History of the Alachua County Safety Net Collaborative

A Nation Wrestles with Change

The seeds of innovation that established the Alachua County Safety Net Collaborative (SNC) were sown by the national winds of social change and health care reform that launched in 1985 when the Report of the Secretary's Task Force on Black and Minority Health¹ was published. This landmark study, the first comprehensive investigation of the health status of Americans with racial and ethnic minority identities, was driven by former U.S. Secretary of Health and Human Services Margaret M. Heckler (1983-1985.) The ‘Heckler Report’ focused national attention on health inequities, a term defined by British scholar Margaret Whitehead² as “health differences that are avoidable, unnecessary, and unjust” and among the report’s findings was the conclusion that “health disparities accounted for 60,000 excess deaths each year and that six causes of death accounted for more than 80 percent of mortality among Blacks and other minority populations.” U.S. Secretary Heckler’s interest in health disparities was informed by the report, Blacks and the Health Professions in the 1980s: A National Crisis and A Time for Action³ and Heckler’s outcomes were verified and expanded upon when three more commissioned investigations released Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care⁴ (2003), Missing Persons: Minorities in the Health Professions⁵ (2003), and In the Nation’s Compelling Interest: Ensuring Diversity in the Health-Care Workforce⁶ (2004). 

During this same time span, a spirit of reform in public health was being driven by two Institute of Medicine (IOM) reports, The Future of Public Health (1988)⁷ and The Future of the Public's Health in the 21st Century (2003).⁸ These publications called national attention to the benefits of accreditation for governmental public health departments and with an eye to the future, offered sustainable solutions to improving population health in the U.S.

These simultaneously evolving reform movements in health care and public health converged in 2010 with two events: (1) passage of the Patient Protection and Affordable Care Act (ACA), landmark legislation that increased access to primary care, expanded Medicaid, and reduced the percent of Americans without health insurance and (2) the Public Health Accreditation Board (PHAB) released standards for an accreditation process for public health departments. 

Implementation of the ACA and PHAB standards created new programs, rules, and processes at national, state, and local levels. Among them, were new requirements for collaborative, comprehensive, community-based needs assessments (CHA) and community health improvement plans (CHIP). Non-profit hospitals interested in maintaining tax-exempt status with the IRS and public health departments seeking and/or desiring to maintain PHAB accreditation were required to complete CHAs/CHIPs every 3-5 years. 

Local Response 

In Alachua County, progressive reformers were engaged in discussions about health disparities, access to health care, and socioeconomic inequities. They debated the question, “was health care a right, or was it a privilege?” Many were watching the 7-part documentary series, Unnatural Causes: Is Inequality Making Us Sick?⁹ and they were troubled by the unequal opportunities to reach optimal health among Alachua County residents.

By late 2010-2011, Nancy Hardt, MD organized a small group of community leaders (Brendan Shortley, Mona Gil de Gibaja, and Lou Baxter, MD) and began meeting informally at North Florida Regional Medical Center’s cafeteria to discuss health disparities and build relationships to work across community silos. As others learned about the group, they joined as new members and soon, this group outgrew the cafeteria and transitioned to meeting at the Corner Drug Store. By early 2013, they were meeting in the homes of group members and in Nancy’s condominium at Bivens Arm.

By 2012, the Alachua County Health Department (DOH-Alachua County) had its first opportunity to seek state accreditation by conducting a Community Health Improvement Plan (CHIP). Using outcomes from the 2010 Alachua County Health Needs Assessment completed by the WellFlorida Council, Diane Dimperio, MS, Director of Community Development convened a Steering Committee that included physicians, public health professionals, and social service program administrators. A spirit of unity and vision guided their activities and the CHIP report notes on page 4, “The process resulting in the 2012 Community Health Improvement Plan began in June of 2011and concluded in November of 2012. It has been characterized by several key features:

  • Inclusiveness: multiple stakeholders were included throughout the process  

  • Comprehensiveness: many dimensions of health were addressed

  • Local Ownership: the process linked expertise and experience to generate a sustainable plan that includes community ownership and responsibility”¹⁰ 

The 2012 CHIP had two goals:

  1. To ensure access to comprehensive care for all Alachua County residents

  2. To promote wellness among all Alachua County residents

Two subcommittees were formed to address them: the Access to Care Subcommittee assumed responsibility for Goal #1 and the Community Wellness Subcommittee took charge of Goal #2. 

Members of the Access to Care Subcommittee included: 

  1. Tammy Carmichael - Alachua County Health Department

  2. Jack Donovan - Alachua County Coalition for the Homeless and Hungry

  3. Robert Davis - Alachua County Health Department

  4. Jeff Feller - WellFlorida Council

  5. Mona Gil de Gibaja - United Way

  6. Noni Graham - UF HealthStreet

  7. Nancy Hardt - UF College of Medicine

  8. Roy Klossner - Westside Samaritan

  9. Gay Koehler-Sides – Alachua County Health Department (intern)

  10. Maggie Labarta - Meridian Healthcare

  11. Diane Mauldin - Alachua County Healthcare Advisory Board

  12. Julie Moderie - Healthy Start Coalition

  13. Fred Murry - City of Gainesville

  14. Jean Osbrach - Shands Healthcare-Social Work Services

  15. Brendan Shortley - Small Business Owner

  16. Randy Stacey - Helping Hands Clinic

The Alachua County Safety Net Collaborative formed organically in early 2013 when the independent group that was meeting in the community merged with the Access to Care subcommittee. Meetings were held bi-weekly on either Friday afternoon or Sunday evening and new members like Wendy Resnick, Candice King, Robin Lewy, and Laura Guyer were added. SNC members were united by their shared values, interest in building meaningful relationships to work across organizational and disciplinary silos, and desire to eliminate health inequities 

