DRAFTWe live in a time of unprecedented change. The pace

of demographic, technological, social and environmental shifts is accelerating.1, 2 Expectations around health are expanding, bringing greater focus to broader issues such as social needs and equity. 3, 4, 5, 6, 7 In this context, planning for the future is essential and demands a conscious effort to better listen to and understand the communities we serve and the trends shaping all our lives.

Understanding these realities, Contra Costa Health Services (CCHS), along with our community partners, undertook a year-long planning process to ensure our readiness for the future.8 At the heart of that effort was a shared understanding that health shapes the lives of everyone in Contra Costa County. We embraced an appreciation that everything around us also shapes health.9 While CCHS plays a significant role in improving and supporting health, we also understand that the community’s safety, health and well-being are affected by a wide variety of factors, large and small, personal and collective. These include income inequities; structural racism; access to fresh and healthy foods; a clean and healthy environment; opportunities for quality time with family and friends; success in personal and professional endeavors; the ability to find and pay for housing; and even the chance to stroll in a quiet green park.10, 11, 12

We reviewed science, research and proven models, and included these in the planning process.13, 14, 15, 16 We connected with, listened to and learned from a wide variety of people in our county. Hearing from community residents and colleagues, collecting their input, understanding their hopes and values, and learning what they felt they needed to live full, healthy lives grounded these efforts and gave us a fresh perspective on how to deliver on these aspirations. The outcome of this research, planning and listening has led to an ambitious strategy that we call Living Contra Costa.

LIVING CONTRA COSTA

Living Contra Costa is a community inspired, multi-sector strategy that envisions everyone and every organization working together to help all people in Contra Costa County achieve health and well-being. Living Contra Costa evokes a sense of people thriving, enjoying and embracing life and opportunities in Contra Costa County. By aligning the many organizations committed to helping people achieve these aspirations across the region, this process creates an opportunity to build shared understanding of our future as we strive toward equitably advancing well-being.17, 18 It is a moral imperative to reduce and eliminate needless suffering wherever it occurs, and we are committed to a future where the well-being of all people in Contra Costa County is valued and supported.

LIVING CONTRA COSTA

What would it take to create a county paradigm based on eliminating needless suffering? Can an entire county align around an approach that prioritizes on living safely, living healthy and living well? How do we work together to leverage our collective resources, expertise and influence to make this a reality? Living Contra Costa is the community-driven response to these questions — calling on us all to support a future where the health and well-being of all people in Contra Costa, regardless of income, education, race or location, is valued and supported.

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It is a moral imperative to reduce and eliminate needless suffering wherever it occurs, and we are committed to a future where the well-being of all people in Contra Costa County is valued and supported.

After hearing from diverse voices in our county, we organized

the well-being objectives of Living Contra Costa into three

priorities: Living Safely, Living Healthy, and Living Well.

LIVING SAFELY addresses people’s need to feel safe and protected, whether from crime, pollution or unsafe living conditions. The community has been clear that safety is essential. This represents the most basic human need, and the county already plays a key role in addressing this by working to ensure safe air, water and food, as well as providing shelter, first responders, police and fire protection. Finding alignment with state, county, city and regional boards in addition to other non-governmental entities will be essential to further this aim.

LIVING HEALTHY encompasses a variety of issues that are related to a broader definition of health. More than ensuring access to health care, Living Healthy looks at all aspects that allow people to pursue health, such as clean and safe parks, walkable streets, access to affordable and healthy food, and the ability to live a long and independent life. The county has been addressing many of these issues with community partners through better alignment, but there is still more that needs to be done to ensure that people are living healthy.

LIVING WELL encompasses the myriad of factors that fundamentally contribute to emotional fulfillment and satisfaction — including education, income, employment, connections, spirituality and personal growth. This is where community organizations, employers, religious organizations, schools and businesses can leverage their ongoing work to make a positive impact.

We expect that any intervention, initiative or partnership of Living Contra Costa will fall into one of these three categories. There are no absolute lines between them. They are most powerful when they merge and intermingle, as they almost certainly will.

For the many potential partners throughout the county, Living Contra Costa is an invitation to support one or more of these three categories. Living Contra Costa encourages every entity and organization in the county to join us in creating greater opportunities, tackling inequity and disparities, overcoming burdens and fostering healthier lifestyles. Identifying, tracking and measuring activities in each of these three categories is essential as entities throughout the county actively engage and involve themselves in this work.

FRAMEWORK

What must be in place to achieve safety, health and well-being for all community members? How do we support inventive, inclusive spaces for all to engage in this work? What actions do we need to take to ensure that Contra Costa County is ready to collectively advance well-being for all in our county? These are just a few of the key questions that will be addressed with our partners as we start this journey.

Through this planning process, we clearly heard from our community members that they view health and well-being very differently. For people in Contra Costa County, it’s about family and friends, love, financial security, safety, housing, trees and parks, exercise, justice, spirituality, fun and, yes, access to health care.19

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Living Contra Costa evokes a sense of people thriving, enjoying and embracing life and opportunities in Contra Costa County, no longer overburdened by concerns for safety, health and well-being.

