Carl Ellison
President and Chief Executive Officer of the Indiana Minority Health Coalition
As president and CEO of the Indiana Minority Health Coalition (IHMC), a 30-year-old network of 20 local minority health coalitions and community based partners, Carl Ellison saw first hand the devastating impact COVID-19 had on communities of color from Black nursing-home residents to Latino meat-processing employees. Ellison has been with IHMC since its start, when he helped found the organization in 1992 to unify advocacy for health care services for racial and ethnic minorities in Indiana.
Among underserved populations there was just the challenge of communication and “Can you trust the government?” from some newly arrived persons, and also persons who were in the United States and English may not be their first language. Within that context, the State nonetheless did a very good job of creating a dashboard so we could track by county what the rates were, be it hospitalizations, deaths, whatever the case may be. Ultimately our State did subdivide its dashboard to show race/ethnic groups. So we were able to see the impact and see the disparities that continued as a result of the pandemic.
Speaking the Community’s Language
Early on, Ellison’s team worked closely with the Department of Health around how they were messaging their COVID campaign.
“One thing we started, which has gone on to this day, are weekly one-hour “Touch Base” zoom meetings with our whole statewide network. It was a way to check-in on what was happening in local communities and a way to determine to what extent our local coalitions were involved with the response at their own county level. We used these calls as a mechanism to educate and communicate because underserved people needed information if they were going to be able to protect themselves.”
“We were very involved in helping to formulate survey questions to better understand knowledge and perceptions as the pandemic. We also were very involved in helping the state shape, message and target public awareness campaigns. In fact, we had a task -group of ten of our local affiliates and some of the Department of Health staff that went through all of the marketing material, and helped, to the extent we could, make sure the material resonated with underserved populations.”
Early on, as may have been the case in other states, the initial material was all in English. Ultimately the state then put the material in Spanish and other languages as there are other subpopulations such as the Burmese, within the state. Our input helped assure that the state’s dashboards and the marketing information were more subpopulation friendly.
“And then beyond that, when we got to the vaccination part of the pandemic, our local networks convened a number of local campaigns to get people to come take the shot. About one-third of our coalition is Spanish speaking. So, in their counties they would market that demographic to come to a trusted location to get the shot. In other cases, our local partners have long standing relationships with churches, the community centers, barbers, hairdressers, greek organizations, etc. Our local leaders leverage these relationships to reach grassroots community members.”
“We did some targeted work where we primarily were focused on Spanish speaking populations. We identified zip codes in minority neighborhoods with least vaccinations and carried out some door-to-door, face-to-face work, to get the word out about the benefit of getting the shot. “
“Along the way, we created a campaign called “Black & Vax” where we would go to sporting and other events to encourage especially young folks to take the vaccine.”
The value of the organization’s deep community roots became clear when the State tried to establish a vaccination center in a largely Black neighborhood.
The problem was that the state, in doing their coordination work, identified the former Gary Roosevelt High School as a vaccination site because the building was vacant and there was ample free parking. But, the problem was that the community did not perceive that location as safe. So, notwithstanding all the effort, there was very little participation there. This became a situation where, on one hand, the state was trying to do the right thing, but, on the other hand, the people implementing the logistics didn’t have a local partner to talk to, to ask, “Does this make the most sense?” In the end, the implementers did what they thought was correct. But when you got down to it, it just didn’t work.
“The second time around our group identified another vaccination center. It was much more successful. They also had enough time to get the word out, to almost make it a mini campaign.”
A key takeaway is that the people managing the logistics didn’t include local voices who could help them better target the effort…In some cases they didn’t know who the local voice was, and, if they had just called us, we could have told them. There are a lot of players who are not necessarily familiar with, or knowledgeable about, the subpopulation leadership that they could tap into to help make the event more successful.
The pandemic’s unique challenges required IHMC to adopt new approaches to alleviate constituents’ pain and fear.
“We have leaders who interact with populations every day, be they immigrants or be they lower income folks. Primarily it was trying to find out what resources they needed—and sometimes it wasn’t necessarily money.”
For example, there was a Latino congregation in Johnson County where 35% of their congregate population died from COVID. The pandemic had a significant adverse impact that required counseling and other activities. So our local folks helped to bridge that through ministry and other mechanisms, just to help the community deal with grief and deal with how you take the next step the next day. So I would say our impact more was, once we saw the impact on a group or locality we then would intervene to just help the community cope and then help to encourage the community to certainly get vaccinated to preclude greater risk.
Despite the effort, Ellison said his organization still felt unprepared to address the multidimensional impact of the pandemic.
“I wish early on we had been more aware of the plight of nursing home residents, particularly Black nursing home residents, where we had a significant amount of deaths. Families were not well prepared to know how to withstand the pandemic, and what they could or couldn’t do, and how to address some of the hardships of having a loved one in the hospital, but they can’t visit them.”
Getting Human Services Rowing in the Same Direction
Another challenge was the lack of coordination among groups that can provide psychosocial and other services.
In Indiana and in most states you don’t have an effective mechanism for having collaboration be normal or standard among the whole human service delivery network. I do think over time you saw the hospitals and Department of Health coordinate, cooperate, all the emergency preparedness people. All those were pretty much in sync in terms of an overall state response. What we didn’t have is the same thing among the human service network from a coordination standpoint. That’s not to say, the human service network wasn’t involved. It’s just that I think that side of the equation could have been perhaps more impactful, had there been better coordination.
“We pretty much know who the actors are, but if we just had a monthly or some kind of touch base–“What are you doing? Where can we help out?”–I think we would have found it more collaborative, or more things that we can do together, or “We’ll take this shift–you take that shift.” I think we could have used that.”
No one gets paid to do collaboration. No one has the need to be the collaborative partner. But what you, in fact, need is a collaborative leadership to just get the oars aligned so that the boat can move with the full impact of all the oars.
The Value of Independence and Bipartisanship
IMHC works in all of the state’s major population centers in some of the rural areas. The coalition’s independence enabled a flexible, bipartisan approach.
“We don’t have a recipe for everyone; they’re all individualized, depending on the leadership and how the coalition has emerged in those communities. And if you can imagine within a network, we’ve got everything. You’ve got immigrant populations coming to town who need assistance. We’ve got Latino populations. We have a partner in Cass County, which is where there’s a big Tyson chicken factory, and we had some issues around that employer protecting their people during COVID. We did a lot of education, a lot of advocacy and lobbying.”
But also our organization is independent, so we can be the town critic. And I might add, in our state, even though it’s very red, public health has, for the most part, been pretty bipartisan over the years. We have as many relationships on the Republican side as on the Democratic side. And partly evidence of that is that one of my board members is Senator Jean Breaux, a Democrat, who recently passed away. Another board member is Representative Ed Clere, a Republican. So we continue the bipartisan nature of public health, even with our Board representatives of the organization.
“And I guess the takeaway is that I’m pretty sure we’re kind of unique in the United States. There are a lot of folks who do minority health, but pretty much they are part of state health departments. They are not independent voices. We’re sort of free to try different things. Sometimes succeed, sometimes not, but we don’t operate pursuant to a recipe. We operate pursuant to what we think we need to do.”