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Excerpted From: Amanda Harris, Brittíni “Ree Belle” Gray, Ciearra Walker and Melinique Walls Castellanos, Lessons Learned from Community-driven Responsiveness During Covid-19, 14 Saint Louis University Journal of Health Law & Policy 429 (2021) (191 Footnotes) (Full Document)


National and regional data demonstrate that people of color suffer from COVID-19 and its multidimensional consequences at greater rates than the general population. These pandemic-related health disparities compound on a history of existing health disparities, as communities of color have long experienced disproportionate morbidity and mortality from a variety of health conditions. St. Louis, Missouri, is a metropolitan area in which both novel and longstanding racial health disparities are particularly acute. Therefore, it is vital that the St. Louis public health response to COVID-19 prioritize the unique pandemic-related needs of communities of color, while situating the response in the larger goal of promoting racial equity.

PrepareSTL, a campaign spearheaded by community voice, recognizes the urgency of prioritizing communities of color and other at-risk populations through a COVID-19 public health response. The campaign is a collaborative effort of the City of St. Louis Health Department and St. Louis County Department of Public Health, together with the St. Louis Regional Health Commission, St. Louis Integrated Health Network, St. Louis Community Health Worker Coalition, Alive and Well Communities, and the St. Louis Mental Health Board. Through a unified communications and outreach campaign, PrepareSTL provides vital information and resources to disproportionately impacted community members, specifically low-to-moderate income Black residents and other people of color living in St. Louis City and County. The campaign utilizes grassroots canvassing, under the leadership of community advocates, to deliver accurate and culturally responsive information and resources. Canvassers are also deeply engaged to do more than share information and resources: they listen and drive the direction of the work.

During a pandemic, urgent community needs emerge, while systemic, long-term issues grow. In response to this unique combination of needs, PrepareSTL seeks to use its community engagement infrastructure to rapidly respond to COVID-19, while simultaneously addressing potential long-term consequences from the pandemic. Canvassers, representing larger community voices, have identified specific resources and knowledge that would positively impact communities of color in the wake of COVID-19. This community-driven process offers immense learning opportunities for future grassroots advocacy and public health work moving forward.

Before evaluating the PrepareSTL campaign in this Article, we provide additional background and context. Part II outlines COVID-19 racial disparities in the St. Louis region and explicitly connects the disparities to social determinants of health. It also looks at how structural racism reveals itself in the St Louis health care system. Part III outlines best practices for equity-centered public health campaigns to provide a foundation for evaluating the PrepareSTL campaign. Part IV describes the PrepareSTL campaign--from origin to execution. Part V describes the results of our qualitative research study, highlighting the strategies utilized to reach communities of color with public health education and resources.

[. . .]

This study does not comprehensively measure the success of PrepareSTL on activating behavior change. The interviews with canvassers and volunteers highlight knowledge increase and behavior change around preventative public health measures, but residents in targeted neighborhoods were not surveyed at large. Analyzing the success of PrepareSTL from a lens of measured behavior change, such as increased mask usage or physical distancing, is an area deserving of further investigation. While this study does not measure widespread adoption of public health practices, the regional rates of COVID-19 support the equity-centered work of PrepareSTL. As explained in Part II of this Article in greater detail, between July 2020 and February 2021, the St. Louis region saw a decrease in racial disparities in rates of COVID-19 infection and fatality. While no direct causation can be proven, PrepareSTL likely contributed to the significant decline in racial disparity through its targeted, robust media and outreach efforts.

This study aimed to understand the factors that contributed to the success of PrepareSTL as a community-led and equity-centered response to COVID-19 to leverage learnings for other public health initiatives. The interview questions focused on the unique characteristics of PrepareSTL from the perspective of those intimately involved with the campaign. All questions were optional to answer.

We conducted six semi-structured interviews and three semi-structured focused groups, two with canvassers and one with executive leaders and campaign organizers.

We conducted interviews and focus groups over Zoom with video. Interviews lasted approximately one hour, and focus groups lasted two hours. All three focus groups were conducted in December 2020, and interviews occurred in December 2020 and January 2021.

The research team represents three organizations closely involved with the PrepareSTL campaign: the St. Louis Regional Health Commission (two researchers), Saint Louis Integrated Health Network, and Emerging Wisdom. Two members of the research team also serve on the organizing team in volunteer and consulting capacities. All four members of the research team were present at focus groups and were involved in some interviews. The research team prefaced each interview with a request for full transparency and an explanation of the research's confidentiality.

[. . .]

PrepareSTL has challenged the comfort of traditional collaboration and established authentic, bidirectional community problem solving. “You can't be afraid to lose when you're talking about changing a culture that existed for decades at this point,” said a campaign respondent. The unique, collaborative origin of this campaign, born out of mission and not a mandate, exemplifies the commitment, urgency, and fluidity of the campaign's leadership. Furthermore, the campaign's community-centered design and management structure underscores its ability to address the pandemic while building community infrastructure to “[help] St. Louisans of color prepare and prevail.”

In closing, we leave you with one final quote from a campaign respondent, “If you want to see ... similar successes, then you assemble a great group of people; you give them a bunch of money; [you trust them] and you let them go.”

Amanda Harris is the Director of Regional Initiatives at the St. Louis Regional Health Commission in St. Louis, Missouri. She earned a Fulbright Scholarship in 2017 to study an intercultural birthing initiative in northern Chile. She received her Bachelor of Arts from Washington University in St. Louis in 2016.

. As a social entrepreneur, Brittini is the founder of Rebellyen, LLC, a consulting and wellness firm; serves as the Organizing Director of the Black Healers Collective and InPower Institute; is a documentary film director and producer; and is an international retreat host, and enjoys hosting meditation gatherings.

Connecting vision to actionable, on-the-ground strategy is Ciearra Walker's differentiating gift. In St. Louis, she leads a charge to engage a growing network of over 100 Community Health Worker (CHW) neighborhood leaders and more than 50 organizations to design a multifaceted, grassroots, and legislative strategy, ensuring the CHW workforce enjoys long-term viability at regional, state, and national levels.

Melinique Walls Castellanos is a second-year medical student at the University of Chicago Pritzker School of Medicine.

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