With Roots in Civil Rights, Community Health Centers Push for Equity in the Pandemic

In the 1960s, health care across the Mississippi Delta was sparse and much of it was segregated. Some hospitals were dedicated to Black patients, but they often struggled to stay afloat. At the height of the civil rights movement, young Black doctors launched a movement of their own to address the care disparity.

“Mississippi was third-world and was so bad and so separated,” said Dr. Robert Smith. “The community health center movement was the conduit for physicians all over this country who believed that all people have a right to health care.”

In 1967, Smith helped start Delta Health Center, the country’s first rural community health center. They put the clinic in Mound Bayou, a small town in the heart of the Delta, in northwestern Mississippi. The center became a national model and is now one of nearly 1,400 such clinics across the country. These clinics, called federally qualified health centers, are a key resource in Mississippi, Louisiana and Alabama, where about 2 in 5 people live in rural areas. Throughout the U.S., about 1 in 5 people live in rural areas.

The covid-19 pandemic has only exacerbated the challenges facing rural health care, such as lack of broadband internet access and limited public transportation. For much of the vaccine rollout, those barriers have made it difficult for providers, like community health centers, to get shots into the arms of their patients.

“I just assumed that [the vaccine] would flow like water, but we really had to pry open the door to get access to it,” said Smith, who still practices family medicine in Mississippi.

Mound Bayou was founded by formerly enslaved people, many of whom became farmers.

The once-thriving downtown was home to some of the first Black-owned businesses in the state. Today the town is dotted with shuttered or rundown banks, hotels and gas stations.

Mitch Williams grew up on a Mound Bayou farm in the 1930s and ’40s and spent long days working the soil.

“If you would cut yourself, they wouldn’t put no sutures in, no stitches in it. You wrapped it up and kept going,” Williams said.

When Delta Health Center started operations in 1967, it was explicitly for all residents of all races — and free to those who needed financial help.

Williams, 85, was one of its first patients.

“They were seeing patients in the local churches. They had mobile units. I had never seen that kind of comprehensive care,” he said.

Residents really needed it. In the 1960s, many people in Mound Bayou and the surrounding area didn’t have clean drinking water or indoor plumbing.

At the time, the 12,000 Black residents of northern Bolivar County, which includes Mound Bayou, faced unemployment rates as high as 75% and lived on a median annual income of just $900 (around $7,500 in today’s dollars), according to a congressional report. The infant mortality rate was close to 60 for every 1,000 live births — four times the rate for affluent Americans.

Delta Health Center employees helped people insulate their homes. They built outhouses and provided food and sometimes even traveled to patients’ homes to offer care, if someone didn’t have transportation. Staffers believed these factors affected health outcomes, too.

Williams, who later worked for Delta Health, said he’s not sure where the community would be today if the center didn’t exist.

“It’s frightening to think of it,” he said.

Half a century later, the Delta Health Center continues to provide accessible and affordable care in and around Mound Bayou.

Black Southerners still face barriers to health. In April 2020, early in the pandemic, Black residents accounted for nearly half of covid deaths in Alabama and over 70% in Louisiana and Mississippi.

Public health data from last month shows that Black residents of those states have consistently been more likely to die of covid than residents of other races.

“We have a lot of chronic health conditions here, particularly concentrated in the Mississippi Delta, that lead to higher rates of complications and death with covid,” said Nadia Bethley, a clinical psychologist at the center. “It’s been tough.”

Delta Health Center has grown over the decades, from a few trailers in Mound Bayou to a chain of 18 clinics across five counties. It’s managed to vaccinate over 5,500 people against covid. The majority have been Black.

“We don’t have the National Guard, you know, lining up out here, running our site. It’s the people who work here,” Bethley said.

The Mississippi State Department of Health said it has prioritized health centers since the beginning of the rollout. But Delta Health CEO John Fairman said the center was receiving only a couple of hundred doses a week in January and February. The supply became more consistent around early March, center officials said.

“Many states would be much further ahead had they utilized community health centers from the very beginning,” Fairman said. Fairman said his center saw success with vaccinations because of its long-standing relationships with the local communities.

“Use the infrastructure that’s already in place, that has community trust,” said Fairman.

That was the entire point of the health center movement in the first place, said Smith. He said states that were slow to use health centers in the vaccine rollout made a mistake that has made it difficult to get a handle on covid in the most vulnerable communities.

Smith called the slow dispersal of vaccines to rural health centers “an example of systemic racism that continues.”

A spokesperson for Mississippi’s health department said it is “committed to providing vaccines to rural areas but, given the rurality of Mississippi, it is a real challenge.”

Alan Morgan, CEO of the National Rural Health Association, said the low dose allocation to rural health clinics and community health centers early on is “going to cost lives.”

“With hospitalizations and mortality much higher in rural communities, these states need to focus on the hot spots, which in many cases are these small towns,” Morgan said of the vaccine efforts in Mississippi, Louisiana and Alabama.

A report from KFF found that people of color made up the majority of people vaccinated at community health centers and that the centers seem to be vaccinating people at rates similar to or higher than their share of the population. (The KHN newsroom, which collaborated to produce this story, is an editorially independent program of KFF.)

The report added that “ramping up health centers’ involvement in vaccination efforts at the federal, state and local levels” could be a meaningful step in “advancing equity on a larger scale.”

Equal access to care in rural communities is necessary to reach the most vulnerable populations and is just as critical during this global health crisis as it was in the 1960s, according to Smith.

“When health care improves for Blacks, it will improve for all Americans,” Smith said.

This story is from a partnership that includes NPR, KHN and the three stations that make up the Gulf States Newsroom: Mississippi Public Broadcasting; WBHM in Birmingham, Alabama; and WWNO in New Orleans.

