Alexandria Health Department (AHD), as one of the Virginia Department of Health’s 35 districts, serves the City of Alexandria with the mission of “Healthy People, Healthier Communities.”

The City of Alexandria is a vibrant community of about 154,710 people with a rich history and bright future. The City’s defining features are a waterfront location, proximity to Washington, D.C., and diverse population with English, Spanish, Amharic, and Arabic as the major spoken languages. Overall, Alexandria is well-educated and relatively high income, however, like any community, there are significant disparities with an eight year life expectancy gap based on which census tract you live in. About 52% of Alexandrians are white, 22% are black or African American, 17% are Latinx, and 6% are Asian or Pacific Islander.

During the spring and summer, there was rapidly changing COVID-19 guidance from the state and CDC, and many small businesses struggled to know which precautions were appropriate. There was also significant confusion among the public about what they could expect when going to restaurants or other businesses. Therefore, in a collaboration with the local tourism board, Visit Alexandria, the AHD Environmental Health division created ALX Promise, a voluntary accreditation program to help local businesses understand the new COVID-19 regulations and demonstrate their safety commitment to the public. The ALX Promise addressed the safety uncertainty challenges by creating a training program outlining key safety measures that businesses pledge to follow. Businesses that complete the program receive a decal that they can proudly display on their window and their website. The ALX Promise shield sticker instills confidence in the public that the business has been working closely with AHD to implement critical safety standards.

The program launched in May and businesses immediately started signing up. To AHD’s surprise, houses of worship and non-profits also signed up because they, too, valued the clear guidance and training.

After several months into the program and several hundred participants, AHD wanted to ensure that all businesses had access to this opportunity. We created a GIS map of all participating businesses and compared that to a map of all businesses in the City. The map revealed that a number of businesses in our predominantly Latinx neighborhoods had not signed up despite the disproportionate burden of COVID-19 in this community. In response, AHD developed a Spanish version of the program. AHD then created bilingual postcards advertising the program and sent Medical Reserve Corps volunteers to businesses in that neighborhood to drop off the postcards and state mandated signage for restaurants. AHD also reached out to a local Spanish radio station and secured an interview for a bilingual environmental health staff member to promote the program.

While the ALX Promise was created to deal with changing COVID-19 guidance, we hope that the program will evolve and endure as a way for businesses and other organizations to demonstrate their ongoing commitment to employee and customer safety.

Changing state and federal public health guidance created confusion for both businesses trying to follow regulations, and the general public seeking to patronize these businesses. With COVID-19 disproportionately harming small businesses and their employees, this group of people were at risk of both economic instability and the mental health stress that go along with it. The ALX Promise program was developed to support local businesses as they take appropriate safety measures to protect their staff and employees. With many COVID-19 outbreaks occurring among lower-income back-of-the-house restaurant staff who are predominantly Latinx, this was also a tool to address the disproportionate amount of cases among essential workers. It also had the benefit of supporting consumer confidence to use safer options like carryout and curbside pickup.

This program is new to the field of public health in that environmental health staff quickly and creatively adapted their safety checklists and state public health guidance into a voluntary accreditation complete with training modules and a pledge for businesses. We partnered with the organization Visit Alexandria to publish a list of all organizations who had completed the program. This free publicity motivated businesses to complete the training program and create a safer work environment. As a community that supports small businesses and champions independent organizations rather than larger chains, the ALX Promise was critical to instilling consumers with the confidence needed to keep shopping local and supporting our economy rather than only purchasing through Amazon. The practice is not currently evidence-based.

The goal of ALX Promise was to help businesses easily understand and follow complex and quickly changing public health guidance. AHD accomplished that by creating a training program with multiple modules, including offering one-on-one virtual walk throughs of businesses to ensure all best practices were in place. AHD partnered with Visit Alexandria, the local tourism board, as a way to promote the businesses that completed the program. Visit Alexandria was a key partner in planning the roll out of the program and outreach to businesses to sign up. Visit Alexandria also has a consistent role in the implementation as they maintain the website and promotional materials highlighting businesses that have successfully completed the program. AHD also partnered with the local Chamber of Commerce and several business associations to spread the word about this program and raise awareness about important public health guidance. AHD also developed a new partnership with a local Spanish radio station to help promote the Spanish version of the program to local businesses in our Latinx neighborhoods. By building that media partnership, we were able to deliver a key message and address equity in terms of health education. Further, we have since been able to leverage that media relationship to share other COVID-19 health information with our Spanish speaking community. https://www.visitalexandriava.com/alx-promise/

After several months into the program and several hundred participants, AHD wanted to ensure that all businesses had access to this opportunity. We were concerned that our various immigrant-owned businesses may not be as plugged into the Chamber of Commerce and other associations where we promoted the opportunity. Therefore, we worked with our partners in the City of Alexandria local government to create a GIS map of all participating businesses. We then compared that to a map of all businesses in Alexandria, based on business permit data. The maps revealed that a number of businesses in our historically Latinx neighborhoods had not signed up despite the disproportionate burden of COVID-19 in this community.

In response, AHD developed a Spanish version of the program, led by bilingual environmental health staff. As we didn’t have each of these business’s email addresses, AHD created bilingual postcards advertising the program and used bilingual Medical Reserve Corps volunteers to canvass these businesses in person and drop off the postcards. In addition, AHD also developed and delivered signage that met the state mandates for businesses. Finally, AHD reached out to a local Spanish radio station and secured an interview for a bilingual environmental health staff member to promote the program. We hope that the new business relationships that we have made through this program are sustained post-pandemic. Many of these businesses pay minimum wage or tipped wages, so their employees are often at high risk of economic instability and many of the health risks that go along with it. By providing this free, training program and significant technical assistance, we hope we’ve built the good will needed to reach out in the future about other health initiatives.