Goals and objectives of practice
The Public Health Councils program is a critical intervention for reducing rates of COVID-19 transmission and addressing systemic inequities that were further exposed by the pandemic. The primary goal of this practice is to increase worker organizer efficacy and knowledge in five prioritized sectors regarding: how to file complaints with Public Health, the County's anti-retaliation ordinance, vaccine information, and how to engage workers on these topics.
Objectives include:
-Establish PHCs at worksites in the focus sectors
-Increase the number of complaints submitted to Public Health by workers in the focus sectors
-Increase COVID-19 vaccinations among workers in the focus sectors
Timeframe for practice
July 2020: Los Angeles County Board of Supervisors introduced a motion instructing Public Health to consult with labor representatives, worker advocates and business community representatives about feasibility of establishing a Public Health Councils program.
July - October 2020: Public Health worked extensively with labor, business, and academic partners to prepare for program implementation.
November 2020: Board of Supervisors directed Public Health to move forward with implementation.
November 2020: Public Health contracted with UCLA Labor Occupational Safety and Health (LOSH) Program to serve as trainer for the program.
December 2020: Public Health contracted with Liberty Hill Foundation, a fiscal agent, to oversee contracts with community-based organizations.
December 2020: LHF released Request for Proposals for interested community-based organizations; RFP due in January
February – March 2021: LHF contracted with ten CBOs
March – May 2021: UCLA LOSH and Public Health train and certify CBOs
May – December 2021: CBOs conduct outreach and provide education and technical assistance to workers in five prioritized sectors
Partnerships
Based on pre-existing relationships with Public Health, occupational safety and health professional training organizations from academia and the community were quickly on-boarded to provide guidance in developing the initiative, as well as brokering introductions with key community-based organization and partnerships with workers' centers and labor organizations. Through the County's Department of Consumer and Business Affairs, Public Health was able to access key business leaders representing Chambers of Commerce, trade organizations, small business owners, and other interested economic development organizations throughout the county. In addition, Public Health brought on Liberty Hill Foundation as a fiscal agent, based on their longstanding history of supporting struggles for social and economic justice and their relationships with community organizations already working on similar efforts.
These relationships have been key in establishing effective partnerships with community leaders and stakeholders. The expertise that community partners have contributed to the program thus far has allowed for rapid deployment of supplies, resources, messaging and also the two-way information channels for receiving information back from CBOs and workers to Public health personnel regarding real-time violations occurring in the workplace, workers' concerns with issues from taking time off to get vaccinated, to vaccine hesitancy, to retaliation concerns and dispelling rumors and misinformation about COVID and the vaccines amongst low-wage worker populations.
Steps taken to ensure collaboration with community stakeholders
The primary components of the project include contracting with and certifying community-based organizations (CBOs) -- worker centers and ethnic focused organizations -- to serve as the intermediary between workers and Public Health. The CBOs assist workers in learning about their right to form a PHC, understanding HOOs and related guidance; providing technical assistance in identifying non-compliance; and helping PHCs prepare reports and documentation to submit to Public Health for further investigation. Public Health developed the certification criteria, as well as the process, by which CBOs collaborate with Public Health.
To develop the PHC program, Public Health staff held over a dozen listening sessions and meetings with representatives from the business community, labor community and other Public Health and government partners. These listening sessions helped Public Health to navigate the interests of labor organizations with the concerns of the business community to develop a program that would be feasible and successful. The sessions also helped inform the process for onboarding community-based partners and developing programmatic planning components and innovations.
Steps taken to implement practice and Public Health's role
Public Health worked closely with Liberty Hill Foundation (LHF) to release a competitive RFP to solicit qualified CBOs interested in working in one of the five prioritized sectors: food manufacturing, apparel manufacturing, warehousing and storage, restaurants, and grocery stores. LHF, in close collaboration with Public Health, then contracted with ten CBOs in the amount of $150,000 each, to provide services for one-year. Once LHF selected appropriate CBOs, their representatives underwent intensive training conducted by a professional, academic training organization. This training was developed in cooperation with Public Health and experts from government, academia, and industry. Training modules included topics such as: 1) detailed instruction about County HOOs and Public Health protocols specific to the prioritized sectors in which certified CBO staff work; 2) administrative and legal regulations and requirements relevant to the PHC Program; and 3) instructions for how to prioritize businesses within their sector. Public Health certified CBO representatives once they successfully completed the three-day new hire training and demonstrated competence. Once representatives are certified, they can begin to support workers and PHCs. Certified CBO staff who completed training are the only individuals from their organizations authorized to work directly with PHCs and businesses. Regular check-ins between CBO representatives and Public Health are required to ensure good communication, identify barriers to effective implementation and collaborate on problem solving.
