The field of public health deserves a lot of attention right now as this field offers us answers for how we should address the risk factors for this recent pandemic. Importantly, conceptualizing racism and racial justice as a public health issue has also gained traction. Lehigh University’s College of Health is offering a biweekly, faculty run series of webinars that are exploring key concerns of public health in the light of the coronavirus. The most recent installment of the series specifically explores how Covid-19 has impacted health inequities in the Lehigh Valley, and how some public health organizations are addressing these inequities. Specific access to environmental elements like wealth and status determine some of the conditions for health and well-being. For the purposes of this article, health inequities are the unevenly distributed health effects and resources across diverse populations.
Moderated by Dr. Fathima Wakeel, the webinar on July 22nd featured three panelists: Jill Pereira, Vice President of Education and Impact at the United Way of the Greater Lehigh Valley; Dr. Hasshan Batts, Executive Director of Promise Neighborhoods of Lehigh Valley; and Kristen Wenrich, Director of the Bethlehem Health Bureau. Together, the three panelists were able to speak to the impact of Covid-19 in exacerbating health inequities and the root of health inequities in our area. The panelists also gave examples of how the organizations that the panelists represent have begun addressing the needs of the Lehigh Valley community during this time.
Jill Pereira spoke of her role at the United Way of the Greater Lehigh Valley, an 125 year old organization that identifies social justice issues that impact public health, and mobilizes people to improve health for diverse populations in the Lehigh Valley. Pereira specifically notes that the key issues her organization addresses are: ensuring that students are able to read at grade level by third grade, facilitating healthy food access, and the health and well-being of the elderly in our community. Pereira’s perspective was influenced by United Way’s long history and funding focus, which supports many smaller programs and nonprofits in the Lehigh Valley. Dr. Hasshan Batts spoke about his role with Promise Neighborhoods of the Lehigh Valley, which is an organization that works to support community health and opportunities from cradle to career. Dr. Batts spoke of his work as anti-racist because it specifically supports policies and programs that combat racism by ensuring that families and individuals have the resources to succeed in employment, natal care, education, and parental capacity. Dr. Batts’ work occurs within small communities, and as such his organization has a more intimate knowledge of specific communities’ needs in the Lehigh Valley. Finally, Kristen Wenrich’s perspective was contextualized by her work with the Bethlehem Health Bureau. As a government organization, the Bethlehem Health Bureau is able to implement and uphold policy such as safety inspections for environmental health. The Bureau also collects immense data on community health and needs, and is able to hold education campaigns and address health crises as they arise. Together, these three panelists offered a vast array of experiences and knowledge about health inequities in the Lehigh Valley.
What are the leading health inequities in the Lehigh Valley, and what are their root causes?
Jill Pereira started the conversation around health inequities in the Lehigh Valley by emphasizing that the three panelists and the public health organizations they present are not implementing programming that directly relates to bodily health specifically, but rather the “social determinants of health.” Pereira defined this concept as those elements of a person’s environment, which impact health and well-being. For Pereira, it is crucial to address things like unemployment, housing stability, and graduation rates because a lack of support in these kinds of social determinants of health result in “toxic stress.” Toxic stress directly impacts health and has reverberations into the other healthy choices individuals and families are able to make.
Dr. Batts specifically named poverty and racism as key elements that affect allostatic load. Allostatic load is the cost on the body of constant exposure to stressful challenges in life. Dr. Batts noted that the presence of stressful factors and the related hormonal response actually creates physical wear and tear on the body, which reduces the body’s resilience. In the context of this knowledge, reducing the environmental stressors that contribute to allostatic overload is a crucial way to supporting public health.
Kristen Wenrich reported that Bethlehem Health Bureau data has found that income and race have huge roles in health disparities. She also noted that the lowest income groups have actually been reporting decreasing health outcomes over the years that she worked in the field of public health. Importantly, Wenrich also noted the increasing need for organizations to attend to health needs data not in the aggregate but in terms of specific subgroups. By ignoring the ways that health needs are connected to race, ethnicity, or income, health disparities can be obscured and therefore persist.
