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Battling barriers to protect Latinx residents from COVID-19

This summer, a Latinx family welcomed a newborn in the midst of a pandemic. As the baby girl lay in the nursery of Duke Regional Hospital, mother and father shared worries with Dr. Rushina Cholera, a pediatrician-epidemiologist.

Because the father works in construction — an industry with some of the highest rates of COVID-19 among Latinx men — they feared for the family’s health. 

The father said he wears a mask every day, but Cholera soon realized he did not know he was at risk because his coworkers do not.

“Wearing a mask protects the people around you,” she said. “You are not protected from getting it from them.”

More than four months into the coronavirus outbreak in Durham County, members of the Latinx community still don’t have all the information they need to protect themselves and their families. 

“We missed the boat on that early on,” Cholera said.

At highest risk

Latinx residents are disproportionately affected by COVID-19. Despite representing only 14% of Durham County’s population, they make up 61% of reported cases in Durham. Statewide, Latinx people are 10% of the population and 42% of confirmed cases.

Doctors, community advocates and experts say there are still many misconceptions about the spread of COVID-19 in Latinx communities, as well as a lack of testing. That’s because people have not always received Spanish-language and culturally relevant messaging about the virus, they say. 

“There has to be factual, culturally appropriate messaging in Spanish,” said Cholera, who is in the National Clinician Scholars Program, a training program for clinicians working to address health disparities. 

Latinx residents are also vulnerable because they make up a large portion of essential workers in Durham. They often don’t receive paid-sick leave, and they can be wary of accepting government help when they aren’t yet citizens.

“Public services for safety net programs can essentially be used against you or your family members in immigration proceedings,” said Cholera, referring to immigration regulations. “Folks are nervous about seeking testing. They’re nervous about seeking care, because they’re worried that may lead to immigration enforcement, family separation or deportation.” 

In Durham there is now a more concerted effort to address this disparity through targeted testing and communication about immigration policies that may be preventing Latinx residents — especially those who are undocumented — from seeking care. But there is much to overcome. 

Addressing fears, misinformation 

In March, doctors Viviana Martinez-Bianchi and Gabriela Maradiaga Panayotti, who are Latinx, started Latin-19 in Durham with a dozen people to address the disproportionate rate of COVID-19 among the Latinx community.

They now have 140 members, including volunteer doctors, professors of medicine, deans, lawyers, social health workers and community members, said Martinez-Bianchi, a Duke-based family medicine doctor and advisor to the North Carolina Department of Health and Human Services.

A patient held an umbrella for Dr. Viviana Martinez-Bianchi while she administered a coronavirus test last Thursday. Martinez-Bianchi is a founder of Latin-19, a group responding to the high rate of COVID-19 among Durham’s Latinx residents. Photo by Henry Haggart

Along with local government officials, they are trying to educate Latinx residents about misconceptions regarding regulations that affect immigration decisions, such as Public Charge, associated with COVID-19. There is a need to ensure that “real information” is presented to the community, according to Martinez-Bianchi. 

Fearful of being deported or that accessing care will affect their likelihood of being granted permanent resident status, many Latinx residents in Durham are hesitant to get tested and give information to contact tracers, said Martinez-Bianchi.

The Trump administration has promoted hostile rhetoric against undocumented immigrants and expanded  restrictive immigration policies. Under the Obama administration, interior removals focused on people who posed a threat to national security and individuals with serious criminal convictions. Trump overturned these priorities by executive order and instituted policy that now targets any undocumented immigrant, regardless of social, economic or family ties to the U.S.

In February, the Trump administration expanded the federal public charge rule to consider an applicant’s receipt of federally funded benefits like Medicaid, Supplemental Nutrition Assistance Program and housing subsidies in determining whether to grant a green card. That has made people without legal immigration status more reluctant than ever to accept government services, said Cholera.

In March, the U.S. Citizenship and Immigration Services stated that it will not count COVID-19 testing, treatment or preventative care against immigrants seeking legal status.

“Number one, having to go to the hospital is not going to cost your citizenship,” Martinez-Bianchi said.

But too few people know that.  

