Santa Cruz County, CA: 2013 RWJF Culture of Health Prize

When you have people who are making lower wages, they’re spending more of their income on their housing, leaving less for other necessities in life,” said Mary Lou Goeke, executive director of United Way of Santa Cruz County. “So what do people do without? They do without healthy food. They do without opportunities to exercise. They do without visiting doctors when they need care.”

A Data-driven Approach

In Santa Cruz County, diverse partners are facing these and other public health challenges as one. That means coming together across sectors and across the community to engage everyone in the mission to improve the health of all residents.

“Long ago in Santa Cruz County, we all realized that we’re all linked to each other, and that our public safety officers would not succeed without our education leaders, our education leaders would not succeed without our faith communities, and our business communities and our social service sector need all the community to be involved,” said Goeke.

Everything step Santa Cruz County partners take is data driven. And the “North Star” that guides the public health mission is the Community Assessment Project. The annual publication details the goals the community wants to achieve while benchmarking where it stands on indicators such as air quality, unemployment, high school graduation and crime rates.

The Community Assessment Project leads us to the measurement of where we are and where we need to go,” said Goeke.

Today the Project’s 18 years of information on community health, safety, economics and environmental factors is the second-oldest collection of community data in the country—and critical for ongoing evaluation.

Energized Youth

As with many public health efforts across the country, Santa Cruz County emphasizes getting the community’s youth involved. Jóvenes SANOS is part of the “Go for Health!” collaborative to address childhood obesity. The Watsonville-based youth advocacy project works to improve access to healthy food choices and physical activity through the implementation of long-term environmental policy and system change.

They are very savvy at assessing their community and then figuring out how the community needs to change so that these kids have more opportunities, and their little brothers and sisters, and people who come after them will also have opportunities,” said Goeke. 

For example, they noticed that there were almost no healthy food options around the area high school, so they went to the city council and argued for—and gained—new health policies that encouraged new healthy restaurants and rewarded existing restaurants for adding health food choices to their menus. More recently, they’ve been working to bring healthy vending machine options to the county’s metro stations.

What’s more, these are lessons that stay with them.

“My proudest achievement has been bringing back what I’ve learned to my family,” said Gabriela Sanchez-Ramirez, a member of Jóvenes SANOS. “My aunt, she has diabetes, and I’ve influenced her to go to nutrition classes and she has stabilized her diabetes. My dad suffers from high blood pressure and he’s learned how to change his diet and how to control his anxiety of not being able to know how to control his high blood pressure.”

Ensuring Health Care for the Most Vulnerable

For many years, Santa Cruz County has had a goal of ensuring every resident had access to health care. The Healthy Kids of Santa Cruz County program ensures children have access to comprehensive health, dental, vision and psychological care. The success was made possible through a collaborative effort, with diverse organizations coming together to contribute various resources and expertise. Partners assessed which resources were available to which families, and then determined how to fill in the gaps with new insurance opportunities.

We want to reach out and touch every family and every child and enroll them as we can,” said Goeke. “We even enroll newborn babies in the hospital and then set the appointment for their first well-baby check when they get home, so that they’re immediately using the practice of going to the doctor when they’re healthy—getting preventive care early in life.”

There were about 5,000 uninsured children in the county when the program began. Today, several years down the line, more than 23,000 have been ensured and nearly every child age five and under is insured.

Safe, Healthy Alternatives to Incarceration

Goeke and many of her partners believe a community is safer—and healthier—when people who’ve committed minor offenses have access to the support and help they need  to keep themselves from going back again and again to a jail cell.

The Custody Alternatives Program is part of a partnership between law enforcement and the community that lets some people who have committed minor offenses be rehabilitated in their own communities in a way that is both cost-effective and successful. This alternative-to-incarceration program provides education, employment, treatment, and social services to get people's lives back on track.

“The Custody Alternatives Program was really geared to try to reduce unnecessary incarceration for low level offenders…who could safely serve their time with conditions in the community,” said Scott MacDonald, Chief Probation Officer of Santa Cruz County. “This allows people who are working to continue working. This allows people who are providing for children to continue to provide for children. It really serves as not only an alternative to incarceration, but it also provides structure and support for people to make more lasting changes in their lives.”

Collaboration, Innovation

In Santa Cruz County, whatever the effort or the community demographic being helped, the approach is always one of collaboration. When an emerging public health issue is identified, Santa Cruz County, with United Way as a key catalyst, is able to bring together a roster of partners who already have strong relationships and strong records of success. This means they’re able to take innovative approaches—sometimes even without initial funding—while demonstrating a true commitment to the health of everyone in the community, according to Megan Joseph, Director of Community Organizing at the United Way of Santa Cruz County.

We have built relationships across different fields and sectors with a common goal and a common vision for health in our community, and that is a sort of a ‘cradle-to-grave’ equity-based vision where everyone has an opportunity to access good health,” she said. “That is a very special thing about Santa Cruz County.”