Building a More Equitable Economy Post-Pandemic

February 08, 2021 | Ann Flagg

woman-shaking-hands-over-desk-after-hiring_1200x740.pngEconomic security and well-being, job stability, access to safe and affordable housing, access to healthy and nutritious foods, and access to resources to manage mental and physical health—all of these things impact individual, family, and community health. The COVID-19 pandemic has fundamentally impacted each of these social determinants of health for many Americans. Furthermore, some communities and industries have faced harder economic impacts than others, including households with low incomes, non-white households, and households with children.

Healthy People 2020 identified economic stability as a key social determinant of health, and state human services agencies are well positioned to address this key area. In order to help American families recover, state officials are working across sectors and with local communities to make sure services are reaching families in need. In addition, human services and public health leaders can collaborate to make sure we are rebuilding systems and programs in a way that creates healthier, more resilient families and communities.

Responding to the Changing Labor Market During and After COVID-19 Pandemic

State human services agencies are thinking proactively about how the labor market may shift long-term, even after the COVID-19 pandemic subsides. It may be possible that some sectors (like the arts or hospitality industry) will be depressed for a lengthy period after the pandemic. If an individual was employed in that industry for their whole professional life, will they be able to find a job on the other side of the pandemic or will they need to be retrained for a new career that might be more in demand?

APHSA’s members represent the cabinet level leadership of state and local human services agencies. Like state public health officials, they are responsible for leading the state and local agencies that provide direct assistance to families and develop polices, programs, and tools that can be an asset in providing employment and training services. First, states administer the Temporary Assistance for Needy Families (TANF) program to deliver assistance programs that can help families weather a storm. The federal government administers the TANF program by giving states a block grant that can be customized to advance broad goals related to job training, education, child care, income assistance, or other opportunities to help families thrive. TANF is a tool to provide the cash, workforce, and wraparound supports to prevent families from becoming involved in the child welfare or homelessness services continuum.

Families that receive TANF cash assistance are subject to work requirements to remain eligible for benefits—though some states may grant TANF recipients “good cause” from work requirements due to barriers to work. However, states must ensure a certain percentage (known as the Work Participation Rate) of TANF recipients who are participating in eligible work activities for a minimum number of hours. During the COVID-19 pandemic, there has been no statutory change to the Work Participation Rate, though HHS’s Administration for Children and Families has issued guidance stating that, while it cannot waive the Work Participation Rate requirement, it will grant penalty relief for states unable to comply during the pandemic “to the maximum extent possible.” Many states have been thoughtful in broadly granting “good cause” and counting non-traditional work activities—such as supporting children’s virtual schooling—recognizing the barriers to work that persist.

Some states have also been proactive in thinking about how to create continuum of workforce supports across programs, including the Workforce Innovation and Opportunity Act programs—administered as grants by the Department of Labor—and the SNAP Employment and Training programs, administered by the Department of Agriculture. State officials may consider working collaboratively with partners across workforce services, as well as governors’ workforce boards, community technical colleges, and employer associations to understand what kind of new work opportunities will be present during the COVID-19 response and recovery period. For example, some states (including Massachusetts, Hawaii, Delaware, and Utah) are investing in trainings for community health workers (CHWs) to conduct contact tracing as well as social determinants of health needs assessments. In Baltimore, the city health department, the Mayor’s Office of Employment Development, and philanthropic partners are launching an initiative to train and employ city residents as CHWs to assist with contact tracing and public education in the neighborhoods that have been hit the hardest by COVID-19. Other workforce opportunities may exist related to vaccine development and deployment.

Opportunities to Improve Service Delivery Post-Pandemic

Numerous human services agencies are accelerating the adoption of technology solutions that APHSA members have said would otherwise take years to develop. These include telehealth models, virtual communication with clients, and online work engagement for TANF clients. These adaptations have the potential to offer lasting benefits to TANF recipients even beyond COVID-19. Imagine a world in which an individual can access their workforce development and training resources virtually—they would not have to take multiple buses, skip parent-teacher conferences, and miss all the other day-to-day activities of a working family.

Another technology opportunity is in benefits access. States have made great gains in streamlining eligibility processes and making access points simplified (such as through online or mobile applications). Our engagement with APHSA’s members suggests that leaders across health and human services have additional opportunities to leverage technology to improve efficient access to benefits, such as ensuring that families accessing SNAP are easily enrolled in WIC, parents seeking work supports are connected to child care resources, and dislocated workers accessing unemployment benefits are connected to additional supports offered by the human services agencies to help weather the storm.

Based on APHSA’s work, we hypothesize that there may be a significant opportunity to improve service delivery by shifting the human services system from one that is compliance-driven to one that is outcomes-driven. According to feedback from our members who administer these programs, the current structure of the TANF program, which focuses on tracking client participation in specific work activities as a condition for receiving benefits, incentivizes states to prioritize their time counting hours and placing individuals in the most readily available work activities, regardless of what the clients need to succeed in the long-term. The drastic disruptions in the employment market that have led to new structural barriers during the pandemic have further revealed the importance of co-designing solutions with families to support them with the skills, education, and training they need to remove barriers to work and achieve upward mobility. While states strive to remain agile and flexible within the existing policy framework, our theory suggests that changing how TANF helps support family well-being and economic mobility could have a more lasting impact.

Overcoming the Barriers to Public Health and Human Services Collaboration

Ultimately, cross-sector partnerships can be well-served by having a shared vision and common outcomes where all partners are accountable. Public health and human services partners, as well as communities served, can collectively define their desired future state, look at available resources to achieve that vision, and share data to understand if partners are making progress. These steps are often preceded by leadership buy-in and an investment of time in relationship-building. Together, we can work to identify opportunities to avoid duplication, leverage all the dollars on the table, and pursue outcomes-oriented measures.

Based upon our research and experience at APHSA, we suggest that a shift to a more generative and collaborative system could be more efficient in helping people achieve longer-term employment success, which may have greater potential for economic stability for the family. We have an opportunity now to “bounce forward,” build community-level resiliency, and learn how to better respond to crises in the future.

This product was supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as a part of a financial assistance award for State Public Health Capacity Building totaling $148,000, with 5% funded by CDC/HHS for this blog. The contents are those of the author and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS or the U.S. government.