Knocking Down Public Health and Health Care Silos: An Innovative Covid-19 Health Equity Response

Abstract

In Minnesota, age-adjusted case incidence rates of Covid-19 infection were significantly higher among Black and Latine communities compared with non-Hispanic white communities. The siloed nature of public health and health care delivery emerged as a critical obstacle to equitable Covid-19 testing and vaccination. Fragmented care delivery due to varying funding models, complicated administrative frameworks, and systemic barriers to accessing services impeded a rapid, equity-focused response. Saint Paul – Ramsey County Public Health (SPRCPH), Fairview Health Services (Fairview), and many local community and faith-based partners recognized the need to work together to ensure that underserved populations had equitable access to Covid-19 testing and vaccination. The authors describe how these entities, collectively serving a population of about 550,000, sought to establish equitable, low-barrier Covid-19 testing and vaccinations that were accessible, free, and available within a trusted space and given appropriate language and cultural considerations to address long-standing health disparities revealed and exacerbated by the pandemic. The partnership’s strength lay in integrating SPRCPH’s logistics capability with Fairview’s clinical expertise and the community partners’ trusted status, enhancing the credibility and effectiveness of public health initiatives. SPRCPH provided the supplies and operations personnel needed to establish drive-through testing sites capable of serving more than 1,500 patients in a 6-hour operational period. Fairview brought teams of medical staff and colleagues who supported in nonclinical roles and engaged with community partners. Over the course of the response, this cadre of participants learned to function less as a partnership between separate entities and more like one team with staff from multiple organizations. From 2020 to 2023, this initiative set up 38 community mass-testing clinics and organized 210 Covid-19 vaccination clinics across 71 diverse community-based sites, including fire stations, consulates, schools, shelters, and faith-based organizations. Notably, 56 of the sites were situated within census tracts exhibiting a social vulnerability index (SVI) of 0.500 or higher, with 35 sites having an SVI score surpassing 0.800, indicating greater vulnerability. Through this effort, 18,059 Covid-19 tests were conducted and processed, and 16,367 Covid-19 vaccinations were administered, averaging 78 per clinic. Many community members who received services were recent immigrants and persons whose preferred language was not English. The success of this pandemic response depended largely on a common mission and shared sense of purpose among previously infrequent or unfamiliar partners. However, operations were not seamless; if these relationships had existed and been fostered during nonemergency periods, the responsiveness among participants could have produced better results. Although much was accomplished, it is sobering to remember the many lives lost during the pandemic. The authors describe an approach to eliminate silos to maintain and strengthen teamwork between public health and care delivery to improve care and be better prepared for future public health emergencies.