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Community Health Advocate Training

Dr. Elsie Smalls and Nichele Hoskins

Healthy Savannah

Tiffany Young

Think Equity, LLC

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Funder Acknowledgment :

This program is supported by Healthy Savannah and the YMCA of Coastal Georgia through the Racial and Ethnic Approaches to Community Health grant funding awarded through the Centers for Disease Control and Prevention.

The contents of this presentation were developed by Think Equity, LLC.

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Meet Your Trainers

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Community Health Advocate

What is the Community Health Advocate Opportunity?

An education and outreach program focused on COVID-19 and flu vaccine awareness and acceptance.
CHAs will engage their community, family, and friends on the issue of COVID -19 and flu vaccination to provide information that will help make an informed decision.
This training has been expanded to include the other strategies within the REACH grant:

Physical Activity
Nutrition
Information on overall community health and wellness.

A $500 stipend will be provided for those who successfully complete the program.

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CHA Outreach

Who is providing this training?

This effort is funded by a supplemental grant from the Centers for Disease Control and Prevention, is intended to broaden the initiatives of the current Racial and Ethnic Approaches to Community Health (REACH) grant to focus on COVID-19 vaccine education, awareness, and acceptance, particularly in Savannah’s Black and Hispanic communities.

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The Fierce Urgency of Now

“We are now faced with the fact that tomorrow is today. We are confronted with the fierce urgency of now. In this unfolding conundrum of life and history, there 'is' such a thing as being too late. This is no time for apathy or complacency. This is a time for vigorous and positive action.”

- Rev. Dr. Martin Luther King Jr.

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(Tiffany)

Racial equity has had a complicated trajectory. Furthermore, it is important to acknowledge how inextricably linked racism is to the customs, policies, and practices of American society. People of color fare worse than their White counterparts in areas such as wealth, income, education, housing, and health.

Racialized policies and systems shape economic and social institutions.

Over the years, while working with states to develop comprehensive approaches to help us all move toward health equity, it didn’t take long to realize that no matter which social determinant we focused on, race and racism are the greatest predictors of health in our country. Therefore, we must work steadily to counter the root causes of bias and institutional racism in realize better health, better birth and maternal outcomes.

We must be intentional with addressing racial inequities and turning up the volume Infant and Maternal Mortality disparities.

With George Floyd, Breonna Taylor and many more coupled with high unemployment and the pandemic there is a perfect storm so to speak.

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COVID-19 and Influenza:

Where are we now?

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COVID-19 in the United States

As of March 22, 2023, more than 1 million Americans have died from COVID 19
From Pandemic to Endemic
We are NOT returning to the days before February 2020.
We must learn how to live in our new normal
We must take every precaution to protect ourselves and others by:

Getting fully vaccinated
Wearing masks
Social distancing (when possible)
Washing our hands—frequently
Being physically active
Eating healthful foods
Getting plenty of rest

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COVID-19 and Underlying Health Conditions

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What Happens if I Get Infected?

Stay in a specific room and away from other and people and pets in your home.
If you can, use a separate bathroom.
If you must be around other people, wear a mask and practice social distancing.
Tell your close contacts that they may have been exposed to COVID 19
Monitor your symptoms and follow care instructions from your healthcare provider.

When to seek Emergency Medical Attention

Trouble Breathing
Persistent Pain or Pressure in the Chest
New Confusion
Inability to wake or stay awake
Ashen, pale-gray, or bluish colored skin, nail beds, or palms

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html#:~:text=As%20much%20as%20possible%2C,to%20slow%20the%20spread.

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What Treatments are Available?

https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html

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Flu in the United States

https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

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Benefits of the Flu Vaccine

Flu vaccination can keep you from getting sick with flu.
Flu vaccination has been shown in several studies to reduce severity of illness in people who get vaccinated but still get sick.
Flu vaccination can reduce the risk of flu-associated hospitalization.
Flu vaccination is an important preventive tool for people with certain chronic health conditions.
Flu vaccination helps protect pregnant people during and after pregnancy.
Flu vaccine can be lifesaving in children.
Getting vaccinated yourself may also protect people around you

Last year’s flu season was not as severe because of the safety precautions that were in place to reduce COVID-19 transmission.

