Publications

    Federal COVID‐19 Response Funding for Tribal Governments: Lessons from the CARES Act
    Henson, Eric C., Megan M. Hill, Miriam R. Jorgensen, and Joseph P. Kalt. 2021. “Federal COVID‐19 Response Funding for Tribal Governments: Lessons from the CARES Act”. Read the full report Abstract

    The federal response to the COVID19 pandemic has played out in varied ways over the past several months. For Native nations, the CARES Act (i.e., the Coronavirus Aid, Relief, and Economic Security Act) has been the most prominent component of this response to date. Title V of the Act earmarked $8 billion for tribes and was allocated in two rounds, with many disbursements taking place in May and June of this year.

    This federal response has been critical for many tribes because of the lower socioeconomic starting points for their community members as compared to nonIndians. Even before the pandemic, the average income of a reservationresident Native American household was barely half that of the average U.S. household. Low average incomes, chronically high unemployment rates, and dilapidated or nonexistent infrastructure are persistent challenges for tribal communities and tribal leaders. Layering extremely high coronavirus incidence rates (and the effective closure of many tribal nations’ entire economies2) on top of these already challenging circumstances presented tribal governments with a host of new concerns. In other words, at the same time tribal governments’ primary resources were decimated (i.e., the earnings of tribal governmental gaming and nongaming enterprises dried up), the demands on tribes increased. They needed these resources to fight the pandemic and to continue to meet the needs of tribal citizens.

    Bloomberg Harvard City Leadership Initiative, June 2020 

    In the first session of the Leading Social and Economic Recovery series convened by the Bloomberg Harvard City Leadership Initiative, Dr. Josh Sharfstein, Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins Bloomberg School of Public Health provided a briefing of critical public health information on COVID-19 within the United States. Georges Benjamin, Executive Director of the American Public Health Association, discussed racism and protests in the context of COVID-19, offering mayors recommendations on measures to consider when protesting to reduce exposure of COVID-19. Professor Danielle Allen, the James Bryant Conant University Professor at Harvard University, and Director of Harvard’s Edmond J. Safra Center for Ethics, addressed the mayors on how the global pandemic, economic recession, and renewed focus on racial justice provide city leaders with an opportunity to reinvent public governance. The session was moderated by Harvard Kennedy School Professor Jorrit de Jong, and Harvard Business School Professor Rawi Abdelal, the faculty co-chairs of the Bloomberg Harvard City Leadership Initiative.

    Bloomberg Harvard City Leadership Initiative, May 2020 

    In the eleventh session of the COVID-19 Local Response Initiative convened by the Bloomberg Harvard City Leadership Initiative in collaboration with Bloomberg Philanthropies and the Johns Hopkins Bloomberg School of Public Health, Juliette Kayyem, the Belfer Senior Lecturer in International Security at the Harvard Kennedy School, and Dutch Leonard, the George F. Baker Jr. Professor of Public Management at the Kennedy School and Eliot I. Snider and Family Professor of Business Administration and Cochair of the Social Enterprise Initiative at Harvard Business School, and Jorrit de Jong, Faculty Director of the Bloomberg Harvard City Leadership Initiative and Senior Lecturer in Public Policy and Management at the Kennedy School, review the crisis leadership tools to help mayors and city leaders navigate the COVID-19 pandemic. Dr. Josh Sharfstein, Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins Bloomberg School of Public Health provided a briefing of critical public health information on COVID-19 within the United States.

    Bloomberg Harvard City Leadership Initiative, May 2020 

    In the tenth session of the COVID-19 Local Response Initiative convened by the Bloomberg Harvard City Leadership Initiative in collaboration with Bloomberg Philanthropies and the Johns Hopkins Bloomberg School of Public Health, Rebecca Henderson, the John and Natty McArthur University Professor at Harvard University, and Jorrit de Jong, Faculty Director of the Bloomberg Harvard City Leadership Initiative and Senior Lecturer in Public Policy and Management at Harvard Kennedy School, discussed scenario planning in a pandemic and offered tools for imagining and working through the implications of various plausible futures. Dr. Josh Sharfstein, Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins Bloomberg School of Public Health provided a briefing of critical public health information on COVID-19 within the United States. Dr. Anthony Fauci, NIAID Director, offered guidance and answered mayors’ questions on responding to the COVID-19 crisis.

