Community-driven, community-responsive

Grassroots collaborations confront disparities illuminated by pandemic

By Sandra Gray

Dramatic health disparities are not new or limited to COVID-19, but the pandemic has illuminated longstanding gaps in health status and health care stratified by race and ethnicity.

“We knew before the pandemic that health disparities exist and these disparities disproportionately affect the overall health and lifespans of Black, brown, indigenous and immigrant populations,” said Matilde Castiel, MD, associate professor of medicine and commissioner of health and human services for the City of Worcester. “We were aware that families in our city’s Black, Latino and immigrant communities were most likely to contract the virus because they had less opportunity to socially distance, quarantine or work from home.”

UMass Medical School purposefully instills in the health care providers and scientists it trains the means to understand and proactively address the socioeconomic factors that underly health disparities. During the pandemic, the Medical School played a significant role in grassroots initiatives created by the city, community organizations and advocates to help those most affected by COVID-19.

Collaborations initially included engaging Black and Latino communities in vaccine clinical trials and addressing lack of confidence about getting vaccinated through community conversations and town halls. Building upon these collaborations and fostering more community-engaged research, service-learning programs and curriculum focused on health disparities and health equity will remain a focus long after the pandemic ends.

“We want our community to know that we’re here and available to help,” said Ché Anderson, who in 2020 joined UMass Medical School as assistant vice chancellor for city and community relations after nearly seven years with the City of Worcester, most recently as deputy cultural officer. “We look forward to assisting. We want to be active partners.”

Expanding representation and participation in clinical trials

In the fall of 2020, UMass Medical School reached out to diverse communities in Worcester to recruit volunteers for a clinical trial of the PfizerBioNTech vaccine under the leadership of Robert Finberg, MD, distinguished professor of medicine, who has served as principal investigator on more than half a dozen clinical trials related to COVID-19. Dr. Finberg is a member of Gov. Charlie Baker’s COVID-19 Vaccine Advisory Group, which has emphasized equity in COVID-19 vaccination efforts.

“Lack of representation in research is yet another driver of health disparities,” explained Stephenie Lemon, PhD, professor of population & quantitative health sciences, chief of the department’s Division of Preventive and Behavioral Medicine and co-director of the UMass Worcester Prevention Research Center. “Our overarching goal is to make the research accessible to underrepresented groups.”

Sarah Forrester, PhD, is employing a creative approach with Worcester’s COVID-19 Health Equity Task Force and community organizations. In an effort to address barriers to research study participation, the task force is utilizing storytelling by community members who are best positioned to convey messages about why Black and Hispanic people should take part in clinical research.

“COVID-19 is hitting these communities the hardest,” said Dr. Forrester, assistant professor of population & quantitative health sciences. “We connect through personal stories, through hearing and seeing somebody that looks like you and has the same experiences you have had.”

With its mission to achieve social justice through improved health for all, the Department of Population & Quantitative Health Sciences is involved in many health equity efforts at the Medical School. “We have a passion for social justice through improved health,” said Chair and Professor Jeroan Allison, MD.

Delivering answers, dispelling misinformation

UMass Medical School helped address lack of confidence among Black and Latino residents about COVID-19 vaccination by hosting virtual town halls and community conversations to provide reliable information, answer questions and address concerns.

“We tailored the panels to the audience to bring the knowledge of our physicians and scientists to them,” said Dr. Lemon. "There is a lot of interest in populations of color hearing from trusted experts who look like them. Everyone we asked to participate said yes.”

For example, events hosted by African immigrant churches have immigrant physician scientists, including Professor of Pediatrics Benjamin Nwosu, MD, who are well known to the community whose concerns they are addressing, on hand.

Some events have taken a panel presentation approach in which each participating physician and scientist gives a three or four minute overview of their topic, then takes questions. A radio call-in show featured Dr. Castiel answering questions in Spanish.

One of the first gatherings to address the vaccine and the history of distrust and hesitancy in communities of color, hosted by Black Families Together, drew more than 300 attendees. Other organizations hosting UMMS and community speakers—among them clergy who are powerful role models for their congregants—include African Community Education, the Worcester Latino Empowerment Organizing Network, the Latin American Business Organization, Protégete Latino en Contra del Coronavirus, the Worcester Together coalition and City of Worcester employee unions.

Castiel has participated in many of the events, some conducted in Spanish and broadcast on local Latino radio and television stations. Germán Chiriboga, MPH, the project director for the UMMS Science Participation Resource Center and a member of the steering committee of the Worcester Latino Empowerment Organizing Network, has served as a webinar moderator.

Translating information for non-English and English-as-a-second language speakers is essential to these efforts. The UMass Worcester Prevention Research Center, in partnership with the City of Worcester and the Central Massachusetts Regional Public Health Alliance, has produced fact sheets in Spanish, Vietnamese, Swahili, Portuguese, Albanian, Kinyarwanda, Arabic, Hindi, Haitian Creole, French and Mandarin Chinese.

Addressing social determinants of health

Beyond supporting vaccine awareness and access, other Medical School initiatives address the social determinants of health that underlie disparities.

UMass Medical School is one of 22 partner organizations and agencies of the Worcester COVID-19 Health Equity Task Force. The task force was established by the Worcester Department of Health and Human Services and UMMS clinical partner UMass Memorial Health. Its 56 members are leaders from all segments of the community and health care system including UMMS representatives Castiel, Anderson, Forrester, Chiriboga and Ann Moormann, PhD, professor of medicine.

The Greater Worcester Community Health COVID-19 Survey conducted by the Department of Population & Quantitative Health Sciences has informed pandemic relief efforts in Worcester and other local communities. It is being updated to capture concerns about COVID-19 vaccines as well as the overall impact of the pandemic on residents.

Educational outreach programs for high school and college students from backgrounds underrepresented in health care and biomedical sciences are being continued remotely this summer. “It is important to show our students and partners that we can navigate through these challenges as they are presented to us,” said Robert Layne, MEd, assistant dean of outreach programs.

And School of Medicine and Graduate School of Nursing faculty and students continue to serve as trainers and vaccinators for the UMMS-led Vaccine Corps.

More to be done

Community-driven, community-responsive efforts addressing disparities during the current health crisis show promise for sustainability even after the pandemic. But there is much more to be done and proponents fear a loss of momentum.

“What we learned during COVID-19 is that the kind of outreach we were able to do helped people access health care,” said Castiel. “How we collaborated to establish relationships between health care providers and the communities that our institutions have so frequently failed is what should continue happening as we move on.”

“Our intention is to look at sustainable partnerships as we move forward, to maintain longstanding partnerships and to build upon the many new ones we have created,” said Chiriboga. “We are grateful for the opportunities we’ve been given to help strengthen our community.” ■