Sharing expertise

Lawyers with Latin-19 are working to quell concerns about accepting care and resources. Doctors assure patients that they can go to the hospital without it being counted as a public charge. Community members translate important pandemic safety messages like the three Ws — wear a mask, wait six feet apart, and wash your hands — for public service announcements, videos and posters. 

Another issue is pandemic-related financial support that some immigrant families can’t access, including government stimulus checks under the CARES Act passed by the federal government on March 27. 

Those without a social security number are ineligible for money from the federal Coronavirus Relief Fund. Mixed-status families, where one member is a U.S. citizen or permanent resident and another is not but pays taxes with an individual tax identification number to the IRS, are also prohibited from receiving money.

“Immigrant families were put in a position where they were extremely economically dependent on keeping jobs throughout this, and were not able to pay for basic needs like food and housing without a stimulus check,” said Cholera. 

Latinx flea market vendors protested downtown Friday after Durham planning department staff threatened food truck operators and others with fines and law enforcement for setting up a market on state-owned land. Photo courtesy of Alexandra Valladares

Latinx vendors recently protested their treatment at a local flea market, where some make income they depend on during the pandemic, said Italo Medelius, vice chair of the Durham Mayor’s Hispanic-Latino Committee. They alleged that City-County Planning Department staff threatened them with fines and law enforcement for doing business on a lot owned by the state Department of Transportation.

The City-County Planning Department issued a statement Friday saying the staff followed departmental procedures, but the situation could have been handled differently. Department members have offered to help find alternative locations for the vendors.

Making testing more accessible  

Commercial and hospital testing sites, in red, are mainly on the west side of Durham County. But Latinx residents are more likely to live on the east side, says Italo Medelius, vice chair of the Durham Mayor’s Hispanic-Latino Committee. Map by Bella Caracta with data from Durham County Department of Public Health

According to the Durham County Department of Public Health statistics,  the two zip codes in the county with the highest COVID-19 rates are 27704 and 27703 on the east side, with infection rates of 28.25 and 18.61 per 1000 persons respectively. These areas are where many Latinx residents live, according to Martinez-Bianchi. 

“Testing is a problem, especially when it is not present where the most vulnerable communities live,” Martinez-Bianchi said. 

Director Rodney Jenkins of the Department of Public Health said otherwise in his update about testing in Durham during the Recovery and Renewal Task Force meeting on July 17. 

“Durham continues to do a very good job with our testing,” said Jenkins, referring to the number of tests administered. 

The number of tests in Durham County is not the problem. It’s where testing sites are located, said Martinez-Bianchi.

On July 11, the county did set up a new three-day testing site in zip code 27703, located in the parking lot of Holton Wellness Center on North Driver Street.

Staff and volunteers there try to test from 50-75 people, by appointment only on Saturday from 9 am to 11:30 and on Tuesday and Thursday from 4:30 to 7:30 pm to accommodate people who work, especially construction workers, Jenkins told the Recovery and Renewal Task Force on July 17. 

People seeking testing are given educational materials, in Spanish where needed, and enough food to support a family of four for about two weeks in case they test positive and must quarantine themselves, according to Jenkins. Jenkins also reported that the site had about a 50% success rate for testing on July 11, meaning nearly half the tests taken that day returned positive.

People getting coronavirus tests outside Holton Wellness Center last week received food too, in case they needed to remain home to reduce spread of the virus. Photo by Henry Haggart

Martinez-Bianchi said she would like to see mobile testing in Durham that targets neighborhoods with rising COVID-19 diagnoses, specifically in the Latinx community. That is happening in Mecklenburg County, home to Charlotte, she said.

Jenkins said his department’s current plan is to replace testing at the Holton parking lot with testing at El Centro Hispano, a non-profit that supports the local Latinx community.

Spanish-language messaging 

At the beginning of the pandemic, none of the messaging from the local government was in Spanish, said Martinez-Bianchi.

In addition to inaccessible messaging, it was also not culturally appropriate, Cholera and Martinez-Bianchi said. 

Many Latinx households are multi-generational, with more than five people living in the home, Cholera said. Much of the guidance for social distancing was “not practical and not specific” to how these households should protect themselves and each other, she said.

