As governments, businesses, and individuals scramble to respond to the threat of a COVID-19 pandemic, those of us who work in the social sector rightly ask what we can do to effectively contribute.
In 2009, I was the medical director of the Massachusetts Department of Public Health and worked with my colleagues to face similar challenges posed by the H1N1 virus outbreak. I learned from experience that responses during a time of crisis are only as good as the strength of preparedness, support systems, and relationships that existed before the crisis.
Because of the recession the U.S. was experiencing at the same time, we were faced with potential budget cuts to critical components of our response, including to the public health laboratories we needed to help us confirm cases. Luckily, we were able to avoid that and Massachusetts became one of the first states to be authorized to do confirmatory testing locally, rather than having to rely on getting the samples to the CDC. The valuable time saved in getting definitive results in real-time allowed us to effectively respond to protect residents in ways that would not have been possible otherwise. Our laboratory’s ability to gear up to do the testing was only possible because our state had the foresight to have invested in the highly trained staff, necessary facilities, and resources before the pandemic hit.
The moral of this story is that it is essential to be prepared ahead of time and to resist the temptation to gut public health infrastructure when there is no obvious crisis looming. Yet, right now, the Centers for Disease Control, which is a key element of our response to pandemics, is facing a significant budget cut, recommended by the current administration, which has spent the last several years intentionally undermining and dismantling the very parts of the government that are meant to protect us against and respond to these threats.
My work as a pediatrician and a public health official has also hammered home one indelible point: any natural disaster or public health emergency always takes an increased toll on those groups who were marginalized or excluded before the emergency. These groups often have been denied the material resources to buffer them from threats such as an infectious disease outbreak or a devastating storm.
For example, given that most low-wage workers do not have paid sick leave, if they miss work due to their or a family member’s illness, they lose crucial income that could be the difference between being able to pay their rent or not. They also run the risk of being let go if they miss their shifts. And if they also lack adequate health insurance or any insurance at all, they face the threat of crippling medical bills. So, what starts as a simple illness can snowball into a family financial disaster. In the setting of an infectious disease outbreak such as what we are currently experiencing, such pressures can make it very difficult for people to heed the sound public health advice to “stay home when you are sick.” So in addition to a health problem, we face an equity problem, as this excellent article from the New York Times points out: “Unequal access to precautionary measures cuts along the same lines that divide the United States in other ways: income, education, and race.”
Yet, community and individual resiliency—the ability to use available resources to respond to, withstand, and recover from adverse situations—can be actively promoted by philanthropy and others in the social sector. Ideally, this work is begun before disaster strikes, but there is much we can do even if our preparedness has not been what it should have been. Now is a good time to remind ourselves of what my colleague and our partners at the Greater Houston Community Foundation suggested foundations can do in the wake of a natural disaster. Their excellent recommendations are equally relevant for a public health crisis, like a pandemic. In addition, here are some additional ideas crowd-sourced from my colleagues:
- Ask your grantees what their communities need. There’s probably no better time than now to reach out and listen. I know from experience that community residents and leaders know what would be helpful, but they may not have the resources or clout to get it. Use networks of grantees and partners to gather information about what support is needed and to share resources.
- Help community-based organizations and nonprofits prepare and enhance their crisis planning and emergency readiness so they can maintain operations and avoid disruptions in critical services and programs. Fund organizations that already have established and trusted relationships in the community to ramp up their outreach and education efforts. These can be local partners, or national ones such as NAACP or UnidosUS, who have networks that reach into often-excluded communities and have already done great thinking about how to meet the unique needs of their communities.
- Seek out and support groups that are less connected to health care and public health systems and fund effective public information campaigns aimed at hard to reach audiences. Many communities have developed skepticism or even suspicion of these systems based on their prior experiences of exclusion, bias, or poor care. Support community engagement and increased trust in public health organizations to overcome this wariness and increase the uptake and adoption of recommended practices and accurate information. Ensure that trusted messengers and organizations have accurate and timely information for amplification to their constituents and communities. Support the provision of public education messages in languages and via channels that will reach groups that may often been excluded.
- Provide resources to communities to increase their resiliency. For example, should schools need to be closed for an extended period, foundations can provide funds for laptops or tablets for students who don’t have them to be able to stay connected to their teachers and schools. Give unrestricted, general operating grants to organizations. Expedite grant making so that organizations doing critical work can keep up their operations.
- Use all of the philanthropic tools available, beyond grant making, and share what you’re learning. Foundations can leverage their considerable convening power to help community stakeholders, business leaders, and public sector leaders collaborate to ensure a coordinated and comprehensive response. Raise your voice and help raise the voices of your grantees and the communities they serve—our elected officials need to know what is and isn’t working. Use your influence to advocate for sustaining critical public health and community support infrastructure when we are not in crisis.As a U.S. health expert, my lessons are drawn from a U.S. context. Beyond the U.S., the best way philanthropies can help will vary widely, depending on the local government and public health and health care infrastructure. But our teams have found that these two rules apply to almost any effort that is funded by international dollars:
- Tap into existing and local structures. Most governments have processes and structures set up for emergencies, even when they need external support from donors (bilateral, multilateral, philanthropy, etc.). Circumventing them can create additional confusion and stress in a highly tense situation, adding to a country’s or local setting’s burden rather than helping to alleviate it.
- Consent is key. Relatedly, whatever you do, get consent from the local government and the local community. Involve them in the decision-making and processes. For example, in a humanitarian crisis (outbreak, environmental, or manmade), development organizations and International NGOs (e.g., UN, Save the Children, IRC, MSF) aren’t allowed to enter a country to provide support until the country has invited them or accepted their offer. This is one example of tapping into existing structures, which are in place for a reason, as well as the importance of consent.