Culture of Health Blog

When acclaimed Barbadian author Karen Lord envisioned life on a small island during a pandemic in her story The Plague Doctors, she never imagined that within weeks of its publication, “history would become present, and fiction real life.” Lord’s short story in the Robert Wood Johnson Foundation’s (RWJF) first-ever book of fiction, Take Us to a Better Place, was written months before coronavirus emerged. With chilling prescience, it imagines a deadly infectious disease besetting the globe and follows Dr. Audra Lee as she fights to save her 6-year-old niece. The heroine confronts not just the disease but also a society that serves the wealthy at the expense of others.

This latter point was especially relevant here in the United States where COVID-19 hit communities of color dramatically harder than others. Centuries of structural racism have created numerous barriers to health including difficult living conditions; limited educational opportunity; high-risk jobs; lack of access to paid leave and disparities in care. Historical trauma has also driven deeply rooted mistrust of the medical establishment. All of these interconnected factors have magnified risk for both exposure to COVID-19 and the worst possible outcomes from the virus.

Both of us, like many in America, are feeling anxious and unsure about what the upcoming holidays will look like for families. It’s difficult to know how to prepare or talk about this, and really all that is going on, with the young children in our lives.

Throughout this year our kids have continuously faced several changes. Suddenly their routines and schedules are different. Many are not seeing friends, family, teachers, and classmates in person as often or at all. They miss what felt normal and comfortable and they have all sorts of questions about what is happening and why. They struggle with what to do with all the “big feelings” they are experiencing.

They can also sense increased stress that the adults in their lives are facing. Adults are juggling care for their children, often adding homeschool teacher or “videochat technical support wizard” to already increased workloads. Those who are teachers, work in health care, or have other “essential” positions face significant danger and stress in their jobs every day. Others have lost jobs or are trying to protect or care for aging parents during a pandemic. Through all of this uncertainty and loss, parents and caregivers need ways to care for themselves, and children need to know they are going to be safe.

Mel Hannah spent most of his life in service to others. He was the first African American member of the Flagstaff City Council and vice chairman of the NAACP Arizona State Conference. And, in service to his beloved family, Mel and his wife Shirley, now in their 80s, have been helping their daughter Ashley raise her three children these past years. Sadly, however, Ashley contracted and tragically died from COVID-19 in May. Ashley’s untimely death left the Hannahs as the sole caretakers for her young boys, ages 5, 4, and 1.

The Hannahs’ story exemplifies the heavy toll of the pandemic, and especially the unique and often overlooked impact it is having on “grandfamilies” or kinship families. These are families in which children live with and are being raised by grandparents, other extended family members, and adults with whom they have a close family-like relationship, such as godparents and close family friends. Astonishingly, about 7.8 million children across the country live in households headed by grandparents or other relatives. Of that number, 2.7 million do not have a parent living in the household.

When Harris County voters approved a $2.5 billion bond to pay for more than 500 local flood-control projects, it seemed like a sound response to Hurricane Harvey. In 2017, the storm dropped 50 inches of rain in the Houston region, flooding some 166,000 homes. Based on a traditional return-on-investment analysis, it might also have appeared reasonable to spend that bond money in neighborhoods with the most expensive properties.

But county officials understood what that would mean—little protection for communities living with the most inadequate social, physical, and economic resources—many of whom are communities of color. And so, they chose a different policy approach. They gave preference to projects that ranked higher on the Centers for Disease Control and Prevention’s Social Vulnerability Index, which uses socioeconomic status, racial and ethnic status, household composition, housing, access to transportation, and other metrics to uncover potential vulnerability. The result: funds for flood control prioritized towards low-income communities and communities of color, those least able to recover from disasters.

Since we originally published this post in July 2019, more cities and countries are exploring ways of centering decision-making on human and planetary well-being—from Iceland, which revealed a new well-being framework, to Canada, which is exploring budget indicators that encompass happiness and well-being. 

