The COVID-19 pandemic laid bare the social, racial, health and economic inequities entrenched in our systems and institutions. Communities of color, immigrants, low-income, and undocumented people suffered disproportionately: they got sick and died from COVID-19 at significantly higher rates than whites. This did not come as a surprise to three Cal Wellness grantees—California Pan-Ethnic Health Network, Public Health Advocates and Prevention Institute—who have been sounding the alarm on racial injustice and health inequity in our state for decades. Now, these grantees are doing everything in their power to make sure that we heed the lessons we learned the hard way over the last three years. You can read their stories at the bottom of this page.

"I frequently pose this question to people. If I were to take you back to 2018 and say to you, 'In a couple of years we're going to have a pandemic, and it's going to be an infectious disease that devastates the world. Who do you think will be most impacted?’” said Dr. Flojaune Cofer, senior director of policy at Public Health Advocates. “Without knowing what the disease was, most people who pay attention to the world around them could have predicted that people most harmed by this pandemic were going to be low-income folks, people of color, people who worked lower-wage jobs. Most people could have predicted that people who are immune compromised or older were going to be at highest risk for getting the disease and succumbing to it.”

Cofer continued: "That means that there are patterns to how our society is set up that were already in place and that were knowable. And that means that there were opportunities for prevention that we didn't take advantage of."

At Cal Wellness, we believe that our health and wellness are directly affected by our race, class, gender and disability. By our zip code. By our family history. By our immigration status and past involvement with the criminal justice system. In public health, there is a term for this: social determinants of health.

"The social determinants of health ended up being predictive of who would get COVID-19 and who would suffer the worst consequences from it and death,” said Juliet Sims, associate program director at Prevention Institute.

“For example, are you uninsured or under-insured? Do you have access to housing? If you do, is it crowded conditions? Are you able to shelter in place? Or do you have to leave your house and go to work in order to not lose your home? Do you have access to green spaces and parks where you can safely be active and connect with others? Are you a resident who is undocumented? Because our fellow Californians who are undocumented didn't receive federal checks and they didn't automatically have access to emergency healthcare," explained Sims.

The disproportionate health and economic impacts we witnessed during the pandemic are a result of history of inequity in our state and country. We've known about these differences in health status and lived experiences and we could have remedied them, but we didn't.

If we want to see a different outcome in the future, we must address the social determinants of health in ways that promote health and health equity. And to do that, we need a paradigm shift in how our government and our public health system work.

A Just Recovery From the Pandemic is Possible. But We'll Have to Do Things Differently.

It's understandable that most people's instinct after going though a global pandemic is to yearn to go back to the way things were. The so-called "normal" of the Before Times. After all, the last three years have been difficult for everyone and, for many, the negative effects continue to be felt.

However, the pandemic has shown us unequivocally that the old normal is not working for too many of us. It has also given us confidence to know that we do not have to recreate the old systems. Instead, we can reinvent them. We've already started to.

“We were able to get vaccines out to more people and we made them free and not contingent upon having health insurance. That is a model that we should build on because we now have a proof of concept," said Dr. Cofer.

“I hope the experience of the pandemic will allow us to see that different is possible. That we can build back better than what we had before and not just go back to the baseline. Because the baseline wasn’t the best for a lot of people,” she added.

Dr. Cofer reimagines how housing, health and safety net programs could look like if we learned our lessons from the pandemic.

To address the social determinants of health (the social, economic, and environmental factors that influence health) and create a more just public health system, our grantees are asking us all to dream big. And that starts with changing how our government works and how we invest in our communities—how we allocate our public resources. Some counties have already started experimenting with different models and they are seeing success and opportunity.

“Some counties, like Los Angeles, San Bernardino and Ventura, are trying new things and innovating their processes. To them, the pandemic proved that there's something fundamentally wrong with how we're running our governments and making decisions. They’re now trying to figure out how to change that—how not to go backwards," said Weiyu Zhang, associate policy director at California Pan-Ethnic Health Network.

"They're hosting listening sessions. They're looping in their newly created racial equity offices and various stakeholder groups and asking for their input on budgetary decisions. That has not happened before, and we would love for more governments to do that, including our state government," said Zhang.

Zhang tells the story of Los Angeles County, which made racial and health equity the guiding principle for their American Rescue Plan Act budget allocations. Not only do they have an equity dashboard, but they are transparent about how race and place are factored into the way the money is allocated.

Used Equitably, Public Funding Can Help Us Address Health Inequity

At this moment, we have a once-in-a-generation opportunity to "test out equity strategies" and address the social determinants of health that resulted in extreme health inequities and disparate economic outcomes during the pandemic. It comes in the form of federal relief money that has poured into our cities, counties and state over the last three years.

