By Sarah de Guia, Rachel A. Davis, and Kiran Savage-Sangwan
Health justice is not just a cause or an idea, but the way forward for public health agencies and communities alike.
Beyond focusing attention on measurable disparities, the term health justice provides a vision for a fair future that minimizes inequities and sends a clear and urgent call to change discriminatory policies, practices, and systems. To achieve this vision, governments and other large institutions must share power with partners of all kinds to change the structural, systemic, and institutional causes of health and wealth disparities. Otherwise, these disparities will continue to keep our communities from achieving their greatest potential to live healthy, prosperous lives.
Our organizations — ChangeLab Solutions, Prevention Institute, and the California Pan-Ethnic Health Network, with support from The California Wellness Foundation and The Blue Shield of California Foundation — came together to help guide California policymakers in centering health justice in their approaches to COVID-19 response and recovery. Our work analyzing community health efforts in California during the COVID-19 pandemic underscores the necessity of collaborative partnerships in advancing health justice. Most importantly, our findings revealed the indispensable role that community-based organizations (CBOs) played in responding to community needs during this time of crisis.
CBOs are powerful drivers of positive change. As leaders, they inspire and connect community members with one another. As experts, they understand community needs and provide culturally appropriate services. As partners, they leverage resources and build bridges between communities and government policymakers.
Yet, CBOs are often excluded from the decision-making processes that directly affect the communities they serve. CBO staff are often expected to take the limited resources they are given and deliver high quality services to their communities — all on a shoestring budget. How much healthier and fairer would our communities be if the CBOs they depend on and trust were considered an essential part of the social services infrastructure?
Our three organizations interviewed over 20 California CBOs about the ways they stepped up to meet community needs during the pandemic. We also reviewed plans that all 58 counties in California submitted to the state Department of Public Health detailing their “targeted investments to eliminate disparities in levels of COVID-19 transmission.” Our findings showed that while local governments often had gaps and lags in their responses, CBOs successfully and quickly pivoted to meet basic needs within the communities they serve. And, unlike local governments, CBOs were able to deliver their supports and services in person-centered, trauma-informed, and culturally appropriate ways. CBOs also served as a crucial conduit for community members to participate in the policymaking process through virtual engagement — an approach that brought many newcomers and previously excluded voices into the public policy space.
Our partners in community-based organizations (CBOs) helped us understand that many communities did not feel that their needs were met by the response from local and state agencies. In particular, CBOs shared that many community members were not able to access or qualify for the benefits they needed, and that services and benefits did not become accessible quickly enough to prevent economic insecurity. Our CBO partners helped us understand how many community members were greatly affected by the lack of language access to government services, the exclusion of certain immigrant communities from the COVID-19 response, and the pervasive feeling of invisibility experienced by many Californians seeking government supports and services.
The COVID-19 pandemic unfolded along societal fault lines created by structural racism and discrimination, as evident in the disproportionate morbidity and mortality documented in many communities. Black, Indigenous, Latinx, and Asian and Pacific Islander communities experienced health inequities due to racism even before the pandemic started. And these inequities will be perpetuated for future generations unless we change the racist systems, policies, practices, institutions, and cultural stereotypes that created them in the first place.
Through better understanding how CBOs showed up, the real experiences of BIPOC communities during the pandemic, and the shortfalls of government, our report identified several ways that health justice can be embedded into the policy planning, decision-making, and resource allocation processes for local and state government agencies. In particular, our report makes key recommendations for supporting stronger partnerships between government entities and CBOs:
- Government should take steps to invest incoming federal and state funding with CBOs in order to strengthen their role as vital partners in meeting community needs.
- Given the lack of capacity many CBOs have in proactively administering contracts with state and local government, CBO funding should be made as flexible and accessible as possible.
- Policymakers should create longer-term relationship-building opportunities with CBOs to help increase the connection between government and the communities they serve.
The overarching lesson of the report is clear: During the pandemic, CBOs filled many gaps by delivering services that local governments could not provide because of issues with funding, access, logistics, and trust. Local health departments can better serve their communities by coordinating closely with CBOs, providing them with funding and technical assistance, sharing power with them for policy and decision-making, and listening to the concerns they raise.
To learn more about our findings and recommendations, please read the full report online.
Sarah de Guia is Chief Executive Officer of ChangeLab Solutions.
Rachel A. Davis is Executive Director of Prevention Institute.
Kiran Savage-Sangwan is the Executive Director of the California Pan-Ethnic Health Network (CPEHN).