New research-based tools to help Ohioans at higher COVID-19 risk

Those looking to improve the lives of Ohioans facing the greatest COVID-19 risks now have a comprehensive, evidence-based toolkit – one designed to inform the work of everyone from grassroots community groups to state leaders.

Ohio’s COVID-19 Populations Needs Assessment, released today (Oct. 13, 2020) and led by experts at The Ohio State University College of Public Health, aims to improve Ohioans’ ability to prevent transmission of the virus and minimize its impact on communities that are at elevated risk.

The new report, conducted in collaboration with the Ohio Department of Health, is built on information gathered from a survey of 363 Ohioans representing people of color, rural populations and individuals with disabilities. The survey, subsequent analysis and recommendations focus on six populations: Black and African American; Latino and Hispanic; Asian and Asian American; immigrant and refugee; rural; and people with disabilities.

“All of these are communities of people living strong, full, culturally rich lives with various resources and leaders. We sincerely hope that this report helps the communities, and those who serve them, to build upon that foundation,” said Julianna Nemeth, an assistant professor of health behavior and health promotion, who co-led the project with Tasleem Padamsee, an assistant professor of health services management and policy.

Going in, the research team knew that these communities were among those most likely to suffer disproportionately high rates of infection, hospitalization and death because they entered the pandemic already dealing with poorer overall health status, lesser access to health care and more negative social determinants of health than others.

The needs assessment explored where these Ohioans live and work, what resources exist in these areas, what barriers these groups face in accessing public health protections and health care, and how to alleviate those burdens.

“What we set out to create — and now have — is an actionable guidebook that puts the power in the hands of all Ohioans who are seeking to improve the health and well-being of people of color, rural populations and people with disabilities,” Nemeth said. “There is a roadmap here that can be tailored to your work, whether you’re the boots on the ground or developing state-level policy.”

And its value will extend beyond the pandemic.

“Because they address social determinants of health and institutionalized oppression, these recommended actions will help reduce health disparities and improve long-term health outcomes throughout Ohio,” Padamsee said.

The assessment goes into depth on recommendations for specific populations, but also identifies eight across-the-board, top-level recommendations:

• Center the COVID-19 response in the organizations and cultures of local communities • Explicitly address economic injustice and its widespread health and social impacts by directly providing resources • Directly address racism and immigration-related fears • Strengthen employment policy and other relevant public policies • Increase access to affordable, low-density housing • Improve public and shared transportation services • Improve the quality of COVID-related education and increase its dissemination • Address language and communication barriers

“It was a surprise to us to see eight key themes emerge across all the populations. And it was a good surprise because we know that these are the things we have to do to remove barriers across the board,” Padamsee said, adding that the challenges of the “big” goals shouldn’t be seen as an obstacle.

“There are a host of small and medium-sized actions and policy steps that all contribute to meeting these larger aims and we offer clear guidance on what those are,” she said.

The researchers said they hope that those who make use of the report will benefit from data-driven recommendations grounded in the knowledge and experiences of Ohioans. Solving a problem requires looking at it from the perspective of the community, listening to them and equipping them with the appropriate resources, Nemeth and Padamsee said.

“Our top, overarching recommendation is to center the COVID-19 response within Ohio’s communities — working through organizations and people that are trusted and respected by those they serve. That requires building infrastructures that place the power right in the center of the communities we hope to help,” Nemeth said.

To complete the assessment, the researchers asked members and representatives from each population to reflect on their community’s use of — and barriers to — recommended behaviors to stop the spread of COVID-19, including hygiene, social distancing, use of personal protective equipment including masks, testing, contact tracing, isolation, self-quarantine and health care access.

Next, the research team sifted through the data provided by respondents, identifying common ideas and themes. Expert panels then examined these preliminary findings to provide context and ensure that the research team understood the stakeholders’ feedback accurately.

Among the identified obstacles: gaps in access to resources, unsafe working conditions, stigma and mental health challenges, caregiving responsibilities, dense housing conditions, and language and communications barriers.

“We knew right away as COVID began to unfold here in March that some people were going to have worse outcomes, that there would be areas where infections would be more highly concentrated and that there would inevitably be a disproportionate impact among populations already experiencing health disparities,” Nemeth said.

“The basic public health recommendations for containing the virus are complicated for many Ohioans. How can you isolate when you don’t have access to your own room and bathroom? How can you seek testing when you have no transportation? How can you participate in contact tracing when you face a language barrier or fear deportation?”

Added Padamsee, “As I watched the news unfold early on, I thought ‘This isn’t going to affect everybody equally and we in public health need to work on that in a meaningful way, and quickly.’ ”

The report is designed for ease of use — so that advocates and decision-makers can jump to the part that is most applicable to their work, or even start by just looking at a chart that describes recommended interventions at different levels.

The report also provides tools designed to ensure the best possible outcome when someone does take on a project to reduce the spread of COVID-19, Padamsee said.

“If you’re aiming to start a new testing site or install signs about social distancing and don’t think about that plan in the context of the population you’re serving, you might fall short,” she said.

“You need to also think about the other things that have to be done, such as making sure that individuals who test positive have a realistic plan for isolating themselves, a health care provider they can see if necessary and that the testing site is staffed by people who speak the same language as the community it is serving.”

Additionally, Padamsee said, “This report provides scientific evidence for funders when anyone from a church leader to a community health organization to a state leader is looking to support efforts to help communities of color, rural Ohioans or those with disabilities.”

In addition to researchers from Ohio State’s College of Public Health and the Ohio Department of Health, the team behind the needs assessment also includes representatives from Ohio State’s Kirwan Institute for the Study of Race and Ethnicity, Deloitte Consulting LLP and Nationwide Children’s Hospital.

For additional information or consultations about implementing the recommendations of this report, please contact [email protected].

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CONTACTS: Julianna Nemeth, [email protected]; Tasleem Padamsee, [email protected]

Written by Misti Crane, [email protected]