One of the most destructive wildfires in our nation’s history started with a downed power line, deep in the heart of Northern California’s wine country. Extremely dry conditions, from years of drought, and high winds quickly accelerated the growth and spread of what would become known as the Tubbs Fire, ultimately burning more than 36,000 acres in Sonoma, Napa, and Lake Counties, and killing 22 people. Approximately 5,643 structures were destroyed, more than half of which were homes in Santa Rosa, the largest city in Sonoma County. In fact, Santa Rosa lost 5 percent of its housing stock to the Tubbs Fire.
In the tragic aftermath, residents and organizations from a variety of sectors came together to provide vital services like housing, food, and health care, including trauma and mental health services. These partners recognized that longstanding policies and systems had been contributing to poor and inequitable outcomes for vulnerable populations, particularly low-income communities and people of color. In addition to the limited production of housing, income inequality and discriminatory practices had been making affordable housing inaccessible for decades. Many organizations, including Santa Rosa Memorial Hospital, recognized that even with the best attempts at providing health care, these issues meant effective housing strategies had to go beyond the provision of vouchers or even the building of structures. Any real solutions would have to address the root causes of housing inequity.
The Intersections Initiative
At the same time that the Sonoma disaster response and recovery was under way, the St. Joseph Health Community Partnership Fund was launching a new kind of initiative designed to elevate equity and prevention at the community level. The fund’s leadership had come to understand the critical importance of taking on the social determinants of health—issues like housing, education, and income—to achieve better health for low-income communities, people of color, and other historically marginalized groups. They also wanted this new initiative to build on the strengths and resilience of the communities they serve and to pursue fundamental changes to systems and institutions.
The Intersections Initiative brings together coalitions from the seven California communities served by St. Joseph Health System hospitals with the goal of advancing health equity by addressing the community conditions that shape health outcomes. The fund and its partner, Prevention Institute, have been working together since 2016 to better understand the challenges and opportunities for hospitals and their partners to intentionally pursue upstream causes of, and solutions to, community-level health problems.
Centered around those learnings and with hospitals as a partner, convener, and key strategist, the Intersections Initiative has invested resources toward collaborative “forming and storming,” encouraging coalitions to deeply consider the continuum of social needs and social determinants and identify approaches that build resilience for communities as a whole. Success for this three-year, $4 million initiative will be embodied by the strengthened capacity of community-based organizations and stakeholders to serve as advocates and champions of health equity.
Community Approaches
In Sonoma, partners came together to form the Sonoma Intersections Coalition, with Santa Rosa Memorial Hospital (the local St. Joseph Hospital) serving as the backbone. The coalition recognized that low housing inventory was only one of the obstacles making it harder for residents to find affordable housing. Income inequality and past involvement with the criminal justice system were obstacles for some residents as well. Their comprehensive approach to addressing these factors includes support for policy measures that would take questions about past conviction status off of applications and make it illegal to discriminate based on source of income. Additionally, the coalition is training key decision makers to take trauma into account in policy making, especially related to housing.
Across the state of California, Intersections sites are building their bench of partners to address multiple determinants of health and to understand how strategies that affect one determinant can support other determinants. In the arid desert of Victorville and Adelanto, St. Mary Medical Center is working closely with community partners to strengthen local school decision-making processes, so that they include the voices of students and parents and can support better educational outcomes. Simultaneously, partners are considering how economic development opportunities can prioritize existing residents in benefitting from new and emerging jobs. With the potential of a stronger local workforce and jobs with which to connect residents, the partnership is also working to embed equity principles in new housing development plans to discourage displacement of families who have a longstanding presence in the region.
In urban central Orange County, a coalition is making efforts to stabilize rent and housing costs for low-income neighborhoods and families in Santa Ana and Stanton. Additionally, coalition members are pursuing complementary workforce and business development strategies and planning to seek changes to financial and lending policies at banks and other entities to make them inclusive and fair for everyone. The coalition is also advocating for county, regional, and state housing policies that can protect and expand tenant rights and increase affordable housing options across the state.
Similarly, partnerships in Anaheim, south Orange County, Napa, and Eureka are addressing a multitude of community factors, such as housing, education, civic engagement, and economic well-being, recognizing that these issues and others affect community health and health equity. They aim to change systems and policies that create the need for social and health services in the first place.
Moving Forward
With increased fear and uncertainty arising from national rhetoric that alienates and discriminates against people of different faiths, immigrants, the LGBTQ community, and people of color, coalitions can amplify resident voices and serve as organized advocates for social justice across topics and jurisdictions.
As a funder anchored within a health care system, the St. Joseph Health Community Partnership Fund remains committed to meeting the immediate clinical and social needs of the community as part of its mission. However, it is also committed to ensuring that its local hospitals serve as key allies and actors in upstream efforts. Social determinants of health efforts will be more effective and sustainable when they go beyond service creation or coordination as their main goals and also address policy and systems change. This must be done by intentionally considering the intersections between those policies and practices in areas like housing, jobs, education, social connectedness, and others.
Clinical strategies alone won’t lead to healthier outcomes. It is critically important to address the root causes of health problems and eliminate health inequities. For that reason, health systems and funders must engage in community-level initiatives that take on the upstream causes of health problems and seek solutions to them.
