Planning a Strategy: Changing the Way a County Health Department Addresses Health Conditions

Summary

First page of the Los Angeles County In Action story

Los Angeles County Department of Public Health addresses such diverse population health needs by including evidence-based approaches found in The Community Guide as a foundation for its strategic planning. Using evidence has helped them reduce rates of obesity, sexually transmitted infections, heart disease, tobacco use, and more. (Released 2012)

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Lessons Learned

Lead by example. Dr. Fielding recognized the value The Community Guide would bring to the LACDPH. Through his leadership, the importance of using evidence from The Community Guide has been incorporated in all the reviews of program effectiveness and has been a core element of the Department’s ongoing quality assurance functions.
Use science to support accountability. The Community Guide provides information on what decision makers can expect from an intervention. This helps ensure funds are used to implement effective programs, reduce trial and error, and save resources.
Work as an informed team. The Community Guide provides a common framework for researchers, program planners, policymakers, and directors to work together to improve the health of their communities.

Story

Los Angeles (LA) County is the most populous county in the United States with 10 million people living in a 4,000 square mile area that ranges from densely urban to sparsely rural, and includes 88 cities.^1,2 The County also has extensive racial, cultural, linguistic, and socioeconomic diversity. LA County Department of Public Health (LACDPH) faces these challenges head-on by assuring evidence-based practices are part of its strategic planning. With guidance from the Community Preventive Services Task Force’s (Task Force) findings and recommendations in The Guide to Community Preventive Services (The Community Guide), LACDPH is making strides to impact rates of obesity, sexually transmitted infections (STI), heart disease, tobacco use, and other preventable diseases. This large county health department shows how The Community Guide used in day-to-day work can inform policy, assist program design, and justify initiatives to gain community support.

Leadership Champions Change

As a founding member of the Task Force, Dr. Jonathan Fielding, director of LACDPH and health officer of LA County, instituted a major policy change when he strongly encouraged and then required program directors to use The Community Guide as part of a program planning and approval process. It took a few years to build awareness of how useful The Community Guide could be in identifying both evidence-based strategies and gaps in knowledge, but 15 years later it continues to play a pivotal role in the Department’s strategic planning and development. It adds confidence that the programs, services, and policies carried out will be successful and meet the needs of the community.

Implementing Policy Change and Improvements

Physical activity. LACDPH is working to influence local land use policies to create healthier communities. Through several grant programs, LACDPH directly funds cities and community-based organizations to develop planning policies promoting healthy eating and active living. Examples of these include plans for safe and healthy streets, transit-oriented districts, and greenways. The Department also provides technical assistance and financial support for a handful of communities with very high rates of childhood obesity. Cities have been given assistance in developing comprehensive plans that consider how appropriate development can improve health and reduce health disparities.

An example of success is in El Monte, an industrial and residential city with a large Hispanic population and a growing obesity trend. El Monte adopted a Health and Wellness Element in their General Plan to address the city’s lack of safe facilities and parks where residents can be physically active.³ The city developed the Arceo Walk, a 1-mile circuit featuring newly planted trees, health information kiosks, and signs noting distances to neighborhood schools, public transit stops, and community centers. El Monte is now replicating the key elements of the Arceo Walk in two other parks.

Tobacco. LACDPH restructured its Tobacco Control and Prevention Program (TCPP) in 2004 to inform local decision makers and community stakeholders about policy opportunities to reduce tobacco use. Using findings and recommendations in The Community Guide, TCPP worked hard to educate city, health, and business leaders about health impacts associated with reduced indoor and outdoor secondhand smoke exposure. From 2004 to 2010, nearly 100 tobacco control policies have been enacted in LA County. With a smoking prevalence of 14.3 percent, LA County has among the lowest smoking rates of any metropolitan area in the nation.

Pregnancy, HIV/AIDS, and STIs targeting adolescents. In an effort to reduce sexual risk behaviors among adolescents, LACDPH’s Maternal, Child, and Adolescent Health (MCAH) program created a 5-year plan incorporating findings and recommendations in The Community Guide. MCAH is in the process of creating and disseminating a comprehensive toolkit of evidence-based principles and best practices for positive youth development to a network of almost 350 youth-serving agencies throughout the County. A survey tool will be used to measure how well the agencies are implementing the practice.

The LACDPH’s Division of HIV and STD Programs & Policies (DHSP) uses The Community Guide both to obtain and award funding. The LA County HIV Prevention Plan aligns with Task Force findings and recommendations, as well as with the goals of the White House’s National HIV/AIDS Strategy. DHSP requires those proposals for funding to indicate the evidence-based interventions that are intended to be used. Currently, 26 local agencies in communities across the county have funding to conduct group-level health education programs to reduce behaviors that are high risk for HIV. Six of those programs are targeted to youth, all of which are based on the Task Force’s recommendation for comprehensive risk reduction for adolescents. In addition, one of the largest school districts in LA County uses an evidence-based sexual risk reduction intervention that targets adolescents. This program aims to delay the onset of sexual activity and increase protective behaviors among sexually experienced students, resulting in reductions of STIs and teenage birth rates.

Aiming for Continued Improvement in County Programs

The LACDPH staff continues to rely on the results of systematic reviews in The Community Guide to positively affect the public health in their communities. They rely on The Community Guide to plan for likely outcomes and gauge their programs’ potential success. According to Dr. Fielding, The Community Guide “helps staff make the best decisions to maximize available resources and implement interventions and activities known to be effective in community settings.” The LACDPH consults The Community Guide regularly to stay updated on new recommendations and topic areas.

¹ U.S. Census Bureau: State and County QuickFacts-Los Angeles County, California. https://www.census.gov/quickfacts/fact/table/losangelescountycalifornia,US/PST045216. Accessed on March 21,2012.
² Los Angeles County Department of Public Health. Department of Public Health Strategic Plan 2008-2011. http://www.lapublichealth.org/docs/StrategicPlan.pdf. Accessed on March 21, 2012.
³ City of El Monte. El Monte General Plan: Health and Wellness Element Public Review Draft April 2011. http://healthyelmonte.org. Accessed on March 21, 2012