Culture of Health Blog

Rapid response is synonymous with moments of crisis. From first responders to communication experts, responding quickly to a crisis is critical for community health and well-being. But what about rapid response research? 

COVID-19 has epitomized a complex crisis of infectious disease, food and housing insecurity, and mental distress. People who are Black, Latinx, Native American, and living in low-income households are the most vulnerable to these conditions. It is clear that health and social policies enacted during the pandemic will affect communities for decades to come. 

To inform rapid response research and policymaking, my team at Boston University and I developed the COVID-19 U.S. State Policy database—also known as CUSP—in 2020. This resource aims to inform health and social policy decisions that promote health equity and focuses on policies that affect vulnerable and historically excluded populations. Now over a year after its inception, we are assessing what we have learned and where we have yet to go.

Maria S. Gomez is a public health nurse who received a Presidential Citizens Medal in 2012 from President Barack Obama. She along with other colleagues founded Mary’s Center in 1988 an innovative community health center in the D.C. region that has been using an integrated model of health care, education, and social services for more than 30 years. Today, it serves over 60,000 people each year. Here, Gomez shares lessons learned through Mary’s Center vaccination program.

Lesson One: No Wrong Door

Mary’s Center’s vaccination program didn’t have an easy start. Like the community we serve, our team was fearful and struggling in the pandemic. Suddenly, there was a vaccine that offered promise to keep us safe, but people were confused and anxious about it. It fell to us to provide information—but first we had to educate ourselves. There was no shortcut and no chance of success unless we did. So we put in the time, even holding Town Hall Meetings with our team of nearly 800, to learn and become effective messengers.

We learned that for some in the Mary’s Center community, a lack of trust stemmed from our country’s history of medical abuse—and not just horrors like the Tuskegee syphilis study but also more recent atrocities including involuntary sterilizations of Puerto Rican women and of women detained at the U.S. border. Many in our community have experienced those abuses well.

As the pandemic forced women out of the workforce in record numbers, a new survey reveals that men overwhelmingly value care work and want to share it equally with their partners. But the lack of supportive workplace cultures and public policies prevent them from doing so. Where do we go from here?

As pressure mounts to address the many challenges brought to the fore by the pandemic, our nation is experiencing a reckoning in caregiving, and what it means for families and our economy. A new nationally representative survey conducted by New America and funded by the Robert Wood Johnson Foundation, revealed that although our cultural norms have not caught up with our ideals of gender equity, men overwhelmingly value care work, and want not only to participate, but to share it equally with their partners. However, the lack of supportive workplace cultures and public policies keep them from doing so.

Both of us are proud of our immigrant roots and the paths our families forged after coming to the United States. Mona’s parents arrived from India, and Tina immigrated from South Korea as a toddler with her family. As members of the Asian American community, the past year’s wave of hate crimes has been painful and traumatic. But it is not new. What is new, though, is the attention these incidents and the Asian American community as a whole are receiving.

At times, these crimes bring back terrifying memories. Mona was just 10 years old when a hate group in Northern New Jersey sent a racist letter threatening Indians to a local newspaper, and the newspaper published it. The deep societal racism that letter exposed was manifested through verbal abuse, brutal assaults, and murders that occurred time and again over many years. Mona grew up hearing racist comments from police officers and teachers and seeing South Asian businesses and homes, including her own, vandalized.

At times, they remind us how few people seem to consider the intergenerational trauma and challenges faced by Asian Americans. Tina’s parents grew up in South Korea during the Korean War and her father remembers his family losing everything. Arriving in a new country not speaking the language while trying to navigate a culture with a different set of values was incredibly difficult for her parents. Adding to their stress was the need to lean heavily on their children to negotiate, translate, and serve as intermediaries with authorities and agencies.

At times, they compound the numbness and hurt we feel in the face of sometimes-profound insensitivity and endless microaggressions that add up over time and contribute to chronic stress that undeniably harms health.

Editor’s Note: This piece was originally published in the Grantmakers In Health Bulletin.

In Clifton, New Jersey, data on children in poverty, data on obesity, and data on the percent of uninsured residents revealed such pronounced disparities among neighborhoods that the city approved a satellite health office. Now, residents who previously had difficulty getting health screenings, immunizations and other necessary public services have better access.

