The Latinx community accounts for 48 percent of Santa Barbara County’s population. Over the course of the pandemic, the Latinx community has made up 57 percent of COVID-19 cases, 67 percent of COVID-19 hospitalizations, and 50 percent of COVID-19 deaths, a disturbing pattern that indicated an imbalance that medical providers want to correct.
The COVID-19 pandemic instigated several conversations among doctors, nurses, and administrators nationwide about inequities in health care. Area medical providers — like Cottage Health — also re-examined and expanded their efforts to address those inequities. In Santa Barbara, that conversation began with and primarily focused on addressing the disproportionate impact on the Latinx community, but it is beginning to expand.
Santa Barbara Public Health Director Van Do-Reynoso explained that inequity in health care is defined as the disproportionate ways in which communities of color are affected by disease and illness. It had little to do with genetics, she said, and was sadly nothing new. “As public health practitioners, we know that race and ethnicity, socioeconomic status, and zip codes are key indicators of life expectancy, and a variety of other health issues.”
Because people of color were often essential workers, said Do-Reynoso, they were around more people as a result of their work, using public transportation, or living in high-density housing — all of which exposed them to greater threat from the airborne coronavirus. And all were structural factors that influence health.
The virulence of the pandemic pushed Public Health to up the ante on the outreach they’d already been engaged in for tuberculosis and other diseases in the county. With community partners, Public Health created a Latinx and Indigenous COVID-19 response task force, which now plans to broaden its scope to other inequities in health care. For Do-Reynoso, the target was to address the burden of chronic disease in communities of color.
Within its department, Public Health also created an Office of Health Equity, led by Timothy Watts, to look at the department’s infrastructure and identify ways to build capacity. Do-Reynoso was willing to do the hard work and ask the hard questions, to look at language and historical context. “Is it personal choice? Or is it really structural, systemic racism and policies,” she wanted to know, that produced differing health-care outcomes. “It’s getting into that space, learning, engaging, hearing each other, and setting a new course for our county.”
At one of Santa Barbara’s largest private health-care systems, Sansum Clinic, Medical Director Dr. Marjorie Newman said that the COVID-19 pandemic “continued previous conversations [about equity in health care] and enhanced them.” Sansum expanded into tele-health services and hired nurses for a Population Health Outreach Program to meet with individuals discharged from an emergency room or hospital to ensure that they have access to the care that they need. Sansum also began utilizing a platform called Aunt Bertha that consolidates various services — such as food and transportation services — that patients could access for their comfort and safety.
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Newman said that Sansum tries to communicate with patients in their native language but had no current initiatives or programs for long-term outreach with the Latinx community.
A Health Equity Task Force at Cottage Health started up during the pandemic and was designed to “identify inequities and improve health equity, diversity, and inclusion,” said Katy Bazylewicz, vice president for marketing and population health. The task force includes physicians, nurses, data analysts, and other medical-care workers. Bazylewicz noted, “One of the big aspects coming out of the task force was to really delve deeper into our data and making sure we’re capturing that data” to encapsulate where more work could be done to address inequities.
That focus on data inspired a health ambassador program with community leaders in the Latinx community. Cottage’s director of population health, Cara Silva, said the groups include the Santa Barbara Promotores Network and the Isla Vista Youth Projects. Their most recent work includes vaccine education with “hard-to-reach community members.”
They equipped 128 community health ambassadors with education and training “around COVID-19 symptoms, prevention, vaccine education,” said Silva, “connecting them with our clinical infectious disease experts as well as community experts to then deploy them into our neighborhoods to distribute prevention kits and culturally appropriate education materials.” They’ve so far distributed 2,300 education kits and information over 34 zip codes, reaching more than 3,000 people, Silva said.
Bazylewicz said that Cottage is currently looking to hire a director of diversity, equity, and inclusion to continue examining data and ensure that Cottage uses the data to inform equitable practices.
“I think it’s important to just explicitly say that health equity is achievable, but it’s dynamic. And what that means is the work is never done,” said Dr. Lynn Fitzgibbons, Cottage Health’s infectious disease specialist. She expected unforeseen challenges would test the solutions they developed today, and that the new position would ensure they were “equipped to find those solutions when we need to.”
Do-Reynoso said that the funding coming from the CDC through the state has helped put health equity at the forefront of the conversation. “It’s a good time to be in public health, because never before — on a national stage and on the state level — has there been a commitment to allocating appropriate resources that local health jurisdictions need in order to do the work.”
“When you don’t have access to healthy foods, when you don’t have access to a living wage, when you don’t have access to safe neighborhoods to exercise, when you are constantly worried about your safety because of the color of your skin, because of who you are — I think that those really have a huge impact on your health and your risk factors for chronic disease,” Do-Reynoso said. “So, the work is just beginning.”