Building More Equitable Health, Housing and Human Services Systems Post-Pandemic

May 05, 2021 | Frank Alexander

All too often, work in health, housing, and human services systems is siloed. However, when you move upstream and work together, these industries can address the root causes of health and social issues. If we continue to operate our systems in silos, responding with a crisis orientation, we will be unable to fundamentally improve the challenging conditions our communities face. We may be able to create the conditions for strong, thriving families and communities if we focus on strengthening community leadership and working across systems.

Having seen and led such approaches at the community level, I believe we can propel our efforts to emerge from the pandemic and to directly address racial injustice by centering our collective north star on the health, well-being, and economic success of every child, family, and community. The COVID-19 response and recovery present an opportunity for us to build a shared understanding of how to strategically invest in a way that accelerates our shift upstream—from reactive services into prevention-based, family-strengthening supports, and healthier community conditions. We should not waste the hard-won lessons that this moment provides.

Role of public health as a convener

I do not believe our future well-being exists in siloed systems. Rather, the future is in the nexus of these systems and how they work together. That perspective has been informed by talking to thousands of community members that have accessed public supports and services. The themes in community conversations across the country offer similar insights—and this regardless of whether they are a parent of young children, an older adult needing supports and services, a youth transitioning to independence, a family experiencing a disaster, or someone working to re-enter the community from an institutional setting. Individuals and families see governmental systems as a monolith, and they do not understand why we make it so complex to navigate these very systems that are charged with meeting common and consistent needs with supports that will help them move forward. Those are absolutely not problems within individuals and families, these are problems with our systems.

The COVID-19 response offers an opportunity to break down these silos, coordinate referrals and services between agencies, and work together upstream where we can focus together on creating conditions for health and well-being. For example, some states have set up COVID-19 contact tracing and vaccination systems knowing that the impact of COVID-19 has not been felt equitably across our society. In response, community health workers and contact tracers can be trained to facilitate access to resources across systems, such as SNAP, WIC, home visiting, rental assistance, legal representation, and other social service programs.

In addition, public health has a wealth of expertise on the health impacts and long-term societal costs of adverse childhood events. For example, in Colorado during the pandemic, we collectively used federal funding to provide access to diapers, wipes, and formula in partnerships across the state. Our human services agencies, public health sector, and family resource centers used a targeted focus on every family, prenatal to age one. These sectors and agencies can emerge from the pandemic with an eye toward working transformationally together.

Moving upstream requires big picture leadership

During my career leading the Boulder County Department of Housing and Human Services, as well as working in direct community services, I heard consistently from families, parents, caregivers, and youth about what they needed and wanted to thrive. It is never intensive intervention systems, rather access to proactive supports where they can self-determine their own future—supports that are readily available at the time they are needed and fully accessible in the community. Families need access to early care and education for their children, maternal child health and health care, safe and affordable housing, and open pathways for educational and economic opportunity.

Developing relationships and building leadership within the community is essential to create a healthy and thriving society—and to deliver effective and responsive services. A first step can be creating open and consistent forums for community participation, especially from families and youth experiencing disruption in their lives. Longer-term, we want to bring governmental services and supports in close contact with the communities so service delivery is consistently adapting to the voice and expertise of community members, essentially moving toward shared decision-making. That takes time and investment, especially investment in community partnerships and community organizations.

We do not need systems that set the table for community feedback and then move forward without being accountable for incorporating that feedback into its operations. Community engagement should continue even after an intervention to reflect on opportunities for improvement and to develop long-term, trusting relationships. In addition, we don’t want to replicate this approach program-by-program, agency-by-agency. If public health and partner agencies want to build integrated systems with streamlined access points and collective feedback, then we need to incorporate community and family voices about the root causes of inequities that transcend across systems.

Are silos holding us back from reaching our full potential?

There is no amount of philanthropic funding that will ever match the level of federal resources made available through COVID-19 relief bills. By working together across government, community organizations, and philanthropy, we can seize the opportunities that have arisen during the COVID-19 pandemic to shift the focus of our systems toward prevention and to collectively activate and invest the new resources available to us.

If we invest in our professional relationships and shared knowledge, then public health agencies and partners can begin to tackle systems change. This is our chance, as systems, to get it right and rebuild our standard operating procedures both during and after the crisis in a way that reflects what our communities want to see: a rapid deployment of resources, a true focus on racial justice and systemic change, community shared decision-making and leadership, and preventive supports that are accessible long before a family or community falls into crisis.

If we don’t move upstream, we may not arrive at solutions that will improve the health of the full community. As we work across systems and agencies, spend time listening to our partners to understand the ways we all define problems and the struggles our staffs and communities experience. This is our time to think through how we build partnerships to move upstream, help dissolve problems together, and build a far more equitable nation.

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 (cooperative agreement OT18-1802). 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.