Raynard Washington
Director, Mecklenburg County Public Health State of North Carolina
Addressing Inequity Takes a Village
Raynard Washington joined the public health department of Mecklenburg County Health and Human Services Agency as deputy director in March 2020, just as COVID-19 was beginning to spread in the United States. He was appointed director in December of 2021. As racism had recently been declared a public health crisis by the local board of health, ensuring equal access to COVID resources was a priority from the start. While data were difficult to come by initially, Washington said they eventually revealed the extent of inequity in the response. The department was then able to enlist the aid of an established network of healthcare, grassroots, community-based and faith-based organizations and develop focused solutions to increase services to those being left out.
A Scramble for Data
The state public health data management system proved difficult to maneuver initially, but the county found ways around it as the state worked to enhance the system to manage COVID data.
Many local public health departments are required to use state systems for key public health functions like disease surveillance, case investigation and outbreak management. Our data systems were not sophisticated enough to quickly adapt to a novel condition like COVID moving so quickly through the community. The state needed several months to enhance and build a separate system, with robust electronic laboratory reporting to support COVID surveillance and outbreak management. The system, as are most disease surveillance and outbreak management systems, are not always user-friendly and training new team members who were hired specifically for the COVID response took significant lead time. The systems also had very limited end-user reporting and analytic capabilities. Most reports had to be requested from the state, which required additional time. Similar challenges were observed with collecting and reporting vaccine data from the state immunization registry. Data often lagged several weeks, limiting our decisional capacity to drive response activities on the ground.
“Data challenges were also experienced with monitoring and reporting COVID hospitalizations. There were no structured systems allowing for routine reporting on hospital admissions that could be shared at the local, state and federal level, so we had to set up a manual reporting from each of our health systems to each of the various government entities. These disparate systems resulted in lagging and often inconsistent data from different sources.”
Engaging COVID Ambassadors
As data became more reliable, the county developed a dashboard to track vaccination and other services, ascertain the extent of inequities in the response, and take steps to mitigate them.
“We launched full scale equity campaigns – education and outreach campaigns focused on various communities who were being disproportionately impacted by COVID. For example, we focused on the African American community via media partners who were helpful and by engaging trusted messengers such as our faith-based network.”
We have a network of churches here called Village Heartbeat that was started with the health department with more than 60 churches in it. We held education sessions for the pastors, went out to the churches and provided resources including masks. We also teamed up with our health care partners at houses of worship to conduct mobile testing.
“We mobilized on-the-ground teams in – every corner of the county where we were seeing disparities in outcomes or access. From the Latino grocery store to the corner store to the Hindu temple, we were there.”
We established a corp of COVID ambassadors whose responsibility was to assess where there were inequities and helped to align resources. We had to think outside the box to achieve our goals including the hiring and training of a team of folks who were canvassers for a political action organization. We trained them to be COVID experts, and with our training, they knocked on doors to educate our residents about the vaccine and help schedule appointments.
“We also launched a homebound vaccination program for those who might be experiencing disabilities or were otherwise unable to leave the home to receive a vaccine. Our mobile team, that included nurses and paramedics, went directly to resident homes to administer vaccines. All of our equity activities were driven by a dashboard that had census track level data about who was getting vaccinated and who wasn’t.”
Transparent Command & Communication
The push for equity was an important part of the overall response led by the public health director who served as incident commander. The director talked with local elected leaders on a bi-weekly basis, for consistency of messaging and addressing difficult decisions
It was important to have the health officials talk directly to local leaders, which gave them an opportunity to ask questions and to be transparent about why some decisions were being made from day one. That put us in alignment with the leaders as a body, so that we avoided some of the challenges that other jurisdictions had with local leaders not being supportive of changing directions.
“We conducted a wide array of proactive media engagement. As transparency and access were key pillars in our work, we held regular press conferences to be able to answer questions. The goal was to have that frequent communication and to try to be transparent, even if the answer was, ‘We don’t know but we’re trying to figure it out.’ I think that frequent communication helped us throughout much of the response.”
Boots on the Ground
Washington credits North Carolina’s public health structure with providing statewide guidance but also with having a separate department in nearly every county that could provide local logistics and adapt guidance to community needs.
Having boots on the ground in every county has served us well. In general, there’s a home base health department in every county with some base infrastructure for emergency response activities, as well as command and control.
“The state took a strong lead in establishing statewide guidance for many of the response mitigation activities. That allowed the local leaders and teams to focus on response – keeping people alive and not getting into some of the back-and-forth battles about mitigation rules for businesses and other issues.”
Boots on the Ground
The county also established advisory groups that helped ensure everyone had a voice in decision-making and provided a channel for their support.
“The policy group, led by our county manager, included the chief executives from the health systems, school district, emergency management, and other key stakeholder groups. As decisions were being made about local closures of roads, buildings, and institutions, all those folks had an opportunity to speak directly with the county manager. The access to real time information as well as decision deployment timelines and rationale kept the group engaged throughout the response. Being well informed, established a level of trust within the group that was beneficial.”
The county manager established a business community advisory body that helped us make local decisions about reopening and implementation of state guidance for businesses based on our real time situation. That opportunity created space for businesses to hear from each other, including what they were doing and how they were solving various issues. That engagement with the leadership of the business community also helped to keep us largely out of some of the vocal and public discourse that we saw in other places.
“Some of the county’s large employers such as Honeywell and Bank of America, helped us to be messengers to their massive workforce in our community. The employers helped us with education and their own policy setting, allowing people to work remotely, and setting up processes for how people could be as safe as possible in the workplace.”
Through this engagement, the county rolled out a workplace cleanliness and hygiene initiative and provided environmental health inspections to make sure businesses were doing everything possible to keep themselves and their consumers safe.
Our partnerships with businesses really helped establish trust and commitment to make the community as safe as possible. That took exceptional time, effort, and manpower. But we know it was worth the investment, because some of those relationships continue today and impacts our work to promote and protect public health in our community.