How Can a Community Pursue Equitable Health and Well-Being after a Severe Shock? Ideas from an Exploratory Simulation Model
- Affirm racial justice and full inclusion for all people;
- Strengthen belonging and civic muscle by working across differences, which, in turn, unlocks new assets for concerted action;
- Expand all vital conditions with local stewards in the lead;
- Renew civic life; economic life; and social, emotional, and spiritual life.
2. Materials and Methods
2.1. Extending an Earlier Line of Research
2.2. Representing Well-Being and Its Drivers
2.3. Model Structure
2.4. Gathering Assets
2.5. Allocating Assets
2.6. Parametric Assumptions
2.7. Summary Measures
2.8. Illustrative Model Tests
- Status Quo: continue the historical, pre-shock allocation, which gives greatest priority to urgent services capacity (40%) and vital conditions (30%), and far less to equity (15%) and belonging and civic muscle (15%).
- Vital Conditions 40%: switch at Year 2 to a new stable allocation emphasizing vital conditions (40%), with the other three at 20%.
- Equity 40%: switch at Year 2 to a new stable allocation emphasizing equity (40%), with the other three at 20%.
- Belonging and Civic Muscle 40%: switch at Year 2 to a new stable allocation emphasizing belonging and civic muscle (40%), with the other three at 20%.
- Even Balance 25%: switch at Year 2 to a new stable allocation with all four at 25%.
- Best Pivot: switch at Year 2 to emphasize equity first (65%) and belonging and civic muscle (25%), with the other two at 5% each; then, from Years 4–6, pivot back toward urgent services and vital conditions, for an eventual stable allocation at Year 6 of urgent services (45%), vital conditions (35%), belonging and civic muscle (15%), and equity (5%).
2.9. Tests in a More Disorganized Community
4.1. Tentative Strategic Implications
- The best resilience strategy may require decisive shifts from historical priorities.
- The best strategy requires investing early in both equity and belonging and civic muscle so that one may build on those assets later: a kind of self-reinforcing, asset-building maneuver. The value of those early investments is not only because they support thriving by helping people connect and heal through collective trauma. It is also because they support the infrastructure needed for shared stewardship. In a diverse and divided community, it takes dedicated resources to establish greater interdependence and enable stewards to work across differences, devise shared plans, gather and manage assets, and adapt to challenges over time.
- Efforts to transition toward an equitable, thriving future may involve some inevitable sacrifice of greater suffering in the shorter term; a “worse before better” dynamic. This dynamic has been described previously with respect to downstream and upstream health investments , as well as business process improvements and the concept of the “capability trap” .
- A risk-averse approach (changing priorities little from the status quo and leaving them fixed over time) may avoid the worse-before-better pattern, but the lack of a decisive pivot will result in a mediocre trajectory over time. Safe, static allocation avoids sacrifice, but it does not build the reservoirs of equity or belonging and civic muscle needed to both boost thriving and drive down suffering.
- A community that can pivot strongly toward building equity and belonging and civic muscle after a severe shock may be best positioned to spring forward and maximize well-being over time. Although that maneuver is superior in principle (under the conditions of this analysis), it may be perceived as infeasible in practice–especially if it entails somewhat greater suffering immediately after a shock. Actual feasibility, however, depends on how effectively community stewards make the case for equitable system change . For instance, savvy casemakers could portray long-overdue investments in equity and belonging and civic muscle as a decisive break from a status quo that for generations has caused far greater unjust suffering and would otherwise continue to leave the entire community weaker and more vulnerable.
- A focus on summary measures of population-level health and well-being, as opposed to focusing only on a particular subset of health or social outcomes. The model’s main outcome measures (i.e., the Cantril categories of people thriving, struggling, and suffering) are routinely tracked across the US and around the world, allowing standardized comparisons over time and geography.
- Representation of equity as a structural driver affecting the entire system, as opposed to only accounting for differences among certain subpopulations (e.g., by race, gender, or income).
- Broad analytic boundary, encompassing concepts of well-being, vital conditions, urgent services, equity, and belonging and civic muscle and portraying their dynamic interactions.
- Ability to explore alternative paths toward equitable renewal over a decade. The model does not tell leaders what to do, but rather strengthens their ability to interpret local data and negotiate local priorities, spot opportunities, weigh tradeoffs, and think creatively about navigating a multiyear path from crisis to renewal.
- Ability to explain the dynamics of shock and renewal by tracking a suite of interacting variables and outcome metrics over time.
4.3. Limitations and Extensions
Data Availability Statement
Conflicts of Interest
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Milstein, B.; Homer, J.; Soderquist, C. How Can a Community Pursue Equitable Health and Well-Being after a Severe Shock? Ideas from an Exploratory Simulation Model. Systems 2022, 10, 158. https://doi.org/10.3390/systems10050158
Milstein B, Homer J, Soderquist C. How Can a Community Pursue Equitable Health and Well-Being after a Severe Shock? Ideas from an Exploratory Simulation Model. Systems. 2022; 10(5):158. https://doi.org/10.3390/systems10050158Chicago/Turabian Style
Milstein, Bobby, Jack Homer, and Chris Soderquist. 2022. "How Can a Community Pursue Equitable Health and Well-Being after a Severe Shock? Ideas from an Exploratory Simulation Model" Systems 10, no. 5: 158. https://doi.org/10.3390/systems10050158