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The COVID-19 pandemic has been waning over the past several months; however, its impact on the way we approach public health, deliver care, and disseminate information continues to be felt across the country. This is especially true for racial and ethnic minority and American Indian/Alaska Native (AI/AN) communities. COVID-19 has highlighted the importance of health literacy as a tool for understanding public health measures and driving steps to protect ourselves, our families, and our communities. Health Literacy Month, observed every October, gives us a chance to recognize the organizations and initiatives working to improve health outcomes by addressing personal and organizational health literacy.
Studies estimate that only 14% of the U.S. population has proficient health literacy. This means that many of the people we care about struggle to find, understand, and use information and services required to make informed, health-related decisions and actions for themselves and others. Low health literacy levels left many people susceptible to dangerous COVID-19 misinformation and disinformation during the pandemic.
In June 2021, as part of the Biden-Harris administration’s National Strategy for the COVID-19 Response and Pandemic Preparedness, the U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) awarded $250 million to 73 local governments for the Advancing Health Literacy to Enhance Equitable Community Responses to COVID-19 initiative (AHL). During this two-year initiative, local governments are testing enhanced health literacy efforts ultimately intended to reduce COVID-related disparities within racial and ethnic minority populations and other vulnerable communities.
One example of the important work of AHL grantees is the Fairfax County Health Department project titled, “Stronger Partnership, Stronger Community: Using Health Literacy to Increase Resilience (Stronger2).” Stronger2 is an initiative to improve health literacy among local African-American, African, and Hispanic communities. This community outreach and capacity-building initiative brings together fifteen nonprofits, houses of worship, and historically Black fraternities and sororities to increase the acceptability and use of COVID-19 public health information and services by Hispanic, African American, and African individuals living in Fairfax County, Virginia.
Since its launch in July 2021, Stronger2 has hosted 100 capacity-building events focused on cultivating its community members’ ability to find, understand, and use health information and services in a manner that is culturally and linguistically appropriate. Through its efforts, Stronger2 has:
OMH’s unifying goal is the success, sustainability, and spread of health equity-promoting policies, programs, and practices. With this in mind, I encourage you to leverage and spread the great work of Stronger2 by attending one of their many online training sessions or in-person events and sharing their resources with your communities and networks.
As we close out Health Literacy Month in October, it is vital that we continue to come together across sectors to enhance the understanding of health information to reach the highest level of health for all people. When we provide patients with culturally and linguistically appropriate information, we empower them to create healthier outcomes for themselves and their communities.
Ed. note:This blog was previously published on the HHS Blog.
Every year, the United States recognizes National Hispanic Heritage Month (NHHM) from September 15 to October 15, to celebrate the histories, cultures, and contributions of generations of Hispanic Americans born in and outside the U.S. who have helped to shape this diverse country. The theme for this year’s NHHM is Unidos: Inclusivity for a Stronger Nation. In Hispanic culture, unidos (in unity, with inclusivity) is associated with positive outcomes. Being unidos is necessary for getting through tough times, for meeting goals and getting things done together.
NHHM provides an opportunity to acknowledge that while many health indicators have improved for most people in the U.S., significant disparities in health and health care persist, particularly in Hispanic communities. The reasons for these disparities range from minority and socioeconomic status, language barriers, inadequate access, uneven health care, and more. Structural racism, stereotypes, biases, and other systemic factors have also contributed to these disparities. For Hispanic communities, these disparities take on many forms, including higher rates of chronic conditions, worse health outcomes, and premature death, all presenting with significant health, social, and economic consequences.
To improve the public’s health and achieve health equity for the Hispanic/Latino population, we can employ strategies that fully engage communities and address structural, social, and economic conditions in a culturally competent manner. Successfully implementing these strategies will also require focus on communicating relevant and practical information that resonates with Hispanic/Latino audiences and subgroups. With roots in dozens of countries and territories across Latin America and the Caribbean, the Hispanic/Latino population in the United States also represents a diversity of beliefs and attitudes toward many topics, including how we maintain our health and when, why, and from whom we access health care.
