Mobile Health Clinics to Mitigate COVID-19 Systemic Barriers

This essay won first place in the policy opinion and analysis category of the Student Collaborative on Health Policy summer writing competition.

Introduction

COVID-19 has shined a light on structural inequities in the healthcare system that affect the Black and Latinx communities. Throughout the pandemic, Black and Latinx individuals have experienced a greater risk of exposure to COVID-19. Compared to non-Hispanic White persons, Black individuals are at a 1.1 times higher risk of contracting the virus, 2.8 times higher risk of becoming hospitalized, and 2.0 times higher risk of dying. Similarly, Latinx individuals are at 1.9 times higher risk of infection, 2.8 times higher risk of hospitalization, and 2.3 times higher risk of death.¹ Disparities in access to COVID-19 tests and vaccines contribute to the disproportionate impact of COVID-19 on these communities. In ZIP codes with more minoritized community members, there are fewer COVID-19 testing sites per capita.² In most states nationwide, the proportion of total vaccinations allocated to Black and Latinx individuals is smaller than their share of the total population.³ Many inequities embedded in the infrastructure of our healthcare system contribute to these disparities, affecting these communities long before the emergence of COVID-19.

Policy Barriers

To facilitate access to COVID-19 tests and vaccines, it is necessary to address the systemic barriers experienced by Black and Latinx communities. Across the United States, regions with a higher percentage of minoritized communities were associated with a longer travel time to reach testing sites.⁴ Geographic inequities in testing site access hamper the control of COVID-19 in the Black and Latinx communities and lead to the health disparities we see today. A similar trend in COVID-19 vaccine distribution was also seen, especially in the early stages of the pandemic. Hospital-based health clinics initially received vaccines, which can be inaccessible to many Black and Latinx individuals, and age-related priority groups did not account for trends of lower life expectancy for minoritized communities.⁵ In addition to longer distances from testing and vaccine sites, Black and Latinx people face additional barriers when seeking transportation. In areas of the United States that have access to public transit services, 23 percent of Black and 15 percent of Latinx individuals use public transportation regularly, compared to 7 percent of non-Hispanic White persons.⁶ Public transit has been limited during the pandemic and is another factor contributing to increased exposure to COVID-19. Many regions may not have access to public transportation, leaving Black and Latinx who are homebound or lack access to a car without access to COVID-19 testing and vaccines. If a Black or Latinx individual can reach a COVID-19 testing or vaccine site, additional obstacles may exist. For the Latinx community specifically, language barriers can inhibit patients from navigating a health clinic, as approximately one-third of the Latinx community nationwide are not proficient in English.⁷ Multilingual resources can be scarce in several regions of the United States, and Spanish-speaking health workers may not be present at many COVID-19 testing or vaccine sites.

Policy Recommendation

Based on these policy barriers, a mobile health clinic delivering COVID-19 tests and vaccines to minoritized communities that currently do not have access to these resources is a promising solution. A mobile health clinic is a form of care delivery focused on serving historically marginalized populations where health providers deliver services to rural communities. They often employ community health workers, building trust in Black and Latinx patients. Mobile health clinics address many obstacles to care delivery, most notably transportation and geographic barriers. Several states have used this approach in isolated incidences for not only COVID but also other health conditions.^8-9 To address current health inequities, mobile health clinics can employ multilingual community health workers who speak Spanish, addressing the concerns of many Latinx individuals. Mobile health clinics can also partner with local community organizations that engage with the Black and Latinx communities to build trust and confidence.

Overall, mobile health clinics have the potential to solve the geographic, transportation, and language barriers that contribute to health inequities. State governments should consider these recommendations to establish mobile health clinics in areas of most need. Had a coordinated mobile health clinic initiative existed before COVID, providers would have been able to reach rural areas with COVID-19 tests and vaccines, slowing the spread of the virus and addressing the many racial and ethnic disparities we see today. State governments need to incentivize health systems to invest in mobile health clinics and allocate funding to this initiative using equity-based alternative payment models. Stakeholders must work with community leaders to build this infrastructure and reach communities in need. Expanding bilingual and bicultural community health workers at mobile health clinics can alleviate fear and concerns that inhibit testing and vaccine access. Not only can these clinics provide COVID-19 testing and vaccines, but they can also offer preventative screening or treatment for other health conditions. With the proper support and coordination, mobile health clinics can solve many of the barriers associated with COVID-19 and ensure a more equitable healthcare system in the future.

References

¹CDC. (2021, July 16). Risk for Covid-19 infection, hospitalization, and death by race/ethnicity. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019- ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html.

²Owens, C., & Witherspoon, A. (2020, June 23). Minorities have less access to coronavirus testing. Axios. https://www.axios.com/minorities-coronavirus-testing-9a6397e4-a7e7- 4077-bad2-bbd77fe5d1c2.html.

³Ndugga, N., Hill, L., & Artiga, S. (2021, August 4). Latest data On COVID-19 Vaccinations by Race/Ethnicity. KFF. https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on- covid-19-vaccinations-race-ethnicity/.

⁴Rader, B., Astley, C. M., Sy, K. T. L., Sewalk, K., Hswen, Y., Brownstein, J. S., & Kraemer, M. U. G. (2020). Geographic access to United States SARS-CoV-2 testing sites highlights healthcare disparities and may bias transmission estimates. Journal of Travel Medicine, 27(7), taaa076. https://doi.org/10.1093/jtm/taaa076

⁵Ndugga, N., & Artiga, S. (2021, May 11). Disparities in Health and Health Care: 5 Key Questions and Answers | KFF. https://www.kff.org/news-summary/issue-brief-discusses-integration-of-wash-water-conservation-climate-resilience/

⁶Anderson, M. (2016, April 7). Who relies on public transit in the U.S. | Pew Research Center. https://www.pewresearch.org/fact-tank/2016/04/07/who-relies-on-public-transit-in-the-u-s/

⁷Krogstad, J. M., Stepler, R., Lopez, M. H. (2015, May 12). English Proficiency on the Rise Among Latinos | Pew Research Center. https://www.pewresearch.org/hispanic/2015/05/12/english-proficiency-on-the-rise- among-latinos/

⁸Yu, S. W. Y., Hill, C., Ricks, M. L., Bennet, J., & Oriol, N. E. (2017). The scope and impact of mobile health clinics in the United States: A literature review. International Journal for Equity in Health, 16(1), 178. https://doi.org/10.1186/s12939-017-0671-2

⁹Attipoe-Dorcoo, S., Delgado, R., Gupta, A., Bennet, J., Oriol, N. E., & Jain, S. H. (2020). Mobile health clinic model in the COVID-19 pandemic: Lessons learned and opportunities for policy changes and innovation. International Journal for Equity in Health, 19(1), 73. https://doi.org/10.1186/s12939-020-01175-7