As 2020 continues, the COVID-19 pandemic has become a way of life. Across the globe, people are engaging in novel routines that these unprecedented times demand to stay healthy, gainfully employed, and connected, and to navigate the roller coaster of emotions. Compounding the personal rigors of managing daily lives is the increasing scarcity of community resources on which people depend. Community leaders and government officials are scrambling to determine the most efficient and effective ways to assist people during a crisis with no apparent end, facing decisions that were, up until this point, not part of the local planning process. The funds required to support this heightened level of need are insufficient at the local government level, straining budgets for years to come.
Although disparities in resource distribution have always run deep across our communities, the pandemic has exposed and further exacerbated these inequities. Rates of infection are higher in lower income and more populated areas, increasing the contagion risk. Available assistance to disadvantaged communities tends to focus more on immediate life and death concerns rather than strategies to prevent the enduring economic, medical and mental health damage that will likely be suffered by those with preexisting scarcities in supportive resources. The evidence is clear that racial and ethnic minority groups are bearing the brunt of this pandemic due to disproportionate levels of poverty, less access to health care, preexisting conditions and other social determinants of economic, physical and emotional health outcomes (see figure 1). Lasting effects will be accrued in greater societal problems overall (United Nations, 2020).
Adding injury to insult, inequities have been further magnified by the social unrest in response to George Floyd’s killing and many other unarmed Black people. The ensuing protests signal that the lack of societal resolve to eradicate longstanding systemic racial bias has come to a boiling point. These crises are not unrelated, but rather a reflection of a syndemic that has taken an extreme toll on particular racial groups due to unchecked marginalization and ensuing disparities across multiple sectors of society.
A wake-up call for communities
In general, the current crisis is a giant wake-up call for communities to bolster stability and well-being for all as a way to more effectively and equitably provide needed services, and then better positioned to withstand the next pandemic. Government services are only effective if they first assist people who are most in need, which leads to more equity and goodwill among local citizens. Achieving this aim is not just a matter of having enough funds in government coffers to face global emergencies. It is critical to have well-functioning systems in place that encourage cooperation and coordination across local governments and community stakeholders to enable more effective and immediate ways to address problems as they arise.
For the sake of efficiency and averting poor outcomes, an on-going focus on prevention is also vital and more cost effective than reactive approaches. Long-standing evidence has established the impact preventive efforts can have in reducing common community issues, such as alcohol and drug abuse, criminal activity, chronic disease and mental health problems. An ongoing community focus on prevention will also lay the groundwork for improved well-being that, in turn, bolsters the ability to face new crises.
In this post, we describe four key aspects of strengthening the overall health of a community that are part of this ‘wake-up call.’
Collaboration across sectors
The mark of a cohesive and healthy community is when various sectors—including education, healthcare, child welfare, criminal justice, faith, volunteer groups and government entities—work together to solve local problems and serve the common good. This framework for tackling issues across domains addresses community concerns in a structured and cooperative manner. In places where there is little connection between sectors, there could be inconsistent, siloed or even redundant efforts to solve or prevent issues. Such collaboration makes even more sense in current times, where data systems can more readily be linked to track individual health records and needs.
While different sectors will always be overseen by different local entities, including private and public organizations, data systems and knowledge sharing can help providers, educators and government officials be cognizant of how public health issues are being addressed. The National Governors Association has highlighted examples of coordinated efforts underway in several localities throughout the nation, with objectives to both mitigate spread of the virus as well as to reduce disparities in its impacts. Several states have created multi-sector data systems, task forces and public-private partnerships to comprehensively assess the needs, more equitably allocate funds and resources, and develop new strategies with inputs from all major stakeholders. Knowledge about how issues are being handled can help community leaders to know how to more effectively and efficiently allocate resources. As noted above, the social injustice that has come to the forefront this year has further revealed the need for stronger cross-sector collaborations (e.g., police departments aligned with local mental health providers). Insufficient attention toward any area of need for individuals and families can undermine well-being overall. Thus, local coordination of services is vital for community health in general and, during a pandemic, will lead to both a rapid response for those affected and a more coordinated effort to prevent further spread of the virus.
Coalitions for prevention
An emphasis on prevention in communities is critical to reduce problems and promote health and resiliency across the nation. The value of prevention has never been so evident as it is now, in the midst of this pandemic, as hospitals have filled to capacity with ICU units saturated and healthcare costs reaching exorbitant levels. Had preventative measures been in place and activated at a greater scale, the impact of the pandemic would have been far less severe.
Clearly, preventative measures such as social distancing, masks and hand hygiene have contained the virus in countries such as South Korea and part of Europe. But more broadly, the presence of systems that imbed prevention programs and practices --for example, high quality child care, education, nutrition, mental and physical health care--promise to lessen pre-existing disparities in economic, social and physical health, thereby reducing the uneven impacts the virus has had in the United States. Systematic delivery of evidence-based prevention services can occur through the creation of community coalitions that include community members -- parents, teachers, government officials – aligned with corporations, educational institutions and other key stakeholders. Coalition activities seek to identify, install, support and sustain high quality programming to address identified local needs. The establishment of such coalitions, where various perspectives are represented, can ensure that the right preventive steps in key domains (e.g., adolescent substance abuse, delinquency prevention, obesity, violence) are addressed. Research has shown coalitions can be highly effective in averting community problems before they occur, with the appropriate levels of funding, high quality technical assistance and implementation, strong leadership, internal and external relationships, and representation from the community.
