2022 was a difficult year for the US public health system.
was plagued by public distrustcompeted with raging misinformationand treated institutional dysfunction, legal challengesY financial insecurity. But amid the chaos, a handful of public health victories gave me hope.
In particular, these victories reinforced the importance of an underappreciated and often underfunded public health strategy: the use of grassroots, community campaigns to save lives and improve health.
These mostly local campaigns quelled an outbreak of a fast-traveling disease through sexual networks, extended covid-19 vaccines to those neglected by the status quo, and overcame stigma and provider shortages to ease the impacts of mental illness, substance use and overdose.
What they had in common: a “for us, by us” approach to public health, in which people working with community-led groups provided health outreach services to members of their own often-marginalized communities.
These successes are worth championing, especially as rampant dysfunction in America’s health care creates a widening chasm between the haves and the have-nots.
Mpox found quick action in the LBGTQ community
In May, the rapidly accumulating cases of a little-known virus, mpox (previously called monkeypox), began to set off alarm bells. While rarely fatal, the virus was spreading rapidly between people and in places that had never seen large, sustained outbreaks before.
Since the early days of the outbreak, the vast majority of cases were among gay men and their sexual networksand the most effective responses to the outbreak came from these communities.
In the US, government-run public health institutions were slow to communicate clearly on specific sexual risk, acquire an adequate supply of vaccinesY expedite access to treatment. Meanwhile, gay men’s health organizations conducted immensely successful mpox education, vaccination, and prevention efforts.
Most community based queer Health the organizations that partnered with health departments on vaccine rollouts were led by members of the LGBTQ community. Gay men and the organizations they lead led effective public education and advocacy efforts that helped increase US supply of Jynneos mpox vaccine, expedite access to mpox treatmentY provide guidance to men on how to play safely. dating apps, bath house ownersY party promoters got on board.
And the mpox curve finally flattened: As of December 14, only five cases dailyon average, they were reported across the US, down from a peak of 460 on August 1.
The mpox response has been far from perfect, and not all communities benefited equally from vaccination and treatment efforts: although people of color accounted for 70 percent of the cases, received less than half the share of the vaccines. Y thousands of mpox diagnoses in women and non-binary people they have probably been overlooked in the course of the outbreak. (The Centers for Disease Control and Prevention is funding the efforts of community organizations to overcome these disparities.)
Despite these issues, it is worth acknowledging that without swift action from organizations rooted in the gay community in the early days of the crisis, the shape of the mpox outbreak would likely look very different than it is.
Community-led covid-19 vaccination campaigns reached underserved communities
Almost three years after the Covid-19 pandemic, 31 percent of Americans have not yet completed their primary series of vaccinations. Overrepresented in this group: communities of color. Here, community-led efforts have also moved the needle.
Early in the pandemic, African Americans bore the highest burden of severe disease from Covid-19, but also had the lowest vaccine uptake rates. More recently, a massive wave of disclosure Led by black medical professionals in coordination with community leaders, including religious leaders and respected local influencers, it has produced some major success stories.
In Philadelphia, the Consortium of Black Covid-19 Physicians extension of vaccination helped bridge the immunization gap between black and white city residents 18 to 7 percentage points. Testing and vaccinating black Philadelphians was just the beginning for the organization: It recently opened a primary care clinic to provide a full suite of medical services to the community you have fought for since the start of the pandemic.
The city of Clarkston, Georgia, achieved some of the highest vaccination rates in its region by employing vaccine outreach workers from refugee communities, which make up 40 percent of the city’s population by some Dear. As of July, 70 percent of residents were fully vaccinated. That’s a substantially higher rate than in surrounding DeKalb County, where 62 percent of residents were fully vaccinated. Other community run programs have helped improve vaccination rates among Marshallese, Vietnamese, and Hispanic communities elsewhere in the US.
Community-led public health works because it is delivered by workers people trust
Community public health is not just for infectious diseases.
Other community-led programs aimed at slowing down drug overdose, reduce substance use in pregnancyand improve mental health Come in farmers Y Black mens they have recently been shown to work. For all of them, the secret ingredient is a cadre of health workers drawn from the community they serve.
When community-led public health programs are successful, it is often because they deploy trusted messengers.
If you are not someone who trusts health experts or providers, think about the person you trust the most to give you health information. Now imagine if they had the support and tools to work full-time as a health resource for you, for example, to answer questions about your health risks or to screen for certain conditions. That’s powerful, right?
The approach recognizes that everyone trusts the same people, so a scientist who cites a bunch of studies will not be equally convincing to all audiences. That’s especially important when it comes to reaching people in marginalized groups, who often have less trust in experts than in religious leaders, teachers, or other influential people in their communities. If you can’t be sure your trusted courier is behind a vaccine, you’re much less likely to stand in line for it.
Grassroots approaches created by and for people within marginalized groups, including peer support networks Y community health worker programs—are often particularly effective in changing opinions and actions. But they are less common in the United States than in the rest of the world. If we pay more attention to the capital gains that these strategies can generate, that could change.
There is some good news on this front: more support for these programs is on the way.
This year, the Biden administration announced that it would commit $226 million in pandemic funds toward developing community health worker programs that train people with no medical background to provide health services to underserved members of their communities.
No one knows what new public health challenges the next few years will bring. But to have any hope of addressing them with effective and equitable responses, we must let communities lead.