Social Work and the Next Frontier of Racial Justice: Using COVID-19 as a Vehicle for Healing

ABSTRACT

The COVID-19 pandemic has put the United States and the world into a state of uncertainty. Before the onset of the coronavirus, awareness of health disparities across cities in the United States was questionable at best. As the world continues to grapple with the fallout of the pandemic and the response to it, several states and developed and developing countries created and implemented response efforts that were used as a guide, which social workers are most qualified to address but have not been a focus on a national nor international stage. This commentary focuses on two American states – Texas and Ohio as well as other global countries, and their responses that gained worldwide attention related to healthcare accessibility, service provision, and the role social workers should play moving forward and beyond the pandemic.

KEYWORDS:

• Social work
• pandemic
• COVID-19
• racial injustice

Coronavirus disease (COVID-19) remains a worldwide health concern due to its rapid spread and the serious health problems associated with it. Americans reported more physical symptoms, contact history, and perceived likelihood of contracting COVID-19 than people from the second largest economy, China. Americans also reported more stress and depressive symptoms than Chinese during the COVID-19 pandemic (Wang et al., 2021). Currently, there are more than 55,000,000 confirmed cases of COVID-19 and more than 6,330,000 deaths linked to the disease globally (World Health Organization [WHO] Coronavirus [COVID-19] Dashboard, 2022). The eruption of COVID-19 in the United States has resulted in over 80.2 million confirmed cases and resulted in more than 980,000 lives lost (Centers for Disease Control and Prevention [CDC], 2022). Even though most people recuperate from the disease without hospitalization, it has caused severe, persisting and lifetime complications and led to death for many (Ali, Mortula, & Sadiq, 2021; World Health Organization, 2020a). Even more problematic is that the COVID-19 pandemic has put the United States and the world into a state of grave uncertainty (Jones, 2020). Before the onset of the coronavirus, awareness of health disparities across cities in the United States was questionable at best. Among 535 mayors from cities across the United States, many mayors and some health commissioners were unaware of the potential of local policies to reduce health disparities (Purtle et al., 2018). Given this reality, there is no surprise that some local, state, and federal responses to COVID-19 were uncoordinated leading to increased loss of life.

Federal and local responses to COVID-19

There were distinct trends of the COVID-19 pandemic in the United States that are explainable by the responsiveness of the mitigation measures. The ability to respond to the chaotic nature of COVID-19 was based on unpredictability and understanding (or lack thereof) and modeling of the trends, which required a precise representation of the big-picture behaviors across the country (Siegenfeld, Taleb, & Bar-Yam, 2020). By the end of March 2020, all 50 states had confirmed COVID-19 cases and the United States led the world with its vast number of confirmed cases. In efforts to respond to the overall health and safety of the public, several states created and implemented executive orders, which were used as a guide for individuals, businesses, transportation companies, healthcare and educational systems, congregate living facilities and religious organizations to follow. This led to national and worldwide lock downs for travel and orders for people to stay home causing millions of United States residents to lose their jobs and the unemployment rate to skyrocket from 3.8% in February 2020 to 11.1% in June 2020 (Ali et al., 2021). Consequently, many states soon decided to reopen, i.e., relaxed stay-at-home, face covering and social distancing orders, and the number of people infected, as well as the death toll rose and/or fluctuated, which has had a psychological and economic toll on individuals and communities (Boyraz & Legros, 2020).

The impact of COVID-19 on people of color

The Coronavirus pandemic revealed the severity of health inequities, which have plagued many, including the most vulnerable among us. Specifically, the elderly as well as African Americans, Latinx, and Indigenous individuals in the United States who have experienced a disproportionate burden of COVID-19 associated infections and deaths (Hooper, Napoles, & Perez- Stable, 2020). Initial reports on health disparities associated with COVID-19 included higher rates of hospitalizations and mortality among both African American/Black¹ and Latinx populations that were consistent with rates during the 2009 H1N1 pandemic (Soyemi et al., 2014; Yancy, 2020). The Centers for Disease Prevention and Control (CDC) published data on the pandemic in the United States from the first month noting approximately 1 in 3 people who transmitted the virus were African American. This is significant since African Americans only comprise 13% of the population in the United States; however, they were overrepresented by more than a third (33%) of individuals who were hospitalized COVID-19 patients in 14 states (California, Colorado, Connecticut, Georgia, Iowa, Maryland, Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah) (CDC, 2020). A systemic review of racial and ethnic disparities in COVID-19 about rates of infections, hospitalizations and deaths identified that African American/Black and Latinx groups experienced disproportionately higher infection rates and excess mortality but not higher case fatality due to COVID-19. In addition, Latinx individuals, who only account for 18% of the population (U.S. Census Bureau, 2019), comprise 17% of COVID-19 cases (Fariña, Kim, Watson, & Dyson, 2021). They also had an increased risk for hospitalization due to COVID-19 (Mackey et al., 2021). Yet, much of the attention focused on these individual’s behavior and chronic disease burden that was purported to predispose them to worse outcomes if they became infected by the virus versus the health and social related needs, social determinants of health and structural and systemic racism. Social determinants of health (SDOH) like unemployment, being underinsured and/or uninsured with no access to healthcare, living in poverty, unemployment, poor housing, and environmental justice hazards all add to adverse health outcomes for Latinx and African Americans. These issues serve to further increase their risk for chronic diseases and mortality rates (Baah, Teitelman, & Riegel, 2018), and may reflect the root causes of African American/Black and Latinx individuals’ demise and health disparities (Gray, Anyane-Yeboa, Balzora, Issaka, & May, 2020).

