Community Engagement of African Americans in the COVID-19 Era
Abstract and Introduction
African Americans, compared with all other racial/ethnic groups, are more likely to contract coronavirus disease 2019 (COVID-19), be hospitalized for it, and die of the disease. Psychosocial, sociocultural, and environmental vulnerabilities, compounded by preexisting health conditions, exacerbate this health disparity. Interconnected historical, policy, clinical, and community factors explain and underpin community-based participatory research approaches to advance the art and science of community engagement among African Americans in the COVID-19 era. In this commentary, we detail the pandemic response strategies of the Morehouse School of Medicine Prevention Research Center. We discuss the implications of these complex factors and propose recommendations for addressing them that, adopted together, will result in community and data-informed mitigation strategies. These approaches will proactively prepare for the next pandemic and advance community leadership toward health equity.
Racial/ethnic minority populations have historically borne a disproportionate burden of illness, hospitalization, and death during public health emergencies, including the 2009 H1N1 influenza pandemic and the Zika virus epidemic.[1–4] This disproportionate burden is due to a higher level of social vulnerability — “individual and community characteristics that affect capacities to anticipate, confront, repair, and recover from the effects of a disaster” — among racial/ethnic minority populations than among non-Hispanic White populations. These characteristics include, but are not limited to, low socioeconomic status and power, predisposing racial/ethnic minority populations in general and African Americans in particular to less-than-optimal living conditions. Some racial/ethnic minority populations are more likely than non-Hispanic White populations to live in densely populated areas, overcrowded housing, and/or multigenerational homes; lack adequate plumbing and access to clean water; and/or have jobs that do not offer paid leave or the opportunity to work from home.[6,7] These factors contribute to a person’s ability to comply with the mitigation mandates of the coronavirus disease 2019 (COVID-19) pandemic established to reduce risk for infection, such as physical distancing and sheltering in place.
The COVID-19 pandemic presents new challenges for public health evaluators, policy makers, and practitioners, yet it mirrors historical trends in health disparities and poor health outcomes among African Americans. African Americans are more likely to contract, be hospitalized, and die of COVID-19–related complications.[9–12] Social vulnerability is often compounded by preexisting health conditions, exacerbated during times of crisis.[13–17]
Public health leaders are now at a critical juncture to advance health equity among vulnerable African Americans. To advance this health equity, we must first have a comprehensive understanding of the factors that create health disparities and the factors that can contribute to an effective, multilevel response. With this understanding, we can then deploy effective mitigation strategies based on a community-based participatory research framework that fosters and sustains community leadership in the assessment and implementation of culturally appropriate and evidence-based interventions that enhance translation of research findings for community and policy change.[18,19] The objective of this commentary is to 1) detail the interconnected historical, policy, clinical, community, and research challenges and considerations central to comprehensively advancing the art and science of community engagement among African Americans in the COVID-19 era; 2) describe The Morehouse School of Medicine Prevention Research Center (MSM PRC) pandemic response strategies, driven by community-based participatory research (CBPR); and 3) discuss community-centered implications and next steps for public health action.