The COVID-19 crisis has both underscored and created a host of problems affecting health disparities and health equity that urgently require attention. Successfully addressing the complex challenges that affect community health — such as COVID-19 and its economic impacts — requires health care, public health, and social services to work together in new ways.
Prior to the pandemic, some communities made meaningful progress in building cross-sector alignment between the health care, public health, and social service sectors. But, resource limitations, social distancing, urgent public health responsibilities, and health care system strain threaten progress towards the building of sustainable connections across organizations and sectors at a time when they are needed most.
Aligning Systems for Health, led by the Georgia Health Policy Center with the support of the Robert Wood Johnson Foundation, believes that collaboratives will be more successful if they move toward cross-sector alignment, which involves building sustainable connections across organizations and sectors. These connection points include developing critical capacity around a shared purpose, governance structure, sustainable financing with incentives and accountability, and shared data and measurement systems. These connections can help public health, health care, and social services together tackle big challenges, like health equity, when combined with external urgency, organizational capacity, and community engagement.
COVID-19 Requires a Multifaceted Response
The role of cross-sector alignment in the response to COVID-19 is complex. It is clear that a pandemic response needs to pay attention to social determinants of health. While it is too early to definitively say, it is believed that by having the core elements of alignment in place, local and regional systems possess greater capacity to address the social and economic effects of COVID-19, including addressing housing and food insecurity resulting from pandemic-related loss of jobs and income.
This whole-person approach to well-being is a core tenet of aligned systems, which relies upon collaboratives to connect individuals with services and resources across a continuum of needs, beyond what traditional health care can provide. This approach requires an understanding of the interplay of multiple factors that influence individuals’ and communities’ health and well-being, as well as an understanding of how to address these needs by efficiently connecting individuals with needed services.
Opportunities to Strengthen Alignment During the Pandemic
As part of the Georgia Health Policy Center’s ongoing efforts to identify factors strengthening cross-sector alignment, the following opportunities emerged from a review of the literature and surveys of alignment stakeholders relevant to the response to the COVID crisis.
The pandemic has given communities an obvious, urgent reason to unite around a common cause. But the pandemic runs the risk of pivoting energy away from core efforts of to create a shared sense of purpose around health-related social needs in favor of urgent COVID-19-related needs. A sense of shared purpose across sectors, can prevent a local COVID response from being too narrowly focused on physical and health challenges, rather than addressing the mental health and economic impact that, ultimately, will later impact community well-being.
Established, purposeful processes, relationships, and trust are enabling aligned organizations to pivot quickly toward emerging needs. However, patience may be lacking for existing or emerging governance processes, which may be pushed aside for a quicker response. During the crisis collaboratives should consider striking the right balance between formal and informal arrangements.
Many resources are now being dedicated to COVID-19 testing and treatment. Aligning organizations should consider sources of funding and funding mechanisms for responding to the crisis broadly and inclusively of social services. Blending and braiding of funds, where different sources of funds are mixed together to varying degrees and dedicated to a shared objective, may be a particularly useful mechanism during the emerging crisis, particularly if funds are not earmarked and can be used more flexibly.
Efforts to track and trace the virus can be supported with data-sharing infrastructure. Building collaborative data infrastructure often takes time and can be highly resource intensive. But, some community collaboratives report that data-sharing agreements are being fast-tracked during the pandemic. Shared data can expose disparities among vulnerable groups. Such data would be broken down by categories such as race, age, income, or gender to provide an in-depth look at trends across specific subgroups. The use of this type of data sheds light on the scope of the problem, which allows collaboratives to develop effective solutions
Without face-to-face meetings and events, including community voice in COVID-19 response efforts will require creative solutions. There is concern that meaningful community engagement is falling off with disruptions to regularly scheduled, in-person meetings, competing demands of front-line workers, and disparities in ability to access technology. Additionally, if prepandemic community engagement did not already exist, it is difficult to create it in a virtual environment.
There is a need for increased engagement and outreach in communities of color. Community-based organizations (CBOs) are well-connected to their communities and understand their needs, so while involving community members directly is preferable, community voice can still be included in response efforts by engaging CBOs as a proxy for individuals in the community. Aligned systems could activate existing networks by collaborating with community health workers within collaboratives. Community health workers may be able to serve as a bridge between sectors and communities of color, helping to engage individual community members.
The use of remote communication technology could also help in engaging community members. However, it is important to account for inequities in access to internet services and computers, which negatively affect many under-resourced communities.
The pandemic underscores population-level health inequities in terms of those most infected, critically ill, and dying from coronavirus. The COVID-19 crisis has worsened many already-existing inequities. For example, front-line workers with relatively low incomes have also been put at greater infection risk to keep essential services running. The pandemic highlights a need to rethink our approach to inequity.
The inclusion of community voice at all stages of alignment is important for addressing inequities, and organizations can improve their crisis response by building relationships with community residents and introducing an equity focus into their work.
A potential silver lining in the pandemic in that the public has a heightened awareness of equity and that there may be more motivation to address disparities. There is an opportunity to translate this increased understanding of the social determinants of health and their connections to health and public health into enhanced engagement.
The pandemic has exacerbated already-existing cracks in our health care, public health, and social service systems. Aligning organizations may be better positioned to address these cracks, and now is a good time to consider how to strengthen cross-sector alignment to help address a broad range of issues the pandemic has brought to the foreground.
A Theory of Change for Aligning Health Care, Public Health, and Social Services in the Time of COVID-19, published in the American Journal of Public Health