    Bloomberg Harvard City Leadership Initiative, May 2020 

    In the ninth session of the COVID-19 Local Response Initiative convened by the Bloomberg Harvard City Leadership Initiative in collaboration with Bloomberg Philanthropies and the Johns Hopkins Bloomberg School of Public Health, Amy Edmondson, the Novartis Professor of Leadership and Management at the Harvard Business School, and Jorrit de Jong, Faculty Director of the Bloomberg Harvard City Leadership Initiative and Senior Lecturer in Public Policy and Management at Harvard Kennedy School, discussed leading diverse and dispersed teams in times of crisis. Dr. Josh Sharfstein, Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins Bloomberg School of Public Health; and Dr. Caitlin Rivers, Senior Scholar at the Johns Hopkins Center for Health Security and an Assistant Professor in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health, provide critical public health updates and general guidance for what organizations, businesses, and other settings need to do when they reopen, with information on how mayors can both help as well as support these efforts.

    Vice President Joe Biden highlighted the ongoing role mayors have in leading the response to the crisis.

    Bloomberg Harvard City Leadership Initiative, May 2020 

    In the eighth session of the COVID-19 Local Response Initiative convened by the Bloomberg Harvard City Leadership Initiative in collaboration with Bloomberg Philanthropies and the Johns Hopkins Bloomberg School of Public Health, Linda Bilmes, the Daniel Patrick Moynihan Senior Lecturer in Public Policy and a leading expert on budgetary and public financial issues, and Jorrit de Jong, Faculty Director of the Bloomberg Harvard City Leadership Initiative and Senior Lecturer in Public Policy and Management at Harvard Kennedy School, discuss budgeting during a COVID-19. Dr. Josh Sharfstein, Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins Bloomberg School of Public Health; and Dr. Jennifer Nuzzo, Senior Scholar at the Johns Hopkins Center for Health Security and an Associate Professor in the Department of Environmental Health and Engineering and the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, provide critical public health updates and examine metrics mayors need to have in order to reopen their communities. Chef Jose Andres offered words of inspiration in his welcoming remarks to the mayors.

    Bloomberg Harvard City Leadership Initiative, April 2020 

    In the seventh session of the COVID-19 Local Response Initiative convened by the Bloomberg Harvard City Leadership Initiative in collaboration with Bloomberg Philanthropies and the Johns Hopkins Bloomberg School of Public Health, Mitchell Weiss, Professor of Management Practice in the Entrepreneurial Management unit and the Richard L. Menschel Faculty Fellow at the Harvard Business School, and Jorrit de Jong, Faculty Director of the Bloomberg Harvard City Leadership Initiative and Senior Lecturer in Public Policy and Management at Harvard Kennedy School, lead a discussion on public entrepreneurship and how mayors can generate, try out and scale up new ideas while managing risk. Josh Sharfstein, Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins Bloomberg School of Public Health; and Dr. Lisa Cooper, Bloomberg Distinguished Professor at the Johns Hopkins Bloomberg School of Public Health, provide critical public health updates, examine racial disparities we are seeing during COVID-19, and offer actions mayors can take to address these disparities in their cities. Governor Hogan offered advice on convening a coronavirus response team to address the crisis in his welcoming remarks to the mayors.

    Bloomberg Harvard City Leadership Initiative, April 2020 

    In the sixth session of the COVID-19 Local Response Initiative convened by the Bloomberg Harvard City Leadership Initiative in collaboration with Bloomberg Philanthropies and the Johns Hopkins Bloomberg School of Public Health, Nancy Koehn, James E. Robison chair of Business Administration at Harvard Business School, and Jorrit de Jong, Faculty Director of the Bloomberg Harvard City Leadership Initiative and Senior Lecturer in Public Policy and Management at Harvard Kennedy School, explored principles of leadership to effectively guide teams and communities during an unprecedented, multi-stage crisis. Josh Sharfstein, Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins Bloomberg School of Public Health, and Dr. Jennifer Nuzzo, Senior Scholar at the Johns Hopkins Center for Health Security and an Associate Professor in the Department of Environmental Health and Engineering and the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, provided critical public health updates and guidance on preventing the spread of the virus in nursing homes and assisted living facilities. Speaker of the House Nancy Pelosi advised the mayors to rely on science in her welcoming remarks.

    Bloomberg Harvard City Leadership Initiative, April 2020 

    In the fifth session of the COVID-19 Local Response Initiative convened by the Bloomberg Harvard City Leadership Initiative in collaboration with Bloomberg Philanthropies and the Johns Hopkins Bloomberg School of Public Health, Howard Koh, Harvard T.H. Chan School of Public Health, Harvard Kennedy School; Jorrit de Jong, Faculty Director of the Bloomberg Harvard City Leadership Initiative and Senior Lecturer in Public Policy and Management at Harvard Kennedy School; Josh Sharfstein, Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins Bloomberg School of Public Health; and Tom Frieden, former director of CDC, president and CEO of Resolve to Save Lives, explored collaboration—across sectors, departments, and levels of government—and the challenges, conflicts, and opportunities for effective leadership and a resilient recovery that come with this work. Bill Gates stressed the importance of relying on science to guide reopening the economy in his welcoming remarks to mayors.