Reaching different Hispanic/Latino groups to help decrease health disparities requires more than a one-size-fits-all approach. Understanding and accepting this rich diversity supports effective outreach, with strategies informed by science, and with an understanding of how various Hispanic groups best receive, understand and act to protect their health. This tailored social approach to inclusion may help Hispanic and other minority populations to have the opportunity to lead longer, healthier lives.
I can’t think of a better theme, not just for NHHM, but throughout the year, for all of us living in and loving our country. We know that we can’t do it all alone; we can join forces and do it together. The Unidos: Inclusivity for a Stronger Nation theme reinforces the need to ensure that diverse voices and perspectives are welcome and to engage people in health and health care decision-making, especially in the public health sector.
We can proactively support and intentionally improve representation of the Hispanic and Latino workforce now. Besides celebrating the Hispanic and Latino heritage in general, this can be done specifically by recruiting with intention for leadership positions and at all levels across the workforce, leveraging employee networks, and providing opportunities for mentorship and growth for Hispanic individuals. We can strive to reach equal representation and inclusion of Hispanic and other minority populations across the workforce and at all levels of seniority.
This year is a call to action for unity, and like my mother always says, no matter what, unidos somos mas fuerte (united we are stronger). Let’s all celebrate NHHM this year by uniting and becoming stronger. Together we can reach health equity, decrease disparities, improve health outcomes, and make our country and all its people safer and healthier.
Visit OMH’s Hispanic Heritage Month Resources page for more information on the factors impacting the health of Hispanic and Latino communities.
Visit the Centers for Disease Control and Prevention’s website to learn more about the Division for Heart Disease and Stroke Prevention (DHDSP).
Denise Octavia Smith, MBA, CHW, PN, is the founding Executive Director of the National Association of Community Health Workers (NACHW) . In September 2020, Mrs. Smith joined the Office of Minority Health (OMH) for a virtual symposium highlighting state, tribal, territorial, and community-based efforts to address COVID-19 among racial and ethnic minority and American Indian and Alaska Native populations.
OMH is focused on the success, sustainability, and spread of health equity-promoting policies, programs, and practices. As part of its blog series, “Advancing the Response to COVID-19,” OMH followed up with Mrs. Smith to discuss how NACHW’s strategy and efforts have evolved since her presentation in September 2020, including leveraging cultural and linguistic competency to address COVID-19 misinformation and addressing the lack of mental health resources for CHWs.
What role has cultural and linguistic competency played in the COVID-19 impact on minority communities?
We should consider that, during this global pandemic, many of the systems, sectors, and providers needed to prevent, diagnose, or treat infection were not initially designed to benefit the diverse communities now living in the United States. Thus, when we see significant disparities in COVID infections and deaths, and in the other impacts of COVID-19, such as layoffs from work, lack of internet access, food insecurity, and the rise in mental health symptoms, we understand that each of these is made worse when the systems and sectors designed to help people in a crisis are difficult to access or inaccessible due to lack of language diversity or cultural competency, prejudice, or bias.
How has NACHW addressed the lack of culturally appropriate materials and access to basic needs since you presented at the OMH Virtual Symposium in September 2020?
NACHW has a diverse membership representing many different languages, ethnicities, and cultures. When the pandemic began, NACHW recognized the need for culturally and linguistically appropriate materials. We consulted with a team of Spanish speakers from a variety of cultures and national backgrounds to review our translations and endorse them.
In the spring of 2020, with the rise of community and physical violence against Asian American and Pacific Islander (AAPI) communities, we responded by partnering with organizations representing these languages, ethnicities, and cultures to develop materials to stop AAPI hate and to provide support for these community members. In January 2022, we partnered with the White House to help roll out covidtest.gov , focusing our efforts on marginalized communities and culturally and linguistically diverse community-based organizations, including translating our website and materials into Chinese, Spanish, Haitian Creole, Arabic, and Korean languages.
How has NACHW addressed misinformation and distrust within the communities you serve?
NACHW has been on the front lines of amplifying the roles, capacity, and leadership of our profession in addressing misinformation and distrust during and before the COVID-19 pandemic. CHWs work in many different sectors and many different programs providing factual information and educating people about risk factors, diagnoses, or treatments. We regularly address the misinformation that we know the community may have based on what they have heard or read about a risk factor, disease, treatment, program, or organization. We respond with compassion, patience, and determination to provide individuals and families with the factual information they need to make decisions to protect themselves and their families.
