State Category: California

The Private Sector’s Role in Preparing for and Responding to Public Health Emergencies

By Nicolette A. Louissaint, Ph.D., Executive Director, Healthcare Ready

This story was published in Ready or Not? 2017.

The private sector can often respond to rapidly changing circumstances nimbly and usually knows the communities they serve incredibly well. As such, amidst an emergency, there is opportunity for private organizations to step in and fill any response gaps.

The public sector takes on an enormous burden and works tirelessly to respond to emergencies, and the private sector sees its role, especially when it operates in affected regions, to surge alongside the public sector, pivot nimbly and augment public efforts—thereby enhancing the public system’s response efforts.

Often to take advantage of public and private sector expertise, there just needs to be a connection between the two.

For example, during the Hepatitis A outbreak in San Diego, public officials reached out to the private sector for help locating a significant amount of vaccines—since one of the solutions was to do a mass vaccination campaign.

Instead of suggesting they import or special order something (possibly at an extremely high cost), Healthcare Ready (HcR), my organization, checked the levels of vaccines in pharmacies in the area. We found the private sector had enough in stock to supply what was needed. Sometimes you just need to know how and who to ask.

As evidenced by this example, one important aspect of coordinating emergency response is sharing critical information. HcR is designated by the Department of Homeland Security as an information sharing and analysis center (ISAC). So, the private sector knows they can trust us with their proprietary information—and we won’t share with any outside parties inappropriately.

This designation also gives us a fuller view of the resources in a community during an emergency. For example, during a flood, we can know where emerging challenges in the medical pipeline might be because roads are not accessible. We can inform the public sector and work on a solution to ensure vital supplies make it to the public workers who are saving lives.

The public sector knows we can provide them with accurate status of response supplies and what is or isn’t happening along the supply chain. It’s absolutely vital for the public sector to know what kind of relief they’ll be getting and when and what might be missing so they can adjust on the fly.

What we’ve learned from 2017’s Hurricanes

After this hurricane season, we realized that the private sector can do a lot fast and rapidly fill gaps to supplement public sector efforts by getting around bureaucracy.

When faced with an emergency response, we initially focus on resuming supply chain operation and work to support any patients who might be falling through the gaps that naturally occur. The public sector can rely on us to gain insight into what the private sector sees—with us being a central hub coordinating private sector information.

One recent example:  There was a small group of patients on St. Thomas who needed a specific drug that could only be prescribed every 30 days. The public sector folks asked us to look for ways to get the drug from Puerto Rico and onto a plane that was making routine trips between the islands after the hurricane.

As we looked into that, we also were able to reach out to the pharmacies on St. Thomas that we knew had re-opened. And we asked them to speak with their distributors who supply them with medicine. We actually found that one pharmacy had the necessary medicine and it was already on the island. We just had to connect the dots.

While this sounds easy written down, there are many competing priorities and everything is in flux during an emergency response. With the public sector relying on the private sector for these kinds of responsibilities it can free them up to handle other vital activities.

How we can better use the private sector?

While there many examples of public and private sectors working well together, too often the private sector is only looked at a supplier, notably of money and medicine, which is frustrating because clearly the private sector wants to and can help in other ways.

This might seem like a minor problem—but if the public sector is only engaging with the private sector amidst a crisis or when money is needed, the relationships aren’t developed that are necessary to work alongside one another during an emergency. A lot of emergency preparedness and response is about knowing the right organization or person to contact to obtain the life saving measure/supply you need.

Currently, in most places, states have just one Emergency Management Coordinator for the entire private sector—encompassing industries like transportation, healthcare, agriculture, food, etc. It really isn’t feasible for the level of coordination that needs to happen to go through a single node.

As such, there should be a coordinator for each industry, setup in advance with regular meetings to fold private sector emergency capabilities into the public sector’s response plans—so when a hurricane makes landfall we all know what to do.

Local Public Health Responsibilities During Wildfire Emergencies

By Dr. Karen Relucio, Chief Public Health Officer, County of Napa

This story was published in Ready or Not? 2017.

Responding to two wildfire events has taught me that public health has a significant role in wildfire emergency response. The role of public health includes shelter assessment, coordinating medical and mental health support in the shelter, ensuring environmental health and safety, and public health messaging.

During our first response in September 2015, there was a 75,000 acre fire that destroyed 1,300 structures, resulting in the evacuation of more than 1,000 people, which required us to open and support an evacuation center. The fire was predominantly in Lake County, which is adjacent to Napa County.