The impact of COVID-19 on Black Americans

Structural racism and discrimination cause numerous adverse health issues and outcomes in the Black community like higher rates of hypertension, infant and maternal mortality, stroke, obesity, diabetes, lung and cardiovascular disease, lower life expectancy, and mental health impairment (Carratala & Maxwell, 2020; Reskin, 2012; Vandiver, 2020). Some scholars coined the “other pandemic” as the upstream systemic inequity of which the identified racial and ethnic disparities in COVID-19 outcomes are a symptom of (Fariña et al., 2021; Gray et al., 2020). In addition, and of utmost importance, these disparities and associated health outcomes are not the result of individual lifestyle choices – they are also the result of implicit biases, including the unconscious stereotypes drawn from experiences learned over time that inadvertently inform meaning and decision-making. They can adversely influence all sorts of communication like those between a patient and a doctor that could result in poorer health outcomes (Gray et al., 2020). Specifically, racism is the system based on power such that the dominant group creates the racial hierarchy and the nondominant groups are deemed inferior (Gray et al., 2020; Williams et al., 2019).

Consequently, it has been suggested that the inequities in infection, hospitalizations, and deaths from the Coronavirus pandemic were associated with racial inequities in housing, lack of health insurance, healthcare, access to clean water, and paid sick leave just like the H1N1 pandemic in 2009 (2020; Gray et al., 2020). For example, African Americans were less likely to receive a confirmatory test that their white counterparts who presented with similar symptoms were able to receive (Dorn, Cooney, & Sabin, 2020) and were often turned away when they presented in the hospital for emergency care because of symptoms of the virus. Consequently, the relationship between COVID-19, racism and SDOH increased the potential for the development of other diseases among those who were already medically underserved (Gray et al., 2020). Populations like the elderly, those with chronic illnesses, those with mental health challenges, and those in rural areas require ongoing care that may not have been covered by insurance before the issuance of the executive orders, thus leading to a lapse in treatment and care.

The convergence of racial injustice, the COVID-19 pandemic as well as the financial fallout from the pandemic in 2020 presented a constellation of crises affecting individuals domestically and globally. However, the impact is especially tragic for people of African descent (Vandiver, 2020). A substantial number of African Americans have not had access to health insurance coverage for proper medical care (Snowden & Graaf, 2019; Vandiver, 2020), which could further exacerbate any undiagnosed or preexisting health issues. In addition, racial disparities in access to and quality of care further contribute to racial and ethnic disparities in the severity and course of disease for African Americans (and Blacks; Williams & Wyatt, 2015) due to systemic racism and discrimination, a general mistrust of health (and mental health) care providers, and a lack of cultural competency/humility on the part of providers (Ferketich, 2020; Lindsey, Chambers, Pohle, Beall, & Lucksted, 2013; Williams & Wyatt, 2015). Together, these factors foster and promote increased levels of stress with the already problematic presence of racial disparities that have persisted throughout history since Africans arrived in America, through slavery and post-reconstruction to the present. Consequently, several states, e.g., Michigan, Nevada, and Ohio have declared that “racism is a public health crisis” (Kovac, 2020, p. 1).

Of note, some medical professional organizations have proclaimed and reiterated this notion, including the words of Vestal (2020) when he stated “Being black is bad for your health. And pervasive racism is the cause” (p. 1). Although it could be surmised that Vestal (2020) is primarily referring to physical health, being Black is also bad for your safety – one’s very existence. As the disproportionate impact of COVID-19 on communities of color put into stark reality the health inequity of Blacks in the United States given the deaths of Breonna Taylor and George Floyd who were killed at the hands of law enforcement and continue to highlight how the deck remains stacked against Black people (Ehrenfeld & Harris, 2020; Ferketich, 2020).

