Abstract

Integrating Community Organizing & Research Engagement for Health Equity into Federally Qualified Health Centers

Gloria Montiel, Aisli Valenica, Neomi Mendez, Alicia Rodarte, Eulises Cibrian, Corina Martinez AltaMed Institute for Health Equity

APHA 2022 Annual Meeting and Expo

The Social Determinants of Health (SDOH) framework presents distinct domains to address in efforts to improve health equity. However, the framework reduces civic/community engagement to a function of the “Community, Safety, and Social Context sphere, missing an opportunity to both examine and address the impact of the lack of power in working-class communities of color. Historical exclusion, disinvestment, and disenfranchisement of these communities have created or perpetuated SDOH and thereby health disparities. Advancing health equity, therefore, requires building power in communities and sustaining opportunities for community members to engage in policy, systems, and environmental change strategies that address SDOH and underlying inequities.

In 2021, the AltaMed Institute for Health Equity, situated within one of the largest federally qualified health centers in the United States, created a Community Organizing & Research Engagement (CORE) arm to build power among community residents and patients residing in medically underserved areas. Using principles of community-based participatory research and community organizing for health equity (Wallerstein, 1992; Wallerstein & Duran, 2006), AltaMed created programming around three key areas: 1) building critical consciousness around issues of power and social determinants of health; 2) skills- and capacity-building around community advocacy and research, and; 3) community organizing and community-led initiatives.
From 2021-2022, 140 community resident and patient leaders ages 18-72 were engaged across the various initiative areas. Outcomes of this work include: the development of a patient- and community advocacy agenda, the implementation of various community-led public health campaigns, and the development of a framework for the integration of community power-building as an upstream strategy to address health disparities, social determinants of health, and their underlying inequities.

While working-class communities of color have been labeled as “civically disengaged, after 1-year of implementing CORE initiatives, we learn that patients and community members are ready and willing to lead health equity initiatives through multi-systemic interventions. However, in order to facilitate this participation, engagement opportunities have to be designed with equity at the center and allow for co-leadership. This work can serve as a model for FQHCs--who serve communities experiencing social vulnerabilities and structural inequities--to engage their patients and community members as central partners in building health through addressing the historical root causes of inequity.

Abstract

Equity Now and Beyond: Immigrant Coalition for Vaccine Access and Healthcare-Community Partnerships

Laetitia Pierre-Louis¹, Dieufort Fleurissant², Heloisa Galvao³, Damaris Velasquez⁴, Clare Okalany⁵, Kamini Mallick⁶, Ashley Scott⁷, Dina Hernandez⁸, Faizo Tahlil⁵, Stephanie Jean⁹, Dr. Lance Laird¹⁰ (1)Northeastern University; Center to Support Immigrant Organizing, (2)Haitian American United; True Alliance Center, (3)Brazilian Women's Group, (4)Agencia ALPHA, (5)African Community Economic Development of New England, (6)Harvard University School of Public Health, (7) Boston University School of Medicine, (8)Boston College School of Social Work; Agencia ALPHA, (9)Haitian American United, (10)Boston University School of Medicine

APHA 2022 Annual Meeting and Expo

Issues. Vaccination rates within immigrant communities were disproportionately low in Massachusetts during the early rollout of COVID-19 vaccines. Medical mistrust, lack of access to information in their primary languages, and barriers to mass vaccination sites all played a role.

Description. Four immigrant support and advocacy organizations (Haitian, Latinx, Brazilian, and African) created a cohort called Equity Now and Beyond, to provide vaccine information from trusted sources, in their own languages, and to partner with healthcare providers to hold mobile clinics. Academic collaborators hired and trained members of these communities to analyze how these partnerships worked by conducting media analysis, participant observation, interviews, surveys, and community assets mapping.

Lessons learned. Immigrant community leaders have existing networks, priorities, and strategies for mobilizing and educating their constituents, particularly those who are undocumented. Pandemic response catalyzed the coalition to combine resources, strengths, and relationships to multiply their impact. Growing trust and mutual support between these leaders strengthened connections between city officials, healthcare organizations, and immigrant communities. As they learned to navigate the public health system, they developed greater skill in health communication and advocacy for broader health equity.

Recommendations. The Equity Now & Beyond Coalition recommends policies and practices to build on strengths and strategies of community-based organizations; co-create interventions that address social and structural dimensions of health; develop the immigrant health professional workforce; and establish reciprocal relationships.

