We are living in an unprecedented moment in our history: COVID-19, racial tensions and a push for restructuring an anti-racist society, social isolation and distancing, economic gaps and inequities. Well, if not unprecedented, at the very least we are seeing a stunning confluence of events and tensions in our political, societal, and economic systems that leaves us thinking about really big questions.
Academics would call many of these issues wicked problems – social or cultural problems that are difficult or impossible to solve because we either have: 1) incomplete or contradictory knowledge, 2) too many conflicting people or opinions involved, 3) a large economic burden, or 4) highly interconnected problems. My colleague Don Mathews touched on this in the June 17th, 2020 column in his discussion of race and poverty from an economic perspective. Race and poverty are linked to other issues like access to education, nutrition, healthcare access, and so on. There is no definitive formula for figuring out these questions and the solutions are centered on improvement rather than an end state.
The good news is that history and research can provide guidance to reach a state of improvement. I recently read a study by Jason Coburn et al. (Health in All Urban Policy: City Services through the Prism of Health, 2014) that examined inequality factors and health; another wicked problem. It sought to explain some of the determinants of health and social equity. It also highlighted a policy strategy called “Health in All Policies (HiAP)” that ensures that policy making outside the health sector addresses the determinants of health and social equity. There is an explicit focus on equity and participation by government, experts, and communities.
The Coburn article made me think about the COVID-19 pandemic and the disproportionate impact on people of color. The same determinants explained in the article and by the World Health Organization – economic policies and systems, development agendas, social norms, social policies and political systems – are creating conditions that lead to disproportionately higher death rates in people of color due to COVID-19.
Pre-pandemic realities that limit access to health and wealth for people of color are also leading to higher death rates during the pandemic. For instance, higher rates of underlying conditions (related to less access to quality healthcare), lower access to transportation, and disproportionate representation in occupations that are now frontline jobs, have all led to this unequal share of deaths due to the pandemic.
This wicked problem is a systemic issue. As a result, solutions have to be tailored to address the system. For example, because predominantly African American communities in New Orleans had lower access to personal transportation, Louisiana changed their testing strategy from drive-through testing sites to targeted testing within these communities. This is but one of a set of structural issues related to the pandemic, but it illustrates ways that our public health organizations and states can improve outcomes for racial and socioeconomic groups that are being impacted in unimaginable ways by simply meeting basic needs.
When you can’t access food, private spaces to self-isolate, transportation, quality healthcare, or outdoor spaces away from others, your prospects for successful recovery from COVID-19 shrink significantly. As we grapple right now with ways to combat systemic racism, we should also be considering ways that the system can be changed to generate better outcomes for those communities that are most vulnerable during this ongoing pandemic. The HiAP strategy provides one such option by “integrat[ing] community knowledge and health equity considerations into the agendas of policymakers who have not previously considered health as their responsibility or view the value of such an approach” (Coburn et al. 2014). Tackling these wicked problems is going to require new thinking, but fortunately we have some tested strategies and ideas to guide us along the way.
Dr. Heather Farley is a professor of Public Management in the School of Business and Public Management at College of Coastal Georgia and Chair of the Department of Criminal Justice, Public Policy & Management. She is an associate of the College’s Reg Murphy Center for Economic and Policy Studies.
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