Community health centers (“health centers”) are a cornerstone for medically underserved communities across the U.S. and its territories. Beacons of healthcare accessibility, health centers play an indispensable role in addressing the multifaceted needs of communities, particularly for vulnerable populations. The significance of these centers becomes especially evident during crises, which can lead to a rapid influx of patients that overwhelms health facilities and causes other disruptions to health access. When that occurs, health centers must shift operations to expand services while continuing to provide care for existing patients who often have more complex conditions than the general population. Conditions can worsen due to disaster-related impacts impeding access to medicine or health services.
Over 31.5 million patients annually receive care from more than 14,000 health center locations nationwide. These centers are pivotal in addressing health disparities by providing comprehensive care to medically underserved rural and urban communities. Health center patients represent 1 in 11 Americans. Notably, 63% of these patients belong to racial or ethnic minority populations, with 90% living 200% below the federal poverty line.
Investments in health centers are imperative, as they represent investments in primary care. Beyond the professionals providing direct clinical care to patients, the full spectrum of individuals working in a health center are essential staff. From administrative schedulers to environmental services staff, all play a necessary and crucial role in ensuring patients can continue to receive care despite potential disruptions caused by disasters. These frontline workers are critical in enabling access to preventive services, chronic disease management, and overall health promotion, making their sustainability and resilience crucial for national well-being.
Understanding Disaster-Related Impacts and Recovery Needs of Frontline Workers
Public health emergencies and disasters – both natural and otherwise – often impact health centers disproportionately due to a variety of factors, including geography (42% were Rural Health Centers as of 2020), staff size, smaller operating budgets, limited flexibility around funding sources, and cost of care associated with the served populations. In addition, chronic underfunding in public health over the past two decades has left health centers with lean operating margins (typically dramatically leaner than operating margins observed for more resourced healthcare facilities, such as hospitals), limiting their ability to invest in crucial areas at a rate that matches patient growth. Strategic investment areas – such as staff training, infrastructure development, and support for supply chain resiliency (i.e., the ability to withstand impacts to normal supply chain operations amid disruptions) – when left short, may increase health centers’ vulnerability from disaster-related changes and hinder their capacity to implement robust preparedness measures for the next disaster. This ongoing struggle for resources jeopardizes the immediate health services these centers provide and places the institutions and the communities they serve at increased risk of disaster-related impacts.
The Health Resources and Services Administration, through the Bureau of Primary Health Care, provides cooperative agreement funding through the National Training and Technical Assistance Partners program (NTTAP). Funded through NTTAP, more than 20 leading national organizations aid health centers in their work to serve diverse, medically underserved populations, providing comprehensive support for trainings and technical assistance. Among them is the Association of Clinicians for the Underserved (ACU) and the National Association of Community Health Centers (NACHC). Find more information by visiting ACU’s Solutions, Training, and Assistance for Recruitment and Retention (STAR2) Center and the Health Center Resource Clearinghouse managed by NACHC.
Healthcare Ready, a nonprofit organization whose mission is to leverage unique relationships with government, nonprofit, and medical supply chains to build and enhance the resiliency of communities before, during, and after disaster, also launched an initiative in 2023 to examine workforce impacts of the COVID-19 pandemic specific to people who work in community health centers and free and charitable clinics. The Restoring the Healthcare Workforce for Equity initiative sought to better understand how frontline workers in safety-net facilities might be disproportionately affected by impacts that started during the pandemic and continue as communities navigate their recovery from the years-long event. Many of the challenges faced by the healthcare system during the COVID-19 pandemic were not new and helped to underscore the critical need for resilient and adaptable systems. Some of the unprecedented challenges health centers faced included rapidly expanding testing and vaccination efforts, including administering 18 million COVID-19 tests and 21 million vaccines to patients in 2021.
The initiative, funded by the Center for Disaster Philanthropy COVID-19 Response Fund, found that ongoing pandemic-related stress has led to significant staff shortages in health centers and clinics, with recruitment and retention challenges further exacerbating burnout and potentially worsening healthcare access for the communities served by these facilities. Additionally, the analysis revealed that people living in U.S. counties that experienced disproportionately greater rates of COVID-19 cases and deaths are at increased risk of being impacted during future disasters. These cases included communities of color, communities with greater numbers of older populations, or communities that saw lower than average percentages of vaccinated residents, potentially due to worsening disparities in healthcare access caused by workforce challenges.
Healthcare Investments for Community Resilience
Healthcare workers across all levels and roles in health centers and clinics demonstrate remarkable resilience and an unyielding commitment to patients, even in exceptionally challenging conditions, as was evident through the COVID-19 pandemic and other disasters. Often, these professional challenges coincide with mounting personal pressures. For example, health centers and clinics are frequently staffed by individuals who are local to the communities they serve or may identify as members of the communities affected by the same disasters that affect their patients. When a crisis strikes, the community, health center, and clinic workers will likely be personally affected. Baseline investments in the workforce and specific investments for response and recovery among workers can help strengthen the national healthcare infrastructure.
Funding at all levels and investments for recruitment, retention, and training resources are crucial for health centers and clinics to address health disparities. Federal funding for key programs such as the Community Health Center Fund and support for graduate medical education via the National Health Service Corps and Teaching Health Center Graduate Medical Education play pivotal roles in addressing workforce shortages. These programs offer financial incentives for providers to work in underserved areas, thereby strengthening the healthcare infrastructure of local communities and leading to greater community resilience.
The COVID-19 pandemic underscores the importance of these programs in mitigating healthcare challenges. The aftermath of the COVID-19 pandemic starkly highlighted the repercussions of disrupted routine services and the impacts of rising misinformation and mistrust. These challenges lead to missed vaccinations, including among populations already more vulnerable to disproportionate disaster impacts. Health centers are pillars of trust within communities, fostering strong relationships and a firm understanding of unique community needs. Their presence and commitment are foundational to addressing health disparities and ensuring equitable access to healthcare resources. Therefore, lessons learned from the pandemic underscore the need to reinforce workforce capacity by supporting investments to increase the diversity and representation of those in the healthcare workforce. This support addresses the wide-ranging mental health and emotional impacts workers often experience in the wake of responding to disasters.
By strategically investing in primary care within health centers, it is possible to fortify the nation’s healthcare infrastructure and cultivate more resilient communities in preparation for and response to disasters. This proactive approach ensures communities are better equipped to navigate challenges before, during, and after crises.
Angie Im
Angie Im is Healthcare Ready’s associate director of Research and Policy. In this role, she oversees the organization’s portfolio of research projects with government agencies and private partners. Prior to Healthcare Ready, Angie served in various roles, helping scale digital health startups in artificial intelligence and telemedicine and supporting digital transformation initiatives as a management consultant with IBM Global Consulting Services. Before her work in the private sector, Angie worked with nonprofit organizations and government agencies to design, build, and deploy information transparency tools. Angie has an M.S. in Public Policy & Management from Carnegie Mellon University and a B.S. in Public Health Sciences from the University of California, Irvine.