“Togetherness is usually a big part of the resilience of the community. And in this case, it has actually acted against them. Because the virus loves that kind of environment,” said Martinez-Bianchi. 

Martinez-Bianchi also highlighted the lack of public and private resources to help people once a family member tests positive to move out of residences housing multiple generations. 

There has been hope that the state or organizations would fund hotel rooms to quarantine individuals who live in small homes with multiple people, said Cholera, though this program is not yet instituted in Durham County.

Some local organizations like the Immigrant Solidarity Fund and El Centro Hispano work to financially support immigrants regardless of documentation.

These advocacy groups cannot guarantee that ICE won’t seek information about undocumented residents from all who are trying to help them, said Pilar Rocha-Goldberg, president of El Centro Hispano, in the Recovery and Renewal Task Force meeting on July 17. 

As officials continue to work on accessible testing, Martinez-Bianchi said it’s also important to give people peace of mind. 

“What has to be promised is that data is not going to be shared with those who can damage this community,” said Martinez-Bianchi.

9th Street Journal reporter Bella Caracta can be reached at isabella.caracta@duke.edu

At top: Dr. Alex Cho administers a coronavirus test during a thunderstorm on Thursday outside Holton Wellness Center in Durham. Photo by Henry Haggart

Contact tracers fight the pandemic, one phone call at a time

When someone is sick with COVID-19 or suspects they may be, the Centers for Disease Control and Prevention says they should isolate themselves in a single room at home. One Durham parent took it a step further.

Worried about infecting children under the same roof, the parent moved into a car parked outside, despite the North Carolina summer heat. The kids delivered food and drinks there.

Katy Roys knows this because she is a contact tracer, a public health worker who finds and coaches people at risk of spreading the coronavirus. This time-tested outreach helped reduce deaths during the HIV/AIDs outbreak in the 1980s, SARS in 2003, swine flu in 2009 and now COVID-19.

Here in Durham and around the world, tracers have front-row seats to ways the new coronavirus disrupts lives. 

“You can read everything about coronavirus in the newspaper and reports, and it’s another thing to call people yourself and see how they’re doing,” said Edwin Lee, who like Roys became a county contact tracer while training to be a physician assistant at Duke University.

A dangerous illness

During Lee’s first week tracing in May, he called a Hispanic man who had recently tested positive for the virus. Like Lee, the man was in his twenties. “I feel horrendous,” was the first thing he said.   

On paper, the young man had no known chronic illnesses. During an interview the day before with another contact tracer, he reported a fever, cough and slight chest pain.

But on the phone with Lee and a Spanish interpreter, the man was struggling to speak, pausing mid sentence to catch his breath. In response to Lee’s scripted questions, he said he had significant chest pain, chills and fevers. 

“Hearing his voice and how sick he sounded, I just told him to hang up and call 911,” Lee said. 

It was only his second or third day on the job and Lee wondered whether he overreacted. When he asked a nurse on the county health department staff, she was more concerned with whether the man called 911. 

Contact tracers have observed that some Hispanic residents can be reluctant to do so, Lee said, even though new cases of the coronavirus recently were mostly detected among Latinx people in Durham County.

“If he didn’t call 911, this was certainly a person that we would have sent someone to do a welfare check on. But thankfully, he did,” said Lee, adding the man was admitted to the hospital.

Public health detectives

The county Health Department uses social media to brief residents on differences between contact tracers and phone scammers. This lesson was posted on Twitter.

On the the third floor of the Durham County Human Services Building downtown, tracers each day check a whiteboard for their duties, grab case files from a basket and get to work making calls, the students said.

Some on the job have medical backgrounds, some are health department employees pulled from jobs with lower demand during the pandemic, including restaurant inspectors.

Much like detective work, contact tracing requires creativity to fill in gaps. When Lee pulled a file that described a woman who fainted at a local business while trying to pay a bill, he had to figure out who else she may have exposed. 

“We had to make a lot of phone calls,” said Lee.

The first obstacle was finding the store’s telephone number. Despite having a physical location, the business did not have a listed phone number. So Lee dialed a restaurant in the same shopping plaza. 

