Local community health leaders throughout Orange County are looking to gain a seat at the table with local public health officials and be included more in the county’s pandemic response efforts.

There’s been consistent calls from local health clinics and community organizations for more funding and partnerships from the county Health Care Agency and state officials – especially during the early days of the pandemic.

“We want to be at the table when the crisis starts and not at the tail end – that’s how we have felt. We get brought in in the end when they realize they can’t address the problem without bringing in the partners that are living and breathing with the populations they serve,” said Isabel Becerra, CEO of the Coalition of Orange County Community Health Centers.

[Read: Health Clinics, Community Groups and OC Health Care Agency Are Left Out of Gov. Newsom’s Proposed Budget]

It could take a research study to get that seat.

Researchers at UC Irvine are aiming to close various gaps in Orange County’s COVID-19 response, like the lagging Latino vaccination rate and disproportionate impacts to working class, often minority neighborhoods.

They’re going to study and interview frontline community health workers, community organizations and the health clinics – all of which have worked together to close various pandemic gaps and soften COVID’s blow to the community.

Jose Gomez receives his second vaccine dose at the Santa Ana college vaccination pod on April 22, 2021. Vaccinations through the non-profit Abrazar are administered on the bus, clients do not have to walk through the vaccination pod. Credit: JULIE LEOPO, Voice of OC

“The project’s dominant lens is COVID. That being said, the pandemic is the perfect sort of illustration of the realities that you can’t separate COVID from other health issues and other social issues,” said Alana LeBròn, one of the leading researchers on the project, in a phone interview. 

The pandemic has taken a magnifying glass to existing health gaps – like lopsided rates of diabetes, obesity and other serious health issues – faced by communities hardest hit throughout neighborhoods scattered throughout cities in North and Central Orange County.

The study, LeBròn said, is aimed at providing a greater understanding of the community health workers’ critical role during the pandemic. 

She also said it will be a roadmap of sorts for local politicians and public health officials so they know who can help curb lopsided health impacts to underserved communities. 

“Really the goal is helping us to bring public health into deeper conversation with those who hold really key understandings of structural factors that shape inequities and health so we can strengthen our public health response and also so our public health systems understand where our partners are,” said LeBròn, also a UCI public health professor who researches health inequities.

[Read: Community Efforts to Bring COVID Vaccines to OC’s Hardest Hit Neighborhoods Are Paying Off]

“I think in Orange County, it would help us to understand an underappreciated role that’s been critical in COVID response, which is the role of community health workers,” she said.

A Latino Health Access promotora goes through her address checklist while she walks through neighborhoods in Santa Ana on Dec. 11, 2020. Credit: JULIE LEOPO, Voice of OC

Cassie Rossel, spokeswoman for the local health clinic Families Together of Orange County, said they’re happy the study focused on community clinic workers.

She also said the report can help highlight some of the funding gaps that prevent clinics from alleviating more health disparities. 

“We’re in the position to properly address those issues if properly funded,” Rossel said in a phone interview. “In some ways we help relieve the cycle of poverty by providing these services at low cost or no cost. And we’re able to help educate people about their health.” 

Rossel said she also hopes researchers will examine the pandemic’s lopsided impact on the working class community. 

“People of lower income in Orange County reported their health got worse – there’s data in our own backyard,” she said. “Lower income communities, they really suffered. The wealthier communities actually reported to have an increase in their overall health.”

The existing disparities, coupled with the gaps faced in the pandemic, forced Santa Ana City Councilmembers to ask themselves whether it’s time for the city to create its own health department. 

[Read: Santa Ana May Create Its Own Health Department Given COVID Coverage Gaps from County]

“Communities of color were disproportionately living in crowded housing situations and were also disproportionately in essential worker situations that could not be done remotely,” said John Billimek, the study’s other lead researcher.

Billimek, also a UCI public health professor, said there’s going to be a focus on frontline community health workers, who have been providing residents with vital pandemic resources like testing. 

“They found out that people who already had a pretty insecure housing situation might’ve seen that become more acute. Maybe a household that had six family members living in a one bedroom apartment may have to have 10 family members now living in that same space,” Billimek said in a phone interview.

Last year, county officials rolled out a health equity map for Orange County, in partnership with Advance OC, a nonprofit community health organization.

The county’s new inequity assessment tool may be the first ever of its kind, officials and nonprofit workers say. Credit: Advance OC

The data map details a wide range of health and social inequities, like rates of chronic disease or access to broadband internet service. 

