Connecting Systems to Build Health Equity During COVID-19
Mar 1, 2021, 12:00 AM, Posted by Chris Lyttle
Editor’s note: This piece was originally published in July 2020.
A Personal Journey
It's hard to describe water to a fish while it’s swimming in it. I was that fish, growing up in a working-class, majority Black community in southwest Ohio. For instance, it hadn’t occurred to me to question why my school had metal detectors and armed police officers at every entrance yet so few textbooks that students had no choice but to share. Or why we had to travel to find affordable fresh vegetables while unhealthy food nearby was as easily accessible as payday loans and other predatory financial products. Having unmet needs was normal in these waters.
I was in high school when I began wondering why there were so many of these unmet needs in my community. An invitation to a cancer research conference hosted at a neighboring public school was an eye-opening experience. The school was one of the top-ranked in the state, nestled in a wealthy neighborhood with a well-stocked grocery store and multiple banks within walking distance.
These waters were different.
That sense of unfairness filtered into my own life from another angle. I attended a school with limited resources which meant that opportunities within the school were offered to only a few. Since my mother was a powerful advocate for my education, I had access to after-school activities and advanced placement classes while friends living on the same block did not. That bothered me too.
It was some years before I learned the language that explained the difference. Studying law gave me a framework to consider racial inequality by exposing me to structural barriers such as red lining, the school to prison pipeline, and Black exclusion from wealth building opportunities such as the GI Bill. I carried this framing into my later work advocating for health equity in public policy and health services research. My early experiences clarified for me what was already intuited. Race-based inequities aren’t the result of personal choices. They reflect societal decisions that give blackness second-class status and normalize their unmet needs.
This knowledge has been empowering for me because it informs the pathway to change.
A strong evidence base confirms what many of us recognize intuitively—multiple systems influence health and must be aligned to improve lives. For example, one significant study found that when systems collaborate, there are fewer premature deaths from cardiovascular disease, diabetes, and the flu.
Conversely, fragmented systems prevent us from treating the whole person. Urging a diabetic to eat nutritious food doesn’t mean much if she lives in a food desert. Providing someone else with job training but taking away his subsidized medical care once he is employed is self-defeating. Policies that keep people who have been involved with the criminal justice system out of public housing break the link between a secure home and positive health outcomes.
COVID-19 Enters the Equation
The COVID-19 pandemic has heightened our sense of urgency. There’s a through-line from our ongoing work at Systems for Action across COVID-19 and the racial injustice that has sparked such an outpouring of protest. Black and Latino communities have borne the brunt of the pandemic—from the risk of infection and the severity of the illness to its economic reverberations. And the racist practices that have been so vividly documented in numerous locales have also sent a stark message about the need for system-wide change.
I’m not naïve enough to believe that if we could just align our systems, we would vanquish racial disparities but I am convinced the pressure we are seeing on communities of color foregrounds the power of better alignment. New data stemming from that same study I mentioned earlier about diabetes, heart disease, and the flu suggest that communities with strong multi-sector networks have fewer COVID-related deaths and lower infection rates. That information should certainly inspire action.
The Wrong-Pocket Problem
There are many tools to align systems—including shared decision making, budgets, or data spelled out in agreements. But we need to learn more about what works best and get that into wider practice.
Too often, cost-benefit imbalance can, in fact, destabilize cross-systems partnerships. A common pitfall is what’s referred to as the “wrong-pocket problem.” Wrong pocket problems arise when costs are taken from one pocket, while the benefits flow into another.
For example, in many cities, police are called to address mental health issues stemming from homelessness or addiction. Many cities understand that expanding mental health services can reduce law enforcement involvement. Making this type of collaboration work is difficult due to costs and benefits flowing in and out of the wrong pockets. In Eugene, Ore., the city created a program that diverts 911 calls involving non-violent offenders to a team that can intervene with mental health services. The city created a successful model that puts money where resources are needed, and alleviates work for another sector that was not well suited for that work in the first place. We want to understand how others solve wrong-pocket problems.
Who Should Apply
This funding opportunity is for research and practitioner teams to evaluate existing models. We welcome all types of cross-sector models, as long as they examine how one sector (like education, criminal justice, housing, urban design, etc.) works in collaboration with the health or public health sector. We also welcome non-academic groups such as community-based organizations, government programs, etc., to apply in coordination with a research team. The proposal must include detailed research methodology. Please read our funding announcement for more information.
I encourage you to join my colleagues and me on March 17 for an informational webinar where we will describe this opportunity in greater detail and answer your questions.
My personal and professional journeys have led me to much the same awareness—systems need to work together to advance health equity. Let’s join forces in gathering the evidence that will inform how cross-sector collaborations can effectively help communities improve health outcomes.
Researchers, Systems for Action seeks proposals to study collaborations across medical, social, and public health systems that allow organizations to share in the costs, benefits, and power fairly. Learn more and apply by June 9.
About the Author
Chris Lyttle is the deputy director of Systems for Action, where he provides strategic direction on cross-system collaborations that address the social determinants of health.