes, cardiovascular disease, lung cancer, and access to health care?
Which factors have facilitated or inhibited the collaborative atmosphere in Maricopa County? How have individuals and organizations sought to overcome obstacles?
In what ways have budgetary limitations affected the health department’s efforts to foster cross-sector collaborations to improve public health?
To what extent are community leaders working in a coordinated manner to improve the public health infrastructure?
What types of agencies have formed to address gaps in access to services among vulnerable populations, especially among unauthorized immigrants who are unable to receive most government-provided services?
How are various sectors of the community (e.g., education, health, business) working together to address socio-economic disparities?
In what ways are leaders in Maricopa County working to incorporate underrepresented minority groups into the public discussion on health and well-being?