When something like this occurs, local public health works with our emergency management agency, fire and law, other County agencies and community partners to respond.  Immediately, Napa County opened a shelter at the fairgrounds in Calistoga and stood up the emergency operations center.

Napa County Public Health took on the responsibility of assessing the health needs of most of the evacuees by using a modified community assessment for public health emergency response (CASPER). While Red Cross was on site, they only handled doing health assessments of the people that chose to stay inside the shelter. Surprisingly, we had many people show up in cars or RVs or with their own tents and with pets. Because animals were not allowed inside the building, they stayed outside on the fairgrounds property.  It became our job to conduct health needs assessments of the majority of the 1,000 evacuees.

Additionally, our other role was providing medical support within the evacuation center.  We worked with our local Federally Qualified Health Center, healthcare providers from our local medical centers and Medical Reserve Corps from Napa and neighboring counties to see patients. Most of the medical visits involved refilling medications and treating people who had respiratory issues from smoke inhalation or exacerbation of underlying health issues (diabetes, allergies and asthma). Thankfully, there were only a few people with slight injuries from the evacuation itself.  We also provided flu and Tdap vaccinations.

It was also apparent that mental health needed to be addressed for the evacuees in a comprehensive way. We leaned on other local jurisdictions and nonprofits and were able to enlist a number of mental health professionals to come onsite. We quickly found that it was best to do more ad hoc checks and have the mental health professionals serve as support staff. They found it was easier to talk to folks—and avoid the stigma that might come with needing mental health services.

Another important aspect of our response was environmental health.  These professionals ensured the shelter was safe and clean and that food was prepared and served safely. They went into the shelter and found donated food served potluck style, not at the appropriate temperature. In addition, there weren’t enough hand washing stations or bathroom facilities and the pets of evacuees were relieving themselves in areas where people were walking. We felt this was a prime setup for a gastrointestinal virus outbreak, which would make the situation worse.  Our folks figured out how to maintain the integrity of food, installed more portable toilets and hand sanitizing stations, and provided bags for pet waste.

Throughout the response, public health information included a smoke advisory, heat advisory, and repopulation safety for evacuees once they went back to their homes. We also had to ensure people knew they shouldn’t sort through the debris without personal protective equipment.

This was great preparation for our recent fire in October 2017—which started at the same time our region was experiencing hurricane level winds of 50 to 90 miles per hour, resulting in rapid spread of the fire to our county and Sonoma County.  The first 72 hours was focused on evacuations and safety.

We opened three different evacuation centers on that first evening and immediately began the plans for the type of medical coordination that we did in 2015. We also coordinated ambulance strike teams all over the region to help evacuate residential care and skilled nursing facilities.

In many ways our response was similar to 2015, except the scope of this emergency was much bigger and the recovery is much more complex.  We had to declare a local emergency and a local health emergency to receive assistance for toxic ash and debris cleanup which is still in progress.  Residential wildfire debris can include toxic materials such as asbestos, heavy metals, dioxins and polycyclic aromatic hydrocarbons that can be harmful to human health, and cleanup needs to be done carefully by experts.  At this point, debris cleanup is still underway.

Additionally, we opened a local assistance center to help those who have lost properties, homes, and jobs.  And, there are many crews working on erosion control in burn areas around water reservoirs, as we are now having heavy rains and anticipate debris flow and possible water contamination.

While we have begun to create an almost turnkey response plan to wild fires, we could always be better prepared, especially for the recovery phase. And, we really need to know a lot more about the long-term health impact of wildfires. For instance, will we see cancer rates go up?  Will health inequities be worsened due to loss of homes and income? If so, is that something public health can work to prevent during the response or in the aftermath?

We also need more information and research on the impact of toxic debris and additional long-term health consequences as a result of repopulating an area that has suffered wildfire damage.  The only studies that come close to looking at long-term health impacts of fire debris are the 2001 World Trade Center attacks. We can speculate on health impacts based on knowing what is contained in ash but, to my knowledge, there hasn’t been a long-term health impact study about residential wildfires. It is hard to make decisions and align future resources when we are uncertain about the long-term effects.

Boyle Heights’ Efforts to Prevent and Respond to Childhood Lead Exposure

Background

A Vernon, California, lead-battery acid recycling plant, which opened in 1922, contributed to air pollution in Boyle Heights, a nearby Los Angeles neighborhood, for more than 90 years. The plant logged at least 88 violations of emissions standards between 1996 and 2015. Exide Technologies, which purchased the facility in 2000, ran it seven days a week and processed 25,000 batteries a day. It emitted lead, arsenic and other pollutants into the air.

