health equity – GW Nursing Magazine

November 1, 2021November 10, 2021

Amid Pandemic, Working to Address Health Disparities and Vaccine Hesitancy in Washington, D.C.

For the past few years, GW Nursing Assistant Professor Erin Athey, D.N.P., FNP-BC, RN, FAANP has been working with United Medical Center (UMC) in Washington, D.C., running its mobile clinic program. Before COVID-19 struck, she partnered with the District of Columbia Housing Authority to provide primary and preventative care to people in Wards 7 and 8 public housing. The UMC mobile vans, out of which she operates the clinic, help to address health disparities and improve access to health care for the most underserved populations in D.C. These clinics also provide a unique and vital opportunity for GW Nursing students to get clinical hours and serve these communities.

COVID-19-era work

Once the COVID-19 pandemic hit in early 2020, the mobile clinic program received federal funds through the Coronavirus Aid, Relief, and Economic Security (CARES) Act to support its ongoing work and to equip it for the new challenges posed by COVID-19. By July 2020, the mobile clinic was going into the community two to three days each week. Dr. Athey and her students conducted extensive PCR COVID-19 testing during the summer and fall of 2020 while continuing to provide care such as HIV testing, general health care screenings, and referrals.

Beginning in 2021, once the COVID-19 vaccines received emergency use authorization, Dr. Athey used the vans as vaccination clinics, going to family properties throughout Wards 7 and 8. As was the case throughout much of the country, there was initially a huge demand for the vaccine, but in summer 2021, Dr. Athey and her team began to encounter fewer people willing to take the jab and more resistance to vaccination. This phenomenon is known as vaccine hesitancy.

According to Dr. Athey, the two main issues now leading to vaccine hesitancy and low vaccine uptake are access and trust. She said that even the complicated issue of misinformation can be broken down into having access to the facts and trusting the source enough to believe them. Overall, access issues can be greatly mitigated with the mobile clinic, which takes the shot directly to the people who might not have the time or means to get to the pharmacy. Trust, however, takes time to build. The strategy of the clinicians and students running the mobile van: Make connections, bring the facts, keep showing up. Dr. Athey said, “I do feel like it matters to go out, to show up… It’s not overnight that it’ll get fixed, but being there continuously over time makes a difference.”

Wards 7 and 8 have the lowest vaccine uptake of all of D.C., and given that these are primarily Black communities, this is a matter of health and racial equity. In D.C., Black people make up 56 percent of COVID-19 cases, 71 percent of deaths, and 46 percent of the total population, but they have received only 43 percent of vaccinations.ⁱ Continued vaccination efforts like those of the mobile clinic are crucial.

One unique way that Dr. Athey and her team have sought to reach new populations with the COVID-19 vaccine in recent months was the Beat the Streets program, a community outreach event in which they partnered with the Metropolitan Police Department. Outreach events like this allow Dr. Athey, the students, and other clinicians to talk to people in their own communities and help inspire confidence in vaccine safety, an approach that has been most successful with people who are still on the fence about the vaccine. With those who are firmly opposed to the vaccine, talking about its merits often has limitations. However, as vaccine mandates become more and more common among various employers—including the D.C. police, health care institutions, federal government, and many private businesses—there has been an influx of vaccine acceptance. Tapping into this, Dr. Athey and the mobile clinic team recently held a clinic downtown for restaurant employees as new mandates went into effect for their places of work.

The future of the clinic

The mobile clinic will continue to operate throughout the pandemic, providing testing and vaccinations, and building trust with the community. Dr. Athey hopes that the program will continue to grow. She is looking for grants, donors, and foundations to help fund the clinic’s care of the underserved communities in D.C. Furthermore, although UMC has not previously seen children, Dr. Athey is hopeful that the clinic can soon expand its services to include wellness exams, prevention, and vaccinations for kids. She also would like to expand the partnership with the D.C. Housing Authority and begin creating place-based clinics at some of the public housing properties. This would follow the cost-saving “minute clinic” model, utilizing nurse practitioners, nursing students, and resident navigators to continue to build trust and provide access to care.

