Public Health Advocates Supports Investing in Public Health and Prevention
Public Health Advocates works with communities to pass laws and reform systems for racial and health equity. (Photo by Lawrence Crayton. )
Public Health Advocates (PHA) brings a public health lens to today’s most pressing problems by working with communities to pass laws, reform systems, and establish norms that foster justice, equity, and health.
During the pandemic, PHA launched California COVID Justice: Recovery, Response & Repair, a statewide campaign to strengthen the ability of California’s public, nonprofit, and grassroots public health infrastructure. The campaign had three goals. One, to reduce the spread of COVID-19 in historically underinvested communities. Two, to advocate for equity-focused state and local protections and interventions to mitigate the pandemic’s impact on key social determinants of health in these communities. Three, build our collective capacity to dismantle the deeply embedded systems and structures that perpetuate longstanding health disparities.
In our conversation with Senior Director of Policy Flojaune Cofer, Ph.D, MPH, we talk about California COVID Justice, lessons learned from the pandemic, and what is possible for our public health system going forward. Dr. Cofer tells us that she’s hopeful, that the main lesson she's learned is that “different is possible” and that we all need to get much better at understanding municipal budgets.
Our interview with Dr. Flojaune Cofer has been edited for length and clarity.
I’d like to see public health be a little more radical.
Dr. Flojaune Cofer, Public Health Advocates
When you hear the words “equitable recovery from the COVID-19 pandemic,” what first comes to mind?
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 will be most harmed?"
Most people who pay attention to the world around them could predict that it was going to be low-income folks, people of color, and people who worked lower-wage jobs. Most people could have predicted that people who are immunocompromised or older were going to be at highest risk for getting the disease and succumbing to it. We could have predicted all of that without even knowing what the disease was.
That means that there are patterns to how our society is set up and these patterns were already in place and they were knowable. Which means that there were opportunities for prevention that we did not take advantage of.
Since we didn't do that, when I think about equitable recovery, I think of it as an opportunity to prepare so that we do not repeat the same mistakes in the future. Because there will be future emergencies. I also think about learning our lessons and doing something a little bit better than what we had done before.
Ultimately, we want folks in the community who are doing the work to know that these dollars are there and to advocate for what to do with them. Without the advocacy, those dollars may not be spent in the most beneficial ways.
Flojaune Cofer, Phd, MPH, Public Health Advocates
Tell us about California COVID Justice. What issues have you been working on? What comes next?
California COVID Justice was started to address the critical challenges that our BIPOC and other historically underinvested communities were facing during the pandemic, and to figure out how to do the necessary repair, but also plan for the future.
We are doing this in a few ways. One of them is working throughout the state to advertise the American Rescue Plan Act, the fact that these dollars exist, that $16 billion went into California cities and counties, and that there is a lot of good work that community-based organizations and other advocates should be asking for those dollars to be spent on.
We want folks in the community who are doing the work to know that these dollars are there and to advocate for what to do with them. Without the advocacy, those dollars may not be spent in the most beneficial ways. For example, can we address housing with some of those dollars, and get people into safe and affordable shelter? Can we do jobs training for people who lost their jobs during the pandemic so that they can do some of the essential work that's necessary to help us mitigate climate change? That's what I call killing two birds with one stone.
We're also providing technical assistance if people want to submit letters to city government and county supervisors around how the dollars should be spent. We have resources in Spanish and English available on our website.
Another way that we are working is by trying to think forward and preparing for future pandemics and future emergencies. We sponsored a bill this year, AB 2360, to create a work group under the Office of Health Equity to look at COVID-19 and a few other recent emergencies and identify what the unmet needs were, especially as it relates to historically disenfranchised populations: racial and ethnic groups in California, low-income folks, people with disabilities, and LGBTQ members of our communities.
Our aim was to put together a framework for funding to address those gaps so that when future emergencies occur, we can make sure that there are dollars available for translation of materials into languages other than English, that we have cultural brokers available to provide messages in culturally and linguistically appropriate ways, and that we are able to reach our rural populations or folks who don't have regular access to technology.
In the below audio clip, Dr. Cofer explains that AB 2360 unexpectedly died in Appropriations this year. However, PHA and partners are moving forward on their own.
We've been spending all this money on law enforcement and we still don't feel safe. Maybe we need to invest in the things that the literature says will make us safe. And that's investing in public health and housing and education. Investing in the things that allow people to live happy, healthy, well-adjusted lives. They’re less likely to commit crimes of necessity, crimes of passion, or crime—period.
