Speaker Series #4 – Resilient Health Systems

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Cities on the Frontline Speaker Series

#4 – Resilient Health Systems

We launched our Cities on the Frontline Speaker Series at the outset of the Covid-19 pandemic almost 2 years ago. Throughout this period, cities and state governments have learned a lot throughout the crisis and its somewhat repetitive cycle of response and recovery to the different variants that have emerged. Two years after the start of the pandemic, the virus is not yet considered endemic, but communities across the world have had to address health system crisis, gaps and innovations to be able to live with the virus circulating, as well as other healthcare related challenges. In this fourth Cities on the Frontline session, we explore where cities and state governments find themselves two years after the WHO declaration of the Covid-19 pandemic.  

City and state representatives, Eric Friedlander, Secretary Health and Family Services, State of Kentucky and Dr. Natacha Berkowitz, Epidemiologist for City Health at the City of Cape Town started this session with insightful presentations of their state and city’s journey managing the COVID-19 pandemic including strategies that we successful in supporting their respective health systems as well as the key learnings that came out form this experience.

Secretary Friedlander, for instance talked about how the State of Kentucky’s managed the COVID-19 pandemic emphasising that at the heart of this process were the pillars of resilience and equity. As their first case was detected in March of 2020, with limited knowledge and resources and with a system of emergency response that was not ready to deal with a shock of this magnitude, the response of the State had to be built form the ground up. The focus from an early stage was on communication and collaboration to combat the biggest challenges that they faced, including misinformation that rapidly spread and inequalities in access to services that resulted in disproportionate death rates in the population based on race and ethnicity. To combat these challenges the State worked on providing engaging and up to date information on the pandemic with an initiative called “Beers with Bechear at 5 pm” as well as analysing data to create the Social Vulnerability Index to drive equity into the process of distribution of the Covid-19 vaccine. As a closing remark, Secretary Friedlander acknowledged this crisis has shed a light into the flaws of the US health system, stressing that it needs to become more robust with the active challenge still remaining of fighting misinformation. However, he said, he remains optimistic that these learnings that governments and other entities are gaining form this decade of challenges will be carried onto the next decade for better prepared and healthier cities.

Dr. Natacha Berkowitz, followed the Secretary’s intervention emphasizing that even though the State of Kentucky and the City of Cape Town have two very different settings they have a lot of similarities in terms of their challenges and their enablers. One of the main challenges that Dr. Natacha pointed out was the significant divide in the communities within the city that resulted in a divide in approach. This divide was evidenced by two very segregated health systems, the public and the private health system. Collected data revealed that the public health sector experienced much higher levels of contagion that the private health sector which was determined by their ability or inability to self-isolate. Based on the analysis of this development the City of Cape Town put in place a response in a mechanism learnt through drought response called the Covid Crisis Committee (CCC). This committee pulled individuals from organizations together for a stronger response including epidemiologists, disaster management officials, communication officials, data scientists, policy advisors, etc. In a similar way than Secretary Friedlander, Natacha emphasized the key role that communication and the availability of a public data for targeted and well informed decision making had on their Covid journey.

Currently we are 2 years into the pandemic with 6 million deaths worldwide and with shocks and stresses that have put our healthcare systems over the brink of capacity. Jeannette Ickovics, Ph.D., professor and former Dean of Faculty, Yale-NUS College, wrapped up the session by addressing the most important lessons learned from the public health sector thus far.

Some of the learnings Jeannette shared are the following:

  1. Cities must explicitly address persistent racial and social disparities to reduce stigma and to increase access to competent care, especially for vulnerable groups
  2. Cities must nurture trust and respect of science, public health, and medicine as well as in their leaders with transparent communication
  3. Cities must be able to respond to crisis while maintaining core functions of other systems in cities which requires multisector collaboration

As a final remark Jeannette emphasized the need to understand the explicit link between health, climate change and biodiversity. With climate change that makes outbreaks of diseases more common and more severe, a decrease in air quality in cities as well as the disproportionate impacts of these shocks and stresses on vulnerable communities, governments must prioritize investment in health and climate stimulus packages for synergistic gain with multisectoral approaches that make these links explicit. Complex solutions are need for complex problems.


Eric Friedlander,
Secretary Health and Family Services, State of Kentucky

From the first diagnosis of COVID-19, we had to build our response from the ground up and respond quickly & nimbly. We developed a level of communication & collaboration we had never seen before


Dr. Natacha Berkowitz
Epidemiologist for City Health, City of Cape Town

The Covid Crisis Committee brought together officials from different departments, and ensured we had experts to advise & colleagues to act, including community leaders to reach our most vulnerable populations


Jeannette Ickovics, Ph.D.
Professor and former Dean of Faculty, Yale-NUS College

“Deforestation and biodiversity loss impact animal & insect migration and, in turn, this had a direct impact on the risk of infectious diseases, we’ve seen this with Covid-19, Dengue & Zica”


Watch full session here:

Black climate change thematic icon with blue circular background. Black built environment thematic icon with blue circular background. Black economy and finance thematic icon with blue circular background. Black equity thematic icon with blue circular background.

Speaker Series #4 – Resilient Health Systems