WE STARTED IN 2012. WE SAW THE IMPACT DURING COVID-19.
SDOH, the social determinants of health defined by the Center for Disease Control (CDC) is a conceptual framework supported by research that has now been widely accepted. These determinants include poverty, unsafe and unaffordable housing, low wages, and racism, factors which cannot be addressed alone by improving "access". But as one VP for a major health insurance corporation stated at a Greensboro housing panel, his corporation didn't know how to "do" SDOH. That is, take action. COVID-19 overwhelmingly demonstrated the health gaps, limits and failures of large corporations and institutions charged with responding, as well as the key roles played by grassroots groups, and community-based organizations like MDA, to inform, educate, and intervene to provide basic life-saving supplies. Since 2012, researchers working with MDA had adopted community-based participatory research (CBPR) practices and used the community health worker (CHW, or promotores) model to conduct research, build community capacity, inform and educate families, and intervene in order to deliver a wide range of services. For our network, the CHW model solved two critical issues, intervention during the course of research and "give back" at the project's conclusion.
Example 1: Proof of Concept
Following the Great Recession, through MDA we were aware that Montagnard families were suffering from food shortages due to the longer economic recovery Greensboro and the Triad region were experiencing compared to Raleigh, Durham, Chapel Hill, and Charlotte. Through a combination of funding sources, we selected and trained two older women we knew through MDA's own ESOL class. Although their formal education level was very low, 0 and five years, they were respected and well liked among women and across tribes. They were multilingual and natural helpers, able to spot family and health problems and initiate medical interventions. Their work interviewing 50 families resulted in published research*, funding for their own neighborhood women's life skills classes, backyard gardens, job training and eventual employment for many stay at home moms.
Jigna M. Dharod , Huaibo Xin , Sharon D. Morrison , Andrew Young & Maura Nsonwu (2013) Lifestyle and Food-Related Challenges Refugee Groups Face Upon Resettlement: Do We Have to Move Beyond Job and Language Training Programs?, Journal of Hunger & Environmental Nutrition, 8:2, 187-199, DOI: 10.1080/19320248.2012.761574
Example 2: Ahead of Our Time
In 2013, we unsuccessfully proposed to the regional health provider that it help us retain our two trained CHWs and fund us to increase their number. We argued that two years after we had introduced unlicensed Montagnard medical doctors to hospital staff, there was still no interest in training or employing them in any capacity. Instead, we proposed very modestly paid community health workers such as the older mothers we had already trained to act as community cultural experts able to bridge the serious gaps that existed between health providers and community members. Again, we received no response.