Public Health Accountability in Action: The King County Pandemic and Racism Community Advisory Group.

After a tumultuous 3 years of pandemic-, political-, and race-related unrest in the United States, the public is demanding accountability to communities of color (defined here as American Indian/Alaska Native, Asian, Black, Native Hawaiian/Pacific Islander, and Hispanic people) to rectify historic and contemporary injustices that perpetuate health inequities and threaten public health. Structural racism pervades all major societal systems and exposes people to detrimental social determinants of health. Disrupting structural racism within public health systems is essential to advancing health equity and requires organized partnerships between health departments and community leaders. As those who are most affected by structural racism, communities of color are the experts in knowing its impacts. This case study describes the King County Pandemic and Racism Community Advisory Group (PARCAG) and its use of an innovative accountability tool. The tool facilitated institutional transparency and accountability in the adoption of community recommendations. PARCAG was influential in shaping Public Health-Seattle & King County's COVID-19 and antiracism work, with 66 of 75 (88%) recommendations adopted partially or fully. For example, a fully adopted recommendation in May 2020 was to report King County COVID-19 case data by race and ethnicity, and a partially adopted recommendation was to translate COVID-19 information into additional languages. PARCAG members were recruited from a 2019 advisory board on Census 2020 and were adept at shifting to advising on COVID-19 and equitable practices and policies. Organizations that have made declarations that racism is a public health crisis should center the experiences, expertise, and leadership of communities of color in accountable ways when developing and implementing strategies to disrupt and repair the effects of structural racism and efforts to promote and protect public health.

Listen and Be Ready to Shift: How Racial Equity and Community Leadership Launched "Communities of Opportunity".

Multisector partnerships that put racial equity and community leadership at their center can create pathways to healthy communities. With funding from the Seattle Foundation and King County government, Communities of Opportunity was launched in 2014 to close gaps by place and by race in health outcomes and in measures of 3 social determinants-employment, housing, and social environment. The initiative is governed by a multisector partnership with community leaders in the majority. Relationships and decisions made during Communities of Opportunity's early years led to an expansion of the work from a $1 million per year place-based focus to an $8 million per year policy and system change enterprise. The initiative now funds 68 nonprofits to improve racial equity by increasing community capacity, investing in leadership development, and making policy changes. A committed group of community leaders worked with the funders to create an innovative structure that redresses past and current racial injustices and supports local leaders acting on ambitious priorities. A shared analysis of structural racism in the past and the present can deepen relationships and increase local government and funder credibility. When health departments and funders create the space for community leadership, initiatives can have broader reach and greater sustainability. We are in the early stages of developing the evidence base for improving community health equity and further work is needed to identify and disseminate successful processes and interventions.

Kids get care: integrating preventive dental and medical care using a public health case management model.

Kids Get Care is a public health-based program in the Seattle area designed to ensure that low-income children, regardless of insurance status, receive early integrated preventive medical, dental, and developmental health services through attachment to medical and dental homes (the usual sources of medical or dental care). The oral health component of the program focuses on cross-training medical and dental providers, providing partner medical clinics with a case manager, and educating staff in nearby community-based organizations about how to identify incipient dental disease and possible early childhood developmental delays. The program identifies a local, well-respected dentist to champion the delivery of oral health screening within a medical clinic and to provide oral health training to medical clinic staff. The program works with community agencies to educate families on the importance of healthy baby teeth, routine dental care beginning at age one, and general prevention. In its first year, the program trained 355 community staff and 184 primary care providers on how to conduct an oral health assessment. These staff and providers screened more than 5,500 children for oral health problems. One medical clinic more than doubled the number of fluoride varnishes it provided, increasing from 80 to 167 during a nine-month pilot phase. Other outcome studies are in progress.