We can stay safe by doing the same things we’ve been doing… →

Flu vaccination prevents millions of illnesses and flu-related doctor’s visits each year. For example, during 2019-2020 flu vaccination prevented an estimated 7.5 million influenza illnesses, 3.7 million influenza-associated medical visits, 105,000 influenza-associated hospitalizations, and 6,300 influenza-associated deaths.
During seasons when flu vaccine viruses are similar to circulating flu viruses, flu vaccine has been shown to reduce the risk of having to go to the doctor with flu by 40 percent to 60 percent.

showed that among adults, flu vaccination was associated with a 26% lower risk of ICU admission and a 31% lower risk of death from flu compared to those who were unvaccinated.

A 2018 study

showed that among adults hospitalized with flu, vaccinated patients were 59 percent less likely to be admitted to the ICU than those who had not been vaccinated. Among adults in the ICU with flu, vaccinated patients on average spent 4 fewer days in the hospital than those who were not vaccinated.

Flu vaccination prevents tens of thousands of hospitalizations each year. For example, during 2019-2020 flu vaccination prevented an estimated 105,000 flu-related hospitalizations.
A 2014 study
showed that flu vaccination reduced children’s risk of flu-related pediatric intensive care unit (PICU) admission by 74 percent during flu seasons from 2010-2012. A 2017 study found that during 2009-2016, flu vaccines reduced the risk of flu-associated hospitalization among older adults by about 40 percent on average.
A 2018 study showed that from 2012 to 2015, flu vaccination among adults reduced the risk of being admitted to an intensive care unit (ICU) with flu by 82 percent.

Flu vaccination has been associated with lower rates of some cardiac events
among people with heart disease, especially among those who have had a cardiac event in the past year.
Flu vaccination can reduce the risk of a flu-related worsening of chronic lung disease (for example, chronic obstructive pulmonary disease (COPD
) requiring hospitalization.
Among people with diabetes
and chronic lung disease

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The Social Determinants of Health and Health Equity

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It’s Really Complicated!

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*Delete for pdf

Come back to this question: Prompt: Why is health equity important to you?

What would happen if we dropped some added weight or pressure to the yarn web?

What would happen if just one person let go?

Reflection: (Tiffany)

The web will gradually lose shape, form, connection, and life. When the web is lying on the floor, ask everyone to sit down and discuss what has occurred.
Why did we do this in this way?
When the web was created and we were playing with it, in what ways was it like your clinic?
What happened to the web when the first person let go of the yarn? The next person? How is that like what happens when people are excluded from a community?
As more and more people dropped the yarn, what happened to the web? How did this affect its usefulness (or playfulness)?
What lesson for community living could you draw from this exercise?

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Equity

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Factors Affecting (Influencing) Health

Physical environment

Clean air and water

Social & economic factors

Education, income, race/ethnicity, religion

Clinical care

Access to quality medical care

Health behaviors

Smoking, drinking, healthy food & activity

Genes and biology

Predisposition to certain diseases

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Social & Economic Factors

40%

Health

Behaviors

30%

Physical environment

10%

Genes & Biology

10%

Clinical care

10%

Why do people get sick?

More than your family’s history of sickness and disease, where you live and what you do determines your health or sickness.

Social and Economic Factors (Housing, Education, Economic Status) and Health Behaviors (70% total) have more impact on health and sickness than family history (genes/biology) which is only 10% of the pie.

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Social Factors Impacting Health

Economic Stability

Health Care

Neighborhood and Community

Education

Chronic Stress

Physical Environment

(Tiffany)

“Health is not just the outcome of genetic or biological processes but is also influenced by the social and economic conditions in which we live. These influences have become known as the ‘social determinants of health.’ Inequalities in social conditions give rise to unequal and unjust health outcomes for different social groups.”

