Author Archives: Carolyn Miller

The Case for Having Health Equity Guide Community Preparedness

Aug 24, 2021, 1:00 PM, Posted by Anita Chandra, Carolyn Miller

The coronavirus pandemic has exacerbated long-standing inequities in communities across the United States. To prepare for the next crisis, communities must build health equity infrastructure now.

Health equity and community preparedness illustration.

We can’t prevent disasters, but proactively developing strategies to address health equity can ease some of their most harmful effects on people and communities. 

In our research, we’ve found communities that developed these strategies before and throughout the pandemic were better positioned to target resources to address health disparities that were highlighted and exacerbated by COVID-19.

Take Harris County, Texas, for example. In 2014, Harris County Public Health (HCPH) developed a health equity framework that was tested by an outbreak of the Zika virus in the county two years later. This experience informed HCPH’s management of the COVID-19 vaccine rollout and decision to collect vaccination data by race. While the state of Texas’ vaccination strategy emphasized mass vaccination sites, mobile vaccine clinics administered the one-shot Johnson & Johnson vaccine in parts of Harris County that were hit hardest by the pandemic.

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How Communities Can Support Children and Families to Recover From the Impacts of COVID-19

Apr 26, 2021, 3:00 PM, Posted by Brian C. Quinn, Carolyn Miller

Communities nationwide are showing that helping families recover helps our society recover.

Family greets each other while wearing masks.

COVID-19 has been devastating for children and families.

Millions of parents and caregivers lost jobs and income, hindering their ability to put food on the table. School closures, remote learning, and limited-to-no access to child care has weighed heavily on many, especially those with lower incomes working essential jobs everywhere from grocery stores to nursing homes. The pandemic has also exacerbated existing housing challenges, from high rental costs to an ongoing eviction crisis.

In spite of these challenges, our colleague Jennifer Ng'andu recently noted that families are resilient and hopeful. Because the pandemic weighs so heavily on working families, a key piece of inclusive recovery is ensuring that caregivers and their children have the support they need to thrive.

As researchers, our job is to glean lessons from the data and understand what will help communities recover. Since 2016, we’ve been following 29 diverse communities to understand how they approach health, well-being, and equity. When the pandemic hit, we pivoted to focus on nine of these communities. Doing so allowed us to closely follow COVID-19’s impact and understand local response and recovery efforts.

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Understanding Our Health Before the Pandemic Can Help Us Improve It Afterward

Jan 29, 2021, 10:45 AM, Posted by Anita Chandra, Carolyn Miller

Measuring health and the social and economic factors that influenced it before the pandemic helps us understand the kind of risks the nation faced previously. It can also inform how to move forward toward recovery. 

Man receives blood pressure test.

2020 was arguably one of the most difficult years in American history, challenging our resilience and surfacing enduring and systemic challenges to our collective health and well-being. As we continue to measure the pandemic’s impact on short- and long-term health, as well as other social and economic indicators, it is useful to note where we stood pre-pandemic. Understanding the conditions and trends that shaped our health before COVID-19 helps us assess whether the systems now being tested to respond to COVID-19 are robust. 

Last year, the Robert Wood Johnson Foundation (RWJF), along with the RAND Corporation, shared an update on the national set of measures that we have been using to track our journey toward a culture where every person has a fair and just opportunity to live the healthiest life possible. The goal of the Culture of Health measures is to offer signals of change with a focus on broader social and economic drivers of health, well-being, and equity, as well as the role all sectors play in influencing health outcomes. Developing a clearer picture of what is changing (or not) via the Culture of Health measures is useful for directing investments and identifying where, as a nation, we need to make progress. 

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COVID-19 Research at the Community Level

Oct 6, 2020, 10:45 AM, Posted by Alonzo L. Plough, Carolyn Miller

What investments, priorities and values are shared by communities that are faring better in the COVID-19 pandemic?

Contact tracers. Contact tracers in Harris County, Texas, discuss a COVID-19 case. (AP Photo/David J. Phillip)

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.

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Incarceration Rates: A Key Measure of Health in America

Apr 2, 2020, 1:00 PM, Posted by Carolyn Miller, Douglas Yeung

Mass incarceration is a pervasive problem that undermines health and health equity for individuals, families and communities. That’s why we have included it in the 35 measures RWJF is using to track progress toward becoming a country that values and promotes health everywhere, for everyone.

American flag behind barbed wire fence.

As coronavirus sweeps our nation it has brought deep-seated health inequities, including those linked to incarceration, to the forefront. Overcrowding and poor sanitation are putting prisoners at risk now more than ever. Persistent, widespread reports that guards and prisoners are testing positive for COVID-19 are especially alarming, and a sobering reminder that quarantines are nearly impossible among incarcerated populations. To address this, many jurisdictions are releasing select prisoners.

The Robert Wood Johnson Foundation (RWJF) has long recognized how incarceration adversely affects health and health equity for prisoners as well as families and communities. With some 2.2 million adults and youth in juvenile detention facilities, prisons, and jails, the United States incarcerates many more people—and a higher percentage of our population—than any other nation in the world. There is widespread agreement that incarceration has adverse effects on health and health equity, not just for prisoners themselves but also for families and communities. That’s why, in 2018, RWJF included it among 35 illustrative measures we are using to track our progress toward building a Culture of Health in America—that is, becoming a country that values health everywhere, for everyone.

The measures linked to RWJF’s Action Framework are intended to be viewed together to identify priorities for investment and collaboration, and to understand progress being made toward realizing our vision. We are also considering the impact each individual measure has on efforts to build a Culture of Health. Because mass incarceration is a pervasive problem that undermines health and health equity, tracking it allows us to examine how it compounds the persistent challenges associated with achieving health equity nationwide and affects communities.

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