Meanwhile, the COVID-19 pandemic is a reminder of how interconnected we are and always have been across lives, livelihoods, and well-being of communities and societies everywhere. In the United States, its spread has sharply illuminated inequitable conditions and ongoing systemic racism. Rates of infection and complications from the virus are significantly higher in communities of color, Native communities and tribes, immigrant communities, and other groups that live with higher rates of air pollution, spotty health insurance coverage, persistent health inequities, and lack of paid leave or a financial safety net to follow “stay home” public health orders. As we recover, prepare for potential future outbreaks and rebuild, we must prioritize equitable well-being as the ultimate goal. We might take a lesson from New Zealand, which adopted a well-being budget last year, has made significant investments in vital services like mental health and education as well as environmental protections, and has had an exceptionally low mortality rate and relatively rapid recovery from COVID-19.

While working from home and caring for our families as we wait out the COVID-19 pandemic hasn’t always been easy, it certainly is a privilege that we value during these unprecedented times. We’re fortunate that our organization recognizes the importance of families and caregiving. In addition, the nature of our jobs allows us to work remotely and have flexible schedules. This helps us support our families during a global pandemic. Unfortunately, the vast majority of working parents in America today, especially women of color, don’t have this choice.

Instead, as pressure mounts to reopen the country, many working parents face an impossible dilemma. Those without the option to telecommute are forced to return to work while struggling to find safe and affordable child care. Or they must stay at home to care for their children and face financial ruin. This burden falls disproportionately on women of color who are on the frontlines of many essential jobs. Many are also child-care providers who face the monumental feat of juggling their low wage, high risk jobs with caring for their families and themselves in the midst of a pandemic. Ultimately, the entire country faces the consequences of an inequitable childhood care system in deep crisis.

Fifteen years ago the Robert Wood Johnson Foundation (RWJF) confronted a puzzling question that still resonates today: Why can some communities rebound after disasters, while others are unable to recover? We first studied this in the aftermath of Hurricane Katrina. Some parts of the Gulf Coast were irreparably damaged, while others were able to recover. Researchers at the RAND Corporation, with RWJF support, sought to identify the qualities that resilient communities shared after a natural disaster, such as the strength of collaborations among government and non-governmental organizations pre-disaster and robust plans to support those most affected. The same team later built on that research by examining community well-being after other types of disasters, including economic downturns and community violence. The researchers partnered with local governments and—time and again—found that prioritizing equity and building collaborative networks bolstered communities under extreme stress.

New Jersey is ranked as one of the nation’s healthiest states—on average. But if you were to look more closely, you’d see the numbers mask significant differences in health across the state. For instance life expectancy in one Newark census tract is 75.6 years while just a few miles outside the city, it’s 87.7 years.

Race is a big factor contributing to this and other health disparities. For example, babies born into Black families in New Jersey are twice as likely to die before their first birthday in contrast to those born into white families.

Other factors contributing to health disparities include income, gender, and education. Some are less apparent, like the distance from people’s homes to parks and grocery stores or the availability of public transit. The point is that many things beyond what might immediately be thought of as health related do, in fact, play a major role in determining health. 

As COVID-19 swept our nation this year, the important influence utility services have on our health became clearer than ever. Running water is essential for washing hands to prevent infection. Electricity keeps individuals and families comfortable while they follow recommendations to stay home. And internet access allows employees to work from home, children to learn remotely while schools remain closed, patients to access needed health check-ups, and all of us to stay connected.

Conveniently powering up our laptops, logging onto the internet and turning on the faucet are things many of us take for granted. But the COVID-19 pandemic has also revealed fault lines in America’s aging infrastructure. These inequities especially impact people of color, rural and tribal communities, and low-income households. For them, energy, water, and broadband are often unavailable, unaffordable, unreliable—and even unsafe.

In the almost seven months since the novel coronavirus national emergency was declared, we’ve witnessed how it has magnified centuries-long inequities that have created deep-rooted barriers to health and opportunity in communities of color and tribal communities.

At the County Health Rankings & Roadmaps, my colleagues and I know the first step to action is knowledge. We cannot address the disparities the coronavirus has brought to light without first understanding the data, challenges, and historical context at play.

Through conversations with six leaders from Black, Latino, and tribal communities, we examined the inequities the pandemic has exacerbated and explored strategies and solutions for where we can go from here. Three lessons emerged from these conversations that can inform an equitable response and recovery.