GW Nursing is proud to be in partnership with Dr. Athey, UMC, the D.C. Housing Authority, and so many others who are working to advance health equity in our community. It is important for nurses and our GW Nursing community to be innovative and committed to equity, continuing to create new models of health care that build trust and increase engagement with disenfranchised communities. The mobile clinic is just one such model. As the most trusted health care professionals, nurses are in a unique position to lead this movement. Dream big and take action!

i. Nambi Ndugga, Latoya Hill, and Samantha Artiga. Latest Data on COVID-19 Vaccinations by Race/Ethnicity. September 2021. https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/

AUTHOR Meredith Lidard Kleeman

May 11, 2019October 12, 2020

Teaching Healthy Living to Middle Schoolers

Delivering high-quality health care requires knowing more than a patient’s blood pressure, heart rate and weight. Patients are more than these numbers; where they live, what they eat, whether they exercise also play a role in their health. GW Nursing’s Bachelor of Science in Nursing (BSN) students are learning this crucial lesson through a participatory action research project conducted in partnership with the AnBryce Foundation.

“During this project, our nursing students, along with the middle school students whom they taught, learned the importance of social determinants of health and how they can facilitate or impede the making of a heart-healthy community,” said Sandra Davis, the school’s assistant dean for diversity, equity and inclusion, and principal investigator on
this project funded by the NPHF/Astellas Foundation.

This project made such an impact on its community that it was on display in an exhibit at the Smithsonian’s National Museum of African American History and Culture through May 2019.

The middle schoolers learned by completing a PhotoVoice project in which they explored and documented their surroundings by taking photos, writing commentary on what was unhealthy and noting how their environment could be made healthier.

“Children get used to what they see at home,” said Iris Fountain, a parent who attended the Saturday Institute PhotoVoice Exhibit held at Thurgood Marshall Academy Public Charter High School in December. Ms. Fountain pointed out that neighborhoods in the D.C. area can have as many as three liquor stores on one block that open as early as 6 a.m. “If I notice, children notice it,” she said.

Indeed, one student wrote about the prevalence of alcohol.

“The picture on the left shows people drinking liquor and throwing it away in the streets. This shows that there are drunk people who hang out in the community, and that it is full of bottles of liquor,” one student wrote. “The photo can educate people in my community by showing what most people are hooked on, and telling them to cut down the amount of liquor they consume. The picture on the right is an example of how to improve the community. For every one liquor store you have there should be one organic store too.”

Through this project, area middle schoolers learned not only how to take care of themselves, but also how to advocate for and in their communities. GW Nursing BSN students guided the middle school students under instruction by Dr. Davis and her co-principal investigators, Assistant Professors Karen Dawn and Adriana Glenn, as part of the BSN program’s community health portion.

Social and environmental factors—such as education, housing, places to exercise and healthy places to eat—all matter when it comes to heart disease and risk factors for heart disease. Underrepresented groups, especially African Americans, suffer a disproportionate risk factor burden for heart disease. In addition to being one of the poorest cities in the United States, D.C. has one of the highest avoidable death rates from heart disease of all major U.S. cities.

Earlier this month, Ms. Fountain’s son wrote Maryland Gov. Larry Hogan encouraging him to create more community gardens in public areas. This was the Fountains’ first activity with GW Nursing and the AnBryce Foundation, but it will not be the son’s last as he hopes to attend Camp Dogwood, where BSN students provide first aid to campers, later this summer.

by ERIN JULIUS

May 11, 2019October 12, 2020

Forging Lasting Partnerships

Sandra Davis speaking with students at event

Diversity in the health care workforce, continuing education for care providers and building partnerships with community stakeholders are the pillars on which healthy, resilient communities are built, according to Jehan El-Bayoumi, executive director of GW’s Rodham Institute. Dr. El-Bayoumi gave the keynote address this winter at the first annual community partners engagement event.