CONTRA COSTA COUNTY VISIONContra Costa County is recognized as a world-class service organization where innovation and partnerships merge to enable our residents to enjoy a safe, healthy and prosperous life.

As such, all of us have to think far more broadly, since ultimately the people of Contra Costa County will thrive not just when they are free from disease or illness but when they are truly living life to the fullest and embracing those aspects that matter dearly to them.

The three priorities of Living Contra Costa — Living Safely, Living Healthy and Living Well — enhance CCHS’s mission to care for and improve the health of all people in Contra Costa County, with special attention to the most vulnerable. They reflect an expansion of our approach. They highlight the need for us to build strong alignment with other county departments as well as cities, businesses, schools, law enforcement, courts, parks, community-based organizations and Bay Area organizations. Living Contra Costa also recognizes that success is incumbent on continuing to engage with the community — to listen to their concerns, gather their input and amend plans to meet changing needs and expectations.

A beginning point of this work is the development of a measurement strategy. How will we know that we are making improvements in quality of life and making progress toward our shared vision of Living Contra Costa? How will we target interventions and resources to areas of greatest need? How will we ensure that traditionally overlooked, under-resourced areas and populations are raised to an equitable standing? To address these concerns and ensure the integrity of the Living Contra Costa metrics while delivering meaningful information to the community, all Living Contra Costa metrics must meet four criteria:

VALIDATED metrics are those that are widely accepted, sourced and accurate.

COMPARABLE metrics allow Contra Costa to compare itself to other communities, inviting the opportunity to examine similar regions that are performing better and learn from their successes.

STRATIFIED metrics enable us to look more deeply into specific areas of our community and evaluate performance based not just on geography, but also on race/ethnicity, gender and income, etc.

EASILY UNDERSTOOD metrics are those that people would readily recognize as important and relative to the goals of Living Contra Costa.

For instance, Living Safely includes a measure of homelessness, and specifically a metric for those who are living unsheltered. This metric of the number of people living unsheltered in our county has been collected for several years. It is required by the federal government and used for funding purposes and it is measured annually and can be compared to other communities across the state and nation. Homelessness metrics help us work together to develop long-term and short-term strategies specific to our county. With other collected data, we can work on root causes of homelessness, such as a lack of affordable housing, mental health services, substance abuse counseling, criminal justice reform and inherent bias. We can also see if this number is higher in some cities and which groups are more likely to be unsheltered.

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LIVING HEALTHY

Life Expectancy

82.2Average number of years a person born today is expected to live

Quality of Life

94.7%Percent of population sufficiently healthy to live independently

Food Security

8.5%Percent of population who have experienced food insecurity

Built Environment

80.3%Percent of population living within a 1/2 mile of a park or community space

K E Y M E T R I C S

LIVING WELL

Education

89%Population 18-years-old & older with at least a high school diploma or equivalent

Income

64.5%Percent of population spending <1/3 of household income on housing

Employment

9.8%Percent of total labor force that is unemployed

Belonging

TBD% Percent of population who volunteer

LIVING CONTRA COSTA

LIVING SAFELY

Security

2,469Number of crimes per 100,000 people reported to law enforcement

Air Quality

5.1%Percent of days air quality rated unhealthy for sensitive populations

Shelter

135Number of unsheltered persons per 100,000

Community Resilience

TBD

AS OF SEPTEMBER 2020

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BUSINESSES:

A vibrant and flourishing Contra Costa becomes a recruiting point for new employees and leads to lower health care costs.

LOCAL CITIES:

A successful Contra Costa is comprised of cities with community cohesion, involvement and support.

EDUCATORS:

A thriving Contra Costa embraces upward mobility through learning.

LAW ENFORCEMENT:

A resilient Contra Costa translates into fewer conflicts, reduced recidivism and the opportunity to examine the allocation of policing resources.

VULNERABLE COMMUNITIES:

An empathetic Contra Costa invites healing, justice and additional opportunities to achieve success.

FAMILIES:

A safe Contra Costa means less anxiety, stronger relationships and greater connectivity.

HEALTH AND CARE PROVIDERS:

A healthier Contra Costa allows for greater attention to prevention issues, reduced costs and increased member satisfaction.

FAITH COMMUNITIES:

A supportive Contra Costa means greater dedication to service.

HOMEOWNERS:

A desirable Contra Costa translates to increased property values.

LOCAL AND REGIONAL PARKS:

An environmentally responsible Contra Costa means increased support for open spaces.

CONTRA COSTA COUNTY GOVERNMENT:

A fully aligned Contra Costa means excellent leadership, greater efficiency, increased resources and joy in the workplace for employees.

