Leading UCSF’s pandemic response with a population mindset

Health systems are designed to care for one person at a time, but the COVID-19 pandemic demands a more complex response. It requires a population mindset with strategies to reach entire communities and entire populations, as well as an equity focus to understand that the most marginalized communities are the most affected.

“Linking population health and health equity to address the pandemic is essential,” notes Dr. Kirsten Bibbins-Domingo, UCSF’s Vice Dean for Population Health and Health Equity, explaining, “Testing and vaccinations happen one person at a time, but in order for them to have their respective effects, we have to get a large enough proportion of the population tested, and we have to ensure that the populations with the highest transmission have access to vaccines.”

UCSF’s COVID-19 Community Public Health Initiative exemplifies this approach, coupling the population perspective with health equity interventions designed to deliver needed services, resources, and ongoing support to marginalized Bay Area communities hard hit by the pandemic. Central to the Initiative’s success are the partnerships with trusted local leaders – individuals with lived experience and deep familiarity with community needs.

Leading Locally

The challenges posed by the pandemic were obvious to community members in Bay Area neighborhoods throughout Oakland and in San Francisco’s Bayview, Tenderloin and Mission district. Barriers existed to testing, care and sheltering in place. The Initiative’s first effort, the Unidos en Salud collaboration, was designed to address these very issues. UCSF scientific lead Dr. Diane Havlir and colleagues partnered with the San Francisco Latino Task Force to launch a community-wide COVID-19 testing effort in San Francisco’s densely populated Mission District in early April, 2020. Results showed that the Latino population living and working in the Mission had a disproportionately high number of cases, more than half of which were asymptomatic.

In addition to making it easier to get tested, Unidos en Salud collaborators implemented a Test to Care model to link individuals to needed follow up care and community resources. Designed by Latino Task Force collaborators, Test to Care services are provided by trusted Community Wellness Teams to meet the breadth of financial, education, and social needs faced by affected low income populations for whom sheltering in place is an unaffordable luxury. The collaboration’s data and insights also informed changes to public health approaches, like making it easier for people without symptoms to get tested, and local policies, such as providing economic support for those recovering from COVID-19.

Since the Initiative’s launch, community mobilizers, healthcare providers and infectious disease experts have formed similar community-led collaborations throughout the Bay Area to test over 20,000 individuals who live and work in disproportionately affected areas, including:

  • United in Health D10: An effort based in San Francisco’s medically underserved Bayview, Sunnydale, and Visitacion Valley neighborhoods and home to large African American, Pacific Islander, Chinese, and Latino populations. The collaborative involves Bayview Hunters Point Community Advocates, District 10 Supervisor Shamann Walton, UCSF’s Kim Rhoads, MD, MS, MPH, associate professor of epidemiology and biostatistics, and scientific lead Diane Havlir, MD, as well as the San Francisco Department of Public Health.
  • United in Health—Unhoused: An effort led by Margot Kushel MD focused on reaching individuals who are unhoused in San Francisco’s Bayview, Tenderloin, and South of Market neighborhoods. The partnership includes the UCSF Benioff Homelessness and Housing Initiative, Glide, St. Anthony’s, the San Francisco Department of Public Health, and District 6 Supervisor Matt Haney.
  • Sanando Juntos – Fruitvale: An effort led by Alicia Fernandez MD based in the primarily Latino Fruitvale neighborhood of Oakland. The collaborative includes UCSF, the Unity Council, La Clínica de la Raza, La Familia Counseling, Street Level Health Clinic, Native American Health Center, the Oakland Mayor’s Office, Oakland Unified School District, Alameda County Public Health Department, the Oakland Public Library, and the Chan Zuckerberg Biohub.
  • Umoja Health: An effort also led by Kim Rhoads, MD, MS, MPH, focused on reaching Black and African American communities across Oakland. The partnership involves Friends of Frank, Oakland Frontline Healers, Brotherhood of Elders Network, Roots Clinic, Life Long Medical, Wise Health, Adamika Village, Alameda County Public Health Department, the Oakland Mayor’s office, Samuel Merritt University, UCSF and the Chan Zuckerberg Biohub.

Building Sustainable Foundations

Reflecting on the Initiative, Bibbins-Domingo notes, “It turns out that the principles of population health – recognizing the social context and structural factors that affect the health of a population, using data to understand the challenges, and partnering effectively with communities all while keeping equity as a focus – are the essential elements in these testing stories.” When population health and health equity approaches are combined with the deep knowledge and experience of community leaders, it establishes a foundation of trust.

Each of the Initiative’s efforts followed a similar blueprint for building sustainable community partnerships:

  • Develop a partnership where the community leads – recognize the community members as experts.
  • Pair community outreach with follow-up support – acknowledge the realities in the communities, and also take steps to mitigate barriers (provide test results and connections to care).
  • Be very data driven – collect and use data to inform how and what things get done.
  • Tie efforts to policy – work in close partnership with public health and political leaders to address structural gaps.
  • Make it easy for populations to access resources – ensure access to testing and vaccines.

Early evidence indicates that the trusting relationships forged during the pandemic’s early days are robust enough to support ongoing engagement. Unidos en Salud recently partnered with the San Francisco Department of Public Health to launch a vaccine distribution effort at the site of its initial Mission district testing effort. Similar vaccination efforts are planned in the coming weeks. Looking ahead, the hope is to continue with a focus on addressing the persistent disparities that pre-dated the pandemic and fueled its devastating effects.