Future Planning for the Public Health Emergency Preparedness Enterprise Lessons Learned from the COVID-19 Pandemic: Proceedings of a Workshop (2023) / Chapter Skim
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4 Equity, Risk Communication, and Public Engagement
4 Equity, Risk Communication, and Public Engagement
Pages 39-54
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From page 39... ...
Speakers discuss ethics and equity with historically marginalized populations, as well as suggestions on changes needed moving forward. EQUITY AND ENGAGEMENT WITH HISTORICALLY MARGINALIZED POPULATIONS The inequities we have seen with the pandemic were certainly not a surprise, said Joneigh Khaldun, vice president and chief health equity officer at CVS Health.
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There are some basic principles underlying nondiscrimination that apply to any entity that receives federal funds, including federal civil rights statutes that prohibit discrimination on the basis of race, color, national origin (including limited English proficiency) , disability, age, and sex.
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For example, since the start of the COVID-19 pandemic ASPR has launched efforts to make monoclonal BOX 4-2 Examples of Civil Rights Complaints During COVID-19 • Categorical decisions excluding groups of individuals and ensuring nondis crimination in other factors in allocation of scarce medical resources, including crisis standards of care • Inaccessible services for people with disabilities and individuals with limited English proficiency and considerations for other protected and underserved populations o Scheduling appointments; web accessibility o Location of testing and vaccination sites; transportation; in-home services o Telehealth • Reasonable modifications and effective communication for persons with dis abilities; meaningful access to individuals with limited English proficiency o During hospital stay and for hospital visitations o Mask requirements • Adequate supports to help individuals remain in their homes and communities SOURCE: Presented by Robinsue Frohboese, May 17, 2022.
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program that collects tools, templates, and resources that are immediately implementable for people looking for help on various topics. They have subpages on ethics, access and functional needs, disasters and health care disparity, home care and hospice, and more.
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Accius called for more investment in infrastructure, reiterating the public health concept of a person's health code being determined by their zip code. He also advocated for closing opportunity gaps in these marginalized communities, allowing everyone to benefit as a result.
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For example, Gray explained that the psychological issues need to be addressed by examining some of the behavioral health effects in our communities. Some of the response triggered historical trauma with tribes because several centers received body bags when they placed orders for personal protective equipment (PPE)
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A participant asked what successful preparedness and response would look like if local health departments were fully funded. Accius said it would be hugely influential to have robust data to really understand the gaps and needs of a community and be able to tailor that to solve problems.
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Anne Zink, chief medical officer of Alaska State Health Department, asked how new infrastructure money for broadband will affect equity, and how geography might affect equity. For example, she noted that she may receive only one shipment of Paxlovid, but the communities that need it are 200 miles apart.
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From these experiences, he learned how public health had to embrace emergency preparedness and risk communication as core parts of its mission. He noted that while the major elements of ideal crisis communication regularly focus on having trusted messengers delivering messages that are easily understood and based on high-quality science, the context is much broader than that (see Figure 4-1)
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48 FIGURE 4-1 Elements of ideal pandemic crisis communications. SOURCE: Howard Koh presentation, May 17, 2022.
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Examples include people adopting bike helmets, living in and demanding smoke-free environments, and wearing seatbelts. Early tobacco control debates also centered on individual choice, until studies documented the dangers of second-hand smoke.
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50 FIGURE 4-2 Trust and sources of information. SOURCE: Howard Koh presentation, May 17, 2022; Blendon and Benson, 2022b.
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• Promote: Promote factual information, prioritize public health risk communication, and coordinate with social and news media. • Resilience: Increase public resilience through health and digital literacy.
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Lastly, he shared a toolkit called Phrases, which is public health reaching across sectors, and acts as a communica tions guide for a chief health strategist. We need to start building relation ships and, as Sell said, build trust back so people will be more receptive to public health messaging and guidance.
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He argued for investment in training and expanding the minimum requirement for recruiting public health officials, beyond simply a medical degree. Andrew Pavia of the Infectious Disease Society of America shared an experience where he was told by a producer of a national network that if you go on television and say, "We don't have the answers yet but we're working on it," you won't get invited back.
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Regarding trusted messengers, Ronald Stewart, chair of the Department of Surgery at the University of Texas Health San Antonio, said they have realized that this is a critical aspect of communicating. He recalled working with someone trying to reach certain segments of the population and realizing that the target audience not only lacked scientific literacy but also did not understand that science changes over time.
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