As the country emerges from the devastation of the COVID-19 pandemic, it may be time to examine the choices communities made during the last year to see how these approaches shape continued COVID-19 response and recovery and help build resilience for future pandemic response.
There have been important surveys of individual attitudes about the pandemic, but far less analysis of how whole communities have been coming together, or have not. How has the prepandemic approach to health equity been factoring into pandemic response? Are community institutions finding new ways to work together, and will this collaboration hold should new COVID-19 crises arise?
In 2020, the Robert Wood Johnson Foundation and the nonprofit RAND Corporation began tracking the COVID-19 response and recovery efforts of nine communities across the United States—Finney County, Kansas; Harris County, Texas; Milwaukee; Mobile, Alabama; San Juan County, New Mexico; Sanilac County, Michigan; Tacoma, Washington; Tampa, Florida; and White Plains, New York—with the goal of better understanding how the pandemic, and the local response to it, was impacting health, well-being, and equity in those communities.
This was a deeper examination of nine of the 29 communities the team has been tracking since 2016, via the Sentinel Communities Surveillance Project, to monitor activities related to how a Culture of Health is developing in a set of diverse communities around the country. The team produced a series of four reports from July 2020 to July 2021.
So, what insights can be gleaned from the journeys of nine communities, and what might be considered as communities fully recover and renew?
What Have Been the Keys to Community Response?
Three themes emerged from this community analysis. It was clear that efforts to holistically address community health and well-being and health equity mattered when communities had those strategies and supporting structures in place before the pandemic. For instance, Finney County leaned on its LiveWell initiative, which predated COVID-19, to distribute personal protective equipment and connect families to food programs. Milwaukee had been pursuing various equity efforts to address impacts of racial residential segregation, employment gaps, and gun violence before the pandemic. During the pandemic, grassroots organizations within Milwaukee mobilized to raise awareness about differential health care access by race as well as other underlying inequities.
Efforts to address community health, well-being, and health equity mattered when communities had those strategies and supporting structures in place before the pandemic.Share on Twitter
Data infrastructure also helped enable communities to quickly and effectively use data to marshal resources, support community members with multiple social needs, and ensure vaccination access. In Harris County, the United Way of Greater Houston and Greater Houston Community Foundation collaborated to create the Greater Houston COVID-19 Recovery Fund, which monitored community priorities via a nonprofit needs data dashboard. Tacoma used its Equity Index, developed before the pandemic, to guide local decisionmaking and help the public understand the differential impact of COVID-19 in the city.
San Juan County, meanwhile, followed a vaccine allocation approach, which used the CDC's Social Vulnerability Index and COVID-19 rates to reallocate vaccine supply based on community vulnerability and infection rates to prioritize providers in underserved communities. The vaccine rollout in New Mexico was very efficient and equitable, with 57 percent of adults receiving at least one dose of the vaccine by mid-April 2021. Native Americans in the county received the vaccine at a similar rate to white residents, an equity challenge still facing many U.S. communities.
The pandemic catalyzed new collaborations among organizations within and across systems and sectors. In Tampa, former competitors and sectors that had not previously come together partnered to address complex issues related to health and equity. A new collaborative of hospitals and health care systems via the COVID-19 Florida West Coast Regional Data Exchange resulted in agreements to share data, share messaging to the public, pool resources, and collaborate to meet the COVID-19–related health needs of the community.
The pandemic catalyzed new collaborations among organizations within and across systems and sectors.Share on Twitter
In Sanilac County the Community Foundation created an Emergency Assistance Fund to support local organizations, eliminating usual funding barriers, lifting grant administrative fees, and allowing organizations to use funds for operating costs as well as direct services. Collaborations also helped to strengthen weak infrastructure to support families. In White Plains, the Child Care Council of Westchester and the Westchester Community Foundation COVID-19 Response Fund helped cover the costs of childcare for first responders, essential workers, and low-income families. In Mobile city officials used CARES Act funds to help those facing eviction navigate the court system.
Where Must Gaps Be Filled in Planning for Future Pandemic Response?
Despite these innovative community solutions, there were clear issues that cannot be papered over as the nation responds to the Delta variant and before the next pandemic or any other disaster appears on the horizon. While some communities were finding new paths to address needs and to collect and distribute resources, sobering system fractures impeded an equitable response.
Communities that had not previously prioritized health equity were challenged to addresses disparities in COVID-19 impact. This included not being able to report COVID-19 data by race/ethnicity, not being able to link health and social service data, and relying on overburdened individual organizations and residents to meet the urgent needs of populations experiencing vulnerability. Some communities faced challenges with cross-sector alignment and governance that predated the pandemic. This created a disconnect between public health leadership and other government leaders about policies like mask mandates, business restrictions, and ownership of responsibility for COVID-19 testing. It also underscored disagreements about the role of public health in local decisions and policymaking.
Communities that had not previously prioritized health equity were challenged to addresses disparities in COVID-19 impact.Share on Twitter
As communities allocate resources from the American Rescue Plan, there are opportunities to address these system fractures. But these opportunities could depend on improved community-level funding strategies and decisions to ensure that investments support community resilience. With respect to the economy, some communities are prioritizing making budgets whole and supporting small businesses, while others are setting aside funds to better support unemployment systems. As communities get more resources to tackle long-standing challenges, shifts that have occurred during the pandemic could spur long-term, equitable change.
Anita Chandra is vice president and director of RAND Social and Economic Well-Being, Linnea Warren May is an associate policy researcher at the nonprofit, nonpartisan RAND Corporation, and Laurie Martin is a senior policy researcher at RAND.
Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.