North Carolina Cabarrus Health Alliance: Addressing Health Equity Infrastructure

Recipients of the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities grant are telling their success stories of how they are addressing COVID-19-related health disparities and advancing health equity through programs and activities funded by the grant.

Challenge

The year 2020 will be remembered as a year that forever changed how we live. Our nation witnessed the start of a global pandemic, which has so far claimed more than 1.1 million lives in the United States, along with a rise in political turmoil and social unrest in the wake of the George Floyd killing—a potent reminder of the disproportionate burden African Americans bear in terms of criminal justice outcomes and health equity. During this tenuous time, many US health departments, like those in North Carolina, did not have the organizational capacity to address health equity.

Funding from the Centers for Disease Control and Prevention’s National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities grant was disseminated across more than 60 local and county health departments in North Carolina to address health equity infrastructure, specifically policy, environmental, and systems change. As part of this effort, North Carolina’s Cabarrus Health Alliance (CHA), formerly the Cabarrus County Health Department, applied a new health equity framework to implement their Advancing Equity program, which helped agencies expand organizational capacities and services to mitigate COVID-19’s impact on disproportionately affected populations.

Solution

On September 24, 2020, CHA joined what would soon become more than 260 organizations nationwide in declaring racism a public health crisis. At the height of the nation’s pandemic and social outcry, CHA leaders and governing body members conducted community listening strategy sessions that would soon reshape the entire organization’s future, prompting its leaders to take a solid stand on addressing racism to advance health equity.

As a result, CHA established a new organizational framework consisting of four sustainability pillars: data, training, community engagement, and policy. Within these pillars, CHA developed a long-term strategic plan for the first time to advance health and racial equity by moving toward a diverse public health workforce, encouraging innovation in public health service delivery, using effective assessment tools to identify opportunities for organizational growth, and promoting equitable policies that enable successful health outcomes for all.

CHA also created and filled an equity coordinator position. The equity coordinator led all activities related to health and racial equity goals, including establishing an Equity Pulse Team to oversee internal equity efforts, and an external Equity Advisory Council (EAC) to collaborate on community-based strategy implementation projects and effective community engagement measures.

Additionally, proceeds from the cross-sectoral summit on equity-based practices were donated to a community equity fund, and those funds were reinvested in equity-related projects based on input from the council.

Outcome

The Equity Pulse Team, composed of supervisors and executive and departmental leaders, helped spark a new wave of CHA interdepartmental, cross-functional collaborations and innovative approaches toward health equity.

The council’s monthly meetings proved impactful, providing members with opportunities to learn more about local social determinants of health while contributing to CHA’s overall strategic planning process. Understanding the need for broad-based community buy-in, CHA engaged a local City Council member to serve on its council so community members could directly communicate with municipal leaders and foster accountability.

EAC efforts also led to promising growth in linkages to care services. In collaboration with CHA’s Community Health Workers, CHA was able to identify and offer services to local groups with extensive histories of inadequate access to healthcare services and expand local health department community-based prevention and care services programs that address needs related to dental hygiene, healthy living, vaccinations, and metabolic and sexual health-related blood screens.

Since the formation of the EAC, CHA has spawned a Recovery & Resiliency Coalition, formed a Patient & Family Advisory Council, and secured funding for a new mobile unit, with services that will range from immunizations to blood pressure and cholesterol screenings and community health worker services.