One of the most important things Alameda County Public Health Department (ACPHD) learned from the COVID pandemic is that you can’t solve a problem you can’t see. Thanks to Future of Public Health (FoPH) funding, ACPHD is now shedding light on public health issues in parts of their population that had been undetected before. 

Like all health departments during the pandemic, ACPHD collected all kinds of data to better serve their communities. But they noticed serious gaps for some of the populations that were the hardest hit by COVID. By investing FoPH funds to improve their data and expand their staff, ACPHD has found health challenges impacting some communities much more than others. And they are developing plans to address them.

“This is ​one of the first times during my public health career that we have seen a largescale investment supporting local public health across the board. It really allows us to do better in serving our communities,” ​Alameda County Public Health Department Health Officer Dr. Nick Moss shared.  

 Lessons from COVID: Incomplete Data Hid Life-Limiting Inequities

​“When COVID first hit, we didn't have complete data. We didn't even have data by race and ethnicity on a national level,” shared Julia Raifman, ACPHD Director of Community Assessment Planning & Evaluation​ (CAPE). “Once we recognized the importance of collecting COVID data by race and ethnicity, it still wasn't always available for smaller population groups. We learned that COVID was having a greater impact on Asian American Pacific Islanders (AAPI), Native Americans and Alaskan natives.”  ​

Fortunately, FoPH funding gave them staff and bandwidth to create new data standards with a universalist approach, aligning with their values centered on populations most affected. Raifman says they started going the extra mile to report the data for AAPI, American Indian and Alaska native populations in Alameda County. What they found was dismaying – AAPI populations were not just unevenly affected by COVID but are still, years later, unevenly affected by every leading cause of mortality. 

Uncovering Race and Ethnicity Gaps in County Mortality Rates 

The county’s overall life expectancy data revealed a major imbalance in mortality rates depending on a person’s race and ethnicity. Alameda County residents with the longest life expectancy (87.2 years old), when sorted by race/ethnicity, and those with the shortest life expectancy (72.5 years old), showed that African American/Black residents’ lives are an average of 14.7 years shorter than their Asian counterparts. Looking at data from 2018 through 2023 shows the gap is widening. 

ACPHD looked at causes of death and the data on AAPI, Native American and Alaskan native populations showed a wide swath of inequities. Poverty, access to healthcare, housing and education. This now informs how staff approach community outreach, guidance for health care providers and hospitals, and partnerships with community-based organizations. 

Applying Data to Reduce Health Barriers and Opioid Overdose 

Raifman said the data was a wakeup call, prompting ACPHD to take a new look at the way they collected and shared data across the public health system. They take a more complete look, being more intentional about what reduces barriers and looking at ways to develop educational materials tailored to specific populations. ACPHD’s goal is to center many programs and outreach on previously overlooked populations to ensure that those communities are empowered with public health information that is easier to understand and act upon.  

Liz Maker, a 20-year veteran of ACPHD, is the FoPH-funded Evaluation Manager for the CAPE program. Hers is a key role leading a mission-critical unit that supports all of ACPHD. She works with both internal and external partners to evaluate the effectiveness of their programs and identify areas needing improvement. The CAPE program is something of a “one stop shop” where ACPHD staff and agency partners can get assistance on everything from surveys and focus groups to help them better understand their community’s needs, barriers to health care access and the effectiveness of their programs. 

“We’ve created a repository of [evaluation] methods that staff and partners can refer to,” said Maker. “They're also free to call and say, ‘Hey, I need some help with this.’ We coach them on how to collect their data. How they choose the best way to get the information they need.”  

Maker’s multi-faceted team is doing a needs assessment for the Alameda County  Overdose Data-to-Action project and maintaining an Opioid Indicator Dashboard. They provide current info on practices for doctors who prescribe medications for managing substance use as well as data to inform local policymakers on the community impacts of opioid use. The team works with partner agencies and community-based organizations, providing feedback and helping them develop recommendations for improving their direct-service programs. The project is in its early stages and Maker is committed to helping their local healthcare partners gather reliable information that will help reduce opioid-related overdose and death. ​

Sustained Funding Enables a Deeper Look at People Experiencing Homelessness  

Another project Maker’s team is heavily involved in started in 2023, when they did a large needs assessment study with agency partner Health Care for the Homeless to evaluate data from interviews with 157 people experiencing homelessness. The goal was to understand the experiences, barriers and recommendations for better provision of health care services for people experiencing homelessness. The ACHCH team went to 16 different sites but still felt like they missed some populations, so with the help of the ongoing resources and staff from FoPH funding, they are revisiting the project now with a focus group of Black/African American men.   

“We just completed 10 focus groups with 81 Black/African American men experiencing homelessness and we're in the process of working to make sense of that information. We work with people who work closely with that population because we're bringing our own culture and biases, and we have to counteract that,” Maker shared. 

Deeper Data for Healthier Outcomes ​

These examples of how Alameda County has expanded and deepened their understanding of their populations’ health challenges and opportunities to improve, are just a few of the many ways the CAPE team is using better data practices to address a wide range of health issues. From more effective suicide-prevention programs for LGBTQ+ youth to the causes of maternal mortality they are digging deeper to collect and evaluate data to identify gaps in health outcomes and find more effective solutions.  

There is no doubt FoPH funding is a cornerstone of ACPHD’s efforts to use more complete data toward creating healthier communities. The funding allows the CAPE team to continually look for ways to understand and improve outcomes for all county residents, especially those in communities too often overlooked and left behind in health care systems.  

As ​Raifman expressed, “Having FoPH funds really supports the department as a whole to dive into infrastructure development and push ourselves to continually improve. It makes a foundational difference. Everyone deserves good health.”  ​