Tackling Health Inequities an All Ireland Approach to Social Determinants 2008

Environmental demands that tax or exceed the adaptive capacity of an organism, resulting in physiological and psychological changes that may place the organism at risk for disease

Chronic stressor from social source includes poverty, unemployment, violent low-income neighborhoods, and racism.
The body response to stress is the cascade activation and expression of several hormones via the hypothalamus pituitary axis (HPA) that culminates in the release of glucocorticoids (cortisol). Prolonged or chronic activation of the stress response system causes “wear and tear” on the human body causing diseases.
Stress-related diseases include- Cardiovascular diseases, respiratory conditions, arthritis, obesity, cancer, mental illness, Alzheimer’s disease and lower life expectancy.
These are conditions disproportionately represented in minority populations such as African-Americans.

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What are the Root Causes of Health Inequities?

Structural Racism

Class Oppression

Gender Inequity

Heterosexism

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Acknowledging the Past to Understand the Present

Redlining

Urban Renewal

Jim Crow Laws

Racial Home and Land Covenants

Racial Zoning

(Tiffany)

Racial and social exclusion, and exploitation were primary driving forces in 20th century urban development
When we look at today’s landscape of inequality, we must understand the historical drivers which created this landscape
These things have strongly influenced what we see today.

Brief political context

Institutionalized discrimination by creating color-coded maps and ratings systems that downgraded neighborhoods based on the racial and class demographics of their residents
Home Owners’ Loan Corporation (HOLC), and subsequent programs to subsidize the cost of mortgages.

Jim Crow was a person and a set of policies/laws
This system was a reaction to gains made by African Americans during reconstruction
Jim Crow was the country’s attempt to maintain White power and relegate Blacks

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Health insurance
Educational and/or income gaps
Housing situations
Language barriers
Inadequate transportation
Work and childcare responsibilities

Everyday racism surrounding (and within) medicine contributes to people’s mistrust in the systems which are supposed to protect their health and well-being.

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Community Health and Wellbeing:

It Starts with You!

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"We have to be alive, in our spirits, emotions, and physical bodies, to do great restorative work in the community."

Lyrica Fils-Aimé

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The Equity Triad

Head: Knowledge, Data, Information
Heart: Physical, Emotional, Spiritual
Hands: Action, Power, and Voice

Think. Feel. Do.

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Equity Work is not Hard Work…It’s Heart Work

Physical Health: Keeping our beating hearts (and bodies) healthy.

Without physical health, our equity work suffers.

How do we advocate for ourselves and our health?

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Equity Work is not Hard Work…It’s Heart Work

Emotional/Mental Health: Self-care, Introspection, Self-examination

How do we care for ourselves and others while caring for others?

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Equity Work is not Hard Work…It’s Heart Work

Spiritual Health: Connecting equity work to a higher purpose and larger “why”

What is my reason for doing equity work in my community?

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Maintaining Your Health

Healthy Walks with Healthy Savannah: Every Tuesday Morning
Police Memorial Trail and Tide to Town: Savannah’s Urban Trail System

People who eat a healthy diet live longer and are at lower risk for serious health problems such as heart disease and type 2 diabetes
Farm Truck 912
Fresh Express

Ample sleep supports the immune system, which reduces the risk of infection and can improve outcomes for people fighting a virus.

Physical Activity

Healthful Eating

Rest

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Physical Activity

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Maintaining Your Health: Physical Activity

Boosts Your Mood | Sharpens Your Focus | Reduces Your Stress | Improves Your Sleep

https://health.gov/sites/default/files/2019-11/PAG_MYW_Adult_FS.pdf

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Maintaining Your Health: Physical Activity

Small lifestyle changes = Big Rewards

Improves Brain Health

Increased Cognitive Ability
Decreased risk for depression and anxiety

Weight Management
Reduce Health Risk & Better Disease Mgmt.

Heart Disease and Stroke
Type 2 Diabetes
Cancer

Strengthen Bones and Muscles
Prevents Falls and Improves Activities of Daily Living
Live Longer!

https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm

What is your biggest obstacle to getting 150 minutes of PA each week?

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Nutrition

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Maintaining Your Health: Nutrition

https://www.cdc.gov/nutrition/about-nutrition/why-it-matters.html

What is your biggest obstacle to eating foods that are higher in nutrition?

