Arkansas Black Vitality Staff — The University of Arkansas for Medical Sciences (UAMS) Heart Healthy Communities Project is partnering with researchers at the University of California-Los Angeles (UCLA) and Howard University to proactively engage historically marginalized and disadvantaged populations and provide crucial information and resources during public health crises.

The goal of the project to improve the quality and length of lives in the community. Poor health outcomes disproportionately impact underserved, low-income communities. The UAMS Heart Healthy Communities’ mission is to improve health outcomes among impoverished rural populations by deploying community health workers to engage residents and determine which health and social services are needed to improve health outcomes, said Irion “Chip” Pursell Jr., MPH, RN, principal investigator for the project.

Assisted by a $1.7 million grant from the CDC Foundation, the UCLA and Howard University researchers launched Project REFOCUS (Racial Ethnic Framing of Community-Informed and Unifying Surveillance) in October 2020 to study COVID-19-related stigma and discrimination in underserved communities and provide related real-time information through an electronic dashboard. The dashboard is intended to be easily accessible to public health officials, the public and policymakers to help them build trust with — and respond to — the communities.

Project REFOCUS leverages more than a decade of their experience applying epidemiology and health communication to racism as a public health problem. It tracks the intersecting pandemics of racism, especially as expressed through stigma, and COVID-19, with a focus on providing information to the communities most directly impacted. Key concerns include stereotypes about the origins of coronavirus disease (COVID-19) and the historical and present-day ways structural racism influences the social determinants of health and health access among diverse communities.

“During crises, fear can have a counter effect on access and adherence to community-level mitigation efforts,” said Dr. Monica Ponder, an epidemiologist and assistant professor of health communication in the Department of Communication, Culture and Media Studies at Howard University’s Cathy Hughes School of Communications. “Chronic stress is an important pathway by which stigma influences physical and mental health. That can become a vicious cycle, fueled by racism and bias. Public health crisis communications must also recognize the historical trauma, lived experiences, and political climate in which people reside … to ignore this context is malpractice.”

In addition, prejudice stemming from rumors and scare-mongering can lead to unfair treatment and stress, which negatively impacts physical and mental health.

“We have to shift the focus beyond merely documenting higher rates of death, disease and underlying conditions in our communities toward eradicating the inequities. As with any other threat to health, we can only do that by identifying the root causes – meaning, the causes of the causes of the unequal social conditions” said Chandra L. Ford, Ph.D., founding director of the UCLA Fielding School of Public Health’s Center for the Study of Racism, Social Justice & Health and professor in the Department of Community Health Sciences. “Further, as with prior pandemics, COVID-19 stigma is highly racialized, making Asian populations in particular susceptible to hate crimes.”

Through its ongoing work with local community health workers, the UAMS Heart Health Communities project will add actionable health and social data to the dashboard, said Pursell.

“The goal would be to determine which types of information to include, guided by input from the community, to assess the feasibility of integrating the data, and to see if/how local officials might use the dashboard with the additional data to inform their efforts to improve health locally,” said Ford, who leads the UCLA researchers.

Even before Heart Healthy Communities became one of only six projects in the country selected to work with Project Refocus, it developed a network of local providers and other community partners to connect people in the designated Arkansas communities with resources to improve health and wellness.

“Poor health outcomes tend to cluster in low-wealth neighborhoods, and the HHC community-centric approach facilitates the collection of actionable data that can be integrated into the Project Refocus dashboard,” said Pursell. “This will inform local stakeholders’ efforts to improve community health and well-being, and monitor the impact of COVID-19 and future public health emergencies.”

“Public health practitioners face challenges in effectively monitoring the presence, spread and impacts of COVID-19 among these disadvantaged populations,” said Ford, who is the founding director of the UCLA Fielding School of Public Health’s Center for the Study of Racism, Social Justice & Health, and a professor in the UCLA Department of Community Health Sciences.

“Lessons learned from prior epidemics, such as HIV/AIDS, make it clear that stigma and mistrust slow disease mitigation efforts among the most disadvantaged populations, contribute to mistrust of public health messages, delay access to services and reduce adherence to treatment,” she added. “This mistrust is rooted not in science denialism, but in legitimate concerns about the unequal treatment African American and other communities have received in health care.”

Monica Ponder, Ph.D., an epidemiologist and assistant professor of health communication at Howard University, noted that “during crises, fear can have a counter effect on access and adherence to community-level mitigation efforts.”

“Chronic stress is an important pathway by which stigma influences physical and mental health,” she said. “That can become a vicious cycle, fueled by racism and bias. Public health crisis communications must recognize the historical trauma, lived experiences and political climate in which people reside.”

The CDC Foundation is an independent, nonprofit organization created by Congress to mobilize philanthropic and private-sector resources to support the work of the Centers for Disease Control and Prevention and the public health community.

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