EXAMPLES OF HOW KEY SECTORS COULD BENEFIT UNDER LIVING CONTRA COSTA

BUILDING PARTNERSHIPS

What CCHS came to appreciate throughout our planning phase is that this broader call for health and well-being in every aspect of our lives parallels the needs of our cities, our businesses, our institutions and our families. Indeed, if we work together, we can build alignment that invites a broad spectrum of diverse voices to work in tandem.

For individual sectors, this broad-based, county-wide approach to fostering well-being will draw people together, create more viable, connected communities and make Contra Costa a more attractive place in which to live, learn, work and play.20

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CONCLUSION

For the county and CCHS to play a meaningful role in shaping the safety, health and wellness of our communities, we must acknowledge that hundreds of other sectors, businesses, organizations and individuals control the levers to that success. Our job

is to encourage vision, invite partnerships, find alignment and continually measure results. We must hold ourselves accountable, continue to listen and take on equity

as a key component of health. Delivering on the county’s promise of quality of life and economic viability demands that we invest in these universal and collaborative efforts.

Living Contra Costa is a far-reaching approach that reshapes what county government delivers, how we partner with local communities and, most importantly, what the county’s

promise is to the people of Contra Costa. Living Contra Costa is a fundamental shift that can facilitate health and well-being for everyone. We welcome that future. We are confident that by aligning the power of our entire county around Living Contra Costa’s shared aspirational goals, we can transform challenges into opportunities.

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REFERENCES1 The Global Risks Report 2020, (https://reports.weforum.org/global-risks-report-2020/).

2 Kneebone, E & Berube, A 2013, Confronting suburban poverty in America, The Brookings Institute Press, Washington DC.

3 Bradley, E & Taylor, L 2013, The American health care paradox: why spending more is getting us less, PublicAffairs, NYC.

4 Developing Healthy People 2030, (https://www.healthypeople.gov).

5 Getting to Health & Well-Being for the Nation 2018, (http://www.nasdoh.org/wp-content/uploads/2018/09/NASDOH-White-Paper.pdf).

6 ACEs Awareness 2019, (https://www.dhcs.ca.gov/Documents/ACEs-AWARE-INITIATIVE.pdf).

7 Spur’s Agenda for Change in the San Francisco Bay Area, (https://www.spur.org/sites/default/files/publications_pdfs/SPUR%27s_Agenda_for_Change_2016.pdf#page=6).

8 IDEO 2013, The Field Guide to Human-Centered Design. IDEO: Palo Alto.

9 Let’s Get Health California, (https://letsgethealthy.ca.gov/).

10 Live Well San Diego: 2018-2019, Live Well San Diego Annual Impact Report, (http://www.livewellsd.org/content/dam/livewell/2019AnnualReport/2019-annual-report-summary-final-10.07.19.pdf).

11 HealthyPeople2020, (https://www.healthypeople.gov/).

12 Institute for Population Health Improvement UC Davis: Four Themes Prepared for CCHS 2019, (https://889c51bd-2ec9-4d79-ad7e-3770eeb9de5e.filesusr.com/ugd/ee8930_d8c25c07a62443068a13ced8cf04df46.pdf).

13 Robert Wood Johnson Foundation, 2019 Well-being in the nation (WIN) measurement framework: measures for improving health, well-being, and equity across sectors, 100 Million Healthier Lives, (https://www.communitycommons.org/entities/041046ce-f89b-42a4-aa3f-82034a5ac625).

14 Vogenberg, R & Santilli, J, 2018, ‘Healthcare Trends for 2018, American Health Drug Benefits’ Am Health Drug Benefits, vol. 11, pp 48-54, (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902765).

15 Deloitte, 2020, US & Global Health Care Outlook, (https://documents.deloitte.com/insights/2020globalhealthcareoutlook).

16 State of California Health and Human Services Department of Health Care Services, 2020, Medi-Cal Healthier California For All 2019, (https://www.dhcs.ca.gov/provgovpart/Documents/6422/Medi-CalHealthierCAforAllExecSummary.pdf).

17 Brewster, A, Brault, M, Tan A, Curry, L & Bradley, E 2017, ‘Patterns of Collaboration Among Health Care And Social Services Providers in Communities with Lower Health Care Utilization and Cost’, Health Services Res, (https://www.ncbi.nlm.nih.gov/pubmed/28925041).

18 Foresight, 2018, The Process, (https://foresightforhealth.org/about/#step_1).

19 Envision Health Listening Tool, (https://LivingContraCosta.org).

20 Mann, P 2019, Advancing Cross System Partnerships, National Association of Counties (NACo), (https://www.naco.org/resources/featured/advancing-cross-system-partnerships-leadership-lab-case-studies).

Photos used under Creative Commons License. Photos on this page courtesy of Pete Nowicki and Henry Huey.

DRAFT

Initial planning and community outreach efforts to inform Living Contra Costa were made possible, in part, with

funding from the Contra Costa Regional Health Foundation.

LIVING CONTRA COSTA

living safely, living healthy, living well