Can Strategies for Flu Mitigation among Public Housing and Low-Income Residents Apply to COVID-19?

By the end of March 2020, the coronavirus changed almost every facet of life in communities in the US and around the world. More and more US communities are working to restrict the spread of the coronavirus by shutting down schools, closing nonessential businesses, and asking residents to stay at home or shelter in place. In times like these, effective emergency preparedness and response strategies are essential for ensuring important safety messages and services reach all populations so everyone understands how to keep themselves and their communities safe and healthy.

Unfortunately, few emergency plans offer culturally specific messages and education, and many don’t engage with community members as partners to reach groups who may face greater barriers to complying with pandemic containment policies, such as school closures, work changes, and social distancing.

In 2009, a group of researchers with the Office of Minority Health and Health Disparities in the Centers for Disease Control and Prevention (CDC) (what is now the Office of Minority Health and Health Equity) sought to develop a conceptual framework for linking the contributing and causal factors of preparing public housing residents, single-parent families, and low-income populations in the event of an influenza pandemic. Although their research does not focus on COVID-19 specifically, it offers some startling parallels to today and helpful suggestions for public health practitioners, health care providers, emergency managers, and other partners engaging and supporting these populations during the current pandemic. The article was published in a special pandemic flu issue of the American Journal of Public Health.

To develop a framework, the researchers conducted a literature review and convened 26 stakeholders at the CDC in May 2008. Convening participants were asked about effective methods of community participation, support, and capacity building specifically related to public housing residents, single-parent families, and low-income populations. The researchers then gathered the list of recommendations that the stakeholders offered, along with a list of needs, barriers, and solutions for containing and mitigating the spread of pandemic flu.

In addition to the items summarized below, the report has a detailed table of pandemic mitigation strategies that includes solutions related to school closures, workplace policies, and social distancing. Organizations engaging public housing residents, single-parent families, and low-income households can review this table through the full text link.

Key findings

• Public housing residents, single-parent families, and low-income families are more susceptible to complications from the pandemic flu because of risks produced by economic disadvantage.
• Subsidized housing providers and resident services staff should be alert to the likelihood of added pandemic risks to low-income households, including unstable employment or insufficient job benefits, reluctance to stay home from work because of risks of income loss, a lack of flexibility to work from home, poor access to health care facilities, low immunization rates, a lack of or insufficient health insurance coverage, difficulty obtaining medicine and supplies, and exposure to other hazardous environmental factors.
• Public housing residents, single-parent families, and low-income families also experience inequities in health status and challenges accessing safe and quality health care. For example, the researchers point out that many members of these groups obtain regular medical care in emergency rooms and community health centers where they are more likely to be exposed to the virus.
• Public housing residents are more likely than the general community to have poor health. Whether through distressed public housing or substandard housing in the private market, low-income households have preexisting risks of respiratory infections, asthma, lead poisoning, injuries, and mental health problems.
• Preexisting health problems for low-income households may increase susceptibility to a pandemic virus or lead to negative health outcomes from additional time spent at home.

The following are communication recommendations for public health officials seeking to reach public housing residents, single parents, and low-income households:

• Understand the cultural context, social environment, and past experiences of these groups and design communications strategies and awareness programs that reflect their cultural backgrounds and linguistic diversity, and use interpreters when needed.
• Build community trust by using gatekeepers, social networks, and local communication leaders to help spread important messages and design and implement communication strategies.
• Use participatory action research to engage target population members in completing a community risk assessment and gathering resources.
• Establish partnerships with faith-based organizations, community-based organizations, and neighborhood-planning units to mobilize and distribute information, food, goods, and services.
• Measure and evaluate how well messaging reaches target populations.
• Use trained and trusted staff to handle inquiries and problems related to school closings, workplace policies, public gatherings, alternatives for child care, social support, and distribution plans.

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