In Waco, Texas, a nonprofit organization used the COVID Local Risk Index, a measure of city and neighborhood-level risk of COVID transmission and mortality, to pinpoint the level of COVID risk by neighborhood. Comparing this data to the city’s COVID cases added vital context to community preparation for and response to the pandemic.

Both of these cities used data from the City Health Dashboard ("Dashboard"). Launched in 2018, the Dashboard addresses the problem of data inaccessibility for cities and communities.

My wife and I have been married since 2019, but we’ve known each other since we were 14-year-olds. We are raising a blended family. She has a daughter who is 9 and a 7-year-old son. I have a son who is 8, and together we have a 2-year-old son.

The pandemic has profoundly shaped my parenting experience in numerous ways. I had to transform my house into a combined virtual school, daycare, and work setting. The last year has negatively impacted our seven year old, who is autistic, mostly due to disruptions to the in-person support that he needs to truly thrive. Navigating these evolving dynamics, while working, running a household, and trying to stay sane has been extremely challenging. But being present in my children’s lives makes every moment worth it.

My father left when I was 3 years old. Because he wasn’t in the picture for my upbringing, in some ways, I am trying to reach an ideal as a father that I couldn’t actually see as a child. Something inside pushed me to be different, to counter the “absent Black father" narrative.

When I was younger, my perception of a father’s role was very different than it is now. I grew up in Newark, New Jersey, where norms for a Black child, a Black young adult, and a Black man could be stifling. The limits were very clear on what society deemed appropriate for a Black man, and how you were supposed to interact with others. I was never comfortable with those unwritten rules.

The pandemic and this past year’s racial reckoning have given us a decisive moment. We have an opportunity to build a movement for positive change and collective healing. Part of the national awakening is recognizing the urgency to improve public health and advance equity. Today, multiple organizations and people across sectors are eager to do their part in creating a better, more equitable future.

My colleagues at the Robert Wood Johnson Foundation and I, too, seek bold and lasting change. We believe our path forward must be rooted in the best available evidence. What we need now, urgently, is research on how to eliminate inequities in health outcomes by addressing structural racism. How do we create evidence-based policies and practices so everyone has fair and just opportunities to thrive? 

Long-established biases in our research field have determined who conducts research, and they tend to favor the same institutions and individuals. We also have deeply held beliefs about which types of research are valuable, and too often this constrains innovation.

EDITOR'S NOTE: A recent NPR story (May 18, 2021) highlighted expert insights on how stress from discrimination negatively affects the health of Black men regardless of income level or educational status. Our own RWJF Trustee Dr. David Williams was featured in NPR's story.

Dr. Williams shared a similar, powerful message in a Culture of Health Blog post originally published in October 2017 that we are re-sharing. In this post, he underscored the need for all of us to work together to make America a healthier place for all.

Forty-one years after graduating from Yale University, Clyde Murphy—a renowned civil-rights attorney—died of a blood clot in his lungs. Soon afterward, his African-American classmates Ron Norwood and Jeff Palmer each succumbed to cancer.

In fact, more than 10 percent of African-Americans in the Yale class of 1970 had died—a mortality rate more than three times higher than that of their white classmates.

That’s stunning.

What does it take to overcome systemic racism and become a community where race is not a predictor of success? An assistant county administrator shares the steps her community is taking to transform vision into reality.

During the early days of the COVID-19 pandemic, Bo-Yee Poon and her children left China, where she had been studying Tai Chi for 16 years, to return home to Vermont. What she thought would be a short stay before returning to her studies turned into a much longer one as all flights back to China were grounded indefinitely. With a home but no immediate job prospects in Vermont, Bo-Yee managed to access insurance through Vermont Health Connect, which fortunately made her and her family eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).     

WIC is a federal program that provides critical nutrition assistance to lower-income women, infants, and young children. In 2019, more than 6 million people participated in WIC each month, including roughly half of all infants born in the United States. 

WIC turned out to be just what Bo-Yee and her children needed. It provided access to healthy groceries and tips on how to feed her children vegetables and fruit. But more importantly, it helped alleviate her stress and anxiety around providing nutritious food for her family. She knew that even though she couldn’t work or afford childcare, her family would be taken care of. Today, WIC has helped millions of families like Bo-Yee’s eat healthy food on a lower budget, providing a sense of relief during particularly difficult times.