Illinois Unidos: A Community Demands Equity, Justice, and Inclusion

Abstract

At the onset of the COVID-19 pandemic, neither government officials nor members of the news media fully grasped what was happening in the Latino community. Underreporting of COVID-19 cases led to a systematic neglect of the Latino population and resulted in disproportionately high rates of infection, hospitalization, and death. Illinois Unidos was formed to engage in community mobilization, health communication, advocacy, and policy work in response to inequalities exacerbated by COVID-19 in Latino communities in Illinois. (Am J Public Health. 2021;111(S3):S204–S207. https://doi.org/10.2105/AJPH.2021.306407)

COVID-19 data trends during April 2020, Illinois’s first pandemic peak, demonstrated that the virus spread among Latinos faster than among any other racial/ethnic group. Yet, COVID-19’s impact on Latinos was not emphasized by the media, public health experts, or government officials. Changing the COVID-19 narrative was necessary to ensure equitable responses and resource allocations.

INTERVENTION

To confront this pressing situation in Illinois, we formed a cross-sector partnership: Illinois Unidos. The partnership’s main objectives were addressing health, social, and economic impact; reducing transmission; and preventing morbidity and mortality from COVID-19 in Illinois’s Latino communities.

PLACE AND TIME

Illinois Unidos first convened on April 11, 2020, via Web conference to enable rapid response strategic planning to evolving COVID-19 data trends. Members initially met for 12 consecutive Saturdays and in June 2020 organized into working committees on education, workplace safety, health literacy, health policy, and community health workers. This transferred the bulk of Illinois Unidos’s activities to biweekly committee meetings staggered between general membership meetings (Figure A [available as a supplement to the online version of this article at http://www.ajph.org]).

PERSON

Illinois Unidos’s education, advocacy, and policy analysis work was and continues to be focused on Illinois’s Latino communities.

PURPOSE

According to the Centers for Disease Control and Prevention, Latinos in the United States have higher age-adjusted hospitalization and mortality rates from COVID-19 than do non-Hispanic White, Asian, and Black people.¹ Consistent with national trends, Illinois’s Latinos have been disproportionately affected by COVID-19. In March 2021, Latinos, who comprise 18% of Illinois’s population, accounted for more than 25% of infections.² Ten of the top 15 zip codes with the highest rates of COVID-19 cases and deaths have a Latino majority population.³ Latinos account for 30% of Chicago’s population and, on April 6, 2021, represented 43% of COVID-19 cases. Age-adjusted mortality rates of Latinos in Chicago are 4 times the rates of non-Hispanic Whites and twice the rates of Blacks and Asians.⁴

Underlying complex causes of the disproportionate burden of COVID-19 among Latinos are explained by the overarching presence of structural racism and xenophobic policies; these predate the onset of the pandemic. Latinos in the United States are too often defined by conditions that place them at increased risk for contracting COVID-19.⁵ Proximate risk factors include occupational exposure because of working in crowded, high-risk, low-wage essential jobs and residing in multigenerational overcrowded living spaces. Many Latinos work in occupations with no or limited paid sick leave, thereby increasing the opportunity for further transmission of COVID-19. Latinos experience poor access to health because of financial (e.g., low rates of health insurance coverage), linguistic, and cultural barriers in accessing the health care system as well as uncertain citizenship status.⁶ Latinos also have high, and often undiagnosed, rates of chronic diseases (e.g., diabetes, hypertension, obesity).⁶ These conditions greatly exacerbate the impact of COVID-19 on Latinos. However, the devastation this pandemic has inflicted on Latinos is still not at the epicenter of the dominant COVID-19 narrative.

IMPLEMENTATION

The current public health framework, Public Health 3.0 (PH 3.0) assumes that “public health experts” with knowledge in public health policy know how to eradicate socioeconomic burdens and advocate for all communities, especially communities where people of color reside.⁷ We saw this play out at the onset of the COVID-19 pandemic, when government leaned on scientific experts with academic standing and political connections to design and implement solutions for marginalized communities. Yet, structural change requires leaders who understand daily challenges and are willing to engage the community in mobilization and action to change practices and policies that have kept Latinos oppressed. PH 3.0 has failed those most vulnerable and therefore needs to be redesigned. The founding members of Illinois Unidos recognized the importance of bringing together representatives from multiple sectors to analyze, prioritize, and recommend policies and actions. Illinois Unidos’s membership exemplifies the array of community partners who must be included in successful expansion of public health interventions: frontline health care providers, researchers, community leaders, labor organizers, promotoras de salud, and grassroots workers, as well as government officials (Figure A).

The development of Illinois Unidos as a network stands as a vivid example of how to improve public health by improving some of the elements of PH 3.0. Illinois Unidos exposed the limitations of COVID-19–related data on race and ethnicity and the inadequacy of existing metrics used to assess equity. The coalition advocated easily accessible data that reflect the COVID-19 reality in the Latino community. The partnership persuaded officials in both the public and private sectors to reconsider resource allocation based on infection, hospitalization, death rates, and social determinants of health.

The COVID-19 pandemic also reinforced the need for hyperlocal partnerships. When it became clear that the existing strategy for public health messaging was failing Latinos, community leaders joined local and state governments to develop and implement a COVID-19 health communication campaign. Promotoras de salud, labor organizers, and community-based organizations partnered with health care providers to create culturally and linguistically appropriate educational materials for community stakeholders, human service organizations, and public health departments to distribute.

