As Maryland contends with newly emerging COVID-19 hot spots in Baltimore and Langley Park, certain glaring realities have come to light. COVID-19 has illuminated the stark contrast in health disparities between different socioeconomic and ethnic groups within the city of Baltimore and elsewhere. Cases vary by ZIP code, sometimes even by blocks, illustrating how our health systems have trouble reaching marginalized parts of our community. We propose a shift to a community-centric care approach to ensure all of our residents have an equal opportunity to stay healthy and avoid infection.
Misinformation about testing, disease transmission and protective practices is widespread. Various social media posts, for example, have encouraged consuming “miracle” remedies that contain bleach. These are not only dangerous recommendations but provide a false sense of security against general physical distancing precautions. Those living in inner city communities initially had far lower rates of COVID-19 testing and are still not getting appropriate treatment for their chronic health conditions and have fallen behind on routine pediatric immunizations.
This is likely due to a lack of awareness about improved access to testing and the reopening of medical practices for non-urgent medical issues. But long-standing issues of mistrust must also be considered. Ideally, we in the medical community can address these issues by improving our ability to relay health information to people where they live and congregate. This means seeking natural community intersections, like local neighborhood associations and churches. These challenges do not require heavily trained medical providers to correct. They require strategic placement of health resources and health training.
What does community-centric care look like? In a 2018 study published in the New England Journal of Medicine, researchers found a successful approach to controlling high blood pressure: Pharmacists teamed with barbers in African American communities and provided blood pressure checks and medication counseling during hair appointments.
Similarly, we can leverage the power of health providers in our own neighborhoods. The University of Maryland Medical Center (UMMC), for example, has distributed important health information through its faith partners, and 1,000 masks to protesters with educational information about social distancing so that they may march not only peacefully, but safely from COVID-19. The hospital has packaged nearly 2,000 COVID Care Kits (hand sanitizer, mask and educational information) for distribution to our neighborhoods and plans to begin contact tracing.
But the real key is to develop a system of local neighborhood leaders trained as community health workers who can meet residents where they live, shop and work to communicate and provide health services from a place of trust. For the past several years, these workers, under a federal government initiative, have worked to reduce health disparities by improving access to health screenings in underserved communities and by holding nutrition, exercise and smoking cessation workshops in local community centers. Now in the COVID-19 era, they are working to increase contact tracing for new infections in underserved communities and vaccination rates in pediatric communities where vaccinations have drastically declined.
While these health workers operate in Baltimore communities, we think they can do more. Providing a single health screening has some benefits, but how can we better track patients to ensure they come back for follow-up care to help them manage their diabetes and heart disease or, better yet, prevent these conditions altogether? Targeted interventions like cellphone apps that help provide continuity of care might not only save lives lost to heart disease and cancer but to infectious diseases like COVID19.
The biggest obstacle to developing any of these approaches is identifying who would be responsible for implementing them. Fortunately, local health systems are often eager to innovate in this population health space. For example, many patients have poor health outcomes due to simply lacking a means of transport to their medical appointments. Certain hospitals have taken community-centric approaches to provide ride sharing services, like Uber and Lyft, to these patients and could be important in implementing these pandemic-oriented solutions.
This pandemic tested an unprepared system. The benefits of community-centric care will extend beyond future public health emergencies and can improve long-term community health. COVID-19 is moving us from isolated systems providing medical care to embedding care into the community. By building a more connected system, we can improve the health of our residents and better protect them from infectious diseases.
Joseph Kannarkat (firstname.lastname@example.org) is a second year medical school student at the University of Maryland School of Medicine. Dr. Chuck Callahan (CharlesCallahan@umm.edu) is vice president of population health at the University of Maryland Medical Center.