Confronting and Combating Health Inequities During the Pandemic
One of the pandemic’s greatest tragedies was COVID-19’s disproportionate impact on underserved communities, particularly among people of color — a grim trend caused by structural inequities throughout the nation, local communities and the health care system at large.
During the pandemic, state data revealed several “hotspots” — areas with disproportionately high rates of infection – in predominantly Black and Latinx communities, including Dorchester, East Boston, Hyde Park and Roxbury.
By late April, Black residents of Boston accounted for 41 percent of known COVID-19 cases and 34 percent of deaths, yet Black people comprise only 22 percent of Boston’s population. Similar disparities were reflected in the Brigham’s own patient census during the pandemic.
“Prior to COVID-19, many of us were painfully aware of the inequities faced by patients in our surrounding communities as a result of racism and poverty,” said Christin Price, MD, program director for Medicaid ACO/E-Care Optimization in Brigham Care Strategies & Innovation. “When COVID-19 disproportionately hit such neighborhoods, these inequities were brought to light for all to witness.”
In mid-March, a large team at the Brigham came together in anticipation of this crisis and to plan a comprehensive response. Meeting daily, the multidisciplinary team worked to identify, escalate and address equity concerns within the Brigham and the communities it serves.
“One of my biggest lessons from the COVID-19 equity response is how necessary it is to have teams that are multidisciplinary, diverse and community-engaged if we hope to be effective at addressing inequities,” said Cheryl Clark, MD, ScD, a hospitalist and health equity researcher, who led Incident Command’s Equity, Diversity and Community Health Response team.
Offering a Helping Hand
One notable aspect of the Brigham’s equity response was the establishment of several temporary sites in Dorchester, Hyde Park, Jamaica Plain and Roxbury where staff provided COVID-19 testing, educational resources and care kits containing cloth masks and hand sanitizer. In addition, eligible residents received boxes of fresh fruits and vegetables. At Brookside Community Health Center, staff also distributed diapers and assisted residents with voter registration.
“Social determinants of health (SDOH) — such as food, housing and financial stability — greatly impact one’s health and access to quality treatment,” Price said. “The Brigham Health response, therefore, involved an approach that served the needs of the whole person.”
Tracy Sylven, CHHC, MCHES, director of Community Health & Wellness at BWFH, worked closely with a team from across Brigham Health, which included Price and Kelly Fanning, MBA, executive director for Ambulatory Services, to stand up the sites, facilitate testing and manage the logistics to support the teams performing SDOH screenings.
“Just as a blood sample can tell us so much about your health, the same rings true about your address,” Sylven said. “We’re committed to reaching those who have been underserved. Our calling is to allow every voice to be heard and to make a positive impact in each community we serve, but the stark reality is that not only do people need our help today more than ever but they’re also going to need our help going forward, too.”
Patricia Gonzalez, a community health worker at the Phyllis Jen Center for Primary Care who supported the community testing sites, said it was “a true blessing” to help local families.
“Through working at these community sites, I have seen firsthand the struggles that families are facing right in our neighborhood,” Gonzalez said. “This experience has given me an even greater sense of responsibility to make sure I am taking care of each of my patients to the best of my ability every time.”
Read more reflections from staff who supported community testing sites.
Wanda McClain, MPH, vice president of Community Health and Health Equity, praised the team’s response and noted that it creates a strong foundation for future equity work.
“This multi-departmental and Brigham Health-wide team broke down silos, came together quickly and got to work,” McClain said. “I could not be prouder of this group and look forward to carrying the lessons learned during the pandemic into our reimagined future.”
Brigham clinicians and staff also helped support Boston Hope, a 1,000-bed medical center built at the Boston Convention and Exhibition Center for COVID-19 patients who could safely recover outside of an acute care facility. Giles Boland, MD, chair of the Department of Radiology, served as its co-medical and operations director.
Bernie Jones, EdM, vice president of Public Policy, expressed his admiration for the many ways the Brigham community supported its neighbors in their hour of need. He applauded the teams led by Fanning, Price and Sylven for stepping up to assist with the sites during the pandemic.
“Their collective work clearly represented our value ‘We’re stronger together’ and embodied teamwork, partnership and community, in every sense of those words,” Jones said. “People came together from across the institution in a way that was nothing short of inspirational, propelled by a common desire to serve communities disproportionately impacted by the virus.”
Supporting the Brigham’s Workforce
In addition to community-based efforts, staff from several areas — including the Center for Diversity & Inclusion, the Center for Community Health and Health Equity, the Office of Diversity, Equity and Inclusion, Patient Safety, Quality and Safety and the COVID-19 Equity, Diversity and Community Health Response team — collaborated to support the Brigham’s workforce on issues related to equity.
They organized several virtual forums on a range of topics, including raising awareness about health equity issues, prejudice against Asian-American communities during the pandemic and the combined trauma of racism and COVID-19.
Recognizing that many members of the Brigham’s workforce live in communities that were disproportionately affected by COVID-19, they also organized a series of educational forums for groups of employees.
“We will continue to be persistent with our anti-racism work, our commitment to health equity, diversity and inclusion as our institutional priorities,” said Tina Gelsomino, MSW, LCSW, RCC, director of the Center for Diversity & Inclusion. “Compassion for ourselves and each other is also an essential tool as we continue to work through this.”
Meeting Multilingual Needs
Interpreter Services staff worked tirelessly throughout the pandemic to ensure multilingual access to resources and information. The team not only provided medical interpreter services in clinical settings, but also completed more than 140 urgent translation projects for materials distributed to staff, patients and families.
“Timely translations are essential to reach underserved populations,” said Yilu Ma, MA, MS, CMI, director of Interpreter Services.
During the pandemic, Interpreter Services and others also helped launch a new program, Bilingual Clinician Volunteers for Interpreter Services Emergency Response Planning, to ensure that patients and families with language barriers wouldn’t experience challenges accessing interpreting services, even during a worst-case pandemic scenario.
Led by Marta Solis, Spanish-language interpreter and training coordinator, the program assessed more than 20 medical professionals at the Brigham who could potentially be called upon to interpret if all other interpreter resources were exhausted.
“Being able to experience firsthand the candidates’ outpouring of love and willingness to help was my silver lining during this pandemic,” Solis said.
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