Advancing health equity at the local level

About the project

In 2022-2023, Lincoln County HHS (Oregon) partnered with HRiA to further embed equity in their organization. Driven by a shared belief that real community impact begins with internal transformation, Lincoln County and HRiA aimed to assess and address equity within Lincoln County’s own practices, policies, and culture. In doing so, the department sets a powerful example of how local health agencies can create the conditions needed to advance equity within their own walls and throughout their community.

This initiative involved a multi-phased approach to examine the department’s equity practices, develop a forward-thinking strategic plan, and equip staff with the tools to enact meaningful change. Recognizing the diverse needs of its divisions – public health, behavioral health, primary care, developmental disabilities, and administration – the project sought to align organizational culture and the department’s mission of equitable service delivery. At its heart, the initiative represented Lincoln County’s commitment to nurture an environment where equity is a value, outcome, and daily practice.

How it worked

HRiA’s Health Equity Framework served as the underpinning for the overarching project as well as each individual phase. Central to this framework is the belief that advancing equity requires challenging entrenched narratives, fostering authentic engagement, and addressing power imbalances—principles that guided Lincoln County HHS throughout this process.

This project consisted of three phases:

1. Assessment. The initiative began with an honest examination of the organization’s culture and practices through an equity assessment. The assessment process used staff surveys, focus groups, and community conversations to establish a clear baseline of the department’s strengths and areas for growth.
2. Strategic planning. Assessment findings informed the creation of a three-year strategic plan that prioritized four key areas: access to care, community engagement, staff voice, and organizational culture.
3. Capacity building. Staff training sessions strengthened the department’s capacity to address power imbalances and foster a shared understanding of equity principles. These sessions emphasized the importance of collaboration and accountability, ensuring that staff at all levels felt empowered to contribute to this effort.

Continuous, authentic engagement. A key strength of this project was the inclusion of a Staff Advisory Committee. This committee played a pivotal role in shaping the project’s direction, serving as champions of equity and stewards of organizational change. Their ideas and feedback helped facilitate a process that was inclusive, relevant, and responsive to the needs of both the organization and the community. This dynamic approach ensured that equity was not merely an outcome, but a continuous and evolving process, integrated into the core of Lincoln County’s mission and identity.

Impact

HRiA’s framework illustrates that equity-driven culture change – a shared set of values, beliefs, and behaviors – is most effective when embedded into daily operations through thoughtful shifts in policies and practices. By grounding the work in the Framework, the department equipped staff with the language, tools, and confidence needed to confront inequities both within the organization and in the broader community. This culture shift has sparked conversations, collaboration, and a renewed commitment to equity as a shared responsibility among staff.

This initiative stands as a powerful example of what is possible when local health departments prioritize internal change as the first step to advance equity. By fostering alignment and accountability within their walls, Lincoln County HHS is paving the way for more compassionate and effective service delivery, positioning themselves as leaders in the ongoing pursuit of health equity and justice.

The success of this initiative was further recognized on a national stage when Lincoln County HHS and HRiA were selected to present their work at the National Association of County and City Health Officials NACCHO 360 Conference in 2023. This honor highlights the significance and replicability of this project, offering an inspiring example for other health departments striving to advance equity. By sharing their journey, Lincoln County HHS is leading the work locally, while also contributing to a larger evolution of public health systems across the country.

Equity is the soul of social justice in public health – when we dismantle barriers within our systems and reimagine how we serve, we honor the humanity of all people and ignite lasting transformation for generations to come.

Jennifer Masdea
Director, Health and Racial Equity, HRiA

Why it worked

While assessments are vital for identifying strengths and gaps, they often leave local health departments without the tools or guidance needed to act on their findings. By integrating capacity building and strategic planning, this project goes beyond the traditional approach of standalone assessments in favor of a cohesive, wraparound approach to advance equity at the local level. This approach ensures insights gained through assessment translate into effective strategies and sustainable results.

The project’s capacity building sessions equipped staff with the shared language, knowledge, and frameworks needed to understand and address equity challenges. These sessions fostered collaboration, trust, and a sense of shared ownership, cultivating and supporting future collective action. The addition of a strategic planning phase provided a roadmap for success, with clear priorities, measurable goals, and actionable strategies that align with the organization’s values and mission.

What makes this project unique is its holistic approach. The integration of equity as a process and outcome ensures that the work is data-driven and deeply rooted in organizational culture and capacity, creating a model that other health departments can replicate or adapt.

The work we did with HRiA helped us lay the foundation for our teams that equity is intrinsic to the work we do.

Florence Pourtal
Lincoln County HHS Public Health Division Director

Looking ahead

The results of this project set the direction for Lincoln County’s new strategic plan. Equity is now central to the organization’s mission and embedded throughout their redefined vision, values, and guiding principles. Soon, Lincoln County will further this work by rehiring a position within the Public Health division that will focus on equity and community partnerships.

Leadership