Abstract

Understanding Community Priorities to Create a Health Equity Agenda in Santa Clara County, CA

Rachel Berkowitz, DrPH, MPH¹, Vicky Gomez, DrPH, MPH¹, Andrew Somera¹, Osiris Perez¹, Janie Thao¹, Thea Marie Echevarria¹, Tran Tran¹, Kristense Cameron, MPH², Jason Blau³, Jessica Yan³ (1)San Jose State University, (2)The Health Trust, (3)Redstone Strategy Group

APHA 2022 Annual Meeting and Expo

Background: In the U.S., health inequities persist across a myriad of health outcomes and determinants. For individuals at the intersection of multiple structural forces, the risk of adverse health outcomes and unjust lack of opportunity is compounded. Santa Clara County (SCC), a diverse county with some of the wealthiest communities in the country, is home to inequities in both outcomes and determinants. A committee of public health, healthcare, and community-based organization leaders has proposed the development of a Health Equity Agenda (HEA) rooted in the priorities and realities of SCC residents.

Methods: A qualitative study is being implemented to understand health inequities in SCC. We will conduct 15-20 interviews with organizational leaders and 30-40 community conversations with residents impacted by one or more structural forces (racism, classism/capitalism, heterosexism, ageism, ableism, xenophobia, and/or interaction with the carceral state) over 5 months. Rapid analysis will be used to identify priority inequities, causes, recommendations.

Results: To date, 16 key stakeholder interviews have been completed, and community conversations are being scheduled. Stakeholders highlighted diverse inequities impacting marginalized communities (e.g., distinct and intersecting challenges with accessing and utilizing quality care experienced by LGBTQ+ individuals, undocumented individuals, and people experiencing unstable housing or homelessness).

Conclusions: Centering the priorities of the SCC community is essential for the effectiveness of the HEA. The insights gathered from the key stakeholder interviews and community conversations will support both the creation of the HEA and understanding of health inequities in other diverse areas in the U.S.

Abstract

Understanding racial and geographic differences in COVID-19 vaccinations in Allegheny County, PA

Carlyn Van Dyke, MS¹, Jason Beery, PhD², Jamil Bey, PhD², Betty Braxter, PhD, CNM, RN, FAAN³, Robert Gradeck, MCP⁴, Ruth Howze, MMT¹, India Hunter, MPH, MSW⁵, Lisa Issac, MD⁶, Ayanna King, MURP¹, Noble Maseru, PhD, MPH⁷, Mickey McGlasson, MS⁸, Gabriel O'Donnell⁸, Stacey Pharrams, MPM⁵, Steven Saylor⁴, Tiffany Gary-Webb, PhD, MHS⁹ (1)Black Equity Coalition, (2)UrbanKind Institute, (3)University of Pittsburgh School of Nursing, (4)University of Pittsburgh Center for Social and Urban Research, (5)Healthy Start, Inc., (6)Gateway Medical Society, (7)University of Pittsburgh Schools of the Health Sciences, (8)Carnegie Mellon University, CREATE Lab, (9)University of Pittsburgh Graduate School of Public Health

APHA 2022 Annual Meeting and Expo

Issues
The Black Equity Coalition (BEC) is a community-based multidisciplinary coalition examining and addressing COVID-19 inequity in Allegheny County, Pennsylvania. Since the vaccine rollout, our Data Working Group has tracked equity dimensions of vaccination rates in the Black community.

Description
The BEC Data Working Group advocated for and worked with the local and state health departments to gain access to data on vaccination rates by race/ethnicity as well as by geography (i.e., neighborhood and zip code).

Lessons Learned
For the 13 months since vaccines became widely available, disparities have persisted. In April 2021, the percentage of vaccine-eligible Black residents who had received at least one shot was 25 percentage points lower than the total vaccine-eligible population in Allegheny County (30.3% vs 55.3%); in April 2022, it was 22.4 percentage points lower (58.7% vs 81.1%).

We mapped vaccination rates by zip code across the county and found that within the 10 zip codes with the largest populations of Black residents, the rates of full COVID-19 vaccination ranged from 47-75% for all residents and 42-49% for Black residents, compared with the countywide rate of 72.2%.

Recommendations
We encourage community coalitions to establish an inclusive, dedicated process of shared discourse to find meaning in data. By regularly bringing people with different perspectives, abilities, and experiences together in conversation we have been able to create trust and solidarity among participants, build data literacy, develop an advocacy agenda, and sustain a culture of data-informed communication and decision-making.