The new map also shows overcrowded housing throughout OC, which is heavily concentrated in Santa Ana and shows parts of Anaheim, Buena Park, Fullerton, Garden Grove and Westminster also dealing with crowded living situations – all neighborhoods where the pandemic hit residents hard. 

[Read: Could OC’s New Health Inequity Map Lead to Real Systemic Change?]

Their efforts also produced a COVID-19 vulnerability map, which shows certain neighborhoods in Anaheim, Fullerton, Fountain Valley, Garden Grove, Santa Ana, San Juan Capistrano and Westminster at highest risk of COVID.

While county Health Care Agency data shows that the Latino community’s disproportionate share of virus cases and deaths has somewhat lessened, there’s still a persisting vaccination gap. 

State data shows Latinos have only received 23% of the overall vaccines, while making up 35% of the population. 

When vaccination efforts were rolled out a little over a year ago, the scheduling app and public outreach materials were only available in English – despite OC having a diverse population.

[Read: Latinos Are Being Left Behind in OC’s Coronavirus Vaccination Efforts]

Gloria Montiel, a research scientist for the community organization Latino Health Access, said government and public health officials often don’t partner with community health workers soon enough during emergencies. 

The community health workers, also known as promotoras, have been key to getting pandemic resources like testing and vaccinations to the hardest hit parts of Orange County. 

“As policies develop, it’s rare that health systems or governments consult those first responders,” Montiel said in a phone interview. “Our promotoras at Latino Health Access for example have advocated for expanded services, messaging that’s a lot more culturally appropriate to our community … it provides us with a unique opportunity to set us on a more equitable path to recovery.”  

A Latino Health Access promotora walks through neighborhoods in Santa Ana on Dec. 11, 2020. Credit: JULIE LEOPO, Voice of OC

Last year, the OC Grand Jury issued a critical report on the county’s pandemic response – finding that public health officials failed to timely partner with community organizations and the health clinics they help support. 

“Nearly half of Orange County is made up of residents with limited English language proficiency,” reads the report. “The [OC Health Care Agency] and County management had not developed strong community partnerships per the CDC guidelines. Although the CARES act funds were available in March 2020, the health care agency did not enter a contract with respective community engagement services organizations until much later in 2020.” 

[Read: OC Grand Jury Issues Scathing Report on County’s Pandemic Response, Plans]

County officials reportedly ignored recommendations from community groups. 

“The Grand Jury also learned that recommendations provided by the local health initiatives, such as the Latino Health Access amongst others, were not followed by either the health care agency or by county management,” states the report. 

Ellen Ahn, executive director of the health clinic Korean Community Services, said it’s not just minority communities taking the brunt of the pandemic.

“It’s not just populations of color. Those of us at community health centers, we see the disparities across all communities. Of course lower income — income is a huge factor. Sexual orientation – there’s so many intersectionalities,” Ahn said in a phone interview. “We see the carnage of that. So any effort to look at it and start addressing the disparities and raise awareness – it’s all good stuff.” 

In a Youtube talk show hosted by OC Health Care Agency officials late February, deputy Health Officer Dr. Regina Chinsio-Kwong praised the efforts of community organizations and health clinics.

“We’ve been working with promotoras and local community based organizations such as Latino Health Access and some of the Asian organizations and community clinics. They’ve been actually going out, door to door. They’ve been canvassing a lot of the communities that are higher risk … we hope that those efforts are being attended by the vulnerable populations,” Chinsio-Kwong said. 

She also acknowledged what numerous public health experts have told Voice of OC over the past couple years: community health workers are more trusted than government officials.

The Cambodian Family’s community center in Santa Ana became a pop-up clinic for COVID-19 vaccinations after partnering with Korean Community Services to increase vaccine access for a vulnerable population, their elders. Credit: Photo courtesy of The Cambodian Family

“We are considered a government agency and already there is hesitance to trust what we say, so we know it’s important to go back to the community leaders,” Chinsio-Kwong said. 

Dr. Jay Lee, chief medical officer for the Share Our Selves health clinic, said it’s been a struggle to both stem COVID infections while dealing with normal patient care to make sure medical conditions don’t go unaddressed. 

In a phone interview, he said he hopes the study leads to a rethinking by public health officials on the importance of health clinics and community organizations. 

“Knowing that there’s been historical reductions in funding or services related to public health and in order for us to avoid calamity with public health emergencies it’s key to best understand how to create a plan for us to respond to future public health emergencies,” Lee said.  

Spencer Custodio is the Voice of OC civic editor. You can reach him at scustodio@voiceofoc.org. Follow him on Twitter @SpencerCustodio.

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