Live. Magazine

The coronavirus pandemic may have been a turning point for one of the biggest challenges in America’s healthcare sector as it opened a fresh avenue to strengthen access to medical services for minorities by leveraging existing networks in which people trust.

Paradoxically, the potential way out of the crisis came during the darkest hour of the pandemic, when the staggering death toll of African Americans and other minorities revealed that something was fundamentally wrong in one of the world’s leading healthcare systems.

The reason for the high death toll among African Americans, which was more than double the country-wide average at the beginning of the crisis, was not only due to economic and social barriers. A key factor was the general distrust in the healthcare system that made many African Americans suspicious of government policies.

Centuries of slavery, social segregation, and outright medical scandals as well as generally poor services for minorities had nourished deep skepticism. From the inhuman treatment of slaves to structural access barriers, African Americans had good reasons to distrust the medical establishment. During the pandemic, social media further fanned this sentiment of distrust when “anti-vaxxers fed into existing anxieties that stem from systemic racism,” according to First Draft, a non-profit social media monitoring group.

While America was able to develop vaccines in record time and produce enough doses for its citizens, many African Americans and other minorities balked at the offerings. They feared that the help they received was only in the self-interest of the elites.

The fact that the first person in the United States to receive the vaccine was a Black woman did little to imbue trust. As USA Today reported, the bleeding wounds of history kept African Americans away from vaccine centers.

Experts agreed. “When people tell me there are Black people skeptical about [the COVID-19 vaccines] … my first impulse is to say that’s what happens when you leave unaddressed these problems of racial inequity and injustices in history,” Rana Hogarth, a history professor at the University of Illinois, told USA Today.

Tapping into existing networks

The way out of the crisis was paved when leaders tackled the paramount question of trust, and medical practitioners, religious and community leaders started to launch outreach programs that targeted people where they are, rather than forcing them to go to medical centers they distrusted.

As the New York Times noted, the outreach programs made all the difference: “These campaigns [were] bottom-up [in] nature” in which “local leaders often designed outreach campaigns to fit their own communities.” From Chattanooga to California, local leaders were catering to the local needs of the people they knew.

In Baltimore, an East-Coast city of some 590000 inhabitants, churches and community centers took up the role of local champions, providing access to vaccines but also important healthcare education to African Americans and other minorities.

One of the leaders in this effort was Terris King, an experienced healthcare professional who also works as a pastor in one of the more than 700 churches in the Baltimore area. As part of his efforts, he not only threw in his knowledge of the Scripture but also tapped into his science background to convince his community to get vaccinated.

The local outreach programs worked. Over a span of several months, death rates among both the Black community and Hispanics dropped sharply, falling in line with the death rates of white people.

Proof-of-concept

For Terris King and many other leaders, the hyperlocal outreach efforts showed that faith networks and local community centers not only helped change the situation on the ground during the pandemic but proved that they can substantially impact the general quality of the healthcare system.

“No institution can out-engage the church,” King told live magazine about the role of the institution in healthcare for minority and underserved communities. “No one can gather as many people nor have a similar outreach. Why? Because we have a history that’s already built in, with our congregants and the community.”

For King, who has served as an executive in the Department of Health and Human Services for many years and founded the Office of Minority Health for the Centers of Medicare & Medicaid Services, churches and other networks can play a pivotal role in overcoming some of the largest healthcare challenges in the United States.

And these challenges are aplenty, especially in the African American community: According to a study published in the Journal of the American Medical Association, data from the Centers for Disease Control and Prevention showed that the Black population had 1.63 million excess deaths, representing more than 80 million years of potential life lost over the study period that lasted during 1999 to 2020.

One of the key killers is heart disease, which is having a disproportionate effect on the African American community. According to the US Department of Health and Human Services of Minority Health, African Americans are 30 percent more likely to die from heart disease than non-Hispanic whites.

Also, the department noted that, although African American adults are 30 percent more likely to have high blood pressure, they are less likely than non-Hispanic whites to have their blood pressure under control. Furthermore, African American women are nearly 50 percent more likely to have high blood pressure than non-Hispanic white women.

Trying a new approach

The work of Terris King and other community workers during the pandemic did not go unnoticed. Many news outlets, from mass media papers to specialized news outlets such as STAT, reported on their efforts.

Research into their work also showed their strong impact. An article in Front Public Health stated that the work of outreach programs with community health workers brings value to the healthcare system. This helped further promote their work as well as attracting the interest of healthcare organizations.

This also included Novartis, which, together with the Global Coalition on Aging, a US-based expert group, was on the lookout for a project that could help underserved communities improve heart health and tackle the challenges related to demographic change – another healthcare pain point with which the United States and many other countries are struggling.

After an extensive country-wide search that included screening more than 300 cities for a potential partnership, the US Novartis Government Affairs function under the leadership of Leo Farber and the Global Coalition on Aging decided to work with the city of Baltimore given its success during the pandemic and its close-knit community networks as well as the backing of local political leaders and the Baltimore City Health Department.