It is because we share the lived experience, culture, faith, language, or even the same diagnosis as many of the people we serve that we have trusting relationships that help us break down barriers of communication, address stigma, shame, and low literacy, and get to the heart of the issue.
Now that vaccines are recommended for anyone age 5 and over, how have you evolved your messaging and community initiatives to ensure you’re reaching the various age groups?
NACHW is a co-founding organization of the Vaccine Equity Cooperative (VEC) , launched in October 2020, to provide access to data, strategy, and resources that are developed and endorsed by community-based organizations and workforce members.
The VEC facilitated a diverse working group of subject matter experts to produce a set of detailed recommendations for the equitable distribution of COVID-19 vaccines to children ages 5 to 11 years old . These recommendations were shared at the highest levels, with the White House and several federal agencies, and also distributed to community-based organizations and CHWs, so that they would have access to clear, actionable recommendations that they could apply to their state, county, or local levels.
What are some ways that community health workers have addressed the lack of mental health support for themselves since you presented at the OMH Virtual Symposium in September 2020?
NACHW confirmed in the early months of COVID-19 that our members were experiencing emotional burden, mental stress, anxiety, and frustration when many of the families and communities they served began to suffer from unemployment, food insecurity, threats of eviction, rising rates of domestic violence, loss of health insurance, and other impacts from COVID-19.
NACHW surveyed our national membership in 2020 to understand their mental health needs and looked across the country to identify what CHWs were doing in response. We found that CHWs were developing online support groups for themselves and their clients. They were developing training to help other CHWs recognize the signs and symptoms of stress, and how to respond to and make referrals.
In 2021, NACHW developed national learning collaboratives after consulting with our members so that CHWs could come together in different cultural, experiential, or language groups to discuss their mental health challenges and get support and strategies from mental health experts.
Watch Mrs. Smith’s original virtual symposium presentation on OMH’s YouTube Channel.
Learn more about Cultural and Linguistic Competency and the National CLAS Standards.
Darielys Cordero, MPH, DrPh is the Special Programs Director at Puerto Rico Primary Healthcare Association (La Asociación de Salud Primaria de Puerto Rico) . In September 2020, Dr. Cordero joined the Office of Minority Health (OMH) for a virtual symposium highlighting state, tribal, territorial, and community-based efforts to address COVID-19 among racial and ethnic minority and American Indian and Alaska Native populations.
OMH is focused on the success, sustainability, and spread of health equity-promoting policies, programs, and practices. As part of its blog series, “Advancing the Response to COVID-19,” OMH followed up with Dr. Cordero to discuss how Puerto Rico’s community health centers have continued to evolve as the pandemic continues.
How has the Puerto Rico Primary Healthcare Association evolved throughout the pandemic to better meet the needs of your communities?
PRPCA has focused its efforts on supporting health centers' response in areas of health communication, education, and community outreach by keeping health care teams informed around COVID-19 vaccination, testing, and treatment. Lack of adherence to management of chronic conditions has been a crucial effect of lockdowns and local restrictions, so innovation and increasing access of services to those patients has been a top priority for the health centers.
The PRPCA is working with health centers to adapt their teams and operational infrastructure to provide self-monitoring equipment for the remote management of chronic conditions on their patients and to distribute medications to their homes. This required adaptation of the health care teams’ roles, education, and electronic medical records to align to this model of care.
The pandemic contributed to the previous burden and detriment of the health and social conditions experienced by the population in Puerto Rico from recent disasters. This represented a noteworthy opportunity for the PRPCA to work with community health centers’ understanding of the direct effects of those social risks on the health status of their patients, improving mechanisms to systematically identify those needs and strengthen and activate new partnerships to address primary risk factors of their specific populations. In summary, we aided in increasing collaborations with partners in health care systems to address those efforts, including support to the health center workforce in managing provider burnout and emotional health.
What role do Puerto Rico’s community health centers play during COVID-19 vaccine distribution?
The role of health centers in Puerto Rico distributing vaccines against COVID-19 has been essential to provide equitable access to communities across the island. This distribution has been carried out through key efforts as community mobilization, community health care work, and local engagement.