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Maintaining Your Health: Nutrition

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Maintaining Your Health: Nutrition

Practice portion control
Veggies help you feel full and satisfied
Experiment with herbs and spices
Make your plate colorful
Choose water instead of Sweet beverages

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Maintaining Your Health: Nutrition

Engage with Healthy Savannah on Facebook and Instagram!

Create a recipe
Record or take a picture
Tag Healthy Savannah
Earn CHA service hours

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Rest and Mental Health

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Maintaining Your Health: Rest

What is Rest: A conscious decision to stop work, activities, groups, technology, habits and experiences so that you can relax, refresh, recover, and tend to your soul.

It is Revolutionary.

It is Resistance.

https://thenapministry.com/

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Maintaining Your Health: Rest

Taking Rest: Do’s and Don'ts

Do: Start an early morning routine

Do Not: Make apologies for resting

Do: Schedule a time for rest daily

Do Not: Shame others for resting

Do: Get a friend/family member to hold you accountable

Do Not: Give yourself a hard time for not getting rest, “right”

Do: Make your rest a TOP PRIORITY

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Maintaining Your Health: Rest

Mantras to Usher in the Rest you Need and Deserve

I forgive myself for not tending to my soul and all its needs.
I give myself permission to rest
I am patient with myself as I make changes to ensure my rest
I will make rest part of my daily spiritual practice
I will not apologize for giving my body, my heart, or my mind the rest they need
Rest is the key to a better, fuller, healthier life

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Support for Community Health Advocates

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CHA Support

Community Health Advocates will provide information on COVID-19 and Flu and support Healthy Savannah’s work in the following ways:

Organize and hold public meetings with community members
Share information at local faith-based organizations, places of worship, local schools, parent meetings, and at student groups and events
Distribute informational flyers, surveys and materials on COVID-19 and Flu at local community events
Participate in city and neighborhood events to share information
Meet with local business owners (barbershops, beauty salons, corner stores, etc.)
Post approved information on social media outlets
Report on activities and measurable outcomes

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CHA Post Training Details

Community Health Advocates will receive a $100 stipend for attending the initial training.

Community Health Advocates will receive up to $400 for completing a three-month training phase and outreach within the community.

Community Health Advocates are asked to sign an agreement with Healthy Savannah and complete a W-9 to receive this stipend.

Community Health Advocates will receive:

A PPT to share with community,
Healthy Savannah Giveaways
CDC COVID and Flu educational materials

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THANK YOU!

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Community Health Advocate Resources for

Engaging Community

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Avoid:

Ask what about the misperception is important to them, e.g., what about the belief is relevant to their values
Use medical jargon in place of plain language
Confront beliefs as being wrong or shame them for believing inaccurate information
Overstate certainty associated with corrective information

Try This:

Show care and openness with body language.
Ask what they have already learned about the vaccination and/or virus
Ask about concerns associated with information they mention, e.g., “what worries you about what you’ve learned?”
Listen, acknowledge, and empathize, e.g. “I understand what you are saying.”
Assess openness to new or different information e.g., “would you be interested in additional information?”
Refer to accurate information resources

When Engaging Community:

Adapted from DukeHealth: Initiating the Conversation on Medical Myths and Misinformation

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Don’t Do This:

Use exclusive language
Assume all have the same expectations
Over-generalize behavior
Use (or allow others to use) disrespectful language
Allow any one person to dominate the conversation
Discourage alternate views or counter-arguments

When Engaging Community:

Try This:

Introductions (Icebreaker)
Be clear about expectations and intentions
Use inclusive language
Ask for clarification
Have respect and consideration for participants
Be aware of/Identify barriers for learning
Provide time for introspection and contribution

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Mentally and physically prepare
Know your material
Ensure expected objectives are clear
Establish expectations
Manage participation
Adjust when necessary!
Bring your genuine personality to every training

Recognize different perspectives.
Create an inclusive environment.
Keep discussions constructive and positive.
Encourage participants
Reflect on the following:

What insight and/or experiences do these participants bring to the group?
What do I bring to the group?

Tips for Talking with Groups

Remember: There is wisdom in every room you enter. Tap into it. Harness it.

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