Flojaune Cofer, Phd, MPH, Public Health Advocates
A big part of the California COVID Justice campaign has been advocating for the equitable use of the ARPA funds. Can you share three lessons you’ve learned so far?
First, I think the biggest structural equity issue is that if we’re not already knowledgeable about how these systems work, the dollars will be spent before you even realize what is going on.
Budgets are moral documents, but they are so incredibly complex, and so few people really understand them, especially at the municipal level. So many of these budget decisions are not transparent. They're not done in a way that takes equity into account or considers the needs of the community.
So the lesson is that we all need to get better at understanding and at paying attention to budgets.
In the below audio clip, Dr. Cofer explains that we need to invest in public health and prevention, and not more law enforcement.
Two, on the municipal government side, we need to start thinking about how to streamline these processes so that they are far less complicated and also far more transparent so that the community is better able to oversee and participate in the process. If we do that, we'll come up with very different ways of spending money. That may scare people at first, but ultimately, we'll be better off if we spend our money based on the outcomes we want to see and not based on our fears. And one outcome we want to see is safety. I think the reason we spend so much money on law enforcement is because we all want to be safe.
My question is: We've been spending all this money for years on law enforcement and we still don't feel safe. Maybe we need to invest in the things that the literature says will make us safe. And those things are investing in public health and housing and education. Investing in the things that allow people to be able to live happy, healthy, well-adjusted lives with all the things that they need. They’re less likely to commit crimes of necessity, crimes of passion, or crime period. You are more likely to live a long and fulfilling life when you're not stressed out, overburdened, and overworked. We know that domestic violence goes up when people are unemployed. We saw an uptick in domestic violence during the pandemic because people were stressed and unemployed.
Third, we’ve learned that different is possible. And what I mean by that is for the longest time, we swore employees couldn't work from home because it was going to be a problem. And then we had to, and the world did not implode. We swore remote learning was going to be the end of education and then we had to. And sure, it's not ideal, but we also found ways to be able to allow people to stay engaged with school even when they weren't in the classroom. We were able to think of the classroom as being more than just the four walls of a school building.
I'm hoping that “different is possible” is a lesson that we hold onto. That we choose not to do things the way that we've always done them, but that we actually consider alternatives. Is there really no way around this, or have we been intellectually lazy about coming up with and thinking through and experimenting with what happens?
We don't need to have our back up against the wall to find a good solution. I know necessity is the mother of invention, but I think sometimes we just need to be able to give ourselves the freedom and capacity to innovate.
What gives you most hope about the future?
The thing that gives me hope is the local work. The fact that communities banded together and said, "Where is our recovery money? We want to see this funded." And some of those things really were funded.
A lot of political will has been built up during the pandemic by people needing to collaborate and needing to get involved and having this heightened attention and awareness on some of the issues. It's one of those things where, once you see it, you can't unsee it
In the below audio clip, Dr. Cofer explains how local work gives her hope.
I'm hoping that public health gets loud after this, gets more radical. Public health is a little too meek sometimes because, in a way, we are most successful when people don't know we exist. And that leads us to often having our funding cut, to people questioning us, turning around after we've saved their lives for generations and saying, “What's in these vaccines? Are they actually good for us?"
Flojaune Cofer, Phd, MPH, Public Health Advocates
Where do you hope public health goes after this?
I'm hoping that public health gets loud after this. I'm hoping that public health starts being more radical. I think that sometimes public health is a little too meek because, in a way, we are most successful when people don't know we exist. And that leads us to often having our funding cut, to people turning around after we've saved their lives for generations and saying, “What's in these vaccines? Are they actually good for us?" To people really questioning us, because we didn't brag and we didn't explain and we didn't do some of the things that we should have done.
I’d like to see public health be a little more radical. I think people will appreciate what's happening if they better understand what could have happened. And I think that's needed more now than ever before.
I also think that the tie between public health departments and communities is essential. I think the goal of public health departments should be to have a community health worker promotora model, where they are deeply embedded on a regular basis in communities so that when something happens, they're not trying to reach out and build relationships from scratch. Instead, those relationships are already there.
And this health worker model should not be short-term. They need to be part of the community, like a school is part of a community. Schools don't think about when they're going to go away or how long the partnership will be. They are an embedded institution in this community, with a playground and community activities. They are a central hub. And public health needs to be that as well in the community.
