Health Equity System Transformation Project

Although California has a national reputation for advancing progressive health care policies, California’s communities of color, including lesbian, gay, bisexual, transgender and queer (LGBTQ+) individuals and persons with disabilities, continue to experience discrimination and have poorer outcomes on key health indicators including asthma, diabetes and mental health than other Californians. Despite individual actions and intentions, our health care system as designed often makes health outcomes worse, particularly for communities of color, by perpetuating the very inequities it seeks to address.

To better understand these disparities, the funded CPEHN in January 2019 to lead a two-year project called the Health Equity System Transformation Project (HEST). California Health Care Foundation funded CPEHN in January 2019 to lead a two-year project called the Health Equity System Transformation Project (HEST). The goal of the project was to develop a set of community-informed policy recommendations that would deliver more equitable health outcomes for diverse and underserved communities. In particular, we looked for ways to link health care delivery and payment reform efforts in Medi-Cal and in commercial insurance to promising strategies to achieve health equity.

HEST was conducted in six phases: state equity assessment, consumer focus groups, regional convenings, state and national responder panels, drafting of the HEST roadmap and mini briefs, and, finally, dissemination of research findings and policy recommendations.

Fact sheets

In 2019, CPEHN conducted a number of focus groups across the state with the goal of engaging diverse stakeholders—communities of color, LGBTQ+, and persons with disabilities—in meaningful discussions regarding their experiences accessing health care. We then developed population-specific fact sheets, which highlighted stark disparities and fundamental barriers in accessing care for underserved populations in California.

Mini Briefs

In 2020, we developed a series of mini-briefs that featured community-informed recommendations for ways to advance health equity in California:

HEST Blueprint for Change

In December 2020, we published the final brief, Centering Equity in Health Care Delivery and Payment Reform: A Guide for California Policymakers, which summarizes two years of research, convenings, focus groups and conversations. We are hopeful that the brief will inform bigger and bolder reforms to our public health care system to address persistent inequities in access, quality, and health outcomes in Medi-Cal and health care more broadly.

The goal of this brief is to move California towards a more equitable, patient-, family- and community-centered health care system where health care is comprehensive and affordable. We envision a world in which all communities regardless of their income, sex, race, ethnicity, primary language, LGBTQ+ status, disability or immigration status, have the opportunity to live with optimal physical, behavioral, oral, and overall health and well-being, and to thrive. In this system, all patients are treated with the same level of dignity and respect, allowing everyone to achieve the best possible health outcomes.

View the interactive report here!

Download the HEST Blueprint for Change.


Californians received coverage through Medi-Cal in 2020


Of people enrolled in Medi-Cal are low-income people of color


Blacks and Latinx have twice the prevalence of type 2 diabetes and are twice as likely to die from the disease than whites