Lessons From the COVID-19 Pandemic: Building Healthier, More Resilient Communities

Since the coronavirus was first identified in late 2019, COVID-19 has affected millions of people around the world—physically, emotionally and financially. 

In the United States, more than 400,000 people have died from the disease. As the pandemic wears on, its compounding effects continue to test the resilience of communities across the country. 

Americans filed 84 million claims for unemployment since mid-March. The U.S. unemployment rate stands at 6.7 percent as of December 2020.

Unsurprisingly, symptoms of anxiety and depression surged over the past year, according to the Centers for Disease Control and Prevention (CDC). Some 40 percent of U.S. adults reported mental health issues or substance abuse in late June 2020.  

The emergency authorization of two safe and effective vaccines has offered Americans much needed hope.  More than 37 million doses of the COVID-19 vaccines have been distributed across the United States as of January 21, and more than 15 million people have received their first shot, the CDC reports.

But the distribution of the vaccines has been more challenging and slower than expected. Now, as millions of Americans anxiously await their turn to roll up their sleeves, it is increasingly important to understand and address the factors that contributed to the greater vulnerability of some parts of the country over the past year.

Conversely, understanding how and why other areas were better equipped to navigate and cope with this unprecedented adversity can help inform strategies to build stronger, healthier communities.

Gaining Insight Into Resilience and Vulnerability

Sharecare’s Community Well-Being (CWBI) Metro Area and County Rankings Report reveals themes that separate the nation’s top 10 percent and bottom 10 percent.

Sharecare released the CWBI rankings report in partnership with Boston University’s School of Public Health (BUSPH) in December 2020. For the first time in well-being rankings history, the report encompassed all Census-designated metropolitan statistical areas (MSAs) and 99.9% of U.S. counties.

This year, Greater San Francisco (CA) achieved the highest score across all 383 ranked MSAs, while Sebring (FL) had the lowest score in the CWBI rankings.

So, what separates the highest and lowest ranking MSAs? What makes one community resilient and another one vulnerable? 

Themes in the Highest-Ranked MSAs

Taking a closer look at this year’s rankings, San Francisco’s top spot in the CWBI can be attributed to the area’s high scores across both its Social Determinant of Health Index (SDOHi) and Well-Being Index (WBI), in which it ranked #1 and #30, respectively. The city’s rankings in the top 10% for domains across housing and transportation (#1), food access (#4), and healthcare (#15) reflect a strong infrastructure. 

A report by PolicyLink suggests that “investing in the physical infrastructure of disinvested communities can restore the aging systems of water, transportation, housing, and toxic remediation that have outsized impacts on community health, and can create new pathways for work and business opportunities in the communities most impacted by COVID-19 job losses.” 

Reliable infrastructure connects people across towns and cities, providing access to greater employment opportunities, access to quality healthcare and education, Brookings points out.

In the highest-ranking MSAs, the CWBI also found common features that may lend to their top positions. These commonalities include trends in greater wealth and diversity.  For instance, several of the nation’s most ethnically and racially diverse communities achieved top scores in the CWBI, including San Francisco (#1), Boston (#5), Honolulu (#7), and New York (#9). 

More education and higher levels of voter participation were other common factors among the highest-ranking MSAs. The top 10% represented higher rates of private schooling, 37 percent greater than average percentage of individuals with college degrees and more than 60 percent greater than average percentage of individuals with advanced degrees.

MSAs in the top 10% for CWBI also represented more than 66% of voter participation in the 2016 presidential election, compared to 54% voter participation in the bottom 10% of MSAs.

Themes in the Lowest-Ranked MSAs

At the opposite end of the spectrum, Sebring ranked in the bottom 10% of MSAs across SDOHi, WBI and 7 out of 10 CWBI domains. The city ranked in the bottom half of all MSAs for healthcare access (#257), resource access (#211) as well as housing and transportation (#193). Across SDOHi, Sebring also ranked among the bottom 5 for economic security (#379).

Overall, scores were markedly lower in many MSAs that experienced incidents of trauma or unrest. For example, the rural community of Sebring (FL) was the site of a mass shooting in January 2019. A gunman opened fire in a bank, resulting in the deaths of five women (NPR).

Crime density data also shows the second lowest ranked MSA, The Hammond (LA), is the most violent city within the nation’s most violent state.

Other commonalities among the lowest ranking MSAs include the presence of prisons or military bases as well as the loss of jobs in the timber, oil and gas industries, the CWBI reveals. Power plant closures due to a shift away from fossil fuels have accelerated since the pandemic began, according to the U.S. Energy Information Administration (EIA).

With comprehensive coverage and new indices, we hope our report can empower leaders, fuel thought leadership, and help inform decision-making to achieve health equity.