Bubbling Up

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The COVID-19 pandemic and ensuing economic crisis have had particularly devastating effects on already distressed communities. Latino, Pacific Islander, Indigenous, and Black people, who are historically less healthy and less wealthy than white Americans, have experienced higher death rates, are more likely to have encountered job and other income losses, and face longer-lasting economic fallout than white people. Women and low-wage workers are more likely to have dropped out of the workforce, often due to loss of child care. Individuals with disabilities have experienced higher death rates, have been more likely to lose their jobs than others, and face barriers to information, testing, and vaccination. And rural communities, which were already poorer and less healthy than metropolitan areas, have experienced higher infection and death rates than urban areas, particularly among rural people of color. The causes of these injustices, varied and intertwined, are blockading our path to health equity.

The American Rescue Plan Act (ARPA), signed into law by President Joe Biden in March 2021, presents an extraordinary opportunity to counteract the effects of the pandemic and address long-standing health and economic disparities. ARPA will provide $1.9 trillion over four years to state and local governments and direct economic relief to individuals, families, and businesses. The state of Missouri will receive $2.7 billion under ARPA, and local governments, including counties, cities, and other jurisdictions, will directly take in another $2.5 billion. Determinations on how to spend most of these funds have not yet been made by state legislators, local elected officials, and others with the responsibility to make these choices. It is important, therefore, that those involved approach spending decisions with a framework that ensures funds are distributed in ways that advance health equity.

The following recommendations should be considered when deliberating the use of ARPA funds:

  • Engage Missourians most affected by the pandemic. First and foremost, those leading this charge should have a solid community engagement approach. Policymakers should hold public meetings and create broadly representative advisory groups. Such efforts are already underway in St. Louis, Springfield, Columbia, and other areas.
  • Use data to identify community needs. Always lead with the science. In addition to collaborating with communities, policymakers should use data to drive priorities. There are several publicly available resources, including the Social Needs Index, the Social Deprivation Index, and the Community Needs Index, among others that can help guide informed decision-making.
  • Emphasize cross-sector collaboration. Interventions to stem the effects of the pandemic have been dependent on the cooperation of not only the public health and health care sectors, but also social services, education, housing, community development, and others. States and localities should leverage local assets by using community foundations, community development financial institutions, and other organizations as intermediaries and planning bodies to develop strategies to distribute funds. At the same time, government agencies should coordinate to eliminate funding silos.
  • Restore, enhance, and remove barriers to public services. In Missouri, as of February 2021, the share of losses in state and local government jobs, which are disproportionately held by Black people and women, exceeded private-sector job losses by more than 10%. While most of these are in the education sector, there have also been significant cutbacks in social services, law enforcement, fire and emergency medical services, and others.

    In addition, there are substantial obstacles to participation in public programs. Lengthy and complex application processes, outdated technology, and siloed systems prevent many people from receiving the services and support they need. Improving these systems – by, for example, investing in modern information technology – to ensure that more Missourians who are eligible are enrolled in public benefits programs, will contribute to a safe, healthy, and equitable recovery.

  • Improve conditions for low-wage workers. The pandemic has exposed entrenched economic and labor inequities. Low-wage workers, Black and Latino people, and women are more likely to be both “essential” or “frontline” and work in sectors hardest hit by the pandemic. Decisionmakers should follow the federal lead and require targeted hiring and living wages for jobs created by ARPA-supported projects.
  • Increase funding in early childhood. A large body of evidence shows that early childhood programs, particularly those that focus on education, have positive effects on emotional and behavioral outcomes, cognitive achievement, and health. These programs also show a positive return on investment, including higher future earnings, less remedial education, and reduced criminality.
  • Collect, analyze, and report disaggregated data on ARPA spending and impact. The only way we will measure the impact of ARPA dollars is by planning, from the beginning, to collect and track state, regional, and local data by race, ethnicity, gender, age, disability, legal status, and other sociodemographic characteristics. To ensure transparency, all information should be publicly available via dashboards and other reporting mechanisms.

Following these principles may lead to prosperity in the wake of tragedy because advancing health equity is never a zero-sum proposition. The Federal Reserve, for example, estimates Missouri’s gross domestic product would be $32 billion higher, an increase of nearly 10%, if gaps in racial and gender equity were eliminated. Businesses that close equity gaps boast gains in revenue, increased profits and investment return, and enhanced productivity and innovation. Improving conditions for those most impacted by the pandemic starts with implementing these actionable solutions. If followed, we will see Missourians prosper in new and equitable ways.