Our three grantees have been leading data collection, budget research, advocacy, power building, community organizing, and capacity building efforts to ensure that this historic influx of public funding is used to support racial and health equity.

“The public health system has been underfunded and under-resourced for many years, decades. Finally, there is an influx of funding. We believe that this is an opportunity to test out equity strategies that were difficult in a more fiscally restrained environment,” said Zhang.

For the first time in decades, the federal government is investing large sums of money into communities across the country and that money comes with no strings attached. First, there was the CARES Act in 2020. California received $15.3 billion for federal pandemic relief. Then there was American Rescue Plan Act (ARPA). California received $43 billion, of which $16 billion went to local governments.

Both relief funds, but especially ARPA, were meant to be used to help Californians recover from the pandemic while prioritizing communities and populations that were hardest hit. At least, that was the aspirational goal that the US Treasury articulated in their guidelines. However, our grantees discovered fairly quickly that our local governments—which received whopping $21.8 billion between CARES Act and ARPA—did not prioritize equity in how they allocated this historic public funding. Most local governments prioritized law enforcement as opposed to helping people impacted by the pandemic and preventing outcomes like we've seen from happening again.

"Most cities and counties are basically municipal military forces. We spend most of our money on police and sheriffs, and then everything else comes secondary. They're the budgets that are least likely to be cut, the most likely to be increased, and everybody else has to scramble for whatever's left. And that remained true during the pandemic. The law enforcement budgets went up. Public health and other places got some infusions of money, but they had to beg for it. Plus, they were already in a deficit from the 2008 deficit in terms of their budgets," said Dr. Cofer.

At the end of the day, all this work around ARPA is one mechanism that's available to us right now. It's timely and can help us accelerate what we want to see happen in California's communities. Ultimately, we need to share and shift power so that the residents and the communities most impacted by racial and health inequities can have a stronger voice and a seat at the table. We want not just community engagement, but leadership and decision making to be sitting with communities that face inequities.
Juliet Sims, Prevention Institute

Watching the CARES Act funding in 2020 go to law enforcement and criminal justice as opposed to addressing social determinants of health—like affordable housing, essential health care, access to critical social services and quality childcare and education—our grantees were committed to not letting that happen with the ARPA funds. They worked hard to ensure that the money actually reached the communities that needed them most to recover and rebuild.

CPEHN and Prevention Institute did an incredible amount of research including their “How California's Community-Based Organizations Filled the Gaps for Underserved Communities” report, coauthored with ChangeLabs Solutions. The report offers recommendations for changes in policies and practices that can help governments partner with community organizations to better meet community needs. Furthermore, their research project called “American Rescue Plan Scorecards for California Counties" evaluated county budgets to see how exactly the counties were spending their ARPA funds and if equity was part of their framework.

One lesson we learned from our research projects was that community-based organizations are part of our public health infrastructure. They are part of our public health ecosystem,” said Zhang. "Focusing on recovery, we need to look for ways to support and fund CBOs."

Zhang explains that there has been a disconnect between traditional public health and the CBOs that are doing the work for public health. And that they must work together.

Public Health Advocates created the California COVID Justice: Recovery, Response & Repair, an advisory committee that advises local community-based organizations on state and local policy and helps them effectively organize and advocate for the federal recovery money to be spent in the communities that most need it and on issues that are most likely to benefit those communities.

"On the advocacy side, the big lesson is that we all need to get better at understanding budgets and at paying attention to budgets. We saw that if you’re not already knowledgeable about how these systems work, the money will be spent before you even realize what's going on. So many of these decisions are not transparent. They're not made in a way that looks at what we need as a community and matches up the funding to the needs,” said Dr. Cofer.

Dr. Cofer explains that budgets are moral documents and that, with community guidance and input, we need to start coming up with very different ways of spending these public funds.

Among many other strategies, Prevention Institute created a policy brief “Investing in Equity: Designing and Implementing Public Funding Programs for a Just Recovery in California,” which powerfully articulated how the ARPA money, and public investments broadly, should be spent to achieve health equity.

“At the end of the day, all this work around ARPA is one mechanism that's available to us right now. It's timely and can help us accelerate what we already want to see happen in California's communities. We need to share and shift power so that the residents and the communities most impacted by racial and health inequities can have a stronger voice and a seat at the table. We want not just community engagement but leadership and decision making to be sitting with communities that face inequities," said Sims.

Juliet Sims explains that community-rooted organizations can act as strategic partners and keep governments accountable. And to do that effectively, local organizations need support from private health funders like Cal Wellness.

We invite you to read our stories about these three visionary grantees.

Meet Three Nonprofits Championing an Equitable Recovery from the Pandemic

A Just Recovery From the Pandemic is Possible. But We'll Have to Do Things Differently.

Used Equitably, Public Funding Can Help Us Address Health Inequity

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