    Bloomberg Harvard City Leadership Initiative, April 2020 

    In the fourth session of the COVID-19 Local Response Initiative convened by the Bloomberg Harvard City Leadership Initiative in collaboration with Bloomberg Philanthropies and the Johns Hopkins Bloomberg School of Public Health, Jorrit de Jong, Faculty Director of the Bloomberg Harvard City Leadership Initiative and Senior Lecturer in Public Policy and Management at Harvard Kennedy School, moderated a discussion with Kimberlyn Leary, Harvard Medical School, Harvard T.H. Chan School of Public Health, on stress and mental health during the COVID-19 crisis. Josh Sharfstein, Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins Bloomberg School of Public Health provided critical public health information, and Tom Frieden, former director of CDC, president and CEO of Resolve to Save Lives, presented the latest thinking on the conditions necessary to lift restrictions, reopen the economy, and resume city life. President Barack Obama offered advice to mayors on speaking truthfully in his opening remarks.

    Bloomberg Harvard City Leadership Initiative, April 2020 

    In the third session of the COVID-19 Local Response Initiative convened by the Bloomberg Harvard City Leadership Initiative in collaboration with Bloomberg Philanthropies and the Johns Hopkins Bloomberg School of Public Health, Josh Sharfstein, Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins Bloomberg School of Public Health provided critical public health information. Jorrit de Jong, Faculty Director of the Bloomberg Harvard City Leadership Initiative and Senior Lecturer in Public Policy and Management at Harvard Kennedy School, moderated the discussion on learning as fast as you can and creating a basis for hope with Dutch Leonard, the George F. Baker, Jr. Professor of Public Management, at HKS and Eliot I. Snider and Family Professor of Business Administration at HBS and Juliette Kayyem, the Belfer Senior Lecturer in International Security at HKS. President George W. Bush offered support for mayors and frontline health care workers in his opening remarks.

    Randall K.Q. Akee, Eric C. Henson, Miriam R. Jorgensen, and Joseph P. Kalt; May 2020 

    This study dissects the US Department of the Treasury’s formula for distributing first-round CARES Act funds to Indian Country. The Department has indicated that its formula is intended to allocate relief funds based on tribes’ populations, but the research team behind this report finds that Treasury has employed a population data series that produces arbitrary and capricious “over-” and “under-representations” of tribes’ enrolled citizens.

    Randall K.Q. Akee, Eric C. Henson, Miriam R. Jorgensen, and Joseph P. Kalt; May 2020 

    Title V of the CARES Act requires that the Act’s funds earmarked for tribal governments be released immediately and that they be used for actions taken to respond to the COVID‐19 pandemic. These may include costs incurred by tribal governments to respond directly to the crisis, such as medical or public health expenditures by tribal health departments. Eligible costs may also include burdens associated with what the U.S. Treasury Department calls “second‐order effects,” such as having to provide economic support to those suffering from employment or business interruptions due to pandemic‐driven business closures. Determining eligible costs is problematic.

    Title V of the CARES Act instructs that the costs to be covered are those incurred between March 1, 2020 and December 30, 2020. Not only does this create the need for some means of approximating expenditures that are not yet incurred or known, but the Act’s emphasis on the rapid release of funds to tribes also makes it imperative that a fair and feasible formula be devised to allocate the funds across 574 tribes without imposing undue delay and costs on either the federal government or the tribes.

    Recognizing the need for reasonable estimation of the burdens of the pandemic on tribes, the authors of this report propose an allocation formula that uses data‐ready drivers of those burdens.  Specifically, they propose a three‐part formula that puts 60% weight on each tribe’s population of enrolled citizens, 20% weight on each tribe’s total of tribal government and tribal enterprise employees, and 20% weight on each tribe’s background rate of coronavirus infections (as predicted by available, peer‐reviewed incidence models for Indian Country).

    Elena Fagotto, Project on Transparency and Technology for Better Health, March 2019

    The Project on Transparency and Technology for Better Health was established to conduct comparative case studies on platforms that empower patients through information to provide an inventory and typology of initiatives. This case study takes a look at Breast Cancer Straight Talk Support, a closed Facebook community for women dealing with breast cancer and survivors. With hundreds of posts every day, the group is a safe space where women can vent about feeling scared, depressed, or lonely and receive support from women who “get them.” For many members, the group is a window into other women’s cancer journeys, which gives them perspective and a more proactive attitude to fight the disease. The community is also an important resource to ask questions on treatments, side effects, surgery and more.

