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Reflections on the Expiration of COVID-19 Emergencies
Public Health Charts a Path to Equity

Impact Story | May 10, 2023
‍LOS ANGELES, CA (Public Health Alliance of Southern California) --  As we reflect on the expiration of federal COVID-19 Public Health Emergencies, the pandemic exposed critical gaps in our emergency response infrastructure while laying bare devastating inequities that continue to place low-income essential workers and communities of color at risk for catastrophic health outcomes.  Racism manifests as a devastating public health crisis in insidious ways, evidenced by instances of police brutality, the alarming surge in violence and discrimination targeting AAPI communities, and the staggering death rates of immigrant farmworkers that soar 20 times higher than their counterparts, among other tragic examples.
‍The crushing toll of COVID-19 on Black Americans highlighted deep-rooted disparities, with a staggering death rate 2.5 times higher than White Americans. Simultaneously, a centuries-old public health emergency rose to the forefront, as Black men and boys face a 2.5 times greater risk of losing their lives to police violence compared to their white counterparts.  

Public Health Emergencies expire May 11th during AAPI Heritage Month; just weeks before the anniversary of George Floyd’s murder, we are placed at a critical point in time.  We must seize this moment of long-term recovery to reinvent our public health systems rooted in lessons learned. Addressing racism as a public health crisis means embedding community-led, equity-focused solutions to heal historic social, emotional, and economic scars. We must also ensure this transformation is driven by the needs and priorities of those most impacted by inequities.  
"The pandemic exposed what so many Californians already understood from lived experiences: that social determinants of health directly impact health outcomes.  Racist policies and practices drive inequities in nearly every measure of health status that we have. The path forward is investing in communities and public health systems to embed equity in policies and systems.  Our public health infrastructure must prioritize co-creating with community leaders, so we can ensure that our systems reflect and serve us all,” said Savannah North, MPH, Director of Administration & Climate Initiatives at the Public Health Alliance of Southern California (the Alliance.)

Best-Practices born from COVID-19 Responses

During the pandemic, it was local health jurisdictions (LHJs), regional agencies, and community-based organizations (CBOs) that were and still are at the forefront of tackling persisting health inequities. Yet, chronic disinvestment in under-resourced communities and their respective LHJs, made it an uphill battle during the onset of the pandemic. However, this crisis also presented an opportunity for transformative change.   Even before CDC COVID-19 Health Disparities funds were dispersed, our LHJs were committed in their efforts to embed equity throughout their response. ‍
Fully embracing the Alliance and regional resources they developed culturally competent strategies to address social determinants that made BIPOC communities more likely to die of COVID-19.

‍From the City of Long Beach vaccinating older Black adults through faith-based mobile clinic partnerships to Los Angeles County improving vaccine accessibility for people in the disability community, watch regional and national success stories at the Alliance’s Vaccine Equity Video Series.  

Read LHJ equity spotlights in our collaborative brief with the Bay Area Regional Health Inequities Initiative, "Embedding equity into emergency operations: Strategies for Local Health Departments During COVID-19 & Beyond”
Watch to learn how Riverside launched mobile vaccination clinics that brought COVID-19 vaccines directly to farmworkers in the fields.

With support from the California Department of Public Health’s Office of Health Equity, the Alliance published “Supporting Communities and Local Public Health Departments During COVID-19 and Beyond, a Roadmap for Equitable and Transformative Change”    The report draws from lessons learned, proposing the following policy, program, and resource recommendations to pave the way for equitable solutions for years to come:
At the forefront of harnessing data for equitable decision-making and resource allocation is the Alliance’s California Healthy Places Index (HPI.)  HPI addresses a critical gap in the presentation and utilization of social determinants of health data through its race and place lens, and proved essential in the pandemic response. Many local counties utilized the HPI to allocate testing and vaccine resources to disproportionately impacted communities and tailor outreach strategies. HPI informed California's Blueprint for a Safer Economy, directing $272 million in investments to communities most affected by the pandemic. San Diego County employed HPI for equitable distribution of $100 million in COVID-19 Emergency Rental Aid, prioritizing applicants in the two lowest HPI quartiles. Kaiser Permanente Southern California harnessed HPI data to develop a place-based strategy, improving COVID-19 vaccine accessibility in marginalized communities. Their hot-spotting approach proved effective, with over two-thirds of vaccine recipients being Hispanic or Black. The Newsom Administration also used HPI to create a Vaccine Equity Metric, allocating 40% of doses to the 400 most pandemic-affected ZIP codes.
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During the pandemic, the Alliance also established its Regional Equity Learning Collaborative (RELC), to provide foundational learning related to addressing equity challenges and opportunities in Southern California. The RELC brought together public health departments committed to advancing equity and laid the foundation for emergent Equity Change Teams. Its key focus areas included addressing racism as a public health crisis, fostering genuine community engagement and co-creation, promoting workforce equity, and implementing equitable data practices.