Ensuring Clean Air and Clean Soil

In 2013, after the South Coast Air Quality Management District found the plant “posed a higher cancer risk to more people than any of 450 operations the agency has regulated in the last 25 years,” state regulators temporarily shut it down. Unfortunately, Exide was able to get the closure overturned, forcing advocates to take further action.

In 2014, the U.S. Environmental Protection Agency (EPA) found that Exide violated new Clean Air Act emissions standards more than 30 times. These were the same violations found by the South Coast Air Quality Management District. But, because of the new Clean Air Act rules, EPA was able to step in and use those violations to fine Exide up to $37,500 per day for each violation.

These regulations forced the plant to close, yet the state continued to find that it emitted lead into the environment. And, in 2015, inspectors found additional issues, namely improperly labelled containers of hazardous materials and holes in the walls and roof of the facility.

At the same time, the company was also under criminal investigation for pollution related matters. To resolve that situation, the company entered into an agreement with the U.S. attorney’s office to, among other things, permanently close the plant.

Under the deal, Exide and its employees would avoid prosecution if they paid $50 million to tear down and clean the plant, with $9 million set aside specifically for removing lead-contaminated soil from homes.

In April 2016, California appropriated an additional $177 million to cleanup about a 2 mile radius surrounding the Exide plant. The state will be looking to Exide to pay this money back.

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In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives.

The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.

California’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

In the mid-1980s, the California state legislature declared childhood lead exposure the most significant environmental health problem in the state and subsequently established the Childhood Lead Poisoning Prevention Branch within the state’s Department of Public Health (CDPH).

The program compiles information, identifies target areas, and analyzes data to design and implement ways to reduce childhood lead exposure. The statutes also determine a “standard of care” to evaluate children for lead-exposure risk; mandate reporting by laboratories of all state blood lead test results; and require public health and environmental services for children identified with elevated blood lead levels, including ordering property owners to remove hazardous lead conditions. The state requires the establishment of procedures and the adoption of regulations regarding residential lead paint, and lead-contaminated dust and soil. It also authorizes and administers a lead-based paint prevention training, certification, and accreditation program.

Funding

To help pay for the program, in 1993, California adopted an annual Childhood Lead Poisoning Prevention Fee, administered jointly by CDPH and the California Board of Equalization (BOE), on manufacturers and other entities involved with the production or sale of lead and lead-based products collected from businesses in the petroleum and architectural coatings industries and from facilities reporting releases of lead into the air. The department deploys a “historical market share attributions” concept to estimate each payer’s long-term contribution to environmental lead contamination and allocate fees. It then deploys collected funds (the fee generated $20.6 million in fiscal 2015) to support healthcare referrals, assessments of homes for hazards, and educational activities.

Banning Lead in Certain Products

California has led U.S. efforts to ban lead from a range of products beginning with a 1986 law, Proposition 65, which requires manufacturers, retailers, and other businesses to notify consumers when they are being exposed to toxic chemicals, including lead. The law has made consumers more aware of toxic chemicals in their environment, and advocates have successfully pressed for more regulations to ban or curtail the use of lead and other toxins in products. In conjunction with these efforts, California passed a number of strict laws to safeguard products and protect its citizens from lead exposure. For example:

  • In 2005, California implemented a lead-in-candy law. The state considers candies with lead levels in excess of 0.1 parts per million (ppm) to be contaminated. The Food and Drug Branch of the California Department of Public Health is required to test samples, notify the manufacturer of the adulteration, and issue a health advisory. The federal Food and Drug Administration subsequently issued national guidance in 2006 recommending that all candy likely to be consumed by children contain no more than 0.1 ppm of lead.
  • In 2006, California enacted the Metal-Containing Jewelry Law. This requires jewelry and components, such as dyes and crystal, that  are sold, shipped, or manufactured for sale in California to meet limits set by the state under a 2004 consent judgment that applied to a number of manufacturers, retailers, and distributors in response to a lawsuit filed by the Attorney General of California and two environmental groups. The law forbids the manufacture, shipping, sale, or offer for retail sale or promotional purposes jewelry in California unless it is made wholly from one or more specified materials. It also mandates lead restrictions for certain specified materials allowed in manufacturing jewelry and establishes provisions for children’s jewelry and that used for body-piercing.
  • California passed additional legislation in 2006, effective in 2010, to reduce the lead content in water distribution products. The law prohibits more than 0.25 percent lead in commercial pipes, fittings, and fixtures.  In 2010, the U.S. Congress amended the Safe Drinking Water Act, including provisions similar to the California standard, and, in 2014, the 0.25 percent standard for lead in pipes, fittings, and fixtures became national.
  • In 2009, California passed the California Lead in Wheel Weights Ban to prevent lead from wheel weights, used to balance tires in vehicles, from entering the environment.  Before the ban, lead wheel weights, which can become dislodged from the wheels and end up on roads where they are abraded into lead dust and debris, were responsible for releasing 500,000 pounds of lead annually onto California roads. Since 2009, six other states, including Washington, Maine, Illinois, New York, Vermont, and Minnesota, have followed California’s lead. Also in 2009, the U.S. Environmental Protection Agency (EPA) started the process to consider banning lead wheel weights in the United States, but it has not taken formal action. The European Union has already banned lead wheel weights, while manufacturers in Japan and Korea stopped installing them in 2005.

