To public health experts and policymakers intent on improving community health, the COVID-19 pandemic has shined a harsh light on the absolute necessity of addressing racial and economic inequities. “We have not invested in everyone equally,” said Donald Schwarz, senior vice president for program at the Robert Wood Johnson Foundation, during a webinar convened by U.S. News & World Report as part of the publication of the third annual Healthiest Communities rankings this week. In fact, Schwarz said, “we have put up barriers to people being able equally to participate,” be they legal, financial or structural ones.
Indeed, the disproportionate burden that COVID-19 has imposed on African American, Native American and Hispanic communities can be attributed in large part to the disadvantages those communities long have faced in housing, education, nutrition and access to health care and economic opportunity.
COVID-19 has “exposed what many of us knew” was already a reality, said Garth Graham, vice president of community health and chief community health officer at CVS Health. (The Healthiest Communities rankings are produced by U.S. News in collaboration with the Aetna Foundation, an independent, charitable and philanthropic affiliate of CVS Health.) He pointed out that the impact of race, poverty, education, housing “and all of those things that really define how long and how well people will live” have had a greater impact on how communities have fared during the pandemic than clinical expertise. “Many of those issues have been long-standing but just now amplified through a different lens,” Graham said. That creates an opportunity to build and strengthen, he added.
The panel, part of a series entitled the U.S. News Community Health Leadership Forum, explored how leaders from across sectors – from public health and health care to economic development, education and finance – can collaborate to successfully overcome the effects of such inequities and advance community well-being.
Schwarz, Graham and the two other panelists – David Erickson, senior vice president and head of outreach and education at the Federal Reserve Bank of New York, and Carol Naughton, president and interim CEO of Atlanta-based nonprofit Purpose Built Communities – all agreed that the right answers lie in the individual community and that success depends on responding in a thoughtful, coordinated way to meet local needs.
One useful approach is to find a “community quarterback” – essentially a party that understands the perspectives and issues of the various sectors and can be the “glue” and the “grease” that allows partners to work together and defeat inherent obstacles, said Naughton. Purpose Built Communities relies on this strategy in its work as a consultant to neighborhoods seeking to revitalize with a focus on housing, education and economic opportunity.
Money, of course, is critical, and there is a lot of it when you calculate the various streams being invested each year by banks, nonprofits and foundations in housing, community development and education, for example – some $400 billion a year, Erickson said. “That is real money, even in Washington terms,” he said. The problem, he said, is that investors have “sprinkled amenities over a neighborhood – built a school here, an affordable apartment there – and hoped that that would tip it over into thriving. But that doesn’t work.”
Erickson cited an analogy that capital is like an airplane that “needs a landing strip.” He noted that, “When someone invites you in, that’s because they’ve been clearing some brush. … But unless the plane lands, you don’t have the money to build the things that the community needs.”
Communities need groups like Naughton’s to “finagle all of these streams of money … to meet community needs as they are identified by community members,” Erickson said. “That is the name of the game, but it is very hard to do.” Hospitals increasingly are taking a leadership role in many places, given their strong incentive to keep their populations healthy and their expertise in investing in and managing real estate projects and large, complex organizations.
The long-term consequences of failing to make these investments, of leaving people behind, will be felt widely, predicted Schwarz. By mid-century, he noted, more than half of Americans will have grown up in poor families and won’t have the capacity to be active consumers. “Long-term disinvestment is to our own peril,” said Schwarz. “We need to take the indicator of children growing up healthy and educated as the way to our future. Otherwise, very soon, we are going to have an economy that can’t support us.”
Where should the money go? The specifics must be up to individual communities, panelists largely agreed, though fundamentally it’s crucial to invest in children and families – in housing and education and economic opportunity, for example. “Social mobility is extremely hard,” said Graham. “The most important thing I think we can do is invest in teachers and early education.”
COVID-19 has exposed an overarching national need for greater broadband internet access. For example, telemedicine could have significant benefits for many people in rural areas without easy access to health care. But those same areas often are inadequately wired for Wi-Fi and cellular service. “So the tool that we think should work really well for communities, including Native American and indigenous communities across this country, is hampered by the fact that we haven’t invested in the infrastructure so that people are included in our economy,” Schwarz said.
One promising example of an effort that’s working: Schwarz noted that the city of San Antonio has made “a concerted effort” to bring broadband to every household to help improve education access, which also puts it in “a great place for telemedicine,” he said.
Naughton agreed, saying that bridging the “digital divide” is critical, not just for medicine but also for education, job opportunities and giving more people access to social services benefits. “We need to be thinking about internet access the same way we’ve thought about electricity and water: fundamental in every community,” she said.
In general, the tools that leaders from across sectors need to create healthy communities are out there, the panel agreed, though that doesn’t mean solutions are easy or one-dimensional.
“I think the answers are in communities,” Graham concluded. “What we need to do is to figure out how to pull from, uplift, draw, elevate and then allow communities to execute on the strategies and the things that they know are important.”
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