COVID recovery plan to allocate $1 million for community health | News
Skagit County management must invest in equity as the county recovers from the COVID-19 pandemic, according to a report from local community health leaders.
The 2022 COVID stimulus package — passed by the county late last month — is intended to help guide Skagit County commissioners as they direct $1 million in federal pandemic relief funding intended to community health.
Members of the county’s Population Health Trust have spent the past year and a half collecting public feedback and have confirmed that the experience of the pandemic has been divided along racial, economic and social lines.
Trust has formed around a public health idea called the social determinants of health, which asserts that the economic and social conditions of an individual or group influence their overall well-being.
As such, the plan focuses on addressing upstream issues that created gaps in health outcomes between groups at the height of the pandemic.
Recognizing that the impact of the pandemic was different for different groups, recovery must be grounded in equity, according to Kristen Ekstran, county community health analyst.
Through their interviews and data analysis, members of the Population Health Trust identified barriers to health were greater for certain groups – Latinos, LGBTQ people, veterans, people with disabilities and families with young children.
Many of the plan’s proposals focus specifically on the county’s Latino population, as they in particular have suffered measurably worse outcomes from COVID-19.
The community was consistently overrepresented in COVID-19 cases, hospitalizations and deaths, as systemic disadvantages leave them worse off than others. On measures such as income, housing, access to health care and high-speed Internet access, the average Latino household is worse off than the average white household.
Additionally, Latinos are more likely to be “essential workers” than whites. Places like grocery stores, food processing plants and farms were staffed throughout the pandemic, meaning those employees were more exposed to the virus than those who could work from home.
Ekstran said in its response to COVID and these disparate impacts, the county has hired members of the Latino community to communicate public health messages in a culturally informed way — called promotores.
As members of the community, they participated in conversations with built-in confidence and were able to communicate public health messages more effectively. They succeeded in knocking down misinformation around the virus and encouraging people to get vaccinated.
The recovery plan takes that idea and follows it, suggesting that medical providers should consider expanding this kind of culturally-informed approach to health care.
Respondents told trust members that bringing people into the healthcare system who are fluent in both language and culture would help Latino patients feel welcome, Ekstran said.
“If medical providers had more of these frontline people who can build trust in their services, more people would come,” she said.
Chris Johnson, executive director of PeaceHealth United General Hospital, used his own hospital as an example of what is not being done for these groups.
“We’ve seen a lot of unintended consequences and blind spots for these special groups,” he said during a presentation to the county board of health with other trust members.
An analysis of the hospital found that despite making up about 18% of the community, only 3% of patients were Latino. It shows that United General is failing to take care of a large part of the community, he said.
Representatives of the LGBTQ community have also raised concerns, saying accidental oversights can make people feel unwelcome and completely disconnect from the healthcare system.
“We see simple things like asking individuals what pronouns they like to be referred to, a very simple piece that often gets overlooked,” Johnson said.
However, in order to hire these and other culturally sensitive services, people from these communities must consider these professions as viable careers.
Ekstran said she was inspired to adapt a successful local partnership called Maestras Para el Pueblo, which encourages Latino children to consider careers in education and then helps them come back and teach in their community.
“We have the same needs here,” she says. “Why can’t we use the same type of model to expand (Latin representation) in areas where we need all kinds of professionals anyway?”
She said a program like this could be used to bring more people into mental health fields and also provide financial stability to the worker.
Labor economist Anneliese Vance-Sherman said the program could be expanded further. For example, companies looking for workers could work together to promote apprenticeships in trades specifically for Latinos, members of the LGBTQ community, and people with disabilities.
“Apprenticeships are a pathway to careers, not just jobs,” she said. “(They are) on-ramps to economic and financial security.”
SAME PROBLEMS — INTENSIFIED
The fundamental issues degrading community health were the same before the pandemic as during it, Ekstran said.
However, these existing problems of access to housing, food, employment and child care have all intensified as families lost their jobs, faced school closures and faced the disease, Ekstran said.
The recovery plan recognizes this, highlighting the problems that were present before COVID-19.
Child care is an obvious example, according to Dean Snider, CEO of the Skagit Family YMCA.
While rare before the pandemic, once schools moved away, parents everywhere struggled to find available and affordable childcare.
One idea that was thrown into the plan, he said, was to encourage employers to offer on-site childcare, possibly in cooperation with other nearby businesses.
On-site child care can be touted as a benefit for employees and a retention tool for employers, he said.
Behavioral health – an umbrella term including both mental health and addictions services – is an area where better access is needed for everyone, but especially for people in underserved groups.
Ekstran pointed to a program called Mental Health Matters, which could be adapted to Skagit County. This training program teaches everyday people – from parents to teachers to hairdressers – how to identify and talk about behavioral health issues.
Margaret Rojas, deputy director of the North Sound Behavioral Health Organization, said the isolation and stress of the pandemic was having an effect on the community.
This is evident in the increase in overdose deaths, alcohol consumption and people seeking mental health services.
“If you’re like me, when you’re at the hairdresser, you talk, and everything comes out,” Rojas said. “It’s a safe place.”
It’s not that hairstylists would be responsible for diagnosis and treatment, but they could be trained to refer someone to mental health resources, or just lend an ear without judgment, she said.
“We know the stigma is huge in the world of behavioral health,” Rojas said. “So one way to break it down is to educate and inform everyone, not just professionals.”
Skagit County Commissioner Peter Browning said when he worked in public health he worked on a similar training program to talk about AIDS.
“I’m so glad you’re doing this,” he said. “It was a very, very successful project in King County, and it was probably one of the best educational projects we’ve done.”
Ekstran said the Population Health Trust has formed a committee to flesh out these goals and strategies into actual projects, which will be presented to the commissioners for funding.
While some members of the trust belong to organizations that could receive county funding, Ekstran said none of the members of that committee are on it, avoiding a potential conflict of interest.
She plans to present the proposals to commissioners in late spring or early summer this year, she said.
But because the scope of this plan is so broad, government funding cannot solve all the problems identified. This is where business and community leaders can step in, she said.
“A lot of these strategies are big, system-level strategies that no single organization can do alone,” she said.
Beyond the county’s $1 million in funding, she said she hopes the plan will be accepted by the community at large and that partnerships will form as individuals, businesses and organizations would try to implement these proposals.
“Not all of these strategies lend themselves to immediate funding, but some of them do,” she said. (Commissioners) seek one-time allocations, and many of these strategies will require ongoing commitments.