Health centers’ mobile units were used to drive vaccination directly to populations with more geographical limitations. Community health workers also provided orientation and vaccinations to patients in their homes, schools, or at work. Central to these efforts was also the development of collaborative alliances with churches, community leaders, and local governments to reach populations that have difficulty accessing health services.
Ninety-five percent of health centers are providers of COVID-19 vaccines and are accessible to the entire family, becoming family center vaccination sites, and contributing to Puerto Rico’s goal of being the first jurisdiction to achieve the highest vaccination rate. Health centers provide vaccine access to all groups of the population in the same facility, and patients can access other vaccines and preventive services. This resulted in mitigating access barriers to primary care during the pandemic.
Health centers in Puerto Rico are one of the largest networks of vaccine providers in the island and from the beginning of the pandemic have been key state partners in response and control strategies, including: surveillance, diagnostics, vaccination, and treatment, along with current efforts to be Test to Treat sites and Long-Term COVID-19 facilities in specific settings.
Many other states and territories in the U.S. have seen a rise in misinformation and distrust in healthcare systems. Have you seen a similar trend in Puerto Rico?
In Puerto Rico, there is also an increase in misinformation and distrust in health systems with the COVID-19 vaccine. During the pandemic, the need to communicate health information to patients in a simple and effective way has been highlighted, considering the capacity of each patient to process and understand the information. For this, health centers have incorporated various health education strategies for the communities they serve.
Health centers, community workers, and proactive health care educators and promoters work daily to combat the myths and lack of confidence in vaccines. This was provided through media, television, and campaigns on social platforms, in addition to on-site, one-to-one orientation. PRPCA supports these efforts by providing weekly newsletters with evidence-based and trustful resources to multidisciplinary staff for addressing patient concerns. Current collaborations with local and national organizations make possible the development of target initiatives to increase confidence in testing, vaccines, and treatment options for patients and workers.
As you noted in your presentation, many people in Puerto Rico don’t have experience with, or access to, technology such as cellphones. How does this impact public health communication strategies?
The demographic profile of the population and limited network connectivity in certain geographies of the island highlight access limitations to healthcare and preventive services. This constrains public health efforts to promote, prevent, and protect health care and vulnerable groups of the population that receive the highest impact. To continue delivering care because of the pandemic, innovations rapidly evolve as telemedicine, virtual education, and other technological enhancements. Considering the current island landscape, those innovations have limited effectiveness in population groups.
As a result, health centers focus their public health communication strategies on education, working with health promoters inside the community served (public places, churches, schools, drive through vaccination, etc.), and through home visits. Health centers increase access to health care, including outreach strategies to homeless, elderly, young, pregnant women, public housing residents, among others vulnerable groups. Using local radio media, telephone messages, in addition to social platforms, were part of the educational interventions. Other health centers renovate internal spaces to provide patients access to connection and telemedicine services.
What are some lessons you have learned during the pandemic that might help other community health centers and public health workers?
Some lessons learned during the pandemic have been:
Watch Dr. Cordero’s original virtual symposium presentation on OMH’s YouTube Channel.
Download and share the U.S Surgeon General’s COVID-19 Misinformation Campaign Toolkit.
Sandra C. Brown, DNS, APRN is Dean and Professor at the College of Nursing and Allied Health, Southern University and A&M Baton Rouge and co-chairs the Louisiana COVID-19 Health Equity Task Force. In September 2020, Dr. Brown joined the Office of Minority Health (OMH) for a virtual symposium highlighting state, tribal, territorial, and community-based efforts to address COVID-19 among racial and ethnic minority and American Indian and Alaska Native populations.
OMH is focused on the success, sustainability, and spread of health equity-promoting policies, programs, and practices. As part of its blog series, “Advancing the Response to COVID-19,” OMH followed up with Ms. Brown to learn more about the continued successes and challenges of the Louisiana COVID-19 Health Equity Task Force since her presentation in 2020.
During your presentation at the OMH Virtual Symposium in September 2020, you mentioned that Louisiana has long been one of the least healthy states in the country. Compared to other states, how did this create more challenges for the Louisiana Health Equity Task Force?