Continuing Critical Work

 Working with our Equity Change Teams during the COVID-19 pandemic elevated the essential role small CBOs played in Southern California’s emergency and recovery response, offering outreach, education, and other services. However, this has financially strained many of them. Equity Change Teams highlighted that the COVID-19 emergency exposed barriers in LHJ contracting and procurement processes. When asked about their top three supports during the COVID-19 public health crisis, 77% of CBOs surveyed in this Alliance report listed funding, grants, and other types of emergency aid as their top support. Nearly 48% of CBOs emphasized technical assistance would positively impact their ability to quickly apply for funding. In response, the Alliance launched its Regional Equity Accelerator, a community of practice uniting public health leaders to operationalize equity in Southern California by engaging cross-departmental Equity Change Teams to adopt and implement structural changes to contracting and procurement procedures.
"As we embark on the journey towards recovery, we must rebuild systems with community and equity at their core. That’s the goal of the Equity Accelerator, to empower our jurisdictions to modify policies and remove barriers to ensure grassroots organizations secure vital funding," said the Alliance’s Health Equity & Justice Manager, Hannah Halliwell, MPH, IBCLC.
Halliwell is working with 10 LHJs to implement the Equity Accelerator and firmly anticipates this framework will be adapted to improve other Public Health practices to ensure they’re best serving historically marginalized communities.  The Equity Accelerator is the first of its kind in the region, Halliwell noted it’s a testament to our partners’ commitment to prioritizing equity and achieving large-scale progress through shared learning and dedication.
 “We’ve gotten positive feedback and know the Equity Accelerator Framework can be replicated to reform other government processes. We are hopeful that this regional approach to equity will support collective action for policy and systems reform at county and state-levels,” Halliwell added.
HPI also continues to catalyze equitable investments and practices, propelling community-led solutions and championing health equity far beyond the expiration of COVID-19 Public Health Emergencies.
"It's easier to say what we haven't used HPI for! A couple of unique projects we've done recently: we used HPI to see the changes in several different iterations of proposed County Board of Supervisors boundaries and saw some significant differences. Another way we've used HPI is with our probation department, creating a dashboard for their data," a local Public Health leader said.
 California’s Creative Corps Pilot Program recently harnessed HPI to allocate $60 million to promote Health Equity through Art across 58 counties within the lowest quartile of the HPI.  The California Arts Council’s executive director, Jonathan Moscone, is encouraging other state agencies to use HPI for equitable investments, noting Creative Corps as a pilot for using HPI to transform all future grant programs.  
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Marin County Office of Equity is using HPI for its first participatory budget initiative, empowering residents and prioritizing action-oriented proposals in under-resourced areas with $2.5 million in American Rescue Plan Act funds. Ideas received to date include free and low-cost early childhood education programs, neighborhood-based disaster response plans, safe havens for social gatherings, and increased access to public transportation in rural communities.  

The launch of HPI's Extreme Heat Index in July of 2022 supports diverse sectors to address climate change-related impacts on under-resourced communities by offering datasets on projected heat exposure, community conditions, and sensitive populations.  The tool aids in understanding community vulnerability and resilience, identifying resources, and prioritizing investments for mitigating extreme heat effects.

Yesterday’s Lessons, Today’s Solutions

  As we face the aftermath of the COVID-19 crisis, California is confronted with a range of critical issues, spanning the health effects of climate change, escalating inflation, enduring disparities, and pressing matters of gun violence and mental health crises.  
We’ve witnessed public health can and must address these vast issues as its the sector that's forged a path forward in the wake of unprecedented times, yet over the past decade, health departments have experienced a 20% reduction in their workforce and up to a 24% decrease in local health department budgets. Pandemic-era government funding enabled many of California's LHJs to establish racial and health equity teams. These teams have proven invaluable in establishing equitable infrastructures across departments and programs to implement multifaceted, neighborhood-led solutions.  However, as the expiration of COVID-19 funding looms, these teams face financial uncertainties that could undermine progress and re-traumatize the very communities they were established to serve.
“Climate change is already taking its toll on community health, especially for our hardworking immigrant farmworkers who put food on our tables. It's vital that we acknowledge climate change as the pressing public health challenge it is. That means investing in our health departments to tackle climate emergencies with equity and community-centered solutions, just as we equipped them during pandemic response,” North explained.
 North added the sustainability of these efforts hinges on establishing stable funding sources by demonstrating to decision-makers the immense achievements already made by incorporating equity into the foundation of public health.   In the wake of our invaluable pandemic learnings and achievements, the Alliance and our partners remain steadfast in confronting pressing challenges of our time by implementing innovative policy, systems, and environmental change strategies that deliver profound and lasting impacts.

Yet, in this pivotal moment, we must continue to elevate lessons learned from our past to forge a brighter future for generations to come. We must cultivate political will among decision-makers to guarantee long-term strategic investments and best practices, that address racism as a public health crisis across all institutional levels for years to come.