Spanning from the Pacific coast to the inland farmlands in central California, Monterey County is a community of 437,9072. Located in Salinas, the largest city in the county, the Monterey County Health Department (MCHD) tackles health issues reflective of its diverse county population. Agriculture in Monterey County contributes $8 billion annually to the local economy and the surrounding Salinas Valley is known as the Salad Bowl of the World.” Yet, the median annual income for farmworkers is $25,000. Overall, 55% of the population is Hispanic/Latino, 33% are White (not Hispanic), 6% are Asian, 3% are Black/African American, and the remaining 3% are Other with 53% of the population not speaking English at home. Monterey County has a 17% poverty rate and 1 in 10 of the county's public school children are homeless.
Community engagement has been identified as a potentially useful strategy to reduce health inequities. Disadvantaged groups systematically suffer from worse health outcomes such as lower life expectancy than non-disadvantaged groups. Engaging members of disadvantaged communities in public health initiatives has been suggested as a way to reduce health inequities.
The goal is to spur community engagement through civic engagement trainings with a health-focus so that community residents can take a more participatory role in their communities. In order to prepare and engage community residents, enLACE participants learn about the social determinants of health, community engagement and their relationship to the health of the community. As they use a health lens for each of the eight-modules, participants connect with county and city staff to learn about their local government systems and how programs and policies impact the social determinants of health and health outcomes.
The program is an eight-week course of two-hour weekly modules based on the cohort learning model. The program is tailored for each community. Participants learn about their own community's local government, current events and local community engagement opportunities. Currently, 11 cohorts have been offered in Spanish and three have been offered in English with the cohorts taking place in 7 different cities throughout Monterey County (including one cohort for youth). Food and childcare are provided during the program.
Given the goals and objectives, the enLACE program seeks to influence the following performance measures: the participant's personal view of making a difference in their community, the participant's knowledge of how to participate in the local school district, and the participant's knowledge of how to participate in local government. Survey results of 64 pre/post matched surveys collected up to 2016 showed the following results: Eighty-nine percent of participants entered the program believing they could make a difference in their community. Despite their beliefs, only 48% initially reported knowing how to participate in the local school district and only 22% in local government. Participants demonstrated their greatest learning around how to participate in local government systems, a 67% increase; this was followed by a 50% increase in knowing how to participate in their local school system.
Upon review and reflection, a number of factors could have led to the success of the enLACE program: the program is tailored to the specific community; the program is accessible in its location, time, language, literacy level, and the provision of childcare and food/light snacks; it is held in familiar and safe community spaces; and participants are directly connected to local community leaders and community engagement opportunities (minimizing the preparation-action gap). Additionally, the program was tailored to the cohort's local community—meaning the issues that were discussed were local issues, the leaders that they met with were local leaders, etc.—and the program managers built relationships with the local community leaders, which may have made them more willing to participate in the program. Finally, no such programs existed in the County to learn about community engagement, local government systems, and how it relates to the overall health of the community. enLACE fills a need in the community and has considerable public health impact through a more engaged and advocacy-oriented population.
enLACE website: http://www.co.monterey.ca.us/government/departments-a-h/health/hd-initiatives/enlace