In 2010, both California and Washington passed legislation restricting the use of heavy metals including lead in motor vehicle brake pads. In 2014, in California, and 2015 in Washington, brake pads sold in those states could not contain more than 0.1 percent by weight. The legislation also limits the levels of asbestiform fibers, cadmium, chromium, copper, and mercury in the brake friction materials. In January 2015, brake manufacturers signed a memorandum of agreement with the Environmental Protection Agency and the Environmental Council of the States declaring that all brake pads sold in the United States will meet the California/Washington standards. The brake- pad standards were adopted immediately, while standards for copper are being phased in.

  • In 2003, California passed the Toxics in Packaging Prevention Act, which limited harmful substances in packaging and reduced the levels of toxins contaminating soil and ground water near landfills. While the original law exempted lead paint or applied ceramic decoration on glass bottles, a 2008 amendment banned such uses if the lead content exceeds 600 ppm.
  • California passed a law in 2013 that made it the first state to require the use of only lead-free ammunition be used for hunting with a firearm in California. The regulations, which began to phase in in 2015, will be fully implemented in 2019. Lead ammunition for hunting waterfowl was banned nationally in 1991, but the California law extends the ban to hunting for all wildlife. The main purpose of the law is to protect endangered wildlife, including the California condor, from lead exposure. However the legislation should have the added benefit of reducing lead exposure for the families of hunters.

Results

The number of children from 0 to under 21 years who have been identified with blood lead levels at and above 4.5 mcg/dL has been decreasing significantly. In 2013, 1.7 percent of tested children had blood lead levels in this range. In 2007, 6.5 percent tested above 4.5 mcg/dL.

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In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives. 

The case study does not attempt to to capture everything a location is doing on lead, but aims to highlight some of the important work.

Improving Lives & Saving Money by Extending Care from the Clinic into the Community

By Brenda Rueda-Yamashita, Chronic Disease Program Director, Alameda County Public Health Department

Asthma Start, which delivers in-home case management services, began nearly 14 years ago, when our local health officer wanted to intentionally address and prevent asthma—at the time, Alameda had the third highest rate of asthma in the state.

At the same time, First Five/Every Child Counts grants became available to organizations that wanted to focus on preventing adverse asthma outcomes for 0- to 5-year-olds.

In short, there was funding and a will to improve lives—and it can be magical when those two factors match-up.

While the initial grant was incredibly important, we’ve been able to grow and continue to implement the program by blending and braiding funding streams. For instance, we are supported by reimbursements from managed care organizations and funding from the hospital community benefit programs, private grants, tobacco settlement funds and sales tax revenue. As can be the case, promising programs disappear when an initial grant runs out, which makes braiding all these funding sources—which can be difficult—absolutely necessary to sustain the program over time.

Creating our approach

To inform our approach, we worked closely with local hospitals. They were uniquely able to provide referrals but also educate us on what questions (e.g., do you have mold, vermin, cockroaches, etc.) we should be asking of patients.

We quickly learned that the biggest benefit we could provide would be an in-home approach – you can’t separate someone’s health from the health of the environment they live in. Also, at the time, we spoke with a local doctor who knew her patient’s family was following her recommendations, yet no one was getting better and there were more and more adverse asthma events. Finally, the patient’s mother asked if the attacks could be because of the mushrooms growing in her home. When you hear that story, clearly a light bulb goes off: health is just as much about outside the clinic as inside.

