Community Engagement of African Americans in the Era of COVID-19

Considerations, Challenges, Implications, and Recommendations for Public Health

Tabia Henry Akintobi, PhD, MPH; Theresa Jacobs, MD; Darrell Sabbs; Kisha Holden, PhD, MSCR; Ronald Braithwaite, PhD; L. Neicey Johnson, JD, RN, BSN; Daniel Dawes, JD; LaShawn Hoffman

Disclosures

Prev Chronic Dis. 2020;17(8):e83 

In This Article

Implications for Public Health

Public health practitioners, evaluators, policy makers, researchers, and clinicians with a community-engaged mindset have long understood, grappled with, and proclaimed the complexities of health disparities in the context of historic and current social determinants.[66] When considered together, the challenges and realities detailed in this commentary create opportunities for new approaches to intentionally engage socially vulnerable African Americans. The response strategies proposed below reflect the complex web of historical and current policy and clinical, mental and behavioral, and community factors. Use of a CBPR framework undergirds all response strategies proposed.

Promote Local Community Leadership to Proactively Inform Mitigation Strategies. The importance of CBPR and related needs assessments and response strategies are heightened during the COVID-19 era. Health promotion for chronic conditions such as diabetes, obesity, and cardiovascular diseases may have previously been structured to result in poor health or premature death for racial/ethnic minority populations through reduced or nonexistent access to health care; these conditions now require more immediate attention because they increase vulnerabilities and risks that can lead to poor health outcomes or death. Community knowledge, perceptions, and approaches to culturally responsive mitigation strategies must be prioritized. Carefully constructed local community governance boards that include multidisciplinary leadership (clinical, policy and social service, and research, among others), should be formed to lead assessments toward community and data-informed COVID-19 mitigation strategies for vulnerable populations in highly affected geographic areas.

Strategically Engage Public Health and Community-attuned Policy Leaders and Prioritize Community Stimulus Strategies. The political landscape calls for public health leadership by mitigation response teams.[25] These teams are key informants from the beginning of public health initiatives designed to mitigate the pandemic, and their engagement is essential. They will provide another lens through which to examine the structures and processes that enable inequities to systematically develop and flourish or be eradicated through community co-created responses.

The essential areas of policy for optimal community health are in prioritized economic development, food security, and access to health care protection for vulnerable African American communities. Collectively, these areas present opportunities for intervention in response to chronic disease self-management (clinical), economic strains (community), and health care protections (policy) associated with the COVID-19 vulnerabilities of many African American communities. These essential policy areas represent a proposed foundation that rests on 4 "Es" hypothesized to narrow disparity gaps and offer opportunities for self-sufficiency and community resiliency.

  • Employ trained/certified, compensated community health workers, coaches, and ambassadors who are charged with cultural messaging and education, contact tracing, and surveillance toward increased adherence to policies on physical distancing and sheltering in place.

  • Expand SNAP programs with vouchers to include the purchase of household and personal care items rather than encouraging recipients to barter for basic care products.

  • Enhance school lunch programs so that all children receive high-quality, balanced meals throughout the year, regardless of the ability to pay.

  • Ensure universal broadband internet access to reduce education, health care, and information barriers.

Cultivate Community-informed Public Health Disaster Health Literacy. Health literacy concepts, modes, and education must be reframed. The media have newly exposed the lay public to the realities of unequal treatment and unequal pandemic risk. The public is, thereby, witnessing the more rapid connection between who they are, where they live, and who is more likely to suffer from and die of COVID-19. Marketing frameworks for community-based prevention can be used to position community leaders to inform and lead health communication strategies. These marketing frameworks will ensure that messages resonate, engage, and foster action with objectivity and community/cultural sensitivity.

Foster Culturally Tailored Behavioral and Mental Health Dialogue and Response. Multidimensional prevention education strategies that encourage resilience (positive adaptation to adversity) must be promoted in African American communities. This promotion should involve advocating for proactive self-care, reducing stigma, and encouraging integrated health care. These strategies should be promoted and proactively integrated as cross-cutting components of any research and health initiative.

Prioritize Patient-centered Medical Homes and Neighborhood Models. Patient-centered medical home infrastructures that include models of integrated care (mental and behavioral health care services in primary health care settings) can help overcome barriers to comprehensive health care and overall wellness. This model engages comprehensive resources to care for a patient, regardless of race/ethnicity, sex/gender, sexual orientation, language, socioeconomic status, or health insurance coverage. Primary care providers are encouraged to incorporate this model into their practices to decrease illness and death among African Americans at heightened risk of COVID-19.[67,68]

Redefine Essential Workers. Although the accomplishments of first responders — physicians, nurses, scientists, and other people fighting to preserve life — are laudable and undeniable, many African American nonclinical frontline workers, such as maintenance, janitorial, or food processing workers, are excluded from the definition of essential workers. The social vulnerability of nonclinical frontline workers, who often have chronic health conditions that place them at particular risk for contracting COVID-19, should be acknowledged and considered in planning.

Community and public health leaders in health care, behavioral health, and policy must consider the implications of health inequities among racial/ethnic minority populations, seriously tackle their root causes, and develop culturally responsive COVID-19 strategies for socially vulnerable African Americans. CBPR-driven approaches that elevate marginalized communities as senior partners in planning, implementing, and evaluating strategies will promote community leadership and increase adherence to health communication messages as the COVID-19 pandemic evolves. Efforts should be characterized by strong data (research or evaluation), contextually relevant community engagement strategies, and action (policy, systems, and environmental change approaches). The COVID-19 pandemic has presented an optimal opportunity to reprioritize and sustain approaches toward advancing community engagement of vulnerable African Americans. These new approaches will prepare us for the next pandemic. More importantly, they will foster CBPR leadership in advancing health equity.

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