    Elena Fagotto, Project on Transparency and Technology for Better Health, March 2019

    The Project on Transparency and Technology for Better Health was established to conduct comparative case studies on platforms that empower patients through information to provide an inventory and typology of initiatives. This case study takes a look at IBD Partners, a research network connecting nearly 15,500 IBD patients with over 300 researchers. Patients can contribute their self-reported health data for research by filling out surveys on their health twice a year. This way, patient-generated data feeds into an extensive database that can be accessed by researchers to conduct longitudinal studies, to connect with patients for clinical trials and for prospective studies. Patients can also use the platform to suggest research questions and vote for the most interesting ideas, generating a truly patient-driven research agenda.

    Elena Fagotto, Transparency and Technology for Better Health, March 2019

    The Project on Transparency and Technology for Better Health was established to conduct comparative case studies on platforms that empower patients through information to provide an inventory and typology of initiatives. This case study details ImproveCareNow (ICN), a network of clinicians, medical centers, patients, families and researchers working together to improve the lives of children with inflammatory bowel disease (IBD). 

    In summer and fall of 2014, thousands of individuals in Liberia, Sierra Leone, and Guinea contracted the Ebola virus. This outbreak of the deadly disease, which until then had been highly uncommon in West Africa, prompted a major (albeit delayed) public health response on the part of the international community, including an unprecedented commitment made by the United States, which sent almost 3,000 active military soldiers to Liberia. “Mission in Flux” focuses on the US military’s role in the Ebola response, emphasizing the Michigan National Guard’s eventual involvement. In particular, it provides readers with a first-hand account of the challenges the Michigan Guard faced as it prepared for and then deployed to Liberia, just as the crisis had begun to abate and federal officials in Washington began considering how to redefine the mission and footprint of Ebola-relief in West Africa.  
    Wilson, Deloris, Linda Kaboolian, Jorrit de Jong, and Guy Stuart. 2017. “Barbershops and Preventative Health: A Case of Embedded Education”. Read full paper Abstract

    Deloris Wilson, Linda Kaboolian, Jorrit de Jong, and Guy Stuart, January 2017   

    This is a case study of the Colorado Black Health Collaborative (CBHC) Barbershop/Salon Health Outreach Program, a community-based initiative that targeted disproportionate rates of hypertension and other health problems within the African American community. 

     

    This epilogue accompanies case number 2055.0. In September 2014, as several West African countries continued to battle a deadly outbreak of the Ebola virus, Dallas, Texas, emerged as ground zero for the disease in the U.S. This case recounts how, over the course of three days, Thomas Eric Duncan, who had recently arrived in the city from Liberia, reported twice to Dallas Presbyterian Hospital exhibiting signs of illness. Having sent him home after his first visit, the hospital admitted him after his second; and with his symptoms worsening rapidly, tests soon revealed everyone’s worst fear: he had Ebola. “Fears and Realities” describes how local, state, and federal public health authorities, along with elected officials and hospital administrators, responded to the alarming news – a hugely difficult task made all the more challenging by confusion over Duncan’s background and travel history, and, eventually, by the intense focus and considerable concern on the part of the media and public at large. Efforts to curtail the spread of the disease were further complicated when two nurses who had cared for Duncan also tested positive for Ebola, even though they apparently had followed CDC protocols when interacting with him. With three confirmed cases of the disease in Dallas – each patient with their own network of contacts – authorities scrambled to understand what was happening and to figure out a way to bring the crisis to an end before more people were exposed to the highly virulent disease.
    In September 2014, as several West African countries continued to battle a deadly outbreak of the Ebola virus, Dallas, Texas, emerged as ground zero for the disease in the U.S. This case recounts how, over the course of three days, Thomas Eric Duncan, who had recently arrived in the city from Liberia, reported twice to Dallas Presbyterian Hospital exhibiting signs of illness. Having sent him home after his first visit, the hospital admitted him after his second; and with his symptoms worsening rapidly, tests soon revealed everyone’s worst fear: he had Ebola. “Fears and Realities” describes how local, state, and federal public health authorities, along with elected officials and hospital administrators, responded to the alarming news – a hugely difficult task made all the more challenging by confusion over Duncan’s background and travel history, and, eventually, by the intense focus and considerable concern on the part of the media and public at large. Efforts to curtail the spread of the disease were further complicated when two nurses who had cared for Duncan also tested positive for Ebola, even though they apparently had followed CDC protocols when interacting with him. With three confirmed cases of the disease in Dallas – each patient with their own network of contacts – authorities scrambled to understand what was happening and to figure out a way to bring the crisis to an end before more people were exposed to the highly virulent disease.