In essence, Asthma Start sends social workers to meet with individuals and families affected by asthma to determine why medication isn’t working. We use social workers because addressing asthma, often, is not just about the disease but is psychosocial as well.

During these home visits, we make sure they have medication and are taking it correctly and outline the most common asthma triggers and how to address them. If needed, we also supply cleaning supplies, ranging from vacuums to dust mite covers to non-bleach-based mold cleaners. We also ask if they have stable housing, jobs, food, a doctor and insurance.

If we identify that a patient requires additional interventions, we can make referrals to our partners at Alameda County’s Health Homes program or other appropriate community resources, programs and organizations. Throughout the years, we have formed deep partnership with many local landlords, our housing authority, the district attorney’s office, schools, the biggest local managed care organization and many others.

Landlords

Clearly, we knew home triggers and poor living conditions were driving asthma attacks. The trick then is to get these alleviated. So, we sent letters and helped tenants send letters and we got issues addressed, sometimes. Seems simple, but it worked.

Housing Authority

In those instances where we couldn’t get a landlord to take appropriate action, it was incredibly important to connect with Healthy Homes and our code enforcement.

Now, Asthma Start, Healthy Homes and code enforcement meet monthly to conference on the existing cases. We identify the housing issues that are affecting a patient’s health and refer those to Healthy Homes which can, if necessary, work with code enforcement to make sure the poor living conditions are addressed.

District Attorney and Truancy Court

Our local district attorney found that many parents were in truancy court for chronic absenteeism because they said their children were having asthma attacks and couldn’t make it to school. These weren’t delinquent parents or children—they had legitimate issues.

Once we identified this issue, the district attorney began to refer every family to us that had asthma issues and they would complete our program, and usually start going back to school and never see the truancy court again.

The district attorney also does a training once a year when school starts to help school officials understand chronic absenteeism and how to refer kids to appropriate health services.

Schools

A lot of school districts have a School Attendance Review Board, which is a board of people who review why folks aren’t making it to school. We sit on many of these boards and if any health issue—asthma or not—is identified, we handle it. We make sure the case follows a similar structure and we get kids back in school. Research indicates that schools/society save about $40 a day per child that attends. If you take the 30,000 children in the U.S. that are out of school every day due to asthma, you are talking huge cost savings.

Chronic absenteeism is silently crippling the country: missing 10 percent of the school year is a huge risk factor for academic failure and, nationwide, more than one out of 10 students miss that much school every year. Asthma alone accounts for around 14 million absences each year and children with persistent asthma are more than three times as likely to have 10 or more absences than their peers.

Managed Care Organization

In around 2003, Alameda Alliance of Health (our main Medicaid managed care organization) wanted to leverage our asthma program. First, they had to find a code to pay for our work and found one related to health and behavior assessment.

We signed a contract with a specific amount of money that we had to bill against. This modest, but successful model, worked well for several years. Alliance, about a year ago, decided it might be easier to expand the program and refer all children that are seen in the emergency room to us and the program on a regular basis receives 20 referrals a week—children with asthma-related conditions are referred to Asthma Start, children with other conditions are referred to public health.

In addition to this reimbursement, Asthma Start is supported with funding from hospital community benefit programs, private grants, tobacco settlement funds and sales tax revenue. Braiding all of these funding sources together to finance the program isn’t easy, but is necessary to sustain the program over time.

Results

I think we’ve been so successful because we were the missing link in the continuum of care from the doctor’s office into the home and community. One recent Alliance patient was referred to us – we saw her at 5 and helped address her asthma. Now, she is 12 and her asthma is a problem again. They were referred to us and immediately the family felt at ease and a conversation started. The problem? Her new allergy medication pill was too big to swallow, so she couldn’t take it. In that one example, we realized part of what we do is just make it okay to talk.

We’ve also saved money, reduced symptoms and improved lives. Our interventions return about $5.00 to $7.00 for each dollar invested. The program has greatly reduced emergency department visits and hospitalizations with 95 percent of children maintaining/reducing their symptoms. And, through these reductions the program has been able to measure a cost savings of up to 50 percent for Alliance.

The bottom line: kids are getting to school and living healthier, happier lives due to Asthma Start. And this work is possible and sustainable because we did the difficult work of blending all the diverse funding sources available to us.