A tale of two states

When the pandemic hit, the catastrophic effects of established, entrenched, structural racism and discrimination on communities of color were observed by everyone, including journalists, public intellectuals, government officials, and entertainers, and most identified the substantial racial and ethnic inequities in COVID-19 prevalence and mortality (Ferketich, 2020). The states of Ohio and Texas seemed to gain national attention based on their responses to the pandemic as it relates to healthcare accessibility and service provision. Both states issued executive orders that permitted the expansion of accessibility and insurance coverage to access healthcare by way of using telehealth systems. These responses came late when compared to orders related to other systems for the public. Late responses created a greater opportunity for a lapse in treatment, especially for more vulnerable populations. Analysis conducted on the new daily cases after stay-at-home/shelter-in-place orders and mandated face covering show upward trends for states defying these orders – for states like Ohio and Texas without mandated face covering, the increasing trend in the daily new cases persisted. Consequently, the distinct trends of the COVID-19 pandemic in these states are explainable by the responsiveness of the mitigation measures (Ali et al., 2021).

Texas

The impact of COVID-19 was disproportionately felt in the state of Texas by not only Black Americans, but Hispanic/Latinx Americans as well (Adepoju & Ojinnaka, 2021). According to the Texas Department of State Health Services, there were at least 51,313 COVID-19 deaths in the state of Texas as of July 2, 2021 (Texas Department of State Health Services, 2021). Of the total confirmed Texas deaths, 46.4% were Latinx, 40.6% were white, 10.2% were Black, 2.1% were Asian and 0.5% were identified as Other (Texas Department of State Health Services, 2021). In a study examining county-level determinants of COVID-19 testing and cases in Texas, researchers found COVID-19 cases per 100,000 were significantly higher among Black Americans and Latinx/Hispanic Americans (Adepoju & Ojinnaka, 2021). Further, the same study highlighted that lack of insurance and primary care physician-to-population ratios were significantly associated with COVID-19 cases in Texas. This is especially important to consider in Texas, as the state ranks 47^th in the United States in primary care physician-to-population ratios, with 67 primary care physicians per 100,000 residents in Texas (Association of American Medical Colleges, 2019; as cited in Adepoju & Ojinnaka, 2021). The data illustrates the importance of considering racial disparities and SDOH when considering the impact of COVID-19 in the United States.

As previously stated, the COVID-19 pandemic has underscored the importance of considering how SDOH (e.g., access to healthcare) impacts health outcomes for different demographics. For example, the state of Texas has the largest population of uninsured Americans in the United States, thus putting populations at higher risk for detrimental outcomes because of the COVID-19 pandemic (Adepoju & Ojinnaka, 2021; Turner, LaVeist, Richard, & Gaskin, 2021). Further, Black and Latinx families are less likely to have health insurance and more likely to reside in neighborhoods of concentrated poverty in Texas (Turner et al., 2021). Specifically, 29% of Latinx and 16.7% of Black Americans are uninsured in the state of Texas (U.S. Census Bureau, 2019). Moreover, Black Americans and Latinx/Hispanic Americans in Texas are more likely to rely on public transportation, live in multi-generational housing and work in front-line service jobs, thus putting them at more risk for COVID-19 than other racial and ethnic groups (Turner et al., 2021).

Ohio

COVID-19ʹs impact was felt in the state of Ohio, but in different ways. According to the state health department, among Ohio’s 38,837 reported Coronavirus cases in June 2020, 56.3% of patients were white and 27.3% were Black. However, Ohio’s population is 82% white and 13% Black and the death rate has closely mirrored the state’s population. Specifically, of the deaths in Ohio in which race was included, 78.8% were white and 18% were Black (Ohio Department of Health, 2021).

In the absence of a coordinated national response, many states resorted to independently acquiring essential equipment and partnering with neighboring states. In many cases, these actions were necessary, while they also created some complications that could have been avoided if there were a strategic national plan in place (Gordon, Dadayan, & Rueben, 2020; Singer, 2020). In Ohio, the governor reacted quickly with stay-at-home/shelter-in-place orders issued on March 22, 2020. The universal approach was taken to decelerate the virus’ transmission rates. One unforeseen issue that resulted from the closure and restricting of businesses was its disproportionate impact on lower-income individuals, many of whom were Black workers (Gaynor & Wilson, 2020). Several states pushed to reopen on a much broader scale to revive businesses and reduce restrictions on their residents. National experts worried that full-scale reopening would lead to increases in COVID-19 transmission and overwhelm the healthcare system that were proven to be accurate (Singer, 2020). Ohio state officials were slower to relax the lockdown to fight the pandemic and drew fierce criticism from Republicans in the statehouse (Gabriel, 2020). In retrospect, policy makers could have created an approach that recognized that laborers deemed essential were more vulnerable to infection and proceeded appropriately (Gaynor & Wilson, 2020).

