Public Health Councils Program to Reduce COVID-19 Transmission in Workplaces

State: CA Type: Model Practice Year: 2022

Description of local health department and public health issue

The Los Angeles County Department of Public Health (Public Health) mission is to protect health, prevent disease, and promote health and well-being for everyone in Los Angeles County. Public Health serves a diverse population of over 10 million people, with 71% of its residents identifying as a person of color. The county is 48.4% Latino, 28.3% white, 14.4% Asian, 8.5% African American, .2% Native Hawaiian or other Pacific Islander, .2% American Indian or Alaskan Native and is home to about 3.5 million immigrants. According to Public Health's 2017 Key Indicators of Health Report, 18.4% of household incomes are below 100% of the Federal poverty level; 29.2% of households are food insecure; 23.6% of adults report difficulty accessing medical care; 1 in 10 residents (10.2%) are unemployed; and 22.4% of adults have less than a high school education. The Public Health Councils program is meant to improve working conditions for low-income workers facing many of these economic and societal barriers.

The lack of compliance with Los Angeles County's Health Officer Orders (HOOs) in workplaces has contributed significantly to COVID-19 outbreaks, illness, and deaths. The virus is not affecting all communities equally, with under-resourced communities and communities of color experiencing disproportionate burden. In response, in November 2020 the Los Angeles County Board of Supervisors directed Public Health to implement the Public Health Councils initiative to protect workers that have been disproportionately impacted by COVID-19. Through this new program, the first of its kind in the country, Public Health is partnering with and training ten community-based organizations to provide outreach, engagement, and technical assistance to workers in the following sectors: food manufacturing, apparel manufacturing, warehousing and storage, restaurants, and grocery stores.

HOOs are mandated and legally enforceable directives that businesses are required to implement to reduce the spread of COVID-19 in their workplaces and in the community. The pilot Public Health Councils program expands Public Health's capacity to increase compliance with HOOs in five sectors that have had the highest incidence rate of COVID-19 worksite outbreaks.

Public Health Councils (PHCs) are comprised of workers that conduct peer-to-peer education with their co-workers regarding required safety measures and worksite compliance. The initiative includes educational outreach to employers regarding required infection control measures for workplaces issued through HOOs and assistance with planning on-site vaccine clinics for employees.  The goal of the program is to expand compliance with HOOs and to reduce COVID-19 outbreaks.

Goals and objectives:

Goals:

1. Increase worker organizer efficacy and knowledge on how to file complaints with Public Health, the County's anti-retaliation ordinance, vaccine information, and how to engage workers on these topics.

Objectives:

1) Establish PHCs at worksites in the focus sectors

2) Increase the number of complaints submitted to Public Health by workers in the focus sectors

3) Increase COVID-19 vaccinations among workers in the focus sectors

Activities implemented:

-Contracted with a fiscal agent, Liberty Hill Foundation (LHF), in December 2020 to provide administrative and fiscal oversight of subcontracted CBOs; subcontracts were finalized February 2021.

-Contracted with UCLA Labor Occupation Safety and Health Program (LOSH) in November 2020 to develop certified worker curriculum and provide training to CBOs.

Process Milestones:

1) Contract with CBOs. Result: LHF contracted with ten CBOs to conduct outreach, education, and technical assistance to workers.

2) Hold Trainings. Result: LOSH and COSH facilitated two successful three-day trainings for CBO staff, one in March and one in May 2021.

3) Certify CBO staff. Result: A total of 51 CWO staff were trained and certified. Ongoing supplemental and refresher trainings are also being provided.

Actual Outcomes

CBOs have been successful in meeting all three programmatic objectives. Between April and December 2021, 25 Public Health Councils were established, and 7360 workers were reached with HOO, COVID-19 Safety, and PHC related information. An additional 616 workers received COVID-19 vaccine education during 26 educational sessions. Approximately 390 workers were vaccinated throughout 18 on-site mobile clinics. Fifteen complaints were submitted to Public Health and one anti-retaliation complaint was submitted to DCBA.

Factors leading to success:

Before launching the program, Public Health consulted with labor organizations, worker advocates, and business community representatives knowledgeable about issues impacting the workplace and convened multiple meetings with constituencies with diverse perspectives to get impact into the proposed program. Labor advocates were generally very supportive of moving forward. While some concerns were raised from the business community, Public Health worked to incorporate business recommendations into the program to the greatest degree possible.

