Throughout the pandemic, local health departments nationwide have leveraged innovative partnerships with community partners to ensure COVID-19 response efforts are equitable, consistent and accessible to the communities they serve. During the pandemic, local health departments have led epidemiological investigations, conducted contact tracing activities, monitored suspected cases, hosted mass testing and vaccination clinics, and enforced isolation and quarantine protocols. These population-based health interventions have a direct impact on New York’s healthcare system through decreased hospitalizations and emergency room visits.
While resources have been made available to all counties throughout the pandemic by the federal and state government, our association, representing the 58 local health departments in New York State, recognized vast disparities in availability and access to resources in rural communities. Testing supplies, personal protective equipment, vaccine supplies were challenging to obtain throughout 2019 and early 2020 with rurally situated local health department being smaller in staff and operating budget with less resources available to purchase additional supplies that may be needed by the community to close gaps in health equity.
Approximately 12% of New York State residents live in rural communities and face numerous health disparities. These residents are typically older in age and have lower incomes than those who live in urban areas. Rural areas also face many challenges due to their geographic isolation, for example, travel and distance barriers. These areas typically experience provider shortages, lack adequate resources, and have few community partners to draw support from. These factors increase the burden on rural public health agencies and rural healthcare systems.
To respond to this health equity challenge, the New York State Association of County Health Officials (NYSACHO) teamed up with the New York State Health Foundation (NYSHF) to allocate private funding in the amount of $250,000 and remove administrative spending barriers for 29 rural local health departments. Our organizations identified the goal of this project to be (1) supporting rural COVID-19 response efforts and (2) enhancing innovative health equitable approaches to pandemic response. These local health departments utilized the funding in a variety of ways, working with their communities and partners to determine where the money would be best spent.
Local health departments identified and solved a variety of health inequities by result of this innovative collaboration between NYSHF and NYSACHO. Inequities addressed varied by participating county and matched the unique needs of each community. Examples of projects that addressed rural health equity challenges included:
Allegany County: Using the CDC Social Vulnerability Index, identified geographic areas that have the most need, based on socioeconomic status, household composition, race/ethnicity, language, and housing/transportation, issued kits to older residents and families with children in high vulnerability areas. Distributed emergency kits containing emergency supplies, and educational material on COVID-19 and emergency preparedness.
Cattaraugus County: Created a database that identifies organizations throughout Cattaraugus County to link community members with access to mental health, education, social determinants, food security, childcare, elder support, and wellness support. The goal of the project was to create a virtual database for residents to access virtual programs with live instructors for all ages. The Cattaraugus County Community Connection is a collaboration of all services, programs, and organizations throughout the county to increase awareness and link community members to organizations to assist with their needs.
Columbia County: Established two person teams to reach those in the community with special needs related to COVID-19 testing access. Team consisted of EMS providers supported by Health Department staff, and traveled to group homes, migrant labor camps, senior centers, and other sites, such as affordable housing locations, where a lack of transportation posed a barrier to testing access. After specimens were obtained, CCDOH staff confirmed that test kits were properly stored, labeled, and delivered for laboratory testing. Following testing, CCDOH Communicable Disease staff provided education, investigation, contact tracing, and surveillance as needed for those who tested positive for COVID-19.
Cortland County: Purchased and assembled kits to be utilized by area agencies that serve those who are seniors, low income, and/or those that have access and functional needs. These bagged kits were distributed to the Cortland County Office of Aging, Cortland County Department of Social Services, Cortland Rural Services, Catholic Charities of Cortland County, Access to Independence, and the Healthy Neighborhoods Program.
Genesee County: Funding was used to enhance Genesee County COVID-19 testing access for those individuals in quarantine on day 7 of their mandatory quarantine in alignment with U.S. COVID Response Resolve to Save Lives. This project addressed barriers related to testing access as COVID-19 testing for surveillance purposes is non reimbursable through insurance, and individuals with lack of or limited medical insurance coverage have been unable to access testing services.
Hamilton County: Supported vulnerable populations and addressed food insecurities by providing each school district in Hamilton County with a hot meal cart and an outdoor propane heater to prevent disease transmission in the school setting.
Herkimer County: Supported County childcare providers with supplemental PPE and cleaning supplies for their staff during this critical time. Funding was measured and evaluated by the number of PPE units (masks) and cleaning supplies distributed to each provider. Herkimer Public Health also checked back in with each provider after 4 weeks to monitor the number of supplies remaining and re-stock as inventory allowed.
Madison County: Collaborating with Syracuse University, SLI-N|Y ESF, SUNY Upstate and Quadrant Biosciences Inc., MCPH conducted baseline testing and surveillance of wastewater in two communities. Once an increase of Covid-19 RNA was identified in the wastewater, Madison County was able to target those communities with testing by setting up and running portable COVID-19 test sites. Madison County had sufficient funding to conduct wastewater sample testing through November 22, 2020.
Schuyler County: funds to support vulnerable populations including older adults, those living with a disability, and homeless individuals. Schuyler and Yates Counties partnered with the Office for the aging to deliver emergency preparedness kits to those in need.