Thread by @IvaCheung

For the next 3 days I'm going to try to catch as much of the @iha_the Health Literacy Conference as I can and live-tweet from the sessions I attend.

I'll be using the hashtag #ihahlc21, so feel free to mute or follow along as desired!

Keynote speaker today is Dr. @rayblock1, on "Literacy Tests and the Modern Day Jim Crow." #ihahlc21

Race, health disparities, and the “dual pandemics”

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane because it often results in physical death.” Dr. Martin Luther King Jr. #ihahlc21

Racism and COVID-19: race gap in vaccine uptake, part of the race gap in impact of COVID-19 on health and wealth outcomes (because people have lost work), which in turn is part of racial disparities in society overall. #ihahlc21

Why does COVID-19 have a disproportionate impact on African Americans?

One answer:
•race gaps in COVID-19 reflect race gaps in health literacy
•understanding race gaps in health literacy helps us address race gaps in COVID-19 health outcomes

#ihahlc21

Literacy tests in historical and political context:
15th Amendment prohibits denying the right to vote based on race. Southern states created requirements that didn’t mention race but still targeted African Americans:
•poll tax
•literacy test
•grandfather clause
#ihahlc21

Literacy tests for voting hurt everyone, but they disproportionately hurt racialized groups. #ihahlc21

Literacy tests, from Jim Crow to COVID-19:
•they both create structural barriers
•they both often do so by exploiting mis- or disinformation
•they both have the cumulative result of discouraging persons of colour
#ihahlc21

Vaccine mis- or disinformation:
“mRNA vaccines promote cancer”
•1% of white & Black people thought this statement was true
•69% of white people thought this statement was false, 29% didn’t know.
•57% of Black people thought this statement was false, 42% didn’t know. #ihahlc21

Dr. Block: “I’m not as concerned about the people who believe it’s true. I’m more concerned about the people who don’t know.” Doubts about whether something is a rumour or if it’s true is the issue. #ihahlc21

If a person’s on the fence about what will happen to them if they get the vaccine based on mis- or disinformation, it makes it that much more difficult to persuade them to get the vaccine. #ihahlc21

Literacy-based reason for hesitancy. Q from the survey: “What has made it difficult for you to get a vaccine?”
29% of Black respondents said “I do not know how to get vaccinated” (compared with 26% of white respondents). #ihahlc21

54% of Black respondents said “It is difficult to find out how to make an appointment” (compared with 41% of white respondents). #ihahlc21

Now up: “Health literacy in support of equity: removing barriers to increase access to care”
Panellists: Emily K. Brunson, Jacinda Abdul-Mutakabbir, Jerry Abraham
#ihahlc21

Emily K. Brunson’s presentation: equity in vaccination—working with communities of colour toward COVID-19 recovery and beyond #ihahlc21

Vaccine uptake involves both intent to get vaccinated and their ability to get access.
Intent: belief/trust in vaccines, in the system (medicine, public health, gov’t)
Access: what ppl end up with is not always a matter of choice

#ihahlc21

Access issues:
•not knowing how to get a vaccine
•sign-up issues (ppl who don’t use the internet)
•lack of transportation
•not being able to take time off from work
•immigration status…
#ihahlc21

The need in BIPOC communities: COVID-19 has disproportionately impacted BIPOC communities, with higher rates of disease, hospitalizations, deaths as well as social/economic upheavals, particularly in low-income communities. #ihahlc21

From a CommuniVax report “A coalition to strengthen the community’s role in an equitable COVID-19 vaccination campaign”

“They [white ppl in charge] did not care about my diabetes. Why do they care now about COVID?”

Repeated engagement with BIPOC communities is needed. #ihahlc21

Assemble durable infrastructure to engage BIPOC communities and engender their trust. Listen and plan together. Engage for the short term (COVID) and for the long term (other health concerns). #ihahlc21

BIPOC community representatives and advocates must become active collaborators in the public health process. Make task forces and decision-making bodies representative of the community. #ihahlc21

Effective communication is essential. Support trusted BIPOC individuals and organizations who can effectively relay information and help set community norms. Explore all avenues to provide information that is reliable, meaningful, culturally relevant, and actionable. #ihahlc21

All of these proposals require investments of time, attention, and funding. Use the COVID-19 vaccination campaign as a gateway for community and health equity. Commit for the long term. #ihahlc21

Recovery will take time. COVID-19 will have long-lasting physical, psychological, social, economic impacts. COVID-19 vaccination is not the end point. It needs to be the first step toward a more complete recovery. #ihahlc21

Now hearing from Jacinda C. Abdul-Mutakabbir.

COVID-19 has affected racialized communities disproportionately. Institutional distrust limits COVID-19 vaccine uptake. Healthcare access limits vaccine allocation in heavily affected urban areas. #ihahlc21

Health equality: everyone gets the same access to COVID-19 vaccines

vs.

Health equity: everyone gets COVID-19 vaccination, delivered in a way that is tailored to their needs

#ihahlc21

3-tired approach for creating equitable COVID-19 vaccination access
•engagement of Black faith leaders
•delivery of vaccine education by Black pharmacists
•low-barrier clinics in Black neighbourhoods
#ihahlc21

Faith leaders have been essential to encouraging sign-ups, giving education, and hosting pop-up vaccination clinics. #ihahlc21

US has a long medical history of discrimination and wrongdoings against Black people. Cultural representation among practitioners has been shown to improve communication. Black pharmacists offering COVID-19 vaccination education help build trust. #ihahlc21

Low-barrier community vaccination clinic removes barriers like transportation and internet/computer access: paper-based registration, pop-up clinics at a church in a Black community. #ihahlc21

People seeing their friends, family getting the vaccine can persuade them to get the vaccine as well. #ihahlc21

Measurable outcomes from community vaccine clinics:
•First mass vaccination clinic saw 3% Black vaccinees
•Community clinics saw 83.5% Black vaccinees

Reproducing these community vaccination clinics for Latinx communities.

#ihahlc21

Long term: hope to translate these clinics to other disease states like influenza, HPV, shingles, and to give information on HIV PrEP. #ihahlc21

Now hearing from Dr. Jerry P. Abraham. Showed a clip from the Rachel Maddow Show about his Kedren clinic in south LA, which is actively removing barriers for people who have no internet access, no transportation to attend other vaccine clinics. #ihahlc21

The Kedren clinic has removed barriers for people with no ID, no address, no English, no phone to get vaccine access. Meet people where they are.

“We won’t have long, miserable lines. We’ll have music and joy.”

#ihahlc21

Kedren became a role model, a template for the whole country for equitable vaccine distribution and timely reporting of the numbers to authorities. Dr. Abraham testified in the US Senate about Kedren’s model. #ihahlc21

Meet people where they “live, work, worship, play.” Kedren takes the time to engage, educate, answer questions. Want to expand this program and integrate it to healthcare system across the country. #ihahl21