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$6.5M grant to fund Pima County work to increase health care equity

Pima County will use a $6.5 million CDC grant to target and solve disparities in access to COVID-19 testing, and use data to increase health-care equity over the next two years.

The federal grant will allow the Pima County Health Department to increase staff and build on already well-developed data practices to enhance work already underway here, said Dr. Theresa Cullen, the director of the department.

The funding will support hiring about 20 employees in the Health Department, including public health nurses, data analysts, a translator, epidemiologists and community health workers, including some focused on trauma, Cullen said.

En español: Departamento de Salud usará subvención de $6.5 millones para crear equidad de salud en el condado

The coronavirus pandemic challenged local officials to more urgently make access to basic healthcare more equitable, but almost everything the county Health Department does already deals with differences in access, Cullen said.

“Almost all our work has been focused on health disparities whether we named it (with that term) or not,” she said. “The most important thing is that there’s this recognition that there are racial and economic inequities, not just due to COVID, but that we see in everything we do.”

There are differences in the health of different populations based on factors such as race, whether people live in urban or rural areas or whether they have insurance coverage, which are shown by the data in the Arizona Department of Health Services in annual population health and vital statistics reports, Cullen said.

“There’s the ability to look at data, because (our work) is really data-driven, based on race and ethnicity, urban/ rural, age grouping, insurance status, all these different things that help enable us to identify where we see what is an inequity or a disparity,” she said.

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In a December memo giving the background to a resolution in which the Pima County Board of Supervisors declared that racial and ethnic health inequities and income inequality are a public health crisis, County Administrator Chuck Huckleberry wrote “while the data fluctuates...Hispanics and Native Americans in Pima County are experiencing disproportionately higher rates of hospitalization, and Hispanics continue to have disproportionately higher rates of of COVID-19 than non-whites.”

Since Cullen started working as PCHD's director last June, she has seen local officials develop a more reliable system of directly reaching underserved parts of the county, building on efforts that were already underway, she said.

PCHD identifies disparities according to the social vulnerability index put out by the Centers for Disease Control, Cullen said. The index uses a quartile system to determine who is most exposed to health concerns by U.S. census tract. On average, each tract includes about 4,000 residents, according to the U.S. Census Bureau.

Census tracts that are in the fourth quartile or rated as the most vulnerable are where Pima County focuses resources, Cullen said. With COVID-19, however, Cullen said that the department has a new set of data to help determine where there are disparities.

By looking at where there were the most coronavirus cases, deaths and testing, among other numbers, Cullen said the county was able to identify disparities during the pandemic the way it does with the social vulnerability index. The experience using data that way has made county officials more prepared to focus their work and resources where external social factors most affect people’s health, she said.

“Because we’ve done so much work with data in the last year, we now have a much more robust data set that enables us to figure out where people are most at risk,” she said. “Obviously we know that factors that affect (who is most at risk) are poverty, education, racial inequity, housing inequity, lately we all know heat inequity, there’s climate inequity.”

The CDC grant, accepted by the Board of Supervisors at a June 22 meeting, will go towards improving disparities related to COVID testing, Cullen said, and one of its four major components is to increase and improve data collection and reporting related to coronavirus.

The other components of the grant are to expand and develop new prevention resources and services to reduce COVID-19-related disparities, to build and expand infrastructure for COVID-19 control in populations at a higher risk and to mobilize partners and collaborators to advance health equity and address the social determinants of disparities as they relate to COVID-19.

The way PCHD will use the grant, Cullen said, starts with taking the data they have and looking at it from a “comprehensive, longitudinal perspective” with an eye on trends before identifying data sets that will help them design a “data informatics system,” or a scientific way of collecting, storing and navigating their data to find disparities and address them directly.

Cullen said they have an informatics system right now for addressing COVID-19 related disparities, but they don’t use it for the larger picture of public health to create a public health informatics system, which they plan to do with this funding.

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Part of the grant also includes improved access to testing in populations that are at a high risk but underserved for testing, and Cullen said PCHD plans to use mobile and at-home testing options, such as sending self-administered testing kits to people who have been in contacts with those who are reported positive cases for the virus.

Cullen said she hopes this will create testing equity in the urban and rural areas, though in rural areas there will be more of a logistical challenge to delivering and returning those kits. She also said that PCHD will do this with “culturally appropriate communications” along the way.

The county will expand prevention efforts through community health workers and public health nurses who will work in high-risk areas and with community-based organizations to provide more information about prevention and control of COVID-19, which will include repeating old safety tips such as washing hands and maintaining six-foot distances.

Health officials have worked with a community advisory committee to help craft a plan to better communicate COVID-19 prevention information with underserved parts of the community. Some of the federal grant will be used to fund smaller, individual operations by community partners.

In 2018, the county received a one-year $762,865 CDC grant to reduce health disparities affecting the county as part of a federal Racial and Ethnic Approaches to Community Health program. The new grant will build on the work that was supported by the previous funding, Cullen said, and will be augmented by another grant to improve access to vaccinations that is still awaiting county approval.

Bennito L. Kelty is TucsonSentinel.com’s IDEA reporter, focusing on Inclusion, Diversity, Equity and Access stories, and a Report for America corps member.

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Cullen during a Dec. 4, 2020, meeting.

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