January 2021 Newsletter

winter in Sedona

Introduction

Welcome to my January 2021 newsletter. You can find past newsletters with additional background materials, and different stories and initiatives on my website and in my LinkedIn articles or posts. Join me in identifying and coordinating initiatives that advance health, health equity and community and healthcare redesign.

Shannah’s Insights and Reflections

The year did not start off well from a pandemic, economic or social unrest/racists standpoint. We will be dealing with the aftermath of a US insurrection facilitated by our past president for years to come. This could be a positive if, as a country, we step back and recognize sadly this also represents the US and structural racism that needs to be acknowledged and addressed.

This newsletter will focus on needed and promising new directions to address the exposed frailty of our health and social infrastructure to highlight the potential for the Biden-Harris Administration and a new Congress. There are enormous challenges that need to shape how we pursue substantive and sustainable change, but it feels like there is also an appetite and expectation.

The Biden Administration swiftly reversed many executive orders that affected or sustained health disparities and inequities. The Executive Order on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government is an ambitious and needed undertaking that should have everyone’s attention. I have to admit it has kept me up some nights thinking about how the government can take this comprehensive approach and still have some real near-term impacts.

To say this is a complex project is an understatement. To recognize it needs a multi-prong approach that looks at both the problems and solutions from different angles will likely be the basis for its success or failure.

This quote from the Executive Order introduction speaks to the breadth of the task:

“Affirmatively advancing equity, civil rights, racial justice, and equal opportunity is the responsibility of the whole of our Government.  Because advancing equity requires a systematic approach to embedding fairness in decision-making processes, executive departments and agencies (agencies) must recognize and work to redress inequities in their policies and programs that serve as barriers to equal opportunity.”

One of the fundamental barriers to support for underserved communities is the fragmented nature of our federal and state government programs. This fragmentation is reflected in the local program implementation and the inability of communities to leverage resources across programs to address their unique priorities. We see this every day when trying to help individuals and families access services, even as local counties and cities try to have a no wrong door policy that connects people to the resources and services they need regardless of where they show up in the system.

In the short term our country needs to make immediate changes in the systemic discrimination evident in our: justice system – policing, courts and jails; schools; housing, and employment. We also need to address basic human needs. Can we set priority goals that would lift all boats; perhaps eliminating or dramatically reducing: homelessness, poverty, hunger, and violence? The challenges emerge when we consider how we make changes and facilitate the needed increased investment in so many critical endeavors.

An RWJF issue brief on Improving affordability and sustainability of housing is a great example of the breadth of needed change in just one target area. The report highlights a broad range of program changes and improvements needed to foster affordable sustainable housing for low income populations, but it does not speak to funding, specifically how do we finance these efforts.

The Ways and Means Committee published A Bold Vision for a Legislative Path toward Health and Economic Equity. It is a great framework for many pieces of needed change in a broad set of policies through legislation. It also makes clear the extraordinary amount of change that is needed. Yet it is arguably only the first of many steps. It embraces many existing approaches that perhaps should be revisited, and the suggested changes are often very incremental in nature.

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