This led to the foundation of Engage with Heart in October 2023, which brings together a variety of partners from churches and community centers to food and urban farming networks as well as healthcare experts from the Johns Hopkins School of Nursing. “For us, Engage with Heart is really about building on our purpose of reimagining medicine to a new level,” said Leo Farber. “While the project is relatively small in scale, it has the potential to provide a new model to drive change in the healthcare landscape in the United States.”

From salad to screening

The lumbering potential of this public-private partnership lies in its holistic strategy. In contrast to previous access projects, which focused predominantly on screening and health data gathering, Engage with Heart tries to solve the health challenges through a much broader approach.

Besides specialized nurses, who organize community health check-ups, it includes nutritionists, chefs, urban farmers, and community workers, who can offer a broad array of services to community members, from fitness programs to health education as well as easy-to-make recipes.

“This differs compared to more technical programs that focus on monitoring and data gathering,” Farber said. “We want to engage the entire community and tap into their knowledge.”

Among others, so-called Community Health Ambassadors are organizing regular meetings with community members to educate them about heart health essentials and provide them with tips and tricks on how to improve their health by adopting new eating and fitness habits. Furthermore, churches are organizing regular heart health check-ups and can help community members get access to a doctor in case they find an increased risk of hypertension or diabetes.

An uphill struggle

As part of the program, Novartis is sponsoring Engage with Heart and is also providing healthcare expertise. The goal is to show that the program can improve heart health in Baltimore and thus help the healthcare system save costs over time. This would form the basis of an investment case in which payers and the government could start funding the work of Community Health Ambassadors and other experts.

For Melissa Gong Mitchell and Michael W. Hodin from the Global Coalition on Aging, the model looks promising as all partners are committed to making the system sustainable, both operationally and financially. “Our goal is to make this sustainable,” said Mellissa Gong Mitchell. “That’s one of the reasons why we created this program with well-trained Community Health Ambassadors that can earn the trust of the communities, which will create value over time for the entire healthcare sector.”

Likewise, Baltimore Mayor Brandon M. Scott sees a huge potential that the program will create a lasting impact for generations to come: “First and foremost, it is about commitment from all the partners who have a role to play. Our work in this area is about overcoming the disproportionate impacts that are happening right now. The next battle is about ensuring those same disparities are not repeated in younger or future generations.”

For him, the preventive nature of the program is a key strength. “By prioritizing preventative measures and early interventions for our younger generations, we aim to establish healthier trajectories for aging while reducing the prevalence of chronic conditions later in life. Additionally, fostering intergenerational connections between our youth and older adults enriches both groups, promoting knowledge exchange and community engagement,” Scott said.

While the first results show that the situation is improving, the effort to fundamentally invigorate the healthcare environment in Baltimore will be difficult. The structural challenges in the city run deep, which have left entire districts cut off from any kind of economic prosperity.

In fact, depending on where one lives in Baltimore, life expectancy can differ by up to 20 years. In districts or neighborhoods such as Downtown Baltimore or close-by Druid Heights, life expectancy is around 65 years. In affluent neighborhoods such as Roland Park, life expectancy is 85 years.

Even without this medical data in mind, the cityscape is telling. As we drove through Baltimore, well-off districts usually sported huge parks and beautiful large trees along the road, while the poorer communities were conspicuous for their high density of liquor stores and fast-food chains.

A symbol of the structural challenges is the Highway to Nowhere, a short stretch of the US Route 40 that was built during the infrastructure boom in the 1960s and 1970s. While the road was never connected to the key highway system, it destroyed the fabric of the nearby African American communities.

Today, efforts are underway to shut down the highway and reconnect the communities and thousands of people that have been affected by its construction. But the costs will most likely reach staggering levels before parks and bike trails could one day replace the concrete monster that is cutting the city in half.

The power of communities

But if the Highway to Nowhere can be fixed, the healthcare environment too can be improved, says Terris King – both here in Baltimore as well as in the rest of the United States because the Black Church and other communities have what it takes.

Research is proving King right. Trust, these days, resides neither with governments nor with corporations. According to the latest Edelman Trust Barometer, it is scientists and “someone like me” that hold the biggest trust.

This is exactly what community leaders are: people one knows and who are like oneself. “As we attempted to build a value-based purchasing healthcare system, one of the things that we left out of the equation was the value of community, the value of the church in its ability to reach communities,” Terris King said.

Engage with Heart is hitting this nerve. “What Engage with Heart does is bring healthcare to the community instead of having the community go to healthcare and it puts it in a place, the church, where there is some sense of joint ownership, so it adds to the trust that the community has in the process.”

Given the high number of people who visit local community centers and regularly come to Sunday Service and cherish the work of the Community Health Ambassadors, Engage with Heart has the chance to carve out a successful path to help improve access to healthcare in the United States, and probably in the rest of the world.