With Louisiana ranking 50th in the country as the least healthy state, the Louisiana COVID-19 Health Equity Task Force knew that we could not address COVID-19 without addressing the health disparities that have plagued our state for over two decades. We also knew that we could not address health disparities without addressing health equity. COVID-19 did not cause the health disparities in our state, but it certainly did expose them. This created more challenges because we knew what the data showed and that we had to act swiftly to come up with meaningful deliverables that could be implemented short-term, intermediately, and long-term for sustainability.
We identified nine key priority areas and divided these areas into subcommittees. The nine priority areas included:
Download a copy of the Louisiana COVID-19 Health Equity Task Force Subcommittee Reports .
You previously noted that the Task Force provided valuable recommendations regarding equitable COVID-19 testing protocols. How did these recommendations influence the delivery of COVID-19 vaccinations once they became available?
The subcommittee on COVID-19 Testing for Vulnerable and At-Risk Communities reviewed the State-wide Testing Plan for COVID-19, antibody testing, and quarantine. They also reviewed statewide protocols for testing, geo-mapping of testing, barriers to testing, testing site locations, COVID-19 mobile testing efforts, local government’s role in testing, and contact tracing efforts. A comprehensive recommendation to facilitate COVID-19 testing for vulnerable and at-risk communities (symptomatic and asymptomatic) was produced. These recommendations helped to influence the process by which COVID-19 vaccinations could be accessed within the community.
At the time of your presentation, the Task Force was in the process of designing a health equity dashboard. Can you tell us more about that development process and about the current state of the dashboard?
The dashboard subcommittee worked to identify the data elements of health equity determinants that would constitute the Health Equity Dashboard. This included a review of existing dashboards in other states and identifying data elements specific to Louisiana. The subcommittee identified major categories of health equity determinants data which included:
The dashboard subcommittee recommended that the Louisiana Department of Health (LDH) Office of Community Partnerships & Health Equity (OPH) provide the authority and administrative responsibility to create, maintain, evaluate, and continually improve the Louisiana Health Equity Dashboard based on current evidence and research.
We are delighted to report that The State Health Assessment Dashboard has been developed and can be accessed at: dashboards.mysidewalk.com/louisiana-state-health-assessment
Louisiana Public Health Institute has worked collaboratively with LDH/OPH in developing the dashboard. Their efforts have resulted in over 5,400 unique visitors to the dashboard since its launch in March 2021. The dashboard has garnered national attention, receiving a Government Experience Award from the Center for Digital Government.
Over the past two years, how has your public health messaging strategy changed to continue addressing distrust and misinformation?
The common theme of our public health messaging strategy was to deliver health and safety content messaging to those who were most vulnerable and those who were at the heart of health disparities in Louisiana including the aged, young adults, people of color, and those who were economically disadvantaged. We felt that any delay in communication and messaging would increase the likelihood that more people would contract COVID-19, more hospitalizations would result, and ultimately more people would die. Therefore, the Communications Subcommittee worked diligently to get messages out quickly. They were charged with producing “products” in the form of advertisements and other messaging to the general public and targeted groups. As the pandemic continued, other platforms were used to address distrust and misinformation as it related to COVID vaccines such as town hall meetings using medical experts, churches and faith-based communities, and Historically Black Colleges and Universities.
They spent a number of weeks studying marketing mechanisms needed to best target messaging through the Louisiana State University Manship School of Mass Communications . Messages in Spanish and Vietnamese were developed. Social media platforms were used as well as digital billboards, television, and radio.
Of the various digital communication platforms, you mentioned – social media, TV ads, and digital billboards – what was the most effective platform for your initiatives?
The effectiveness of communication and messaging to reach, inform, and impact change is multifactorial. We have no empirical data to support that one form of communication was more effective than the other. We tried every communication platform to reach our target audience. Anecdotal comments suggest that social media is the most cost-effective and far-reaching for our younger population, whereas TV and radio commercials may have been more effective for reaching our older population. Digital billboards are costly, so we learned early on to strategically use those in heavily populated areas near the interstate and within vulnerable geographic communities.
Watch Ms. Brown’s original virtual symposium presentation on OMH’s YouTube channel.
Visit The Presidential COVID-19 Health Equity Task Force page to see other recommendations on addressing COVID-19 nationally.