Further, African Americans were singled out and blamed by government officials for the COVID-19 outbreaks. An Ohio state senator, who is also a doctor, said “could it be that African Americans, or the colored population do not wash their hands as well as other groups or wear a mask or do not socially distance themselves?” (Chiu et al., 2020; Gabriel, 2020). These comments were made during a hearing of the Senate Health Committee about the declaration of racism as a public health crisis. Specifically, they resulted when he speculated about the reasons why Black people might be more prone to the virus. A witness before the State Senate Committee, executive director of the Ohio Commission on Minority Health rebuffed his remarks and noted that his opinion was not that of leading medical experts in the country while citing the CDC, among others. Several other state leaders cited the remarks as inappropriate and hurtful while another cited them as examples of systemic racism given the way that the COVID-19 pandemic has disproportionately affected African Americans (Gabriel, 2020).

The global impact of COVID-19

The magnitude of the COVID-19 virus has been felt all over the world in a variety of different capacities, including public health, economic, and environmental ramifications that will be felt for the near and distant future (Ammar et al., 2020; Gauttam, Singh, & Kaur, 2020; Islam et al., 2020; Maital & Barzani, 2020; Mofijur et al., 2021; Saadat, Rawtani, & Hussain, 2020). Although the pandemic has and will continue to have monumental consequences globally, the implications are felt differently depending on the geographic location, government structure, medical infrastructure, and societal/cultural norms of a particular country (Carvalho, Vicente, Jakovljevic, & Teixeira, 2021; Huynh, 2020; Mitrokhin, Reshetnikov, Belova, & Jakovljevic, 2020). For example, Lee et al., 2021 found depressive symptoms during the beginning of the COVID-19 pandemic were higher in countries that enforced strict lockdown procedures later in the pandemic when compared to countries that were quicker to enforce stringent lockdown orders. Further, researchers have highlighted the transition to online learning and remote work has been harder to implement in countries with a lack of internet access and infrastructure to accommodate individuals with unique educational and employment needs (Lorente, Arrabal, & Pulido-Montes, 2020; Nundy, Ghosh, Mesloub, Albaqawy, & Alnaim, 2021). Moreover, ecosystems, specifically protected and conserved geographic areas, have been impacted worldwide (Waithaka et al., 2021). However, the impact has been felt in Latin America and Africa as these countries saw reduced tourism and budgets needed to preserve protected and conserved areas. Overall, the repercussions of the pandemic have been felt internationally, and the global ramifications are nuanced and layered depending on where an individual resides in the world. Specifically, the World Trade Organization (WTO)² devised an official forecast in early May 2020 of an 8.8% contraction of negative economic growth worldwide for the year, which was closest to reality by the year end (Krstic, Westerman, Chattu, V Ekkert, & Jakovljevic, 2020; United Nations Industrial Development Organization (UNIDO), 2020).

COVID-19 in India exposed the widespread disparities in its public health system and left the understaffed and unequipped system inundated as the number of cases increased (Gauttam et al., 2020). The pandemic prompted an evaluation of the national health policy that aims to make quality healthcare available to everyone. The lack of government investment in a public healthcare infrastructure along with the promotion of private investment in the healthcare sector makes affordable quality healthcare inaccessible to most of the population. While both public and private healthcare infrastructure fell short in meeting the needs during the pandemic, innovative regional models that relied on the community-based resources such as volunteer groups and elected local authorities helped in containing the spread of the infection.

In addition, halting the spread of the COVID-19 virus was met with the wake of the distribution and access to quality healthcare of which global health diplomacy has become an integral idea and focus. The monopolization of the COVID-19 vaccine and the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPs) have been identified as barriers to affordable care in many developing countries (Chattu, Singh, Kaur, & Jakovljevic, 2021). In one study, Chattu et al. (2021) conducted a review of 40 full-text articles on the socioeconomic and medical disruptions created by COVID-19 and noted TRIPs exacerbation of the vaccine apartheid, and India’s WTO platform to combat these disruptions. Further, they identified a great degree of variability in the prevalence of vaccines in developing countries as well as the inability of healthcare systems to successfully address rising cases and deaths due to COVID-19. They also found elevated prices for treatments available to patients due to TRIPs’ socioeconomic impacts such as increases in rates of poverty and hunger. Though support for TRIPs has bolstered research and innovation through the deterrence of counterfeiting, opposition from the WTO in 2020 consisted of several European Union (EU) nations denouncing the proposal (Chattu et al., 2021).