Illinois Unidos’s communications team includes media consultants and Latino-owned public relations agency leaders. This team facilitates frequent press releases with policy recommendations that are distributed in ethnic and mainstream media venues, including social media platforms. The communications team has ensured that Illinois Unidos’s messages are regularly infused into the general public dialogue and aimed at key decision makers.

EVALUATION

Box 1 provides some examples of Illinois Unidos’s successes in the areas of data collection, policy, funding, and representation. Illinois Unidos has lifted the voices of Latinos by ensuring the application of equity as a metric for the evaluation of resource distribution; pushed to increase representation of additional Latino leaders in decision-making bodies in the private, philanthropy, and public sectors; secured economic investments for Latinos across Illinois; and ensured that linguistically and culturally appropriate health-related engagement and education occurs throughout the myriad of Latino populations.

BOX 1.

Examples of Illinois Unidos's Successes

Data	Policy	Funding	Enhanced Representation
Advocated improved public health data reporting by state, county, and municipal health departments on COVID-19 testing and positivity, hospitalizations, and mortality by race, ethnicity, and zip code. Partnered with the Chicago Department of Public Health to ensure that public data portals report comparative COVID-19 data through the normalization of populations. Provided leadership to the Data Committee of the Illinois Department of Public Health Equity Task Force and drafted policies for data improvement on COVID-19 and the social determinants of health.	Fostered relationships between health departments and community service organizations, resulting in the expansion of testing and vaccine sites accessible to Latinos. Public health officials partnered with Illinois Unidos to identify vaccine ambassadors to message the Latino community in general and specifically hard-to-reach populations, such as the undocumented. Federal, state, and local elected officials regularly attended Illinois Unidos strategic biweekly planning meetings and actively partner with an array of experts from Illinois Unidos to infuse the policy process with accurate data related to COVID-19 in Latinos.	Sustained efforts alongside supportive members of the Illinois state government led to the allocation of funds aimed at supporting undocumented immigrants and mixed status families who were excluded from federal stimulus dollars. Worked with state legislators to pass health insurance coverage of elderly undocumented persons. Garnered philanthropic financial support for member organizations to develop and implement the following:  1. Hyperlocal interventions to reduce transmission of COVID-19 in Latino neighborhoods.  2. A culturally appropriate and linguistically accessible COVID-19 literacy campaign.	Established partnerships and decision-making roles in other advocacy groups as well as philanthropic and government agencies, such as the Illinois Department of Public Health COVID-19 Health Equity Task Force, the City of Chicago Racial Equity Rapid Response Team, and the Chicagoland Vaccine Corps Partnership The lead team established monthly meetings with representatives from Chicago’s mayor’s office focused on reviewing and improving COVID-19 policies and programs and ensuring that the needs of the Latino community are addressed. Spanish- and English-language local, national, and international media outlets turn to Illinois Unidos membership for messaging and expert analysis and opinion related to COVID-19 data trends and policy proposals.

Note. This box is not a comprehensive catalog of the successes or impact of Illinois Unidos. For more details and links to programmatic and policy interventions, please contact the corresponding author.

LIMITATIONS

The partnership was initially formed to address the needs of all of Illinois’s Latinos, but most members reside in Chicago and Cook County suburbs, thus limiting direct interaction with rural Illinois and the collar counties (DuPage, Kane, Lake, McHenry, and Will counties). In addition, Latino representation in positions of power in government and policymaking remains disproportionately low compared with representation in the Illinois population. Nonetheless, the work of Illinois Unidos has positively affected Latinos all over the state, including agricultural and farmworkers.

SUSTAINABILITY

Leadership development is a dynamic and organic process; members match their priorities, strengths, and special interests to the development and implementation of specific actions and policies. New leadership roles have emerged as Illinois COVID-19 trends have evolved, and the coalition focuses on the future financial, occupational, and educational consequences of the pandemic. Different levels of government have valued our expertise and are constantly reaching out to members for consultation. Because of the public success of the partnership’s activities, private foundations donated a considerable amount of funding to sustain short- and long-term programs and to establish a solid infrastructure (i.e., communication systems, policy, data analyst and staff support). This funding allowed us to distribute mini grants to grassroots community groups to mobilize communities around COVID-19 vaccination and other health equity initiatives.

PUBLIC HEALTH SIGNIFICANCE

Illinois Unidos, a coalition formed as a result of the public health failure to fully address the realities of COVID-19 among Latinos, presents a model for a new public health framework: Public Health 3.x (PH 3.x). Lessons learned from the work of Illinois Unidos serve as a vivid reminder that the health of all requires that public health decisions, resource allocations, programs, and interventions be founded within an equity framework that includes all. PH 3.x should incorporate the Illinois Unidos partnership model to ensure more just policies, resource allocations, and services to marginalized communities (Figure 1). The work of Illinois Unidos unequivocally points to a requirement that accreditation standards that derive from an upgrade from PH 3.0 to PH 3.x reflect a commitment to inclusion, realignment of equity metrics, and expanded definition of public health experts to include trusted community members and organizers. The Illinois Unidos model for PH 3.x applies a social justice lens to all endeavors and ensures that social justice experts and metrics are fully and explicitly at the center of this reconfigured model of public health. As the focus moves from mitigation (i.e., testing, contact tracing) to prevention (i.e., vaccination), the infrastructure set up by Illinois Unidos and the new PH 3.x is ready to take on new challenges and promote equity.

FIGURE 1—

Proposed Upgrade of Public Health Framework 3.x: Realign the Social Justice Lens

Note. IOM = Institute of Medicine. The new Public Health 3.x emphasizes a commitment to inclusion, a realignment of equity metrics, and an expanded definition of public health experts.