A hostess answered but declined to walk only several yards to tell the store manager that the health department was trying to get in touch. When he called a nearby retail store, a helpful employee agreed to deliver the message.

But even after connecting, the situation was murky.

The first employee Lee spoke to said employees weren’t adhering to social distancing protocols that day, a payday, because it was busy. That suggested several people might have been nearby when the women dropped to the ground. Then a manager said the store was adhering to social distancing protocols and there were at most two or three customers in the store.

After six to seven hours and over a dozen calls, including four to the same person, Lee and coworkers determined none of the customers required their help. All of them, including the woman who fainted, were wearing surgical-grade masks, they learned. 

To protect people’s confidentiality, tracers do not publicly disclose names or any information that could identify individuals they work with. Contact tracing can get personal quickly.

Roys recently opened a case whose file listed an adult patient’s parent as a designated contact. When Roys called the parent, she learned patient and parent no longer lived together and no longer spoke. Still, the worried parent asked to be updated on the patient’s status.

When Roys reached the patient, she mentioned the parent’s concern. The patient told her not to talk to that parent again. 

“At the end of the day, if the patient says they don’t want us to contact their parents anymore, we don’t. We can’t,”  she said.

An expanding need

Local health departments collaborate with the state Department of Health and Human Services with contact tracing. More than 1,500 full-time and part-time staff support contact tracing efforts at the local level across North Carolina, 398 of which are contact tracers hired through Community Care of North Carolina, according to Kelly Haight Connor, communications manager at DHHS.

“As cases continue to increase we know we need more and continue to ramp up hiring,” she said in an email. 

Roys and Lee entered contract tracing after enrolling in a Community Health course created by Quincy Jones, an assistant professor in the Department of Family Medicine and Community Health. The Duke class is a service-learning elective that allows students to help with the COVID-19 response in Durham County. 

Had the pandemic not happened, Roys and Lee would have likely learned about this work through textbooks and in the classroom. Now they see the importance of what the health department and contact tracers do in a public health crisis, they said.

“They play a huge role in the control of communicable diseases and outbreaks like COVID, and their work is essential in guiding a safe transition into normal operations,” Lee wrote in a reflection assigned by Jones, his instructor.

And it’s likely they will be needed for the foreseeable future.

“I think it’s even more important now that things are opening up, that contact tracing is happening. Because there’s going to be a lot more exposures,” Roys said.

9th Street Journal reporter Bella Caracta can be reached at isabella.caracta@duke.edu

At top: Katy Roys and Edwin Lee outside the downtown Durham County Human Services Building. Photo by Henry Haggart

77% of new Durham County COVID-19 cases are in Latinx community

Despite making up just 14% of Durham County’s population, over three-quarters of reported COVID-19 cases in June were among Latinx residents, Department of Public Health director Rodney Jenkins said on Friday.

This disparity continues to raise concerns among county officials, community leaders and public health officials, who say they are working hard to address the disparity.

“We look at race and ethnicity distribution in cases just to ensure that we are able to articulate overrepresentation and underrepresentation,” Jenkins told the Durham Recovery and Renewal Task Force in his weekly update. “Overrepresentation lets us know who’s at greater risk.” 

City officials and nonprofits have been mobilizing to better protect Latinx residents from the COVID-19, the disease caused by the novel coronavirus. This latest data shows a significant jump in COVID-19 cases over the last two weeks among Latinx communities.

But reducing exposure among these residents, some of whom lack legal immigration status, isn’t simple, said Italo Medelius, vice-chair of the Mayor’s Hispanic/Latino Committee. Some can’t stay home and still make enough money for food or rent.  

“They’re folks that don’t have hazard pay. There’s no sick leave. There’s no ability for folks that if you’ve been infected, you can go home and not work,” said Medelius. “You know a lot of folks are either not going to tell their employers that they’re sick or their employers just don’t ask.”

Efforts to reduce the spread

When the coronavirus started spreading in Durham, committee members started pushing for more public health messaging in Spanish. 

“We ask that both the City and County publish all COVID-19 notices in both English and Spanish, including electronic, social media, public notices,” read a March 27 letter committee members sent to Mayor Steven Schewel. 

