The Need For National Public Health Infrastructure

Over a Decade After the Great Recession, We Can’t Afford to Make The Same Mistake

Right now, the United States is in the fight of its life. The immediate health crisis requires little explanation; hospitals and healthcare workers are on the front lines every day risking their lives to save others. No one would argue about our first-order priorities: testing, life-saving supplies, protective equipment, beds, more doctors and nurses, and, ultimately, a vaccine.

But there’s another crisis looming, a second wave with repercussions long after we take off our masks and return to restaurants, offices, stores, and schools. In fact, it’s already here–and will be for a long time. The nationwide call to shelter-in-place, close schools, and shut down non-essential businesses, has resulted in mass layoffs and furloughs with millions of Americans struggling to put food on the table and pay their bills.

Life on the Margins

For those already living paycheck-to-paycheck, who now have no income and can no longer rely on the school system to provide meals for their children twice a day, this is a time to worry about survival. Now add to the mix all the people who’ve never needed to access the social safety net before, who suddenly find themselves applying for unemployment benefits and seeking out food assistance. The number of people in desperate need is staggering; in just one month, more than 22 million people have filed for unemployment, essentially eliminating all the employment gains since 2010. The unemployment rate increased from 4.5 to 20.5 percent in just one week from March 29 to April 4; in June it was over 11 percent.

This problem crosses socio-economic, racial, and geographic boundaries. Very few are untouched by either the clinical or social impact of this pandemic. At the same time, it’s affecting communities of color and lower-income communities at a disproportionate rate, shedding a glaring light on the worsening health inequities and disparities in resources and access to information and care.

It’s never been more clear that social care is as critical to people’s overall health and well-being as healthcare.

A Critical Sector Left Out

We know we are not as prepared as we should be for what’s to come. As a result of the Great Recession of 2008, there were massive cuts to local public health departments across the nation that were never fully restored. For more than a decade, rather than investing in public health and social care programs and building sustainable, resilient infrastructure to connect people to the services they need, our country has chipped away at the very foundation of what should be supporting and sustaining communities. Budgets were cut, personnel were let go, and public health departments across the nation have been scraping by to respond to issues far less dire and urgent than the one we currently face.

Today, while hundreds of billions of dollars are flowing to businesses, state governments, and hospitals from the recent CARES Act, community-based organizations (CBOs) are largely left dependent on grants, philanthropy, and individual fundraising to support their important grassroots work. As a result of limited investment over the years, they still work with antiquated computer systems, paper-based applications, and financial processes; they lack the technological capacity necessary to integrate and communicate digitally. Some file stacks of papers to receive local government reimbursement for services on a monthly basis–a time-consuming and tedious process.

What’s more, thousands of social service providers–those who work in homeless shelters, food banks, and senior centers–are furloughed or forced to work at home, struggling to find ways to help people while staying safe, supporting their own families and managing their own personal challenges as a result of the pandemic. And because there was no investment in public health back then, they are left without the technological infrastructure or integrated systems to enable them to seamlessly help people from the safety of their own homes now.

The perfect storm is here: more people than ever need social services, while the non-profit sector designed to help them is itself in grave danger and cannot sustain or meet the demand. And it’s just the beginning.

A Proactive Public Health Infrastructure

Before COVID-19, people in need would end up in hospital emergency departments, not because they were physically ill but because they had no place else to go for help. The pandemic makes that challenging if not impossible. So how do we ensure that people receive the social care and services they need, where they live, and when they need it? And how do we leverage the power of community-based organizations to deliver the best services, closer to people’s homes, holistically in conjunction with our healthcare system?

There are steps we can take now, to lay the groundwork for what needs to happen next:

• Invest in public health infrastructure (including CBOs) that allows for seamless, cross-sector care coordination and service delivery
• Adopt an accountable system to track the distribution of relief funds to grassroots organizations and the outcomes of services provided
• Evaluate gaps in services and address equity issues by shifting investments and policy to the communities with the greatest needs
• Encourage the federal government to invest in communities on the same scale that it invests in large corporations that are at-risk due to the crisis

We know that investments in social care and an integrated public health system that includes community organizations is the best way to keep people healthy, well, and economically resilient – able to navigate stressful, challenging times. But we keep missing the opportunity and end up being reactive rather than proactive. Now is the time to plan and implement an immediate response, continue to build and sustain communities as they recover, and strengthen and support them into the future with a well-funded, integrated, and comprehensive public health infrastructure.

Long after the loved ones have been mourned, the sick have been healed, and life starts to get back on track, we’ll be dealing with the fallout from this pandemic. It’s hard to think about the future when there’s so much at stake right now. But that’s precisely what we need to do so that we have the systems in place for the next inevitable crisis.

We have the opportunity to make effective changes in order to ensure that we don’t fail millions of Americans in the same way we have before.

Social inequity leads to health inequity. Everyone, regardless of income, race, or geography, should at the very least have their basic needs met; even more, they should have the opportunity to thrive, not just survive.

Join us to build a solution fortoday, tomorrow, and the future:

Check out a playbook to coordinate care statewide