The Global Alliance for Vaccines and Immunization (GAVI) were promoted by G7 and G20 nations via summits to ensure that a vaccine was developed promptly. Despite the noted barriers, TRIPs’ articles supported technological innovation and benefit even though the terms of protection were overruled by independent regulatory approval, which provides developed nations with a financial incentive given their previous evaluation and streams of capital to pharmaceutical companies (Chattu et al., 2021). These regulations may have inhibited vaccine availability across the globe. For example, India known as “the world’s pharmacy” had a consistent emphasis on global health diplomacy. Also, India and South Africa’s joint WTO proposal would waive the intellectual property for devices needed for COVID-19 diagnosis and treatment as well as encourage TRIPs to prevent the copyrights from hampering expeditious vaccine administration. The proposal experienced substantial global support and crowned India’s leadership in undermining health inequities even though it was rejected based on overwhelming opposition from other developed nations. Of note, Chattu et al. (2021) calls to action developed nations to prioritize global health and India to continue engaging in global health diplomacy to deter the exacerbation of healthcare inequities.

COVID-19 has resulted in a world-wide system reconfiguration (Grinin, 2020; Krstic et al., 2020). Chattu et al. (2021) notes an increase in funding for global COVID-19 vaccine research and development, and its continued role in expediting the pandemic’s response in global health diplomacy. The pandemic has affected food security worldwide due to massive recession and major interruptions in food value chains. Swinnen et al. (2020) highlights the worst effect on impoverished people, i.e., migrants, women, and children compared to the wealthy, so there is an eminent need to adjust the food supply chains and systems to make them more effective in the future. However, various support methods at diverse levels commenced across the globe, i.e., in China, India, Russia, Germany, the EU and other leading emerging markets (International Labor Organization [ILO], n.d.; Jakovljevic et al., 2020; Krstic et al., 2020). The degree to which both global political pressures and fall-out will persist after the Corona-induced recessions and even depressions in many countries will continue to unfold for the entire world to see (Jakovljevic et al., 2020; Krstic et al., 2020).

Are social workers essential workers?

The state directives across America included medical and public health provisions for “essential workers,” doctors, nurses, and other medical professionals, as well as service workers in transportation, food services, etc. Although social workers perform numerous essential roles, they were excluded from this distinctive group. Social workers are most recognized for their role as caseworkers who separate children from their parents or caregivers due to abuse and neglect allegations. However, social workers are also community advocates, clinicians/therapists, administrators, executives, policymakers, researchers, politicians, professors, etc. Of note, and most essential is that social workers have been on the front lines in some of the most marginalized communities, standing with and fighting for the most marginalized populations, especially Black people who have been hardest hit by the COVID-19 pandemic. This harkens back to the historical role of Black social workers who promoted the strengths of Black Americans (Brice & McLane-Davison, 2020).

The lack of urgency displayed by the federal government and the lack of coordination between government agencies has impacted the magnitude of the pandemic in the United States, which has been noted among Black Americans, given the high rates of their exposure and death to COVID-19 (Wallach & Myers, 2020; Weaver, McKay, & Abbott, 2020). From a lack of widespread testing, delayed financial responses to collapsing industries, and even a lack of acknowledgment of the severity of the pandemic, the federal government was inadequate. Mistakes are going to be made during unprecedented times, but the number of mistakes demonstrated by the federal response has made the road to recovery much more difficult in the United States. Also, this lack of response has fueled the local responses of some states like Texas and Ohio as well as developing nations like India.

The role of historical and collective trauma

The aftermaths of the pandemic have been experienced in all aspects of life and have interrupted life as we knew it. In addition to this interruption, substantial loss, anxiety, and trauma have and continue to affect us all. In addition, historical trauma is both complex and collective and it is experienced over time and across generations by groups of people who share an identity, affiliation, or circumstance (Crawford, 2013; Quinn, 2018). Recognizing historical trauma as an intersectional social determinant of physical and mental health for Black people is a dire step to understanding the impact of trauma on Black Americans’ health, well-being, and healing (Forman, 2012; Ginwright, 2015; McLane-Davison & Hewitt, 2016; Quinn, 2018). However, in the face of the current pandemic and ongoing accounts of police brutality, there is an ever-present collective trauma, which suggests a “blow to the basic tissues of social life that damage the bonds of attaching people and impairing the prevailing sense of community” (Erikson, 1976, p. 194). Collective trauma can “shatter the core” of community connections, and undo aspects of community functioning, especially when resources are destroyed and needs cannot be met (Riedel, 2014, p. 260). The very communities where social workers have been actively engaged are those where they are directly impacted by these traumatic events.