Since then, committee members have worked with translating services to help Latinx residents get information they need. Now, the Durham County Department of Public Health website has 36 COVID-19 graphic and information sheets online, with all except four in English and Spanish. 

It quickly became clear that efforts to reduce COVID-19 diagnoses among Latinx residents had to involve more than messaging, Medelius said.

Handing out masks has been an important effort. Early last month, members of the Mayor’s Hispanic/Latino Committee helped Covering the Triangle, a group of doctors and organizers, hand out free face masks in public spaces, including supermarkets.

“FREE FACE COVERINGS / MASCARILLAS GRATIS” read signs outside Compare Foods in downtown Durham and La Superior on North Roxboro Street.

As grocery shoppers stood six feet apart waiting in line to enter, volunteers handed out 2,000 handmade face masks for free. Since most people said they live in households with five to eight people, Medelius said, volunteers gave out two per person in each household.

Source: Durham County Public Health

Medelius said that mask distributors noticed many people requesting them were construction workers. Outdoors services, including construction and lawn services, were exempted from Durham’s stay-at-home orders but encouraged to practice social distancing. 

Because of the close-contact nature of construction work, volunteers gave out packets of about 50 masks for residents to distribute to coworkers at their construction site. 

On Thursday, volunteers handed out free face masks to Latinx business owners, according to Pilar Rocha-Goldberg, president and CEO of El Centro Hispano and member of the Recovery and Renewal Task Force. A flyer is attached to each mask with information on why it is important to wear a mask, how to wash it, and the three W’s: wash your hands, wait six-feet apart and wear a mask.

Support for communities

There are several programs in the works to support Latinx communities. El Centro Hispano and the Church World Service Durham, along with other organizations, are giving cash to local Latinx residents who are not eligible for federal stimulus checks, unemployment, paid-sick leave or are just short of money to support themselves and their families.

The CWS Durham Immigrant Solidarity Fund, started after U.S. Immigration and Customs Enforcement raids increased in the Triangle area over a year ago, is now focused on the public health crisis. 

The money goes where it’s needed, said Kelly Chauvin, immigration services coordinator for the Durham chapter. Since its creation, the fund has assisted 125 local families and fundraised over $100,000 dollars, Chauvin said.

“Much of the money has been raised and distributed in the last four months to respond to requests involving housing and food security,” said Chauvin.

Both El Centro Hispano’s COVID-19 Crisis Response Fund and the CWS Immigrant Solidarity Fund are accepting donations to continue supporting the Latinx community during the pandemic. So far, El Centro’s donation website lists over 350 donations, most anonymous but some from people who leave comments. 

“I’m donating to redistribute the stimulus check I received for myself and my son to those who need it more and may not have received anything,” wrote Lillian Mindich, who donated $1,700. 

Mayor Steve Schewel donated $250. “So grateful for El Centro’s amazing work in the community,” he wrote. 

Medelius said more government funding and state-led initiatives will be needed to better help Latinx people in Durham County remain well. 

Medelius proposed a few ways he believes the state needs to support the Latinx community during this pandemic, including state-funded mobile health clinics, state-led videos and information campaigns in both English and Spanish and paid sick leave for the duration of the pandemic. 

He also said the North Carolina Department of Labor needs to set up a whistleblower program with Spanish-language options to allow workers to anonymously report any employers not following COVID-19 safety guidelines or not reporting cases.

With the new data showing the disparities in COVID-19 cases, county officials spoke of urgently addressing the problem. 

“This is a statewide issue. And we need help,” Durham County Board of Commissioners chair Wendy Jacobs said at the Friday meeting. “When Durham is only getting $5.48 million of CARES Act funding, and Wake County and Mecklenburg County are getting $194 million in CARES Act funding, we have a problem.” 

Top photo: A worker at a Durham construction site breaks for lunch. Construction work is considered an essential service during the coronavirus pandemic. Photo by Henry Haggart

Health report card: Durham gains ground, big gaps remain

A new State of the County Health Report is out and the message is clear. Durham is making progress on some major health priorities. But more work is needed.