Community partners from across the Washington, D.C., metro area, and GW and local care providers came together to share their ideas and success stories for relationship-building initiatives at an event themed “It Takes a Community!”

Hosted by GW Nursing, the event aimed “to align the goals of our community partners and faculty to better serve the health and well-being of the Washington, D.C., community,” organizers said.

Dr. El-Bayoumi’s keynote address, “Working Together to Improve the Health and Well-Being of the DMV (District of Columbia, Maryland, Virginia),” focused on the broad disparities between different parts of the city as well as some exemplars that have made strides in closing those gaps.

“We at the Rodham Institute like to present not just a problem but a solution,” said Dr. El-Bayoumi before introducing the institute’s three priorities in building health equity: community collaboration, education for health care providers and workforce diversity.

Dr. El-Bayoumi went on to say the model of community partnerships needs to change from one of top-down leadership with one group at the top—be it physicians, nurses or other stakeholders—to a wheel model with rotating leadership. GW Nursing practice and community partners in attendance said the event provided invaluable learning opportunities.

“One of the things that really struck me was the piece about diversity in the workforce,” said Charles Birdie, executive director of the Loudoun Free Clinic. “I’d like to see more minority physicians and health care personnel start to volunteer at the clinic, because I think it’s going to be better for everyone all around. I think the School of Nursing can help us with that.”

GW Nursing sends Bachelor of Science in Nursing students to the Loudoun Free Clinic for clinical assignments, and some students also volunteer there. The partnership has been beneficial for both the clinic and the school, he said.

“I’m really glad GW Nursing put this together, and I’m glad to see it’s the first annual event,” Mr. Birdie said. “I will certainly be back next year.”

by REESE RACKETS

May 11, 2019October 12, 2020

Robert Wood Johnson Foundation Funds Study on State Laws Discouraging Tobacco Control Measures

Some state laws that preemptively prohibit tobacco control measures may be at odds with common public health efforts. A new study, awarded $149,600 by the Robert Wood Johnson Foundation Policies for Action program and led by GW Nursing’s Dr. Y. Tony Yang, will examine the impact these state laws have had on public health in the United States. Specifically, the study will examine laws enacted or repealed between 1997 and 2017.

Effective tobacco control efforts include restrictions on marketing and promoting tobacco products, licensing tobacco, whether young people have access to tobacco products and where smoking is allowed. Preemptive laws block local governments from taking these steps to protect public health.

“Although a consensus exists among tobacco control practitioners that preemption adversely impacts tobacco control efforts, there is limited empirical evidence to quantify its effects on adolescent health and health disparities,” said Dr. Yang, professor and health services and policy researcher at GW Nursing.

Tobacco kills more than 480,000 people annually—more than AIDS, alcohol, car accidents, illegal drugs, murders and suicides combined. Tobacco costs the U.S. approximately $170 billion in health care expenditures and more than $150 billion in lost productivity each year.

Each day, more than 3,200 people under 18 years old become daily cigarette smokers in the United States, according to the Centers for Disease Control and Prevention (CDC), making youths’ access to tobacco products a key public health issue.

Dr. Yang’s team will also examine whether majority-minority counties are disproportionately impacted by state preemption laws, potentially exacerbating health disparities between racial and ethnic groups.

Although African Americans usually smoke fewer cigarettes and start smoking cigarettes at an older age, they are more likely to die from smoking-related diseases than white Americans, according to the CDC. Cigarette smoking among lesbian, gay, bisexual, transgender or queer (LGBTQ) individuals in the U.S. is higher than among heterosexual individuals, with about 1 in 5 LGBTQ adults smoking cigarettes compared with about 1 in 6 heterosexual/straight adults, according to the CDC.

by erin julius