Communities in Ohio Address Rising Inequalities in Response to COVID-19

A serious compounding problem of COVID-19 is how it is intensifying inequalities across the country, including in Ohio where significant disparities in maternal and child health persist.

“Barriers created by bias and difficulties with access to resources—those problems don’t go away because we are facing a national crisis. Instead, you’ve just added this new issue, which really compounds existing inequities,” explains Michelle Edison, MPH, MS, who serves as the Pathways HUB Coordinator for Mahoning County Public Health in Northern Ohio. The Mahoning Valley Pathways HUB is one of six certified HUBs in Ohio, all of which work to address racial disparities in infant mortality and birth outcomes by connecting at-risk families with trained community health workers, resources, education, and support. As the Pathways HUB coordinator, Edison has seen firsthand the impact COVID-19 is having on families with the least resources.

“What it comes down to is this,” continues Edison. “People who can get to the head of the line and get what’s available will be okay. But if you are consistently the one who gets pushed back to the end of the line, you’re going to find yourself further removed from accessing those resources. That’s why the coronavirus is going to have a much bigger impact on populations who are already at some sort of disadvantage, including communities of color.”

Edison’s description illustrates a stark reality that extends from grocery store lines to public resources and programs. In March, when cities began to shut down, people across the country rushed to stockpile goods. Those with less money and resources didn’t have the luxury of stocking up on items, and instead had to pick through empty aisles for what remained. Now, in the face of mass layoffs and closed schools, families across the country are going to heavily rely on public programs and resources—those that already exist, those that have emerged in response to the pandemic, and those that will surface as the crisis continues. And again, getting to front of the line for those resources will be easier for some than others.

This admittedly paints a bleak picture. But it’s one that communities and states can change, if not eradicate, depending on their response to the pandemic. This hope is what’s fueling responses in Mahoning County. According to Edison, they’re seizing the opportunity to get ahead of COVID-19’s consequences by proactively identifying how the pandemic will affect at-risk populations and then developing a comprehensive plan that brings together partners from across the health system. Ultimately, she hopes these solutions will improve health outcomes in Ohio long after COVID-19 passes.

Edison serves as a faculty expert on the NICHQ-led National Action Partnership to Promote Sleep Improvement and Innovation Network (NAPPSS-IIN). NAPPSS-IIN is a Health Resources and Services Administration Maternal and Child Health Bureau-funded initiative seeking to make infant safe sleep and breastfeeding the national norm. As a faculty expert, Edison brings her considerable expertise on partnering with community health workers and organizations to promote change.

“These challenging situations stress and stretch our creativity. They ask us to think differently about how we provide our services and what more we can do to support our clients,” says Edison. “I think this crisis will help us evaluate what we’ve done and what we’re doing, come up with new and innovative approaches, and, in the end, help us have an even more significant impact than we had prior to the pandemic.”

Bright Spots from Ohio’s Response to COVID-19

Public agencies rise to the challenge

Like many states, Ohio has instituted strong social distancing recommendations, which unintentionally affect how public agencies serve their clients and community. Home visiting services have been suspended; schools are closed; and people can’t visit public offices like employment agencies and Women Infant and Children (WIC) offices.

In Mahoning County though, public agencies are rising to the challenge, says Edison. “They’re modifying approaches to make it as easy as possible for clients to access these resources.”

Schools are closed, but parents can still pick up meals for their children and bring them home. Community health workers who can’t schedule in-home visits are calling their clients to check-in and connect them with resources. WIC instituted a new process to make it easier for families to enroll over the phone; and once enrolled, families or a friend of the family can drive to WIC offices and have resources delivered to their car. The county’s local Job and Family Services agencies are providing one-time payments to residents who are struggling financially so they can take care of immediate needs. These are just a handful of the many strategies that agencies have implemented to help families during the crisis.

