In 2016, PI and the St. Joseph Fund (SJF) began to explore a path for advancing upstream, health equity-driven efforts across Providence-St. Joseph Health hospital partners. SJF recognized the potential power of hospitals and health systems to support or lead actions to advance health equity and improve community conditions through local policy. After several months dedicated to planning and design, the Intersections Initiative was created.

Starting in 2017, Intersections supported partnerships in seven California communities served by Providence-St. Joseph Health hospitals. Coalitions addressed interconnected drivers of inequity, including housing, education, workforce development, immigration, community trauma, and civic engagement. The seven coalitions included:

• Anaheim–Orange County Congregation Community Organization (in partnership with St. Jude Hospital–Providence)
• Central Orange County–Kennedy Commission (Central Santa Ana/Stanton Intersections Initiative, in partnership with St. Joseph Heritage Santa Ana – Providence)
• Eureka–Greater Eureka Housing Alliance led by Westside Community Improvement Association (in partnership with Providence St. Joseph Hospital Eureka)
• High Desert–High Desert Intersections Collaborative (led by Providence St. Mary Medical Center and Global Institute for Public Strategies)
• Napa–Community Leaders Coalition (led by Cope Family Center, in partnership with Providence Queen of the Valley Medical Center)
• Sonoma –Sonoma Intersections Coalition (led by Providence Santa Rosa Memorial Hospital)
• South Orange County – South Orange County Equity Leaders Coalition (led by Providence Mission Hospital)

Although each community entered with different histories of collaboration and advocacy, all strengthened their capacity to advance policy solutions, redesign systems, and address structural inequities. In most sites, a CBO served as the backbone organization, with hospitals participating as institutional partners. Collaboration structures reflected local context; no single model was required.

Over four years, partnerships advanced upstream strategies such as housing policy reform, tenant protections, equitable American Rescue Plan Act allocations as part of COVID-19 recovery efforts, redistricting engagement, workforce development, and trauma-informed approaches. Multi-year, flexible funding supported shared ownership among partners. When wildfires, COVID-19, and racial justice uprisings affected communities, coalitions adapted while continuing to pursue upstream goals.

The Role of Healthcare

Hospital partners supported coalitions by sharing data, connecting partners to decision makers, and lending institutional influence to community priorities. In doing so, healthcare partners extended beyond traditional service roles and contributed to upstream systems change while remaining attentive to power dynamics within partnerships.

What We Learned

Consistent lessons emerged across communities:

• Upstream change requires time and trust.
• Flexible funding strengthens equity-driven policy work.
• Collaboration structures must reflect local realities.
• Centering racial justice builds resilience and sustainability.