Labor representatives stressed the importance of addressing potential employer retaliation for the establishment of public health councils and actions to report HOO violations in the workplace. Enlisting the assistance of vulnerable workers to help prevent the deadly spread of coronavirus in the region by reporting on HOO violations would not be feasible without a commensurate County effort to protect these workers from the potential risks they take by participating in the councils. The development and adoption of an anti-retaliation ordinance protecting workers to address these substantial concerns was crucial. The ordinance protects workers from retaliation for reporting or discussing HOO violations or any violations of Chapter 11, the Health and Safety Chapter of the Los Angeles County Code. The ordinance, Preventing Retaliation for Reporting Public Health Violations, was adopted by the Board on 11/20/20.

Public Health impact:

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 program is helping reduce inequities and increase resilience in communities that were disadvantaged long before the pandemic began. By contracting with a network of workers centers -- a key sector that can help safeguard the health and safety of low paid workers -- the Department has established new infrastructure and systems for responding to and preventing public health emergencies. By increasing communication with low paid workers and their employers, the PHC program is well positioned to help protect the health and safety of workers both now and into the future.

Website: http://publichealth.lacounty.gov/media/Coronavirus/phcouncils/index.htm

Target population

The Public Health Councils program is new to the field of public health and responsive to addressing the local health inequities associated with the ongoing COVID-19 pandemic. In Los Angeles County, workplace outbreaks have contributed to increased community spread, impacting communities of color at higher rates, especially Black and Latinx people. Workers in the warehousing and storage, apparel manufacturing, food manufacturing, restaurant, and grocery sectors are predominantly people of color and earn lower wages. The Public Health Councils program is novel in its approach to providing workers in these sectors the protected opportunity to self-organize to provide peer-to-peer education, engage with their employers, and file complaints to Public Health for lack of compliance with Health Officer Orders in their workplaces.

Demographics

Throughout the pandemic Black and Latinx populations have been disproportionately impacted in terms of cases, hospitalizations, and deaths. As we near the end of the 2nd year of the pandemic these disparities continue with only 61.0% of Black people and 68.8% of Latinx people over the age of 12 having received at least one dose of the COVID-19 vaccine compared to 77.7% of White people and 87.5% of Asian people. The differences in vaccination rates have resulted in more Black (17.5 per 100,000) and Latinx (12.8 per 100,000) people continuing to be hospitalized compared to White (11.2 per 100,000) and Asian (4.7 per 100,000) people as of December 18th, 2021. More Black (1.9 per 100,000) and Latinx (1.5 per 100,000) people continue to die from COVID-19 compared to White (1.1 per 100,000) and Asian people (0.7 per 100,000). [Public Health COVID Dashboard: http://publichealth.lacounty.gov/media/Coronavirus/data/reopening-dashboard.htm]

The target population are workers in the restaurant, grocery store, warehouse and storage, apparel manufacturing, and food manufacturing sectors. These workplaces are generally low paid and frequently include many people of color, immigrants, and women. Public Health analyzed incidence rates and total number of outbreaks; and the total number of cases associated with workplace outbreaks were calculated to identify the focus sectors. Incidence rates, which are an indicator of risk, were calculated for each NAICS sub-sector by dividing the total number of cases associated with the outbreaks in the sub-sector by average annual number of employees in that sector. Public Health determined the sub-sector outbreak incidence rate to be the best measure to prioritize industries because it considers the number of cases associated with the outbreaks and the size of the population risk. As of November 30, 2021, in the focus sectors the incidence rate of outbreak associated cases per 100,000 was:

Warehousing and Storage: 9341
Food Manufacturing: 7795
Apparel Manufacturing: 3706
Grocery & Markets: 1620
Restaurants: 353

Addressing health inequities

The Public Health Councils program responds to these inequities by providing resources to workers centers to conduct outreach, education, and technical assistance to workers so that they are better able to organize amongst themselves to improve workplace conditions that are putting their health and safety at risk. Because workers are often fearful of retaliation if they speak up about unhealthy workplace conditions, key to addressing health inequities in the workplace is helping protect workers from employer retaliation. The program provides workers with protection through the County's anti-retaliation ordinance, which enables the County Department of Consumer and Business Affairs to investigate and pursue complaints of retaliation against employers that retaliate against employees for submitting complaints to Public Health regarding lack of compliance with Health Officer Orders.