Of course, even with these adjustments, challenges still exist: phone conversations with families are limited when compared with home visits; public transportation closures mean that not everyone can benefit from school lunches; and overloaded public websites offering resources are crashing because of an unprecedented number of visitors. While taxing, these challenges are also opportunities, says Edison.

“We’re uncovering new ways of doing things that will serve our clients better in the future. We’re learning what barriers make it more difficult for our clients to get what they need, and then adjusting how we deliver resources.  And we’re realizing where we still need to make improvements—whether that’s with our technology or how we collaborate across agencies.”

Collective energy for a coordinated system 

Like many states, Ohio has a range of supports for families: the public agencies at the local, state, and federal level; community-based organizations; and health care providers, to name a few. But because these groups don’t always work in unison, care and support can lack continuity and families can fall through the cracks. These cracks have become even more problematic in the face of COVID-19 because of the urgent need to connect families with resources. Without coordination across services and sectors, it’s difficult to ensure everyone can access supports. This is especially true for those who are already facing access barriers, including racism, bias, and socioeconomic challenges. 

In response, Mahoning County is prioritizing collaboration across the health system, says Edison. “There’s a collective energy to collaborate because coordination matters so much right now. Providers, community health workers, public agencies, local foundations, and community resource centers are all thinking about how we can work better together, so that we have a comprehensive coordinated system that is really effective at addressing the needs of the families we serve.”

Edison is optimistic that the system improvements made during this crisis will benefit their county long after COVID-19 has passed. “It’s given us a chance to be really thoughtful about how we work together—and if we can do it now, in the middle of all of this, we can do it even better once this over. Everything we learn now will change how we do things down the line.”

Enhanced support for public health workers

COVID-19 has placed significant stress on front line public health workers. In Ohio, community health workers’ day-to-day world has turned upside down: they’re facing resource shortages and office closures, navigating the challenges of phone-based home-visiting services, and trying to assuage clients’ concerns even though they don’t always have perfect answers and may face the same fears.

“Community health workers are regular people; they have their own economic challenges, and many have underlying health conditions,” says Edison. “Even with everything going on, they’re still showing up for their clients, but that can have a big mental and emotional impact on their health.”

The HUB has taken purposeful steps to help community health workers in their county feel supported. They’re hosting a virtual meeting where a public health nurse can share updates about the virus, including risk factors, information about exposure, and advice on keeping safe. They’re also launching new processes for increasing communication between community health workers and the HUB, now that they don’t see each other in person anymore. “We’re trying to do whatever we can to take some of the stress off community health workers, whether that’s providing them with a resource or making a phone call to one of their clients for them.” says Edison. “We just want them to know that someone is there for them and we are all going through this together.”

Looking toward the future

Mahoning County’s response to COVID-19 shows the strength of communities in the face of a public health crisis. Still, Edison knows they have a long road ahead. The economic fallout from the virus is only just beginning, and families, especially those affected by disparities or with chronic conditions, will need more resources at an even faster pace. “Even knowing that, I’m still really hopeful,” she says.  

“If we do this right, we can uncover innovative ways to support the health and wellness of our clients; these are opportunities that we would never have explored or thought about had we not been presented with this crisis. I’m excited to see the solutions that we—as a community, as a state, and as a nation—come up with to better support families.”

Public health programs, like NAPPSS-IIN, can learn from these innovative approaches, says NICHQ Senior Project Director Stacy Scott, PhD, MPA. “The pandemic is a unique circumstance, but it has exposed systemic flaws that are all too common. These flaws fuel maternal and child health disparities related to safe sleep and breastfeeding. By learning from COVID-19, we can do more to achieve equity in all our improvement efforts. That’s why we’re fortunate to partner with experts like Edison who are on the ground supporting families.” 

Interested in learning how other states and communities are responding to COVID-19’s impact on children’s health and children’s health programs? Read about Healthy Start’s priorities for the next five years, including addressing COVID-19. Be sure to sign up for NICHQ News to stay informed.