With tens of millions of pandemic relief checks already cashed by citizens across the nation, state and local governments are about to get their turn. That means state leaders must rapidly prepare to accept and distribute billions of dollars from the federal government designated to transform the public health response and local economic recovery in communities from coast to coast.
These unprecedented funds are intended to lay the foundation for an equitable response to future crises. We have seen during this pandemic the tragic consequences of underinvesting in public health and our failure to addresses the health-related social needs of many people, especially racial and ethnic communities. Congress and the Biden administration have joined together to initiate massive investments to counter these system failures.
The fast pace and sheer breadth of recent funding streams — including hundreds of billions from the CARES Act, the fiscal year 2021 budget and the American Rescue Plan Act — present immediate challenges and opportunities for states and localities. Yet, without a strategic plan for flexible distribution of the money, developed and implemented with community input, it remains unclear if these massive investments will be effective and sustained.
States and localities must immediately develop master plans to align these resources, coordinate leaders and then move the funds quickly, something that can be a challenge for many government agencies. Fortunately, groups on the ground with ties to community-based organizations and residents can help.
Intermediary organizations, including community foundations and public health institutes, can support state and local governments in creative partnerships designed to thoughtfully deploy resources in ways that meet the ambitious intent of the funding to rebuild and advance equity.
Leveraging local intermediaries to tackle localized health problems isn’t new. These groups have a legacy of success. Learnings from their existing efforts can be applied in this moment of immense need. Two examples of how to do this immediately come to mind. For years public-private partnerships between state governments and intermediaries have combatted the HIV/AIDS epidemic in southwestern Pennsylvania where the Jewish Healthcare Foundation serves as the fiscal agent for multiple federal funding streams.
In Indiana, a partnership between Marion County and The Health Foundation of Greater Indianapolis accomplishes similar goals. They effectively partner with state and local government to triage the available monies, thoughtfully identify recipients, distribute resources and ensure transparent evaluation.
These intermediary organizations are adept at “braiding” different funding streams in cohesive, coordinated ways that tackle broader health challenges effectively. Zip code, housing status, literacy level, transportation access and food security all affect one’s health and well-being. Health doesn’t happen in a silo. Funding to improve health shouldn’t be distributed through silos either.
Intermediaries can ensure federal investments reflect community priorities. They offer a pathway for sustainability particularly for the community-based workforce. CARES Act funding in North Carolina drove the launch of a community health worker initiative that had been discussed for years. Because of funding for a statewide network called NCCARE360, hundreds of community health workers were hired in high-need counties for COVID-19 contract tracing. As the pandemic wanes these professionals will continue to connect residents with health and nonmedical needs including food, housing and employment that can improve health for generations to come. Los Angeles County, California takes a similar approach, mobilizing nearly 1,000 community health workers in partnership with the California Community Foundation to meet the needs of some of the region’s most vulnerable residents.
Beyond public-private partnerships, some state governments are taking the lead in ensuring there is sustained investment and not just a sudden influx of cash that a community may not be ready for. An effort in Rhode Island is a good example where Health Equity Zones pool multiple sources of local, state and federal funds into a comprehensive initiative that works to promote healthy communities and eliminate health disparities. Importantly this “braiding” ensures efforts can be sustained beyond the life of the grant.
The Biden administration, Congress, states and localities have unprecedented opportunities to help ensure that different federal investments are well spent and profoundly enhance America’s public health capabilities. The resources can transform communities but realizing the potential requires alignment of funds and flexibility in creating public-private partnerships with intermediary organizations to maximize the benefits.
Jeffrey Levi, Ph.D., is a professor of health policy and management at the George Washington University’s Milken Institute School of Public Health.