Racial and ethnic disparities remain a systemic problem, this year’s Partnership for a Healthy Durham report stresses. “Racism is a public health crisis,” it reads, echoing recent statements by local elected officials. 

For one, Black babies here are more likely to die during their first year of life than white babies. From 2014 to 2018, Black infants died at three and a half times the rate that white infants died in Durham County. In addition, life expectancy among Black county residents was 5.3 years shorter than among white residents during 2016 to 2018, according to the report.

While the 2019-focused report doesn’t address the new coronavirus, recent data makes clear that Black and Latinx people living in Durham County are hardest hit by the pandemic. Where people work, construction projects, nursing homes and jails included, explains some of the risk. 

“Racial equity is being embedded in all the activities that we’re involved with,” said Angel Romero Ruiz, coordinator for a local community health program and co-chair of the Partnership for a Healthy Durham.

Three years ago, residents of Durham County ranked their top five health-related priorities, including affordable housing, access to healthcare and health insurance; poverty, mental health,  and links between obesity, diabetes and food access. 

The partnership, a group of 200 active members and dozens of organizations, this year predominantly addresses three of those priorities. Here’s a summary of the latest major findings: 

Expand affordable housing

Source: State of the County Health Report

Between 2010 and 2019, the median sale price for homes in Durham rose by more than 50%, the report notes. Median gross rent rose 27% from 2010 to 2018, from $798 to $1013.

“Durham is gentrifying, so housing that used to be affordable is starting to be unaffordable,” said Romero Ruiz. 

A large proportion of Black and Latinx residents are renters. Only 29% of Black residents and 33% of Latinx residents own their homes, compared to 64% of white, 49% of Native American and 44% of Asian households, according to the report. 

This disparity leaves Black and Latinx renters especially vulnerable to rising house prices. Consequently, Black and Latinx households have less to spend less on food, healthcare and other necessities.

“Housing and health is totally related. You know, depending on what neighborhood you live in, you’re probably more likely to have better or worse outcomes,” said Romero Ruiz.

Progress in 2019

Durham County voters approved a $95 million housing bond last fall. Paired with $65 million in federal and local funding, the bond money will help redevelop public housing properties in downtown Durham over the next five years. The money will also help finance permanent housing for people who are homeless, fund down payments for first-time home buyers with low incomes and assist people in danger of being evicted.

Durham City Council approved Expanded Housing Choices, an ordinance that permits higher density building in neighborhoods near downtown.

Durham County created a coordinated entry program for people who are homeless in October 2019. Anyone who needs shelter must first report to Durham County Department of Social Services for a coordinated entry and diversion intake. This creates one point of entry for shelter and housing resources.

Challenges

Durham was reminded that health and housing are connected in a big way this year. Nearly 900 people living in McDougald Terrace were evacuated from their homes after carbon monoxide leaks were detected in some apartments. Inspectors found stoves, furnaces and water heaters leaking hazardous gas at the public housing complex.

Conditions at McDougald are also a reminder of the long-lasting impact of racial segregation and economic discrimination. McDougald was built in 1954 for Black tenants in what has traditionally been a Black neighborhood at a time when Durham was still racially segregated.

Local officials have big plans to upgrade many public housing properties here, but not McDougald. That’s because it’s located outside the city’s growing downtown, officials say, where investors are less likely to risk their money.

There are multiple ways that long-ago racial discrimination affects the health of Durham residents today, said Jannah Bierens, a health equity consultant and co-chair of the Partnership for a Healthy Durham.

“Just because laws change, that doesn’t mean that people change or that the practices change. So it takes an internalized transformation as well,” she said.

Increase access to care

The proportion of uninsured residents in Durham has decreased from 15% in 2015 to 12.2% in 2018. But among that 12.2%, who remains without coverage? Most are Latinx residents, who cite immigration status as the most common barrier to receiving health insurance.

In 2018, 40% of Latinx residents were uninsured along with 11% of Black residents, according to the report. Durham has a small Native American population, totalling 726 at the last count; 19% of these residents are uninsured. In comparison, the percentage of white and Asian residents uninsured was 6% and 7% respectively. 

