Getting the Message Right: Community Outreach During COVID

It was a sunny, spring day in Atlanta. The streets were empty because of a recently executed shelter-in-place order by Mayor Keisha Lance Bottoms. We were still in the infancy of the COVID pandemic, naïve to the tumultuous road that lay ahead. 

In his role as President of the Atlanta Medical Association and with a goal of facilitating COVID-19 testing in the African-American community, Frank visited a National Guard testing site at a mall in Southwest Atlanta serving primarily African Americans. The testing site was empty. Juxtaposed to the empty testing site was a long line of people waiting to enter the mall. Many were not wearing masks and were not socially distanced. 

While we were just beginning to understand the disease and its impact, this incident made it clear that our community was in trouble. We realized that we needed to do everything in our power to engage and educate our community.

When we married 28 years ago, we never could have imagined that we would be teaming up to help our community during a national pandemic. As medical students at Morehouse School of Medicine (Frank) and Emory School of Medicine (Jada), we rekindled an old friendship and then began to date. It was a great collaboration then, and an even greater collaboration now, both personally and professionally. We have been steady partners in this battle against the COVID-19 virus. 

As we considered the ways we could help during the pandemic, we understood that centuries of structural racism have led to inequities in social determinants of health, like where you live, the quality and amount of your education, and what job you have. We also understood that the higher prevalence of chronic diseases and the resultant poor health outcomes was tied to those social determinants. 

The early reports of the disproportionate impact of COVID-19 on African American, Latinx and Indigenous people made it clear that the pandemic was exposing these longstanding effects of structural racism. In fact, a model developed during the H1N1 influenza pandemic is still useful today. It suggests that race and racism result in differences in social position, which leads to different exposure to the virus. For example, living in smaller or multigenerational homes and a limited ability to telework increase the risk of exposure. 

The model also highlights differences in susceptibility to the virus due to underlying conditions that are also driven by social position. Furthermore, it highlights that once the symptoms start, there are also differences in treatment due to lack of insurance, decreased access to care, and biased or differential treatment. The cumulative impact is additive and leads to unequal illness and death.

With the gravity of this situation in mind, we were both honored to serve as members of the Emory Collaborative Community Outreach and Health Disparities (ECCOHD) Steering Committee. An inquiry by an African-American Emory Healthcare Board member about Emory’s COVID-19 response in the Black community provided the impetus for formation of this group. 

The committee, led by Emory Healthcare Board Members Nicole Franks, MD, and Theodore Johnson, MD, was formed to facilitate partnerships between Emory and members of the Black and Latinx communities in Atlanta. The goal is to deliver healthcare-related messages and services that will mitigate the disparate effect of COVID-19 on underrepresented and under-resourced communities. 

The committee works with a guiding principle of collaboration. Our approach is to build on the strengths and assets that already exist in the community and to provide additional resources and assistance that the community requests. 

The Atlanta Medical Association was invited to participate on this task force as an important community partner with deep roots in the African-American community. The organization has been laser focused on educating the community on COVID-19 issues and providing community outreach to organizations in need. 

One of our most successful platforms has been the “Ask A Black Doctor” series. This is a series of virtual panel discussions that are open to the public, where members of the Black community get a chance to get their medical questions answered by doctors that look like them and share similar life experiences. Seven episodes featured COVID-19 related issues. The organization also produced the video COVID-19 and the Elderly, as well as several animated videos that teach the community how to stay safe during the COVID-19 pandemic. Once produced, the videos were shared with the ECCOHD team and our community partners.

The Emory Collaborative Community Outreach and Health Disparities Committee has produced similar events, developed educational videos and participated in media interviews related to COVID-19 in the Black and Latinx community. There is substantial research demonstrating that patients are more trusting of doctors if they are the same race and speak the same language. Because of this, these offerings have been produced in English and Spanish, and featured African American and Latinx faculty experts from Emory School of Medicine. 

We have established a community advisory board including faith-based leaders that will ensure communication with the committee, address misunderstandings and solicit valuable stakeholder guidance and input. We are developing a speaker’s bureau of available experts (particularly health professionals of color) and topics for ongoing community outreach and intervention. In addition, we implemented a mobile messaging campaign that will serve to amplify safety and prevention messages using mobile devices.

America is experiencing the weight of two simultaneous pandemics – COVID-19 and racial inequality. Both have had a direct effect on the health and well-being of all Americans. We recognize that asking individuals to make and sustain behavioral changes is quite difficult. We further understand that because of the legacy of racism, even in medicine and science, trust must be earned. 

Our committee seeks to engage diverse health professionals and the community with a collaborative spirit in open conversations to establish this trust. Importantly, we know that this will not happen overnight. 

Improving health equity will necessitate strengthened and enduring partnerships between individuals, communities and healthcare systems. It is therefore imperative that we have compassionate, culturally competent, committed leadership on the frontline. We are glad that we are on the frontline together.

References:

1. Blumenshine P, Reingold A, Egerter S, Mockenhaupt R, Braveman P, Marks J. Pandemic influenza planning in the United States from a health disparities perspective. Emerg Infect Dis. 2008;14(5):709-715. doi:10.3201/eid1405.071301

2. Armstrong K, Putt M, Halbert CH, et al. Prior experiences of racial discrimination and racial differences in health care system distrust. Med Care. 2013;51(2):144-150. doi:10.1097/MLR.0b013e31827310a1

3. Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, Gender, and Partnership in the Patient-Physician Relationship. JAMA. 1999;282(6):583–589. doi:10.1001/jama.282.6.583