How has Covid-19 further impacted the health inequities in the Lehigh Valley?
In terms of the impacts of the pandemic on public health, Dr. Batts noted that those who had been wrestling with food and housing security prior to the pandemic have even more challenges and are at greater risk than many other households. He noted also that the pandemic resulted in a swell of need from households who had never been financially insecure before. Pereira contextualized this information in terms of ALICE data, or information about households that are “asset limited, income-constrained employed.” According to Pereira, before Covid-19, 1 in 4 families in Pennsylvania fell into the ALICE category. This is crucial because though these households are not necessarily combating poverty, they are, as Pereira puts it, one crisis away from it, and yet ineligible for assistance from the government. Though Pereira wasn’t able to provide concrete statistics about the effect Covid-19 has on ALICE families, she stated that in the last couple months it has become clear that the pandemic and recession is that back-breaking crisis, and now even more families than ever are within the ALICE category.
How have you and your organization helped to address these health inequities during Covid-19?
Kristen Wenrich reported that the Bethlehem Health Bureau has been implementing policy changes to address health inequities generally. They also designed Covid-19 specific responses that address the unequal effects of the pandemic on Bethlehem’s Latinx and Black populations. The Health Bureau is implementing more staff training on the intersections of race and health and more pre-crisis screenings to determine realms of precarity before crisis hits. Wenrich also noted that the Bureau is making sure all policies take into account health disparities, incorporating more community input for program design, and increasing diversity in the Health Bureau’s staff and board in order to better reflect the make-up of our community. In terms of Covid-19 specifically, the Health Bureau has focused on housing security. They have worked with New Bethany Ministries to provide temporary housing and local hotel rooms for the homeless who need a place to stay in order to comply with the stay-at-home order and reduce their exposure to the pandemic. Wenrich also reported that they have a special focus on facilitating food access during quarantine, and supporting the elderly by mitigating feelings of isolation during this time.
According to Jill Pereira, United Way has addressed Covid-19 by being a central point of information for other nonprofits, as well as helping solve issues and logistics to ensure programs are implemented effectively. United Way also mobilizes people and donors to contribute to their community during this time. The organization is now raising and deploying money to support the racial justice movement. They have also worked on diaper distribution, developing and sharing social-emotional learning tools for kids, teachers, and parents, and ramping up child-abuse mitigation programs, including activating all citizens as mandatory reporters.
Dr. Batts and Promise Neighborhoods first took a pause and turned to neighborhoods first to investigate the needs and attitudes of their communities before springing into action. Dr. Batts and his organization found that there was a incredible amount of distrust between the healthcare sector and vulnerable populations because of the history of medical genocide, including forced sterilization and insufficient healthcare, that has had permanent consequences for communities of color. This distrust resulted in ignoring CDC guidelines and believing that the pandemic was not real, which only put these communities at greater risk. One of the first things Dr. Batts and his organization had to do was think through how to reinstate trust between the community and public health experts. Promise Neighborhoods did so by transforming information from the CDC and WHO into a form that was relatable, working with local community leaders to endorse the public health instructions, and creating instructional literature that used, for example, the pictures of local leaders to make a concrete connection between the health information and the community. Promise Neighborhoods also implemented a mass text service to increase the spread of crucial information, and designed a three stage plan to address crisis, recovery, and resilience. Right now, Dr. Batts and his team are working on providing resources and structures for recovery.
This colloquium on health inequities is enlightening for those outside of the public health sector because it illuminates just how much socio-economic status and racism impact the health of individuals and entire communities. Dr. Batts’ insights also reveal how histories of trauma can further entrench distrust, which can threaten the flow of resources for vulnerable communities. All three panelists showed that attending to the unique needs of vulnerable communities is a crucial way to address health inequities. This webinar also illustrated the necessary and profound work that many people in the Lehigh Valley are doing to increase public health and to manage and mitigate the crisis of the coronavirus pandemic. We should celebrate the work of Dr. Hasshan Batts, Jill Pereira, and Kristen Wenrich, and the many others like them, who are dedicated to helping their community. One way to celebrate them is to donate your time or money to make sure their work can continue.