INSTITUTE OF HEALTH EQUITY AND SOCIAL JUSTICE RESEARCH
For over a decade, equity, particularly racial equity, has been a defining objective in public health and broader public policy. Propelled forward by increasing health disparities, the Black Lives Matter movement, and responses to police brutality, declarations that racism was a public health emergency started emerging in 2018. Strategies to respond to this emergency – and to the reality of structural racism – have continued to evolve and have, among other things, included the purposeful efforts of governmental entities to align their policies and programs internally and with private sector partners.
In the winter of 2024, the American Public Human Services Association and Social Current were concluding a Robert Wood Johnson project supported by investigators from Northeastern University. These organizations were engaged in improving the alignment of public and private human services with a particular focus on addressing racial equity. Their findings prompted interest in better understanding local level public-private cross-sector equity related strategies. The high-level, three-site case study presented here is an outgrowth of that concern.
County-based interviews with governmental and non-governmental entities took place in Milwaukee, Mecklenburg, and San Diego over a fifteen-month period from May 2024 through July 2025. Specifically, the researchers sought to characterize the impetus, process, and impact of public-private cross-sector healthcare and human service delivery innovations that were centered in community and informed by equity. Extensive current and historical document review supported the interview process and analysis.
These conversations and analyses occurred prior to and during the initial changes in national leadership and resulting shifts on racial and other equity policies during the first half of 2025. As intended, the case studies provide high-level descriptive reviews of County practices and enabling circumstances. There has been no attempt to situate these findings in changes that have occurred in the interim or to delineate risks emerging in the current political environment, except to the extent that participants were already forecasting concerns.
Nonetheless, there are several findings that may inform ongoing responses to restrictions on equity related efforts. The experiences in the three settings suggest that the most optimal and the most equitable practices in the delivery of health and human services are based in broader efficacy and efficiency related evidence that has been emerging over a 30-year period. These practices include community-engaged planning and decision-making; alignment of eligibility, enrollment, care management, and service delivery processes; No Wrong Door and other low-barrier access; person-centered planning; population-based and targeted data development and dissemination; and public and private delivery system and community-involved culture change.
Spreading and scaling these practices is at the core of both assuring effective services for all vulnerable populations and of addressing equity, particularly racial equity.
