Successful Community Involvement During the COVID-19 Pandemic: A Student Perspective

“We, as people concerned about health improvement in the world, do hereby commit ourselves to advocacy and action to promote the health rights of all human beings.” These words, the beginning of the International Declaration of Health Rights, ushered in our journey as public health graduate students matriculating during a raging pandemic. Inundated with cutting-edge scientific research, mis- and disinformation, and both the privilege and responsibility of being future epidemiologists, we have identified community connection as an integral and often underappreciated piece of public health that can meaningfully reduce inequities.

EXISTING INEQUITIES EXACERBATED BY COVID-19

The COVID-19 pandemic framed a pivotal point in the perception of public health; many health inequities previously unknown to the general public were laid bare and in the news daily. From the widespread hysteria we experienced to the hoarding of essentials and the inequitable use of preventive interventions such as masking and stay-at-home orders, the COVID-19 pandemic highlighted the existing social and structural issues that keep health care inaccessible by the most vulnerable. These factors aggravated the disproportionate disease burden experienced by marginalized communities, perhaps most evident in the lack of community-level testing and vaccination centers catering to underserved neighborhoods, affecting frontline and service workers who could not spare the time to be tested or vaccinated.

The pandemic also compounded health and educational inequities because of differential access to remote health^1–3 and learning services. Many families did not have access to the technology, Internet connectivity, or physical spaces required to participate in new and virtual learning environments.^4,5 Our experience as graduate students at least partially mirrored these experiences as we struggled to participate in and learn from our own physical and remote communities at the whim of unreliable Internet connections and under the necessity of caring for friends and family. Our role as epidemiology students has also put us in a unique position to address COVID-19–related misinformation that grows in and close to our social circles, arising because of differential access to and comprehension of health information used to make personal and policy decisions.

SUCCESSFUL COMMUNITY-LEVEL INTERVENTIONS

Despite the seemingly endless inequity-exacerbating consequences of the pandemic, particular local and global examples of community-based public health and policy-level interventions instill hope in us that investments in communities and public health do in fact work to promote health and prevent disease.

At the beginning of the pandemic in the United States, the federal pursuit of decarceration, the implementation of stay-at-home orders, and the imposition of eviction moratoriums highlighted the importance of more than just epidemiology in mitigating a pandemic’s disastrous effects.

Community-level partnerships were just as, if not more, important in protecting the public from COVID-19. We have witnessed this firsthand in our own communities. In Arizona, residents were eager to support community relief funds to assist essential in-person workers, an enthusiasm that was later reflected in an extraordinary volume of vaccination volunteer sign ups in early 2021. The ongoing work of community health workers (CHWs) or promotores is credited for much of the successful vaccination uptake in low-income and socioeconomically disadvantaged areas in the state. The Navajo Nation, which made a noteworthy return from having one of the country’s highest case rates to vaccinating more than 80% of its population in just a few months, has relied strongly on the work of community leaders and CHWs to address the diverse needs of its communities.⁶ The self-determination and bidirectional support mechanisms of the Navajo Nation’s CHW response network have helped bridge gaps left by chronic underfunding and resulting health inequities present both before and during the pandemic; providing clinical care, connecting individuals to health resources, and promoting health education are just a handful of such examples.⁷

In Alberta, Canada, there was an increase in services provided to community members to address pandemic-related food insecurity. Local charities and religious and community associations rallied volunteers and donations to offer free food delivery and hampers to area residents quarantining or providing essential services, an effort generously supported by the rest of the community. Workplace and mobile vaccination clinics demonstrated tremendous success in communities in Alberta, predominated by the service sector and other essential providers.^8,9 The promulgation of low-barrier and flexible services made these regions some of the highest vaccinated in the province. At least part of the cause of lower vaccine uptake in rural communities was attributed to lack of access,¹⁰ which, when addressed in these regions, helped reduce interregional variation in vaccination uptake rates. The provision of services tailored to the needs of this community, including linguistic and cultural accessibility, helped improve the uptake rates of these necessary public health interventions.

The most notable and successful responses to the COVID-19 pandemic share this common thread of a community-centered focus. Globally, the strict preventive measures taken by residents of and governments in Taiwan, Singapore, Australia, and New Zealand also shone as beacons of hope, persistence, and solidarity against a reality of mass death all too familiar. Even in our now-local Baltimore, public health communications, mobile health clinics, and pop-up vaccination sites—where music blasts and children play—at their core build on existing community ties to promote public health.

PROPOSED SOLUTIONS

In our training as epidemiologists, we have found that this valuable connection within and between individuals and groups is often relegated to the sidelines of our formal education. Our coursework, as it should, emphasizes quantitative analysis, causal inference, and a rigorous understanding of advanced methods to analyze and interpret public health data. Ever inspired by the people who compose the public of public health, however, we see the primary means of promoting equity as being through a deepened and genuine connection with our communities.

From an academic standpoint, community connection can be fostered through more required community-based coursework/practica for all public health students, developing a dedicated degree or concentration program for social epidemiology, or pursuing funding for more community-based research at the institution level. Public health students are a diverse and fluid body whose interests range from academia to government to industry and beyond. We must leverage this range to provide students with the training that applies classroom-based skills to real-life scenarios. As students, we see the pursuit of such opportunities as a key means to promote health equity and to become community liaisons working hand in hand with individuals and groups to address new and long-standing health inequities.

The adaptability of public health since and even before the start of the COVID-19 pandemic has been simultaneously taxing and admirable. We challenge the field to adapt once more, to truly and justly prioritize community, whether in data collection, policy development, coursework design, health communication, or intervention. Doing so provides deeper insight into the context behind the numbers many are eager to analyze and report and is supported by the hard-won public health achievements of the current pandemic. For sustained success during the inevitable health crises of the future, it is imperative that we not only maintain but also strengthen these relationships.

To truly “commit ourselves to advocacy and action to promote the health rights of all human beings,” we must feel compelled to include them and their essential perspectives in this ever-important work.