Total Health at Kaiser Permanente

Total Health is a state of complete physical, mental, and social well-being. In 2013, Kaiser Permanente launched Total Health to help Kaiser Permanent members and workforce, their families, and communities achieve this vision of health. By focusing on chronic conditions driven by modifiable social and environmental determinants of health, Kaiser Permanente Total Health works to benefit communities through a variety of programs including: Thriving Schools initiative (300 schools participate) which aims to create a culture of wellness in schools including healthy meals; Every Body Walk! which raises awareness about the benefits of walking; and an incentive plan for the Kaiser Permanente workforce to improve health metrics. Partners include safety-net providers, fresh food providers, theatres, and grassroots organizations, in addition to schools and school-related organizations. Kaiser Permanente funds $2 billion that is needed annually for this population health work and supplemental funding is provided by partner organizations. To read more about this innovative program, see this brief summary [link].

St. John’s Wellchild and Family Center

Since 1996, St. John’s Wellchild and Family Center (SJWCFC), a FQHC network in California, has been working to reduce the negative impacts of substandard housing on health. When first launched, SJWCFC and Esperanza Community Housing Corporation worked together on lead poisoning prevention. From 1996 through 2003, Strategic Actions for a Just Society joined the collaborative to collect data about the health impact of substandard housing to influence state and local policy. In 2009, Healthy Homes Healthy Kids joined with a comprehensive approach around home visits, health program enrollment, medical homes, advocacy, and policy development. Highlights of collaborative outcomes include: 100 percent decrease in asthma hospitalizations; 100 percent decrease in missed work days by parents; 80 percent reduction in percent of clients with asthma ER visits; 69 percent reduction in the percentage of children missing one or more days of school due to asthma; and 69 percent reduction in clinic/doctor visits due to acute asthma attacks. SJWCFC is funded by British Petroleum Settlement/Air Quality Management District Funds, First 5 Los Angeles, EveryChild Foundation, Housing and Urban Development Agency, and Kresge Foundation. To read more about this innovative program, see this brief summary [link].

Live Well San Diego

In 2010, the San Diego County Board of Supervisors adopted Live Well San Diego, a 10-year plan to advance health, safety, and well-being of the region’s more than three million residents. The County’s partners include cities and tribal governments; diverse businesses, including health care and technology; military and veterans organizations; schools; and community and faith-based organizations. The initiative has four strategic approaches: building a better service delivery system; supporting positive choices; pursuing policy and environmental changes; and improving the culture Ten indicators have been identified to capture the overall well-being of residents. The initiative now has three components: Building Better Health, Living Safely, and Thriving. Funding began in 2010 with a $16 million Communities Putting Prevention to Work (CPPW) Federal Grant Award. In 2010, Live Well San Diego also received a five-year grant from the Centers for Disease Control and Prevention National Public Health Improvement Initiative. In 2011, they received a five-year, $15 million Community Transformation Grant. To read more about this innovative program, see this brief summary [link].

Health Leads

Health Leads, operated by lay resource specialists and college student volunteers, is a collaborative comprised of partner hospitals, health systems, community health centers, and Federally Qualified Health Centers (FQHCs) working together to integrate basic resources such as access to food, heat, and other necessities into health care delivery. Operating via clinical settings since 1996, this initiative enables providers to prescribe solutions to patients helping them manage their disease and lives. The impact of Health Leads is two-fold. The program expands clinics’ capacity to secure nonmedical resources for patients— in 2013, 92 percent of patients identified that Health Leads helped them secure at least one resource they needed to be healthy. Additionally, Health Leads is producing a pipeline of new leaders—in 2013, nearly 70 percent of Health Leads graduates entered jobs or graduate study in the fields of health or poverty. Health Leads sustainability model utilizes earned revenue, national and local philanthropy, and in-kind contributions from volunteers and health care partners to fund its operation. To read more about this innovative program, see this brief summary [link].

Dignity Health’s Community Health Investments

For more than 20 years, Dignity Health, a health care provider in multiple states, has been investing in the health of the communities it serves through community benefit programs and community economic initiatives, including grants and low-interest loans to nonprofits addressing community needs. Investments are targeted to populations with disproportionate unmet health needs as identified through the community health needs assessment and a Community Need Index developed by Dignity Health. Since 1990, Dignity Health has awarded more than $51 million in areas such as prevention, HIV/AIDS services, behavioral health services, and improving access to care. The Dignity Health Community Investment Program has had a total loan volume of $143 million, benefiting the community-based health programs of California, Nevada, and Arizona including: providing affordable housing for seniors; access to shelters for the homeless discharged from community hospitals; and healthy food projects. To read more about this innovative program, see this brief summary [link].