By Dominic Cappello

The day I encountered a mother of two asking strangers for help, I was busy designing a course to prevent families from finding themselves living on the street.

It was Friday afternoon and I had just spent most of the day with a colleague working on our agency’s course on health equity. We had spent a good amount of time discussing what professionals in the social services fields and the public thought when they heard the term health equity. Because our agency’s mission is the promotion of health equity, it’s easy to forget that most people are not sure what equity means, nor does every person share the same definition of the term health disparities.

When I talk to people about my work I say that health disparities are the differences—community by community— between the quality, quantity, and accessibility of medical, dental, and mental health care. I also explain that “health” means more than health care and disparities exist in access to safe housing, transportation, child development programs, job training, parent support, and youth mentors. Every city has folks who enjoy easy access to services that others don’t. The work of health equity, in my book, means that we are striving to ensure that all children, families, and community members have access to the services that keep people healthy and safe—and being forced to live on the streets.

As I walked through downtown Seattle, a city bursting with tech-driven wealth, I was replaying a conversation I just had with my work colleague who had said to me, “Do people here in Seattle think they really need a course of health equity? Don’t you think folks in public health, youth development, and child welfare already think they do this work effectively?”

I responded, “Most folks in the social service field have a good grasp of the work but that does not mean all the agencies make up what we call a “system of care” are using data to inform action. Nor are they implementing new technologies and software to streamline work so that our most vulnerable residents are helped in significant ways. I think we are a long way from ensuring that our government and foundation-funded work results in measurable and meaningful outcomes.”

The bottom line is that there’s a lot of work to be done.

As I was neared Westfield Center and the monorail to the Space Needle, I glanced down to the left and saw the mother with a boy about age six and a girl close to ten years old. The sign the mother was holding said, “Please help me get $60 for a hotel room for my family.” I did what everyone else on the busy afternoon sidewalk was doing, I glanced quickly at her sign and passed by without missing a beat.

I took about ten steps and stopped dead in my tracks. What the hell am I doing? I thought to myself. You can’t spend a day working on health equity and pass a woman and children sitting on a sidewalk without shelter.

I turned around and walked back to the mother and said, “Hi, I work with public health folks and wanted to make sure you had access to a helpful agency.”

The mother looked up at me, most likely wondering who the heck I was and if she might be in trouble, and said quietly, “I called 211 and they helped me get an advocate to find a shelter. We were in shelter last night but I was kicked out for breaking the rules.”

I looked closely at the kids who appeared well dressed, content to play with little toys next to the curb. I asked if she could get help this afternoon before nightfall and she told me she had a 4pm appointment with her advocate from Mary’s Place. I felt relieved. I had no cash on me, so I could only say, “I hope everything goes okay. Please take care.” She smiled back.

I strolled to the corner and darted into the Starbucks where I pulled out my credit card and bought sandwiches and oranges for the family. I rushed back to the mom and kids but they were already gone. I felt as though I had let them down and strolled around looking for them. Then I took the monorail home. I jumped online to discover that Mary’s Place helps homeless families. I checked 211 to see if Seattle’s version was the same as the 211 help line in Hartford, Connecticut that I was familiar with. There were links to support for housing, domestic violence and substance use disorders.

I am left feeling relieved that services like 211 and Mary’s Place exist. I also know that social services agencies struggle to find funding, and are often hard pressed to meet the needs of our most vulnerable populations. I know I can’t just stroll past a homeless mom and kids, in one of the most abundant cities in the country, and think, “Not to worry, that’s someone else’s job.”

I also know that we need the mapping tools and data to tell us how many parents and kids are living in the streets, on waiting lists to get into shelters. We need to assess, county by county (and actually, to be precise, zip code by zip code) the disparities our residents face.

Working toward community health equity goals requires data, technology, and courage.

  • Data and research reveal the health disparities and challenges families face.
  • Technology provides the tools the solve the problems efficiently.
  • Courage ensures that communities get to meaningful solutions.

I know, given my work and access to the data on unemployment and household poverty rates, those disparities are real in every county in the state, requiring the serious attention at all levels of government.

I know that the goal of health equity is a long way off yet obtainable if enough compassionate folks become engaged in health equity work. And I know we will need to harness all the data, technology and courage that we have to build robust systems of care in every community to ensure that families don’t have to sit on a street begging for shelter.

I think back to my colleague’s question, “Do we really need a course on getting to health equity goals?”

Now more than ever.


Dominic Cappello is the Senior Director Quality Improvement and Design for Healthy Gen. He also leads the implementation of the Child Welfare Data Leaders and Quality Improvement Initiatives in New York, New Mexico and Connecticut, funded by Casey Family Programs. He worked for the NM Department of Health’s Epidemiology and Response Division and the NM Protective Services-Research, Assessment and Data Bureau. He has a Master of Arts in Liberal Studies with an emphasis in Language and Communication from Regis University.

Twitter: @DomCappello