Some examples of collective trauma exposure have identified slavery (also an example of historical trauma; Quinn, 2018), the 9/11/01 attacks on the United States, and Hurricane Katrina (Duane, Stokes, DeAngelis, & Bocknek, 2020; Mazur & Vollhardt, 2016; Peleg, Lev-Wiesel, & Yaniv, 2014; Updegraff et al., 2008). However, other examples of collective trauma include the enslavement of Black Americans, along with individuals involved with the youth punishment³ and criminal justice systems (Quinn, 2018; Quinn et al., 2022). These populations comprise unique identities and experiences that undergird the current circumstances we are facing today, and further compound existing and potentially dormant traumas. Some of the effects of collective trauma suggest many individuals will suffer psychological impacts of the current COVID-19 pandemic, as well as the murders of Black American civilians by police, include posttraumatic, somatic, and other mental health disorder symptoms (Itzhaky, Weiss-Dagan, & Taubman-Ben-Ari, 2018; Loeb et al., 2018; Marshall, Frazier, Frankfurt, & Kuijer, 2015: Riedel, 2014). The impact of the Coronavirus pandemic and the inconsistent United States government responses reflect longstanding collective trauma that requires a comprehensive, long-term, and culturally tailored response.

Social work’s response to COVID-19

The social work profession finds itself at a critical intersection, facing both the COVID-19 and structural racism pandemics. Moreover, social work students have been significantly impacted by both pandemics as well, which also includes interpersonal racism (Baah et al., 2018; Fariña et al., 2021; Gray et al., 2020). To begin the healing process for individuals, students and communities, social workers must be knowledgeable about the historical and collective trauma and policies that exacerbated disparities during these pandemics. Furthermore, social workers and all other social and healthcare providers must be educated on structural and systemic racism and recognize their biases to best address the issues stemming from the pandemic and plan for future responses. Social workers must understand what may work for a rural community in Appalachian Ohio may not work for an urban community in north Texas or the forest lands in Africa and India. These considerations are salient for the effectiveness of social workers based on the profession’s emphasis on social justice (National Association of Social Workers [NASW], 2017).

One approach to understanding social work’s response to COVID-19 is through the socio-ecological framework (Bronfenbrenner, 1979). The socio-ecological framework provides a model that can be used by both the social work and public health fields to start the process of healing needed to recover from the devastation caused by COVID-19 and structural racism pandemics. The framework builds upon Bronfenbrenner’s ecological systems theory (1979) and recognizes the impact of different social factors on human development and well-being. The original conceptualization of the framework includes five levels: (a) individual/interpersonal, individual traits that impact behavior; (b) interpersonal, the relationships with other people; (c) organizational/institutional, regulations and rules of organizations that can influence behavior; (d) community, location of resources that influence social norms, social networks, and resources; and (e) policy, federal, state, and local policies that impact one’s life (Max, Sedivy, & Garrido, 2015; McLeroy, Bibeau, Steckler, & Glanz, 1988). The framework has been adapted and utilized by a variety of organizations, some of which include the CDC and the WHO (Dahlberg & Krug, 2002). The socio-ecological framework provides a model that can inform how strategies can be utilized to address the myriad of different factors that should be considered for responding to the pandemics (Golden & Earp, 2012; Raboisson & Lhermie, 2020).

Stress, anxiety, and depression related to the pandemic can be conveyed across the different levels of the socio‐ecological framework (Lee et al., 2021). Society has undergone widespread, concurrent changes across multiple levels during these pandemics. Specifically, these changes can be felt at the individual level through beliefs, behaviors, and emotions, at the interpersonal level through relational interactions, at the organizational level through political and systemic implications, and finally at the community and policy level. To best address, the devastating impact of the pandemics, social workers and public health officials must strategically utilize interventions that are specific to the needs that arise due to social factors within each level. Our previous discussion about the impact of COVID-19 on people of color and Black Americans provides a solid explanation of its impact on the individual and interpersonal levels. Next, we explain the community level in the United States by describing Head Start and how this program positively affected children in their communities, as well as the societal level with a focus on the role of politics and public health.

Head start programs – community level

Head Start is a dual generational program that serves low-income families with children prenatally through three-years-old. It is one of the largest federally funded programs for infants and toddlers in the United States (Green et al., 2014). A national randomized trial found the program was effective in improving outcomes for both parents and children, including child maltreatment (Green et al., 2014). This is noteworthy since approximately 3.5 million children are reported to CPS for child abuse and neglect allegations (U.S. Department of Health & Human Services [USDHHS], Administration for Children & Families, Administration on Children, Youth, and Families, Children’s Bureau, 2018; Yoon, Quinn, Shockley, & Robertson, 2019), and more than 676,500 children in the United States were abused and neglected in 2011 (U.S. Department of Health & Human Services, 2018). However, the effects of the pandemic have placed greater numbers of children at risk for abuse, especially youth of color. Black families and especially Black girls are experiencing more stress due to the coronavirus and its effect on their mothers (parents/caregivers) with 57% noting that their mental health was worse due to the virus and its response (Power, 2020). Given the prevalence of child maltreatment, its consequences for children’s health, development, and academic outcomes, and how most public and private systems were taxed at the height of both pandemics, it is imperative to have effective programs like Head Start that show improvements in their well-being (Bolger & Patterson, 2003; Green et al., 2014; Leeb, Lewis, & Zolotor, 2011; Yoon et al., 2019). Furthermore, programs like this are even more necessary during times of strife like the COVID-19 pandemic, which has strained people, communities, and systems in ways that have not been experienced in this century.

