The Centers for Disease Control and Prevention (CDC) has declared racism as a threat to public health. Historically marginalized racial and ethnic minority groups experience significantly higher rates of illness and death across health metrics when compared to their White counterparts. Though this is not a new public health concern, the concept of systemic racism as a determinant of health is now gaining the national attention required to provide improved support and resources to ensure all individuals in the United States can attain their highest level of health.
This year’s National Public Health Week (NPHW) (April 4, 2022- April 8, 2022), an initiative of The American Public Health Association (APHA), recognizes this threat to public health by centering Racism: A Public Health Crisis as the week’s first daily theme. Health inequities are driven and impacted by a wide range of factors including but not limited to differential access to services and resources, social determinants of health, and historical and contemporary injustices. Racism is a significant factor in all inequities and therefore, must be openly acknowledged and addressed directly to profoundly move towards health equity for all.
As the voice of the nearly 3,000 local health departments (LHDs) across the country, the National Association of County and City Health Officials’ (NACCHO) portfolio consists of a breadth of projects in which racial health equity is an aim of program planning and implementation across public health domains. As part of efforts to advance racial and health equity, it is important that the perspectives of communities of color are heard because these communities have historically been silenced or dismissed when it comes to equitable access to resources and care. Prioritizing input from communities of color on COVID-19 vaccine decision-making through the Understanding Diverse Communities and Supporting Equitable and Informed COVID-19 Vaccination Decision-Making project, is just one example of a project NACCHO has initiated with support from the Robert Wood Johnson Foundation and the Horizon Foundation. Through this project, stakeholder interviews were conducted for public health practitioners to learn, understand, and support the decision-making of individuals in addition to better understanding under what conditions they feel comfortable getting the COVID-19 vaccine. One project aim was to foster equitable vaccine uptake by listening to the perspectives of communities of color as it is essential that the voices of those who are disproportionately impacted by COVID-19 are heard, understood, and incorporated into public health strategies.
Additional efforts to support equitable access to essential health care services such as vaccination are necessary. Currently, NACCHO serves as a proud partner of CDC’s Racial and Ethnic Approaches to Community Health (REACH) and Partnering for Vaccine Equity (PAVE) projects which seek to improve vaccination coverage among racial and ethnic minority groups. More specifically, through these efforts, NACCHO provides training and technical assistance to funded local jurisdictions to identify and address inequities in adult vaccination with a focus on influenza (flu) and COVID-19 vaccine coverage.
The COVID-19 pandemic has highlighted a range of racial and ethnic inequities, including those that exist in vaccination uptake and coverage rates. Throughout the COVID-19 vaccination campaign, LHDs have served on the frontlines of addressing vaccine inequities through strategies that are specific to community needs. One strategy that LHDs have found effective to improve vaccination uptake among communities of color has been building relationships and leveraging partnerships with trusted community organizations. Two LHD participants of NACCHO’s PAVE project, Georgia Department of Public Health District 2 North (GA DPH District 2), and Monongalia County Health Department in West Virginia, provide prime examples of this strategy. GA DPH District 2 serves a 13-county region which is home to more than 500,000 individuals and is a mix of suburban and rural areas. To improve COVID-19 and flu vaccine uptake among their LatinX community, they partnered with the Latino Chamber of Commerce and the Hispanic Alliance of Georgia to promote vaccination opportunities in Hall County where 30% of the residents are Hispanic or Latino, resulting in hundreds of participants. Similarly, Monongalia County Health Department, which serves a mix of rural and urban areas consisting of approximately 105,000 individuals, partnered with a variety of community-based organizations to implement and promote vaccination clinics to those that are underserved. Clinics at warming shelters and food pantries ensured their homeless population had access to the COVID-19 vaccine. Public health educators promoted these events and provided education at local businesses, city streets, and under bridges. Roaming clinical operations allowed the health department to provide vaccination opportunities by meeting individuals where they are. Both health departments demonstrate the importance of leveraging organizations that the community of interest trusts and values to successfully provide vaccine education and administration.
Vaccination disparities are rooted in racial health inequities due to historical unjust treatment and systems. Equitable distribution and access to vaccination cannot be properly addressed without a strategy to tackle racism in public health and health care. Therefore, while we collectively work to improve policies and systems which can support health equity efforts, it is also important to continue to build trust with historically marginalized racial and ethnic groups at the local level. We must make intentional efforts to listen to the communities we serve to better understand local concerns and barriers which can inform how public health resources and services can be responsive to community needs and input. It is vital to continue to address racial health inequities to ensure all individuals reap the benefits of public health strategies. Local health departments are and continue to be an important link in the chain towards achieving equitable health outcomes for all communities.