A theory of change for aligning health care, public health, and social services in the time of COVID-19

With the nation now in the fight against the COVID-19 pandemic, the health care, public health, and social services sectors are rapidly adapting to new ways of working together as resources are stretched and both workers and the public are more socially distant from one another. The coronavirus creates a new sense of urgency for how we design interactions among the three systems. Efforts to collaborate in new ways have generally been supported by one-off opportunities, whether positive or negative. Onetime grant funding and pilot policies are examples of positive opportunities. Hurricane Katrina and the COVID-19 pandemic are examples of negative opportunities.

Based on their learning from years of their own grant making and that of others, the Robert Wood Johnson Foundation (RWJF) supports and learns from work that seeks to better align health care, public health, and social services. They envision alignment among systems that goes beyond onetime efforts, that better values the unique contributions of each sector, and that gives power and voice to community members. We describe a cross-sector alignment theory of change that aligns with the foundation’s vision of a culture of health that provides everyone in the United States a fair and just opportunity for health and well-being.