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Black community has new option for health care: The church

Black community has new option for health care: The church

In this May 9, 2021, photo, Rev. Joseph Jackson Jr. talks to his congregation at Friendship Missionary Baptist Church in Milwaukee during a service. He is president of the board of directors for Milwaukee Inner City Congregations Allied for Hope, which along with Pastors United, Souls to the Polls and the local health clinic Health Connections, is working to get vaccination clinics into churches to help vaccinate the Black community. He’s also been urging his congregation during Sunday services to get vaccinated. (AP Photo/Carrie Antlfinger)

MILWAUKEE (AP) — Every Sunday at Friendship Missionary Baptist Church, the Rev. Joseph Jackson Jr. praises the Lord before his congregation. But since last fall he’s been praising something else his Black community needs: the COVID-19 vaccine.

“We want to continue to encourage our people to get out, get your shots. I got both of mine,” Jackson said to applause at the church in Milwaukee on a recent Sunday.

Members of Black communities across the U.S. have disproportionately fallen sick or died from the virus, so some church leaders are using their influence and trusted reputations to fight back by preaching from the pulpit, phoning people to encourage vaccinations, and hosting testing clinics and vaccination events in church buildings.

Some want to extend their efforts beyond the fight against COVID-19 and give their flocks a place to seek health care for other ailments at a place they trust — the church.

In this May 9, 2021, photo, Rev. Joseph Jackson Jr. talks to his congregation at Friendship Missionary Baptist Church in Milwaukee during a service. He is president of the board of directors for Milwaukee Inner City Congregations Allied for Hope, which along with Pastors United, Souls to the Polls and the local health clinic Health Connections is working to get vaccination clinics into churches to help vaccinate the Black community. He’s also been urging his congregation during Sunday services to get vaccinated. (AP Photo/Carrie Antlfinger)

“We can’t go back to normal because we died in our normal,” Debra Fraser-Howze, the founder of Choose Healthy Life, told The Associated Press. “We have health disparities that were so serious that one pandemic virtually wiped us out more than anybody else. We can’t allow for that to happen again.”

Choose Healthy Life, a national initiative involving Black clergy, United Way of New York City and others, has been awarded a $9.9 million U.S. Department of Health and Human Services grant to expand vaccinations and and make permanent the “health navigators” who are already doing coronavirus testing and vaccinations in churches.

The navigators will eventually bring in experts for vaccinations, such as the flu, and to screen for ailments that are common in Black communities, including heart disease, hypertension, diabetes, AIDS and asthma. The effort aims to reduce discomfort within Black communities about seeking health care, either due to concerns about racism or a historical distrust of science and government.

The initiative has so far been responsible for over 30,000 vaccinations in the first three months in 50 churches in New York; Newark, New Jersey; Detroit; Washington, D.C.; and Atlanta.

The federal funding will expand the group’s effort to 100 churches, including in rural areas, in 13 states and the District of Columbia, and will help establish an infrastructure for the health navigators to start screenings. Quest Diagnostics and its foundation has already provided funding and testing help.

Choose Healthy Life expects to be involved for at least five years, after which organizers hope control and funding will be handled locally, possibly by health departments or in alignment with federally supported health centers, Fraser-Howze said.

The initiative is also planning to host seminars in churches on common health issues. Some churches already have health clinics and they hope that encourages other churches to follow suit, said Fraser-Howze, who led the National Black Leadership Commission on AIDS for 21 years.

FILE – In this file photo taken June 6, 2021, first lady Jill Biden, center left, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, Choose Healthy Life public health navigator Linda Thompson and Choose Healthy Life Founder Debra Fraser-Howze, far right, speak to a person as they visit a vaccine clinic at the Abyssinian Baptist Church in the Harlem neighborhood of New York. The church is part of Choose Healthy Life, a national initiative involving Black clergy, United Way of New York City and others, that has just been awarded a $9.9 million U.S. Department of Health and Human Services grant to expand vaccinations and provide screening and other health services in churches. (AP Photo/Craig Ruttle, File)

“The Black church is going to have to be that link between faith and science,” she said.

In Milwaukee, nearly 43% of all coronavirus-related deaths have been in the Black community, according to the Milwaukee Health Department. Census data indicates Blacks make up about 39% of the city’s population. An initiative involving Pastors United, Milwaukee Inner City Congregations Allied for Hope and Souls to the Polls has provided vaccinations in at least 80 churches there already.

Milwaukee is one of the most segregated cities in the country, according to the studies by the Brookings Institution. Ericka Sinclair, CEO of Health Connections, Inc., which administers vaccinations, says that’s why putting vaccination centers in churches and other trusted locations is so important.

“Access to services is not the same for everyone. It’s just not. And it is just another reason why when we talk about health equity, we have … to do a course correction,” she said.

She’s also working to get more community health workers funded through insurance companies, including Medicaid.

The church vaccination effort involved Milwaukee Inner City Congregations Allied for Hope, which is faith organization working on social issues. Executive Director and Lead Organizer Lisa Jones says the effect of COVID-19 on the Black community has reinforced the need to address race-related disparities in health care. The group has hired another organizer to address disparities in hospital services in the inner city and housing, and lead contamination.

At a recent vaccination clinic in Milwaukee at St. Matthew, a Christian Methodist Episcopal church, Melanie Paige overcame her fears to get vaccinated. Paige, who has lupus and rheumatoid arthritis, said the church clinic helped motivate her, along with encouragement from her son.

“I was more comfortable because I belong to the church and I know I’ve been here all my life. So that made it easier.”

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Associated Press religion coverage receives support from the Lilly Endowment through The Conversation U.S. The AP is solely responsible for this content.