Healthy Whatcom (Whatcom County Health Department)

Tracking Actions and Disaggregating Data to Advance Health Equity in Whatcom County

Summary of Client Results:

• Clear Impact RBA training brought practical, actionable, and systematic approaches to help Healthy Whatcom plan their Community Health Improvement Plan and will build on RBA to implement and evaluate their Community Health Improvement Plan. 
• Combined with racial equity training (delivered by Racial Equity Institute), Clear Impact RBA training prepared the Healthy Whatcom Team to bring creative, brave, and under-researched solutions to address racial inequity. 
• Healthy Whatcom plans to make its website a hub to access all reports and track progress through data dashboards.
• Healthy Whatcom will use Clear Impact Scorecard’s GANTT chart feature to efficiently manage projects and monitor the completion of ongoing activities related to the plan.

The Story Begins 

Whatcom County is located in northwestern Washington State and shares a border with Canada and two indigenous tribes: the Lummi Nation and the Nooksack Tribe. The county’s population is roughly 230,000, and 86.2% White. Despite this majority, minority populations (notably Hispanic and Native American children) bear the brunt of health issues in Whatcom. Like many communities—as is the case across our country—this isn’t by accident but by historical design. 

Whatcom County is generally healthy when looking at averages. Still, disaggregated health Indicators tell a different story in virtually every community. Take, for example, the COVID-19 pandemic. According to the County Health Department, Hispanic individuals make up 10% of Whatcom County’s population but account for nearly 20% of COVID-19 cases. 

Recognizing the need for new collaborative, diverse, and inclusive systems to help the county root out racism and racial health disparities, the Whatcom County Health Department convened the Healthy Whatcom Team for the first time in 2017. This team is a cross-sector group of stakeholders tasked with developing the County’s Community Health Improvement Process. It operates from the guiding principle that health improvement is fundamentally about advancing health inequities by changing systems, shifting power to communities of color, and centering the voices of marginalized people. 

The first stop on the road to equitable health results? Develop the team’s capacity to create a measurable, impactful Community Health Improvement Plan (CHIP) through training in evidence-based community improvement methodologies. The second? To implement a data and action-plan management system to inform, track, and evaluate the CHIP’s implementation and impact.

The RBA Training Process

Before jumping into action, the Healthy Whatcom team considered the work already underway. They realized that there was a tremendous amount of work, yet they weren’t achieving the intended impact. This realization led to research, and a recognition by Healthy Whatcom that structural racism is at the root of many of the disparities they were trying to address and, that while they were doing good work, as a collective we weren’t holding ourselves accountable to measuring our outcomes. Based on this recognition, eventually, they settled on two types of training in 2020: 1) Results-Based Accountability training delivered by Clear Impact Senior Consultant Marcos Marquez, and 2) racial equity training from the Racial Equity Institute (REI). Marcos Marquez skillfully integrated the racial equity institute’s groundwater approach into Whatcom County’s RBA process.

According to Amy Rydel, Health Planning Specialist with Whatcom County Health Department, the Clear Impact RBA workshop brought “practical, actionable, and methodical approaches to planning, implementing, and evaluating Healthy Whatcom’s CHIP.” For the next two years, Healthy Whatcom engaged in a Results-Based Accountability Implementation process (intermittently delayed by COVID-19) grounded in racial equity. This process helped the team bring “creative, brave, and under-researched solutions to address racial inequity.” 

In February 2022, Healthy Whatcom’s work and training culminated in the release of its 2022-2026 Community Health Improvement Plan, or CHIP.

About the Whatcom County CHIP

Community Health Improvement planning in Whatcom County is a cyclical, multi-year process that continually does the following:

• Healthy Whatcom performs a Community Health Assessment to identify health areas that require the collaboration of multiple agencies and systems to solve. 
• Identify priority areas through a community prioritization process. 
• Priority areas, intended results, strategies, and an action plan (developed through RBA thinking) are compiled into Whatcom County’s CHIP.

Healthy Whatcom believes that focusing on creating positive and lasting change for the youngest members of their community will significantly improve community health through addressing the root causes of racial health inequities. The Racial Equity Institute uses the metaphor of toxic groundwater to describe the pervasiveness of structural racism. Poisoned groundwater inevitably poisons surface water, akin to how structural racism poisons all systems (e.g., education, health care, criminal legal, child welfare, etc.), thus shaping poor outcomes, particularly for marginalized individuals and communities. The Healthy Whatcom CHIP elevates “groundwater solutions” to advance racial equity by focusing on families and improving early childhood well-being for all races and ethnicities in Whatcom County via the three focal areas:

1. Child & Youth Mental Health
2. Early Learning and Care
3. Housing for Children and Families
4. Advance Racial Equity

The Role of Scorecard

Healthy Whatcom developed its CHIP in 2021. In 2022-2026, they plan to bring it to life through four strategic actions. One of these actions includes developing “communication tools to ensure transparency and accountability” and making the Healthy Whatcom website a data hub where the community can easily access reports and track progress on data dashboards.

Healthy Whatcom utilizes Clear Impact Scorecard to track and improve its community health Indicators and strategic action-plan performance measures. They also use Scorecard to develop and organize their Results-Based Accountability Turn the Curve Action Plans. Currently, Healthy Whatcom maintains three overarching CHIP Scorecards organized by Result areas, Indicators, accompanying Indicator strategies, specific strategy action items, and one performance measure per action.

According to Healthy Whatcom, the CHIP Scorecards “represent the work-in-progress of stakeholders, including residents, staff, managers, and leaders, who work together to improve a set of health priorities for Whatcom County, Washington. A shared commitment to racial equity centers the work in these important ways: shifting power intentionally to BIPOC stakeholders in decision-making and authority; assessing disaggregated data regularly by race and ethnicity for key health priorities; exploring what creates disproportionality through groundwater analysis…”

Healthy Whatcom also uses Scorecard’s GANTT chart feature heavily for project management and ongoing monitoring of activities related to the plan. This is an excellent example of the synergy between Scorecard and the day-to-day efforts of a Collective Impact approach to community health (grounded in racial equity).

Healthy Whatcom invites you to view its CHIP Scorecards and a sample GANTT chart here. 

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