In the absence of a nonpartisan approach to provide continued assessment of the best ways to prevent and address potential public health problems, efforts toward prevention are likely to be short-term and quick to change as local government administrations transition. During a crisis like a pandemic, coalitions will increase the likelihood that key services are in place that will accommodate an uptick in problems, such as domestic abuse, child maltreatment and substance abuse.
Whether seeking prevention programs or solutions to address current community problems, the focus should be on evidence-based science. The best use of public funds to support programming in typically limited budgets is enacting policies that have been shown to be effective. Unfortunately, the amount of scholarly research evaluating program effectiveness and determining across-study aggregate evidence far exceeds the degree to which evidence-based programs are actually used in communities. Local programming is often more attentive to anecdotal evidence or the influence of marketing and lobbying efforts by well-resourced organizations. In contrast, recent polls indicate the value that the general public places on the support and use of research evidence by public officials.
Community coalitions are well positioned to determine whether appropriate evidence-based preventive solutions are available that best meet their unique needs. Of course, similar to producing vaccines for pandemics, oftentimes insufficient evidence has been amassed to guide responses, especially where research may not generalize to local populations or important regional subgroups. The increased demand for evidence-based research in real settings, however, will highlight the need for more program evaluation research as well as communication of best practices. Dissemination has increased in recent years, with the availability of repositories for research evidence, such asBlueprints or the What Works Clearinghouse. Another critical aspect of this approach is the need to inform political leaders and policy makers as new research findings become available. Research-to-policy translation will continue to be a vital way to see that quality research can lead to important change at the community level. The global hot spots that have emerged in this country during the pandemic have been marked by policies that ignored the advice of scientists in favor of opening up the economy earlier (and now schools), which ironically has caused further damage to the economy in the long-term.
Addressing inequity/marginalization/inclusiveness across people
A fourth vital aspect of creating a strong community is implementing measures to systematically reduce inequities and avoid marginalization of subgroups of the population. The opportunity for health and happiness should be equal for all citizens, and a community is not truly ‘healthy’ when that is the reality only for segments of the population (e.g., based on race, socio-economic status, age and other characteristics).
While cross-sector collaborations discussed above emphasize how an emphasis on health and well-being across domains can build a strong community, addressing equity within a community refers to policies that improve opportunity across people. Such a focus is especially vital when troubled times or crises hit, which always increase the gaps between the haves and have-nots. At the community level, resources directed toward increasing cooperation across sectors are needed to ensure that certain subgroups are not underserved and suffering disproportionately.
Enhancing equitable access to resources and opportunities relies on data indicative of uneven geographic distribution of problems. This unevenness is commonly observed, especially in areas highly populated or, in reverse, isolated rural regions. But inequities that lead to marginalization of subgroups can allow issues to fester that are then difficult to remedy. As noted above, the issues of social injustice that have come to the forefront this year are emblematic of the lack of equity in society. Well-oiled communities are able to determine which subgroups are underserved on an on-going basis, and to seek solutions that improve health (ideally in tandem with the above 3 goals). Of course, such efforts should include the perspectives of subgroup members, representing the voice of those who may be disproportionately in need but also invested in seeking solutions. For example, in Baltimore, the Annie E. Casey Foundation has funded several organizations to address the prevailing conditions that have led to significant disparities in the City, focusing on economic opportunity, education, foster care, child development, juvenile justice and workforce development. Each initiative and project imbeds the perspectives and involvement of community stakeholders and concerned citizens.
Stronger Communities Through Active Engagement
Throughout the process of strengthening communities, it is vital that all voices and perspectives are heard by change agents. Systems change works best if citizens are engaged and connected with local community leaders and policy makers. Systems change and ongoing evaluation of evolving community needs that accommodate and communicate scientific evidence are crucial. Science should not be politicized, meaning that messages about best practices must be delivered with clarity and transparency in a non-partisan manner. It is critical that key stakeholders communicate, cooperate, and compromise to ensure that solutions are embraced by all parties, are comprehensive, and will serve the greater good.
In strong communities, needed services and opportunities for employment and self-improvement are widely accessible across demographic groups. Strong communities also make economic sense. On a large scale, the pandemic has demonstrated how the imbedding of prevention strategies—from the public health response to efforts to reducing the disparate impacts on vulnerable populations—would have been vastly more effective and equitable. A study has shown that earlier shutdowns and greater uptake of precautionary measures would have saved tens of thousands of lives and reduced the spread of the virus. More proactive planning, in effect, would have saved communities vast amounts of money. The well-known saying—“an ounce of prevention is worth a pound of cure”—is as true now as when it was first said centuries ago.
Better functioning community systems requires forethought, on-going maintenance and sustained public resources. The payoff will far exceed the investment, both in terms of human happiness and burden on public resources. And importantly, with fewer disparities will come greater social and racial justice, thereby stabilizing the unrest as all segments of our society will have similar opportunities to thrive.
To conclude, there is hope for the future with a concerted effort to build strong communities by accommodating the four strategies described above. The result will be measurable improvements in the health and well-being of our communities and its citizens.