Place Matters: Eliminating Health Disparities in King County, Washington

Apr 30, 2014, 5:08 PM

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King County is the largest county in Washington State. Although it ranks among the 100 most affluent counties by income in the United States, it also has some of the poorest people on the country according to Ngozi Oleru, director of the King County Health Department Environmental Health Services Division and Place Matters team leader for the county. The focus area for the Place Matters team in the region is racism, with a goal to institutionalize equity and social justice within government agencies, branches and departments in the county.

Key Team Objectives:

  • Increase the capacity of King County departments to identify actions that will increase health and well-being and decrease inequities.
  • Give communities a role in the decision making within the county by enhancing existing efforts.
  • Work with local communities to partner with county staff and others to address their issues of concern

As work progressed, the initiative became law in 2010, as the Equity and Social Justice Ordinance. The law covers all of King County government and includes a set of determinants of equity that the team continues to work on to be sure they are improving the social determinants of health. Oleru said the ultimate goal is to eliminate any inequities. She noted that the Affordable Care Act provides a strong example of implementation.

“Through the work that we have been doing over the years, we had an idea of how many people did not have health coverage in King County and as it became time to begin enrolling people last year, we made a commitment as a county that we’re going to work on enrolling as many people as possible—if not everyone—who did not have health insurance coverage.”

Every King County agency made a commitment in whatever they do and however they interact with the public to carry that message. That included the transportation and elections departments, so when people came to these agency lobbies they would see messages about how to enroll for health insurance coverage under the Affordable Care Act. The transportation department even added signs about enrollment in public spaces, including all buses and trains and the courts.

“The goal was to get out information through all of those means, not just the health and human services providers,” she said, nothing that they’ve seen progress each year.

“When we started out every department would commit to certain things that they would do that year and be able to report on it at the end of the year, and then we would broaden a practice to be county-wide,” Oleru said. “Now, we’re making cross agency commitments, such as the one about health coverage enrollment.”

Even terminology that’s used speaks to the progress that’s been made.

“When we started Place Matters, the project was about racism, and as you might guess that’s not a word that a lot of people are comfortable with,” she said. “So we started out naming it equity and social justice to begin to meet people where they are, and as part of our growth we’re getting to a point now where we’re actually able to use the word racism.”

Oleru explains that last fall an exhibit on race came to Seattle. The county council went to see the exhibit together and then two weeks later held a public meeting on racism.

One critical thing the team has tried not to do in its work is to create a check list and check things off as if to say, “we’ve done it, we’re through.” Oleru said the county, at all levels, is making a conscious effort to have equity embedded “for this to be the way we work and not just something we do after we’ve done something else. We want this lens to be second nature.”

Toward that goal, the Place Matters team is doing a lot of education and training of staff to understand and think about the fact that this is really the way you do business—that it’s not an add-on.

“It’s not that we need to create a unit and hire people and have their work be equity and social justice. Everybody in the county, this is their work,” she said. “This is how they do work.”

One strong example, adds Oleru, is that the Place Matters team looked at how the county does its contracting. At the end of that assessment and analysis they came out with a different way of contracting that is more accessible to minority businesses, small businesses and women-owned businesses.

The work is being tracked through annual reports—with two published so far—so that “we can see how these determinants of equity are changing,” said Oleru. “These are very entrenched problems, so you’re not going to see any real change in two years or two annual reports, but it provides an understanding of where we’re starting out and what we hope to be achieving in the future.”

This commentary originally appeared on the RWJF New Public Health blog.