By Frank Castelblanco RN, DNP, Kathey Avery RN, BSN –
Pervasive institutional racism in the United States history has profoundly contributed to the health of the African American populace.
Recently, the effects of COVID-19 have highlighted the racial incongruities within the community, which is in desperate need of not only treatment, but justice.
In a 2018 US Census-North Carolina statistic, 21% of black Americans were living in poverty, compared to 10% of white Americans. In addition to poverty, underlying medical conditions in the African American population, such as diabetes and heart disease, make black citizens more susceptible to COVID-19.
Latest CDC data reveals that 30% of the nation’s coronavirus victims are black, while making up only 13% of the population. Social determinants of health that contribute to this statistic include inadequate housing, limited access to professional medical care, food deserts, and greater rates of employment in service industry positions with increased exposure to the public. (In New York, over 6,000 subway workers have become infected. Comprising an estimated 60% of the workforce, black or Latinx workers have a stronger risk-susceptibility and have taken a harder impact from the virus.)
As a community nurse and Robert Wood Johnson Foundation (RWJ) Clinical Scholar, author Kathey Avery has witnessed the disparities in Asheville’s African American community through her work with ABIPA and elsewhere. To address this injustice, a Clinical Team was assembled for a pilot program called H.E.L.P (Health Engagement Leading to Prevention) to create and distribute masks, hand sanitizer, and other essential and potentially life-saving supplies in the Arrowhead housing complex.
With funding from the RWJ Foundation, our team has demonstrated that embedding a healthcare team in a housing complex, focused on dealing with health issues, was needed to change these disproportionate outcomes. A primary goal is to train community health workers (CHW) to address the social determinants of health, a protocol long followed by ABIPA. A community health worker can be any local resident or constituent living in the community who becomes trained in this specific modality.
As the Centers for Disease Control and Prevention states, health equity is achieved “when everyone has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstances.” (CDC, 2008). Social determinants of health, such as poverty, unequal access to health care, lack of education, stigma, and racism, are contributing factors that underlie many health inequities.
The team includes co-author Frank Castelblanco, RN, DNP at MAHEC and ABIPA board member; Shana Roberts, a BSW and Service Coordinator at Arrowhead Apartments; Kevin Rumley, MSW, LCAS, LCSWA, and Veterans Treatment Court Coordinator; Dr. Shuchin Shukla, a MAHEC opioid and substance abuse specialist; and Dr. L. Rosenberg, long-time volunteer at ABCCM. This team’s years of collective experience in addressing disparities in health, safety, and justice in Asheville’s African American community enabled it to set clear, specific goals.
Before COVID-19 arrived, we had begun training Ava Roberts, a resident of Arrowhead, as a CHW. Roberts serves as the “boots on the ground” in addressing the needs at Arrowhead, especially during a period of social distancing and limited access to residents in their homes. By working with fellow CHW and LPN Angelique Scott, the team has been able to rapidly address the needs of one community—and hopefully save lives.
The HUD- and Section 8-subsidized Arrowhead apartments offer affordable housing for seniors and persons living with disabilities, with rent capped at 30% of residents’ adjusted gross income. Sixty-nine percent of the racially diverse population are aged 62 and older, 10 of whom are formerly homeless, and some of whom are living with disabilities. The Arrowhead residents younger than 62 (30%) are also living with disabilities, and six of them are formerly homeless. The diversity within the Arrowhead apartment complex makes this the perfect location for the pilot Clinical Scholars team to begin our work.
With social distancing mandated for public health, it is important to stay connected, because “social distancing” does not need to mean social isolation. In these challenging times, our entire Clinical Scholars Team is working with community members to create “social proximity” and promote healthy outcomes for all Arrowhead residents—and establish a model for other communities in the future.