CBOs speak to employees in prioritized sectors about implementing HOOs and Public Health protocols to inform workers about the voluntary opportunity to form a PHC; train PHCs and increase their awareness of the HOOs and protocols; provide ongoing technical assistance and training to PHCs on increasing compliance with HOOs; and liaise with Public Health on behalf of the PHCs.
PHC members are comprised of workers meeting voluntarily on their own time. Workers in the PHC receive training from the certified CBOs so they can train or facilitate training on the HOO and protocols for other workers and promote peer-to peer education. Peer educators reinforce instructions regarding physical distancing and infection control in the workplace; convene brief, regular meetings of the PHC (e.g., one hour/once per week) offsite and on their own time unless the business grants permission for onsite meetings, to discuss plans to increase adherence to HOOs; and develop detailed recommendations for monitoring compliance with the HOOs and if feasible, share and discuss with management.
Public Health's Acute Communicable Disease Control Program used Los Angeles County COVID-19 worksite outbreak data to identify three of the five focus sectors: food manufacturing, apparel manufacturing, and warehousing and storage. A total of 596 COVID-19 worksite outbreaks occurring in Los Angeles County from April through August of 2020 were classified according to the North American Industry Classification System (NAICS). Restaurants and the grocery and food store sectors were also included based on the public nature of these sectors and number of outbreaks.
Incidence rates, total number of outbreaks, and total number of cases associated with workplace outbreaks were calculated for each sub-sector. Incidence rates, which are an indicator of risk, were calculated for each sub-sector by dividing the total number of cases associated with outbreaks in the sub-sector by the average annual number of employees in that sub-sector. Public Health determined the sub-sector outbreak incidence rate to be the best measure to prioritize industries because it takes into account the number of cases associated with the outbreaks and the size of the population at risk. The three sub-sectors with the highest incidence rates were food manufacturing, apparel manufacturing, and warehousing and storage (the latter two are classified as one sub-sector by the NAICS).
This program has established the groundwork to maintain a new and effective partnership with community-based organizations that advocate on behalf of low wage workers in disproportionally burdened communities in LA County. This infrastructure and the resulting relationships have proven to be invaluable in the County's response to the COVID 19 pandemic allowing for increased ability to send and receive messaging during surge crises, timely and urgent vaccine, and other health related messaging, as well as providing the department with information from communities with a wealth of knowledge and expertise who very often are not seated at the emergency response and recovery planning table with government agencies. This pilot program serves as a model of how business, labor, occupational safety and health, and environmental and public health can collaborate effectively. In fact, what the COVID 19 pandemic has demonstrated is that lines that previously divided sectors and disciplines are now blurred, and many aspects of workers' lives are intersectional, crossing boundaries that government agencies are responsible for. It is our duty to work together to improve working environments for high-risk workers, and to protect the health and safety of their communities -- not just in the remainder of this pandemic, but for future natural or man-made disasters.
This initiative is in the vanguard of public health equity in that the communities of workers hardest hit by this pandemic have been prioritized using real time data, and every step possible was taken by Public Health staff to ensure timely, appropriate, and accessible information, materials and resources to our community partners and stakeholders. Furthermore, Public health continues to work with the business community and their private sector and government allies to improve employers and businesses access to resources, information, and support to keep their businesses open, workers and communities safe
Costs and Funding
The County Board of Supervisors authorized the use of County funds to initiate the PHC program, and additional CDC funding was secured to fund the program through December 2022. In addition, $300,000 of private foundation funding was secured to increase the number of CBO partners from 8 to 10. Total funding to support the program from 2021 through 2022 is $4,276,521 (not including costs for Environmental Health inspectors).
Five contract staff were hired to help manage and run the program: two health educators, two health program analysts, and one administrative assistant. Staffing costs for 2 years are: $1,064,252.
Funding for the fiscal sponsor and subcontracted CBOs for 2 years is: $2,512,269
Funding for the training partners for 2 years is: $400,000