Structural drivers/root causes of problem

Workers in the sectors prioritized for the PHC program are often over worked, underpaid, undocumented, lack health insurance, may not speak English, and may not be aware of their rights or the protections in place for them. Many workers in these sectors have been the victims of wage theft by their employers; in addition to failure to pay wages due, this may include failure to abide by employment law and failure to provide required breaks. Given these experiences, many workers are fearful of bringing up workplace health and safety issues with their employers and of reporting them to Public Health.

Reaching workers in these industries requires building trusted relationships. The pandemic has strained the Public Health workforce and highlighted the value of working with community-based organizations that already have existing trusted relationships with workers in these industries and the ability to provide more comprehensive services that can help build trust with workers by addressing other immediate needs.

How new practice is better

The PH Council program leverages trusted relationships between trained CBOs and workers to attain a desired public health outcome, e.g., reducing inequitable health outcomes among workers in sectors highly impacted by COVID-19. Through contracted academic and community experts in occupational health and safety, Public Health provides training and technical assistance to support CBOs. Public Health also provides CBOs with frequent COVID-19 updates, communications, informational resources, and very importantly, opportunities to gather with peers to discuss best practices related to the PHC program. Because this is the first program of its type in the country, partner agencies must rely on one another to co-invent” the program and identify promising practices together. This provides a great sense of ownership, collaboration, and urgency to figure out the most effective approaches.

Development of promising practice

Los Angeles County's Public Health Council program was cited as a model for a new law passed in New York state in May 2021. New York state enacted S. 1034-B to help prevent occupational exposure to airborne infectious disease. The law requires employers to: develop an airborne infectious disease plan (AID Plan) or standard (or adopt the industry standard); create joint labor management committees focused on prevention of airborne infectious disease; trains and involves workers in the implementation of the plan; covers all workplaces and all types of employers, except government; and includes an anti-retaliation component, to help prevent retaliation for reporting complaints, and for serving on committees required under this law.

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

Evaluation

The evaluation approach for the Public Health Councils (PHC) is formative and includes some outcome evaluation strategies to assess impact of the program objectives. The evaluation is ongoing, and the data collected thus far is preliminary. The data that has been analyzed shows that the CBOs have met all three programmatic objectives and offers evidence for the potential impact of the PHC program and insight into the major challenges many CBOs are facing. For example, several CBOs have been very successful in developing partnerships with employers to coordinate on-site vaccine education sessions followed by vaccine clinics. Some CBOs are facing major obstacles reaching workers while others are starting to see the tides turn in their ability to gain worker trust. For those CBOs that have gained worker trust, there has been a rise in complaint submission to Public Health and increase in the information about workplace conditions that workers share with certified CBO staff.

Objectives:

1) Establish PHCs at worksites in the focus sectors

2) Increase the number of complaints submitted to Public Health by workers in the focus sectors

3) Increase COVID-19 vaccinations among workers in the focus sectors

Public Health is utilizing a mixed-methods data collection approach to assess reach and impact of this initiative, modify the program as needed, understand challenges and lessons learned through implementation, and inform future initiatives.

Data sources

1) Quantitative Public Health created two data tracking systems to track outcome data in real time.

a. CBO data tracker: CBOs input their data related to daily outreach numbers, complaints submitted to Environmental Health, and PHCs (e.g., the number of PHCs formed, monthly meetings, and people that attended each meeting).

b. Vaccination education and mobile clinic tracker: Public Health inputs data related to vaccine education events and mobile vaccine clinics (e.g., the number of vaccine education sessions, mobile clinics, people attended, and vaccines administered) they are organizing at job sites in partnership with CBOs.

2) Qualitative Public Health is collecting qualitative data via monthly CBO reports and through interviews. At the time of this writing, interviews are still ongoing.

a. CBOs' monthly reporting: CBOs are required to submit monthly narrative reporting to inform Public Health of their progress on program objectives, obstacles, lessons learned, and success stories from the field.

b. Interviews: Public Health is interviewing various program stakeholders to gain insight on their experiences in the program and to inform future program modifications if necessary.

