Leveraging Public-Private Partnerships with Community to Increase Health Equity: Building Sustainable Models Guided by Data, Policy, and Practice.

Abstract

Leveraging Public-Private Partnerships with Community to Increase Health Equity:Building Sustainable Models Guided by Data, Policy, and Practice Roslyn Holliday Moore, MS (bio), Juliet Bui, MPA, MSW (bio), Rachel R. Ouellette, PhD (bio), Bridget Kerner, MS (bio), Michael N. Awad, PhD (bio), Alexis F. Leal, MPH, CPHQ (bio), Yanique Edmond, PhD, MPA (bio), Stacey L. Williams (bio), and Derrick M. Gordon, PhD (bio) The nation's quest to dismantle persistent health disparities is marked by policy innovations to promote equitable health. Approaches to interpreting, translating, and monitoring health-related policies can activate key multisectoral partnerships between the federal, state, local governments, and private organizations to foster and sustain community-centered health care and health equity. In these partnerships, the federal government provides funding, strategic direction, logistical support, and encourages further collaborations based on the synthesis of national and local data as part of a singular strategic vision. Through these strategic visions, state and local governments allocate resources, disseminate best practices, and implement localized policies to amplify opportunities for facilitating equitable health outcomes and engaging community-based organizations. Community-based organizations, as trusted messengers, are essential partners for delivering culturally and linguistically appropriate health care. For these layered partnerships to be successful, they must be collaborative, bidirectional, and collectively focused on improving and achieving equitable health care access, use, and outcomes. [End Page 138] Racial and ethnic minority, low-income, and other socially vulnerable populations have experienced long-standing health disparities in the access, use, and outcomes of health care during and prior to the COVID-19 pandemic. Data from the coronavirus disease 2019 (COVID-19) pandemic have highlighted higher exposure, infection, hospitalization, and death rates among racial and ethnic minority populations in comparison with the non-Hispanic White population.1–7 This pattern has been seen with other outbreaks, including the H1N1 pandemic,8 the HIV/AIDS epidemic,9 and even the seasonal flu outbreaks.10 These patterns are due in part to racial and ethnic minority and poor populations being at higher risk for pre-existing health conditions (including diabetes, hypertension, obesity, and coronary heart disease) that increase their likelihood of contracting severe forms of COVID-19.11–13 Consistent inequitable outcomes across health conditions and outbreaks indicate root causes that extend beyond biological issues to include social, systemic, and structural factors.14 Influencers of health, including policies and social determinants of health, provide a lens for understanding patterns of inequity across health outcomes. Two key influencers in the context of COVID-19 are social determinants of health and social vulnerability, which are respectively defined as "the conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes."15[unpaginated] and "the characteristics of a person or community that affect their capacity to anticipate, confront, repair, and recover from the effects of a disaster," such as socioeconomic status and minority status.16[p.1] Understanding their influence can inform policy direction. For instance, systemic inequities in access to health insurance and high-quality care make it difficult to connect racial and ethnic minority and low-income populations with COVID-19 services, likely contributing to sometimes lower rates of testing and vaccination.17–19 Racial and ethnic minority and low-income individuals have also experienced a long-standing history of bias and discrimination in medical settings.20–21 Specific to the pandemic, data revealed that providers were less likely to offer COVID-19 testing to Black patients experiencing the same symptoms as White patients, contributing to medical distrust and vaccine hesitancy.22 Black and Hispanic/Latino individuals have indicated, however, that they would be more likely to consider getting the vaccine if they heard information or experiences from same-race medical professionals and community members, than if they heard it from others.23 These findings suggest that disparate outcomes and community context cannot be addressed without an equity lens or without policies that promote partnerships across sectors. Specifically, pandemic response efforts that integrate alliances with entities that are based in or led by racial and ethnic minority and low-income communities can help bridge access and trust gaps while improving engagement and participation in mitigation efforts. We begin this...