However, some scholars have noted that the social work profession has not been sufficiently involved with Head Start programs (Frankel, 1997). Findings from a representative sample of Head Start programs noted a minimal role professional social workers played with Head Start although sufficient financial resources were available to employ BSWs or MSWs were available (Frankel, 1997). Yet, more recent efforts have been made to utilize social workers in Head Start programs. Specifically, social work–facilitated patient navigation to help mothers with depression engage with mental healthcare was instituted and showed significant benefits to participants (Diaz-Linhart et al., 2016). In a randomized pilot trial in Head Start programs, seven paraprofessional navigators were trained and underwent supervision from professional social workers. After six months, they found an increase in the number who engaged with a social worker, therapist, or psychologist, or who engaged with any provider and later reported having a “depression care provider.” Consequently, the incorporation of social workers via community-based navigation shows feasibility and utility (Diaz-Linhart et al., 2016). Also, this trial took place prior to the pandemic, so it is safe to assert that program models like Head Start, which effectively utilize social workers, are needed during and post-COVID-19.

Politics and public health – societal level

Even when – objectively speaking – death is on the line, the partisan bias between Democrats and Republicans makes it difficult to believe the facts about COVID-19. For instance, Republicans placated to their political base by promoting messages on the importance of the economy and people getting back to work despite the inadequate public health response on how to reduce the number of COVID-19 cases and deaths. Democrats have placated to their base by strongly suggesting the economy remain closed, and once reopened they promoted strict (CDC) guidelines about mask-wearing and/or social distancing when in public. Neither party had an adequate plan or response to help reduce the hospitalizations, deaths or increase COVID-19 testing and vaccine availability especially as the number of deaths continue to increase before they started to decrease, and variant strains like Delta and the Omicron⁴ viruses emerged. Near the end of November 2021, Omicron cases (new variant) were recorded and verified in France, the United Kingdom, Germany, Portugal, and Scotland. Additional cases of the Omicron variant have been confirmed in Canada, Australia, India, and the United States (Banerjee, Robinson, Banerjee, & Sathian, 2021). The political divide in the United States, although not new, its reflection in where and how individuals consume news and, correspondingly, interpret facts, is thus of particular interest, as the different political parties may present different interpretations of factual data, instilling different perceptions of risk in those viewers – who may, in turn, respond differently to information about COVID-19. Information about COVID-19 continues to be deemed acceptable by the public based on their political beliefs and the politicians who share those beliefs. Scholars noted that vulnerable populations like immigrant or ethnic communities and those without formal education, i.e., low literacy or educational attainment may also lack critical health information from government sources (Le et al., 2020; Lee et al., 2021). If both political parties do not find time for tolerance and concession to focus on life-saving measures and halt further spread of the virus(es) worldwide, bipartisan consensus will be harder to reach during and post-pandemic crises.

Social workers are mostly known for working within communities and with families, and children. However, the time is now where social workers must start contributing to the development of national policies around the well-being, health, and healing of families, children, and the most vulnerable people in our country, especially now with Ukrainian refugees in the United States and other countries due to the war with Russia. It has been noted that Americans feel a sense of “threat by Russia’s actions” (Moshagen & Hilbig, 2022, p. 14). Most social workers have the expertise to write, develop and enact policies that can help benefit the American people when pandemics like racial injustice and COVID-19 and war happen during everyday life.

Recommendations and next steps

Ongoing redress is needed to implement a cohesive and coordinated response to the current and past atrocities in American society. Social workers are key to this effort and need to seize the opportunity to enact comprehensive change that exceeds the past adage of “helping people.” The first step in this process is to recognize and obliterate the problem of racism in our practices, policies, and education/training approaches. This process is critical to how we proceed in our response to COVID-19, as well as the ongoing violence perpetrated by the police and carceral system actors to halt further harm and death of Black Americans. In addition, these efforts need to be intentional and shift the focus to a framework of healing justice, which mandates that oppression be seen as community, collective, and global trauma involving an approach “that restores individuals and communities to a state of well-being” (Ginwright, 2015, p. 9).