Process and Outcome Measures

1) Process Measures

a. Sector Outreach

i. The number of 1-way worker outreach; this includes handing out fliers, leaving voice mail messages, or sending mass emails or texts

ii. The number of 2-way worker/employer outreach; this includes interactive conversations with workers/employers in person or by video conference, phone, email, or text

iii. The number of different businesses reached

b. Public Health certified worker education

i. The number of CBO staff trained to be certified workers

ii. The number of educational and training events that were provided to certified CBO staff

iii. The number of certified CBO staff attending educational/training meetings

iv. Qualitative narrative report data from LOSH/COSH on technical assistance they provided certified CBO staff

2) Outcome Measures

a. PHCs

i. The number of PHCs formed

ii. The number of Monthly PHC meetings

iii. The number of People attending monthly PHC meetings

b. Vaccination efforts

i. The number of vaccine education sessions held

ii. The number of workers attending vaccine education sessions

iii. The number of mobile vaccine clinics held

iv. The number of workers receiving vaccines at the mobile clinic

c. Complaints filed

i. The number of HOO violations filed to Public Health

ii. The number of anti-retaliation complaints filed to DCBA

Results

The data collected from various trackers was aggregated below to determine progress on process and outcome measures.

1) Sector Outreach

a. Restaurant

i. 1-way worker outreach 1,398

ii. 2-way worker outreach 901

iii. 2-way employer outreach 399

iv. Total outreach 2811

v. Businesses reached 309

b. Warehouse

i. 1-way worker outreach 1,305

ii. 2-way worker outreach 394

iii. 2-way employer outreach 44

iv. Total outreach 1743

v. Businesses reached 142

c. Garment Manufacturing

i. 1-way worker outreach 1,660

ii. 2-way worker outreach 756

iii. 2-way employer outreach 57

iv. Total outreach 2473

v. Businesses reached 69

d. Food Manufacturing

i. 1-way worker outreach 337

ii. 2-way worker outreach 126

iii. 2-way employer outreach 25

iv. Total outreach 488

v. Businesses reached 60

e. Grocery

i. 1-way worker outreach 189

ii. 2-way worker outreach 41

iii. 2-way employer outreach 184

iv. Total outreach 381

v. Businesses reached 64

2. Public Health certified worker education

a. CBO staff trained - 51

b. Monthly certified worker education/training meetings 10

c. Certified CBO staff attending educational and training meetings 198

d. Qualitative narrative report data from LOSH/COSH on technical assistance they provided CBOs Pending

3.PHCs

a.Total PHCs formed 25

b.Total PHC meetings 110

c.Total people attending monthly PHC meetings 257

4. Vaccination efforts

a.Vaccine education sessions 30

b.Workers attending vaccine education sessions 616

c.Vaccine clinics 18

d.Workers receiving vaccines 390

5. Complaints filed

a. HOO violations filed to Public Health 15

b. Anti-retaliation complaints filed to DCBA 1

Analysis

As a pilot program, all initial data served as a baseline to inform program modifications. After the first six months of implementation, Public Health analyzed all collected data and aggregated it into individualized reports for each CBO. These reports helped inform strengths and weaknesses in the field across sectors and by CBO. The six-month data reports served as a baseline for each CBO. Each CBO is using their baseline data to develop year-long outcome goals and set target metrics for outreach and outcome measures. CBOs were instructed to create specific and measurable goals that could be completed within the span of a year. Additionally, CBOs are creating numerical target goals (e.g., establishing an average monthly target of 2-way conversations with workers).

Lessons learned: practice

Since this initiative was a pilot program, Public Health did not initially create benchmark standards for determining success of the program (e.g., specific mandated targets that contracted agencies must meet).  Instead, at the six-month mark, Public Health met with each contracted CBO to show them their own implementation data and how they compared with other CBOs in the program (data shared was anonymous). Data points included metrics such as: outreach results; days spent in the field; Public Health Councils formed; PHC meetings held, etc. This process allowed CBOs to conduct their own self-assessment as to progress made and determine where they felt improvement was needed. As the program moves forward, Public Health is working closely with each contracted agency to identify specific goals and targets that they set for themselves, along with action plans for achieving these outcomes.  

Data is essential to program evaluation but developing an effective data collection system can be costly and time consuming, especially if consultants are contracted for this purpose. The PHC program utilized staff hired for this purpose to create an in-house data collection system using Google spreadsheets and google forms. This saved time and money and allowed staff to easily make changes to the system, as needed, based on user experience and evaluation needs.  

Lessons learned: partner collaboration

CBOs benefit from continuous training on Health Officer Orders, outreach strategies, vaccine education, worker safety, etc. and to be as effective as possible, providing ongoing training opportunities is critical. Peer support proved to be equally critical as many CBO staff voiced their need and appreciation for opportunities to learn best practices from one another. This led to an increase in CBO led panels and break out discussions at monthly meetings that promoted peer training and opportunities for brainstorming solutions to obstacles and allows worker leaders to gain practice in conducting peer education.

