Black and Latino Minnesotans are facing disproportionate rates of COVID-19 infection, hospitalization and death, which has highlighted a complex public health problem: Distrust of the health care system.
State, county and other public health officials are experimenting with new ways to break down barriers of mistrust built up over centuries.
Ramsey County, for instance, created a “trusted messenger” program to help ensure that the county’s communities of color get the COVID-19 information they need from sources they trust more than the government, which they don’t trust at all.
“People have a fear around getting tested, steeped in history… with all the experimentation that has been done in the [African American] community,” said Julia Freeman, the director of community engagement at Voices for Racial Justice, a Twin Cities-based nonprofit.
Some history: The 1932 “Tuskegee Study of Untreated Syphilis in the Negro Male” involved infecting 399 Black men with syphilis without their informed consent under the guise of treatment for “bad blood.” In 1951 Henrietta Lacks, a Black Baltimore woman, visited Johns Hopkins Hospital where a biopsy from a growth on her cervix was taken, the research eventually leading to significant medical advances including the development of the polio vaccine. Her family has yet to be compensated. The United States also has a long history of using coerced sterilization on people deemed “undesirable.”
Even when not exposed to reckless experimentation, Black patients consistently receive worse health care than whites. As University of Minnesota-Duluth health economist Jennifer Schultz noted recently, a Black woman is 22% more likely to die from heart disease than a white woman, 71% more likely to die from cervical cancer and 350% more likely to die from pregnancy or childbirth.
Other communities of color are also afraid of testing, said Kou Thao, director of the Center for Health Equity at the Minnesota Department of Health. Some fear that “If they’re positive, they can’t work and provide for their families or they fear that if they go to a test site, they’ll be around others who are positive and contract it,” he said. Many undocumented people worry that getting tested lead to deportation.
In Minnesota, 63% of the deaths among adults under 64 are people of color despite comprising just 16% of that population. In the metro area, regardless of income, neighborhoods of color are more likely to have higher COVID-19 rates, according to the Star Tribune.
Nationally, Black and Latino Americans have been three times as likely to be infected with the virus and nearly twice as likely to die from it than their white counterparts.
To combat the misconceptions that can lead to these disparities, the state has set up testing centers at local churches and neighborhoods that were affected by the unrest after the killing of George Floyd in urban areas, while focusing on community centers and schools in more rural locales.
In Ramsey County, Sara Hollie — a racial and health equity administrator — began working on the county’s COVID-19 “Racial Equity and Community Engagement Response Team,” or RECERT, in April. Hollie describes RECERT’s work as “centering the community voice to make sure that we are looking at our system, policies and practices around how we work with and on behalf of communities to keep [them] safe,” she said.
After listening to Ramey residents, Hollie’s team decided the best way to deliver health information to skeptical communities was to use voices from those communities, she said. They’re also turning to dozens of smaller organizations that engage with starkly different subcultures, rather than just a mass media approach.
In early July, the group launched the trusted messenger program to help ensure that the county’s communities of color get the COVID-19 information they need from sources other than the government. RECERT is currently contracting with 27 community partners through the end of August to disseminate information about COVID-19. The information includes everything from what county services are available to accurate health information on how to reduce the spread.
“We’re hoping this [can] start to break down the barriers of mistrust that systems, not communities, have created,” Hollie said. “We’re applying [a] race equity lens and vision to essentially deconstruct and reconstruct how we do this work during COVID and after.”
It works like this: RECERT comes up with the information, resources and materials that partners are then free to use, brand and disseminate in whatever way works best for them. There will be check-ins throughout the process as well as a final report this fall.
Each partner organization is currently in different phases of getting their information out.
Voices for Racial Justice is one of the “trusted messengers.” Freeman started in mid-July disseminating information to 25 organizations in a group called Our St. Paul focused on racial justice.
The pandemic has left some nonprofit groups staggering from the loss of fundraising and uncertainty, however. She was recently working on following up with the organizations that didn’t respond to her original blast and has been delivering the same material to other more unconventional places, even the management of her apartment building to share with residents. “I’m thinking creatively about all different places,” she said.
Steve Thao, executive director of the Center for Hmong Arts and Talent, another RECERT “messenger,” has taken a slower approach. “I want to make sure we have the right message,” he said. “There are a lot of rumors out there, a lot of incorrect information. We want to be a part of the process that gets proper information out at this time — it’s a matter of life and death.” Thao is particularly concerned with reaching older Hmong-Americans who are most vulnerable to illness and misinformation, he said.
Thao said that in the past he has seen claims disseminated through Hmong TV and radio stations “of herbs and medicines that can cure cancer and things like that. I hope nothing like that comes out during this time,” he said.
As a veteran of Hmong media, however, Thao knows exactly how to reach his community: through an unconventional platform — conference call “shows.”
Think of it like a traditional conference call for work, but instead of a presentation from a colleague you’re hearing radio show-like content from a fellow Hmong person independent of any formal media company. The calls, which have become popular over the past decade or so, use free conference call software to convene their callers that sometimes total into the hundreds.
“I know this one guy, he does a regular show every night talking about relationships from 7:00 to 9:00,” Thao said. He said he was “blown away” by the large audience attracted to these conference calls, especially among older Hmong-Americans.
Thao’s expertise is exactly what Ramsey Count needs. Indeed, it’s hard to imagine non-Hmong messengers capitalizing on this eccentric platform.
“I think it’s a really smart strategy, working with nonprofits and organizations that are in the trenches,” Thao said.