Another recommendation is that social workers should strive to capitalize on the assets already present in a community and utilize a community cultural wealth model (Yosso, 2005). Instead of providing answers to communities, social workers should bring their expertise and resources and work side by side with communities to formulate effective strategies. Social workers must advocate for policies that are directly dedicated to improving the lives of communities impacted by COVID-19 and racial injustice pandemics, and now war in Ukraine. For example, social workers can collaborate with local, federal, and global governments to create and promote policy interventions that will “include the mental health community and representatives of vulnerable populations during the development process,” to ensure they are a part of the most effective responses to the pandemic(s) (Lee et al., 2021). They can advocate for increased access to farmers’ markets to address food insecurity in urban and rural neighborhoods whether in Central Ohio, border cities in Texas, or Uganda, Africa and any other areas adversely affected by the global disruptions, i.e., food chain. Also, scholars note the importance of future studies to investigate post-pandemic mental health disparities around the world. Specifically, Lee et al. (2021) suggested another study should assess how the impact of previous lockdown and other safety measures, e.g., wearing masks and face coverings and social distancing may mediate or moderate the incidence of depression due to COVID-19, the Delta and Omicron variant viruses using nationally representative data. The ability of social workers to translate research about health disparities into effective practice and public policies requires that the public and policymakers are knowledgeable about disparities and their causes, especially in the face of COVID-19 (Williams, 2012). Programs like Head Start have proven to be effective with Black Americans, especially those bereft and lacking resources and social capital due to grave losses associated with the pandemics. Social workers have already shown their ability to respond to needs, especially in crises so expanding these efforts now is imperative.

Second, social workers must do the work to educate themselves on racism, historical and collective trauma, sexism, privilege, intersectionality, and other social justice issues that impact the communities they serve. Often, social workers who belong to a minoritized group are placed with the additional burden of educating those in the majority. Social workers must continue to develop and promote an antiracist platform that can be used by both parties to help reduce racial bias, reunify the country (and world), and help create a healthy society for everyone. In addition, learning from the successes and opportunities we witnessed in states like Texas and Ohio and countries like India will be key to social worker’s abilities to transform the communities and organizations they advocate for and work with. Consequently, social workers must continuously educate themselves, beyond attending mandatory diversity training(s).

Social workers must continue to be present in areas where populations are most marginalized. For example, a place such as a prison, domestic and abroad will need social workers to advocate for incarcerated populations. The COVID-19 death rate in prisons was 39 deaths per 100,000 prisoners, which was higher than the United States population rate of 29 deaths per 100,000 (Saloner, Parish, Ward, DiLaura, & Dolovich, 2020). Assisting prisoners in gaining access to accurate public health information as well as advocating for strategies that will help keep them safer in a congregate setting is critical given the adjustments made for COVID-19. Social workers can also enhance mental health treatment for individuals who feel an increase in fear and anxiety in addition to the challenges that come with being a part of a disenfranchised population during times of crises.

In conclusion, our nation and world need a “do-over” and to become a proving ground for the fate of those most vulnerable during and post-COVID-19 pandemics, as well as those affected by police violence and the carceral state. This is necessary if we are going to seize the chance for healing and recovery amid the collective trauma we are living with. Social workers need to claim and lead this movement of healing and demonstrate a strong and comprehensive approach to respond to these crises of our times and create a blueprint for understanding and addressing the physical, psychological, political, and economic outcomes of those with the most intractable needs.

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Notes

1. The authors use the terms Black and African American interchangeably in this chapter to describe people of African descent in the United States.

2. Global health diplomacy is an integral part of Indian foreign policy. Recognizing the urgency of the situation, India and South Africa have jointly submitted a draught request to the World Trade Organization (WTO) for a temporary waiver of intellectual property (IP) rights to make COVID-19 medications affordable and accessible to all (See https://docs.wto.org/dol2fe/Pages/SS/ directdoc.aspx?filename=q:/IP/C/W669.pdf&Open=True).

3. Youth punishment system defined in Quinn, C. R., Boyd, D. T., Beaujolais, B., Hughley, A., Mitchell, M., Allen, J. L., … & Voisin, D. (2022). Perceptions of sexual risk and HIV/STI prevention among Black adolescent girls in a detention center: An investigation of the role of parents and peers. Journal of Racial and Ethnic Health Disparities, 1–10.

4. The initial findings of the mutations present in Omicron called for the WHO to label the variant as one of “concern”, due to it having more mutations than the Delta variant which is still causing thousands of deaths internationally (See Chen, Wang, Gilby, & Wei, 2021; Classification of Omicron, 2021; Ferre’ et al., 2021).