Harris County’s Journey to Promote Health, Well-Being, and Equity
Through progressive collaboration across sectors, organizations have addressed some systematic factors that bear on health and well-being.
Five years into the Sentinel Communities Surveillance Project, community capacity to promote health, equity, and well-being is grounded in the efforts of multiple sectors with a strong presence of public health and healthcare, nonprofits, local government, and higher education institutions as well as philanthropic funding for health efforts. Stakeholders in Harris County were working on several large initiatives to support well-being of community residents that started before 2017, focused on livable communities, economic stability and workforce development, and care coordination, many of which have continued over the past five years. New large-scale efforts have been initiated with a focus on addressing issues across sectors such as the social determinants of health, equity, food security, and housing. Regarding the health narrative, Harris County’s efforts have become more focused on collaboratively addressing the social determinants of health and equity over the past five years, though increasing access to healthcare remains a priority. Relatively isolated efforts to address health equity in Harris County gained momentum over the past five years, as elected officials became more vocal about the issue and additional partners in healthcare made formal commitments to addressing equity.
Health Priorities and Narrative
Harris County is home to two public health departments for the county and the city of Houston, as well as a robust healthcare system.
The Houston Mayor’s Complete Communities Initiative began in 2017, which has grown into a number of other place-based and equity-oriented strategies since then.
The prevalence of poverty in the community has spurned activities that address financial stability, workforce development, and food insecurity—efforts which have grown since 2017.
Health Priorities and Narrative
The role of health in the community has deepened further beyond healthcare with focus on the social determinants of health, particularly through the establishment of the Greater Houston Coalition for Social Determinants of Health (later, the Health Equity Collective).
Momentum that was building around Complete Communities and other City of Houston efforts fueled the development of the H.E.R. Initiative and Task Force in 2020.
While local elected officials have become more vocal about equity issues and more racially representative of the community in recent years, there has been misalignment between the county and the state of Texas.
Lessons Learned: Where is Harris County Five Years Later?
Harris County’s journey to promote health, well-being, and equity is one that illustrates the critical importance of collaboration and shared commitments to equity, as the community worked to develop the necessary structures and shared values over the past five years. Prior experience with natural disasters provided a foundation, but COVID-19, coupled with strong county and city leadership that often conflicted with state priorities, was perceived almost universally as a turning point in the county’s orientation. While the long-term effects of this inflection remain to be seen, other communities can learn from Harris County’s approaches to make these changes, as well as the challenges they encountered, to inform their own journeys. And as COVID-19 recovery continues, with historic funding flowing to local communities, future research could consider the ways in which momentum around health, equity, and well-being influences community health narratives and decisions moving forward.
Harris County has leveraged past disaster response and new leadership and collaboration to begin to make progress on health and well-being goals. Yet the county is challenged by its vast size, significant unmet needs, and governance challenges, resulting in siloed efforts that have proven difficult to align.
Experience with disasters facilitates collaboration
Improved city/county collaboration
Pandemic-related expansion of community engagement
- Data and evaluation partners highlight community needs
Large population with significant need
Fragmentation of efforts
Multiple healthcare systems and public health authorities
Data capacity challenges for community-based organizations
Misalignment between state and local governments