In the rapidly changing environment of COVID-19, CBO staff appreciate weekly email updates that include important public health updates, trainings, and resources, and find them helpful for staying up to date with departmental changes as they relate to COVID and their sectors.  Many CBOs regularly take advantage of these additional training opportunities.  

Building trust and rapport with workers and employers is important. If businesses/workers don't understand the reasons why CBOs are there to begin with, they may not trust an outsider coming in to speak with them. An effective elevator pitch or storytelling can help them understand why CBOs are there. For example, sharing that they are part of the community or a personal story about COVID helped bridge that gap.  

The PHC program is helping reduce inequities and increase resilience in communities that were disadvantaged long before the pandemic began. By contracting with a network of workers centers -- a key sector that can help safeguard the health and safety of low paid workers -- the Department has established new infrastructure and systems for responding to and preventing public health emergencies. By increasing communication with low paid workers and their employers, the PHC program is well positioned to help protect the health and safety of workers both now and into the future.

Lessons learned: business and community engagement

The PHC program relies on contracted CBOs being able to find and access workers; however, this can be challenging, especially in sectors that are not public facing such as warehouses and food manufacturing facilities. CBOs working in this sector successfully established connections with employers and workers by bringing COVID-19 vaccine education events and mobile vaccination clinics directly to workplaces. These efforts increased vaccination rates in food manufacturing facilities and created a link between the business and its employees, the worker organization, and Public Health.

The existence of the County's anti-retaliation ordinance alone is not sufficient to helping workers feel protected from retaliation; workers often remain fearful that filing complaints with Public Health regarding lack of HOO compliance will lead to retaliation from their employer.  Ongoing communications to businesses about the anti-retaliation ordinance is essential so that businesses are aware of the stiff penalties associated with retaliation. Also, rapid follow up from the County when retaliation does occur is key. For example, one CBO had a positive experience with filing a complaint of retaliation, receiving follow-up in less than 24 hours. This made them have more confidence in the process.  

Lessons learned: funding

Initial funding for this program came from the County and additional federal CDC grant resources were allocated to support and extend this program through December 2022. However, Public Health and LHF collaborated with private foundations to secure additional funding for the initiative, significantly extending its reach. Private foundation funds enabled LHF to increase the number of contracted agencies from eight to ten. From this pilot, it is evident that outreach requires a long-term engagement to establish trust and for workers to feel safe to speak up. Public Health is working to identify and secure funding to maintain the program beyond COVID-19 as relationships with organizations focused on reaching low wage workers is vitally important to improve overall workplace health and safety conditions and given climate change, help improve the resilience of our county when natural disasters occur. In addition, maintaining this infrastructure will continue help reduce the potential for worksite outbreaks as new strains of COVID-19 arise and with future pandemics.

Sustainability

The close working relationship established with workers' centers as a result of the PHC program has greatly benefited the Department. For example, when the Board of Supervisors was considering establishing vaccine mandates, Public Health quickly convened a focus group of workers' centers to understand the impact such mandates might have on workers and hear recommendations regarding important factors to consider. The PHC program has extensive support from workers' organizations and the labor movement more broadly and these organizations have expressed to both Public Health and Board Offices that they would like the program to continue and be expanded to other sectors.

Public Health is working to identify and secure funding to maintain the program beyond COVID-19, as relationships with organizations focused on reaching low wage workers is vitally important to improve overall workplace health and safety conditions. Given climate related wildfires, extreme heat and other disasters impacting low wage workers, the PHC Program will help improve the resilience of Los Angeles County. In addition, maintaining this infrastructure will help reduce the potential for worksite outbreaks as new strains of COVID-19 arise and with future pandemics.

Since the program's inception, worker organizations have collaborated with hundreds of workers and businesses to increase compliance with the County's Health Officer Orders related to COVID-19. Along the way, they also identified other health and safety violations, indicating there is a need to confront other types of workplace problems. To address these additional worker concerns, Public Health piloted a program in the garment sector with two of the contracted community-based worker organizations. The pilot's goal is to ensure garment manufacturing businesses comply with the Los Angeles County Code Title 11. The Code enforces sanitation requirements to protect the health and safety of workers and limit the potential for infectious diseases to spread. Public Health trained the two worker organizations to assist workers in identifying and reporting any garment manufacturing sanitation problems to Environmental Health. Public Health will use this pilot within a pilot” to identify potential approaches for the long-term sustainability of the PHC program.