To increase access to care and address racial and ethnic disparities, Partnership for a Healthy Durham has outlined two main goals for 2018-2021: increase knowledge about healthcare resources, such as Lincoln Community Health Center, and increase access to culturally appropriate care. That includes patient care teams trained in racial equity. 

Progress in 2019

The partnership recently received a grant from Duke University to place more bilingual community health workers with organizations such as Project Access of Durham County and El Centro Hispano, according to Romero Ruiz. These health workers help both insured and uninsured members of the Latinx community navigate the resources available to them, said Romero Ruiz. 

For the first time since 2015, the partnership updated its Medical Care Options in Durham brochure, which provides uninsured or underinsured residents a long list of resources, including the Lincoln Community Health Center’s new satellite clinics. The new brochure also includes updated information on how to apply for Medicaid.

Alliance Health, a behavioral health organization, continued to focus on evidence-based care in 2019 for Durham County residents who are uninsured or insured by Medicaid, according to the report. Its staff has expanded efforts to respond to severe mental illness, substance use disorders and long-term needs, according to the report. 

Challenges

Employment and access to care through insurance coverage go hand-in-hand. According to the report, residents ranked lack of employer based plans and unemployment as their second and third barriers to health insurance. The report partially blames workforce discrimination for inequities in access to care.

Linking obesity, diabetes and food access

Source: State of the County Health Report

In 2018, 70.4% of adults in Durham and several nearby countries were overweight or obese, according to the report. Additionally, one in 10 people skipped a meal or cut the size of a meal because they didn’t have enough money to buy food. 

Limited access to healthy food, contributes to obesity, among other health problems like heart disease, diabetes and chronic kidney disease. Additionally, income, employment, race, ethnicity and disability may be factors in residents’ ability to get healthy food options, according to the report. 

Black and Latinx residents are disproportionately affected here too. According to the report, 14.9% of Black residents skipped or cut a meal sometimes or frequently in the past year, compared to 12.6% of Latinx residents and 6.6% of white residents. 

Bierens said that Black and Latinx residents don’t always have access to healthy food. 

“Black and brown neighborhoods are heavily saturated with fast food restaurants and alcohol and tobacco. Those things are also coping mechanisms, so there’s so many interrelated layers,” she said.

Progress in 2019

The City of Durham, Sustainable Duke, Feed My Sheep of Durham, TROSA, Duke Pratt School of Engineering, Sarah Duke Gardens, Duke Farm, Inter-faith Food Shuttle and Healthy Duke created the Bull City Community Garden, a new addition to the local food scene.

The partnership also collaborated with Durham Public Schools to expand more nutritional choices in school meals. It created a document discussing health and nutrition for parents. And it improved Durham’s Healthy Mile Trails,

Challenges

The link between obesity, diabetes and food access is not as simple as many think, according to Bierens. Stress and lack of sleep are commonly overlooked factors that induce higher cortisol levels and a rise in body fat, said Bierens.

Teaching people to eat healthy diets without discussing effects from stress and lack of sleep is not enough, Bierens said.

It’s vital to understand the racial dimension of these community health problems, she said. For that reason, the partnership has a Racial Equity Task Force, whose members will include Durham residents grappling with these problems.

Looking forward

One priority from the 2017 survey was reducing poverty. According to the 2019 report, poverty is decreasing in Durham. But this positive news comes with a caveat.

While the percentage of Durham residents living in poverty decreased from 20% in 2010 to 15.8% in 2018, the actual number of people in this category has increased by 64% since 2000. In 2018, 46,805 people had incomes below the poverty level compared to 28,557 in 2000, according to the report. 

The decrease in the percentage of people living in poverty is likely explained by an increase in the the number of higher-income households moving to Durham.

The partnership, like so many institutions locally and nationally, will focus more than ever on the racial and ethnic dimensions to health disparities in Durham. “We just started adding the ‘why’ and talking about inequities,” Bierens said.

At top: People angry over dangerous conditions at McDougald Terrace public housing protested outside City Council chambers last winter. Access to affordable housing is one of five issues that Durham residents have rated as priority needs. Photo by Bella Hutchins

Correction: This article was modified to correct Jannah Bierens’s work title.