As SNC members spent time together confronting barriers to care, generational poverty, low literacy, racism, and needs within their individual organizations, trust was established. Nancy Hardt noted when interviewed, “There was a genuine esprit de corps expressed in our unity, harmony, and friendship. We served different priority populations in our community but, we served them together.” As our relationships grew, we needed a “boots on the ground” workforce to help create new programs and infrastructures and found them at UF where a growing miniature army of undergraduate students seeking careers in medicine, healthcare and public health were enrolling in a new academic minor, Health Disparities in Society.¹¹ The first twelve students to enroll in the Practicum in Health Disparities in 2013 were placed in service-learning sites housed in SNC’s member’s safety net clinics and non-profit organizations

The academic minor at UF succeeded because there was a thriving symbiotic relationship established among the members of the university and safety net community. Between 2014-2021:

  • 84 safety net clinics, nonprofit organizations, and city, state and federal agencies sponsored undergraduate students; the majority (90%+) were in Alachua County,

  • 783 students enrolled in the capstone practicum course and completed 93,960 hours of service-learning locally and throughout Florida,

  • the estimated value of the in-kind instruction and mentoring donated to UF by community-based preceptors exceeded $5.54 million.

We Have Grown

A decade of time has passed and when reflecting upon SNC’s foundation, one of the early members remarked, “One of our most important first decisions was to declare that competition was pointless. Far too many people had needs to serve. Challenging one another for "poaching" was a waste of time. We wanted to find the gaps in services that our collaborative could fill. We learned to trust one another by sharing information about ourselves and advocating as a group. From the beginning, we have been an independent organization that shared leadership responsibilities, served as an open, unrestricted forum for voicing concerns, and we worked together to benefit all members. An early significant “win” was our advocacy on behalf of the RAHMA Mercy Clinic to get a bus stop near their building and another was the way we shared a bunch of eyeglasses donated by the Lion’s Club. When a local church opened their warehouse to us, we shared the medical equipment and OTC medications that were stored. Everyone benefitted from the work of practicum and undergraduate students who helped patients fill out forms, translated clinic materials into other languages, conducted research on topics of importance, and helped with work our staff had no time to do. We also benefitted from the Community Resource Guide that was created for SNC and updated annually by the undergraduate students.” 

The years ahead will bring new challenges and require different leaders with diverse skills. The common denominator that binds tomorrow to yesterday is the people that we serve. We invite you to stand on our shoulders to share the work and help Alachua County become the welcoming and inclusive community where everyone can achieve their most optimal health and well-being!


Information about SNC’s history came from several founding members who participated in interviews and their names are listed below alphabetically:

  1. Diane Dimperio, MS

  2. Nancy Hardt, MD

  3. Laura Guyer, PhD, MEd, RDN

  4. Candice King, MHA, MBA

  5. Gay Koehler-Sides, MPH

  6. Wendy Resnick

  7. Brendan Shortley

 

References

  1. Task Force on Black and Minority Health, US Department of Health and Human Services. Report of the Secretary’s Task Force on Black and Minority Health. Vols 1-8. Washington, DC: US Department of Health and Human Services; 1985-1986.

  2. M Whitehead. The concepts and principles of equity and health. Int J Health Serv. 1992; 22(3):429-445.

  3. RS Hangt, LE Fishman, WJ Evans. Blacks and the Health Professions in the 1980s: A National Crisis and A Time for Action. 1983.

  4. Smedley BD, Stith AY, Nelson AR, eds; Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press; 2003.

  5. LW Sullivan. Missing Persons: Minorities in the Health Professions, A Report of the Sullivan Commission on Diversity in the Healthcare Workforce. 2004.

  6. Institute of Medicine. In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: The National Academies Press. 2004.

  7. Institute of Medicine. The Future of Public Health. Washington DC: The National Academies Press. 1988. 

  8. National Academies of Sciences, Engineering, and Medicine. The Future of the Public's Health in the 21st Century. Washington, DC: The National Academies Press. 2003.

  9. Produced by California Newsreel, in association with Vital Pictures, Center for Asian American Media; Latino Public Broadcasting; Native American Public Telecommunications; National Black Programming Consortium; Pacific Islanders in Communications; presented by National Minority Consortia; Series creator & executive producer, Larry Adelman. (2008). Unnatural causes : is inequality making us sick? [San Francisco, Calif.]: California Newsreel.

  10. Alachua County Community Health Improvement Plan. Alachua County Health Department, November, 2012.

  11. LK Guyer, ML Wayne, NS Hardt. (2018). Undergraduate Minor in Health Disparities in Society: A Magnet for Under-represented Pre-professional Students. Journal of Racial & Ethnic Health Disparities. 5: 495–503.