The New York City Department of Health and Mental Hygiene (DOHMH) is one of the nation's oldest public health agencies in the United States of America. With over 7,000 employees, the Department is also one of the largest public health agencies in the world. Daily, DOHMH staff and partners protect and promote the health of over 8.4 million New Yorkers across five boroughs. New York City is home to more than 3 million foreign-born residents from more than 200 different countries, making it the most diverse city in the world. New York City is home to the world's largest Orthodox Jewish (OJ) Hassidic and Haredi community outside of Israel, at over 1.6 million. The neighborhoods of Borough Park (Boro Park) and Crown Heights, Brooklyn, have the largest resident population of Hassidic and Haredi Jewish communities estimated at 200,000.
There are enduring gaps in health outcomes in NYC which vary by age, race/ethnicity and place of residence. Established in 2016, the Center for Health Equity and Community Wellness (CHECW), aims to eliminate racial and other inequities resulting in premature mortality. CHECW addresses inequities through community-led, whole-health approaches to address physical, behavioral, social, and community needs. Through CHECW, the DOHMH is tackling health inequities with innovative policies and programs.
Orthodox Hasidic and Haredi Jewish communities are profoundly religious and insular and are often not reached by traditional public health programs. As a result, the Orthodox Jewish (OJ) neighborhoods of Brooklyn have been the epicenter of many vaccine-preventable disease outbreaks. These neighborhoods were hard hit by the COVID-19 pandemic with higher case, hospitalization and death rates than borough-level or city averages. The use of preventive health services, including vaccination, has been historically low. A year after COVID-19 vaccines became available, vaccination coverage in the seven zip codes in Brooklyn with majority OJ residents remained below 40%. In addition to low COVID vaccination rates, vaccination levels for other preventable diseases continued to decline. DOHMH has experienced challenges connecting with the OJ community due to limited engagement opportunities . Early in the COVID pandemic response, there were less than five Yiddish speakers recruited to contact tracing programs. Further, information disseminated by DOHMH did not meet the diverse language needs of the community. It was evident that the traditional model of partnership of DOHMH staff-led outreach efforts was ineffective. The challenge of how to provide culturally and linguistically appropriate messaging that accounts for the unique needs of the Orthodox Jewish Community persisted as vaccination coverage and use of other preventive health services remained low.
The DOHMH established a Brooklyn Orthodox Jewish Partnership (BOJP) to develop community-driven solutions tailored to the Hassidic and Haredi communities in Brooklyn to build trust in the public health infrastructure. Our objective was to pivot from rigid risk communication program models to a true engagement model that fully assigned decision-making and control to community partners, such that the community can fully leverage its own wisdom and experiences to design and implement public health programs. The success of this "for us by us” partnership model with active decentering of the public health department is presented.
Below were the steps taken to implement this partnership model
· A request for applications was issued for community partners with staff and presence in the Hassidic and Haredi communities willing to lead engagement to increase uptake of public health services in Brooklyn zip codes. Three organizations with majority OJ staff responded to the request, including the Jewish Orthodox Women's Medical Association (JOWMA).
· A Collective Action Framework was developed outlining clear responsibilities. DOHMH was responsible for providing funding, material, and data resources to guide and evaluate the partnerships while Partners were responsible for the development and implementation of all activities.
· Partners conducted a needs assessment to document longstanding health priorities in their assigned neighborhoods. The needs assessment was used to guide the development of a responsive program that provides the OJ community with services to meet their stated needs.
· Partners hired culturally competent staff to conduct community outreach, education, provide referrals to health and other social services, and design health events with community leaders.
· Partners created all messaging and communication products. As internet usage is limited, magazines, flyers etc were developed to promote health events and provide health information. All literature was developed in relevant languages with no DOHMH branding.
· One partner received funding to staff a hotline to answer community members' questions about health issues, including COVID.
· Partners formed community advisory groups to inform for their work, including a doctor's advisory group.
· DOHMH provided weekly data on COVID case, hospitalization and mortality rates and vaccination coverage data for each zipcode. DOHMH staff also provided trainings on COVID vaccine 101 and how to access city services and resources.
There are several positive outcomes attributed to this community-led partnership model when compared to traditional models of partnership.
1. Rapid expansion of the public health workforce with culturally competent community health workers that were recruited, supervised, and trained by community-based organizations
2. Increased uptake of testing, vaccination, social services, and primary health care in historically underserved OJ community
a. Vaccination increased from an average of 40% to 60% in the 7 zipcodes
b. Testing rates increased and consistently exceeded borough and city averages
c. Number of people who called the hotline for health-related information at any time 1,332 and average calls per month 266
d. In-person outreach to 4,977 community members by 104 Community health workers
e. 26 in-person community conversations.
f. 1,664 pieces of educational literature distributed
g. Vaccine information was provided to 7,671 people.
3. Reduction in COVID cases, hospitalization, and death rates in the OJ communities from higher than to the city average
4. Trust and partnership with the OJ community and willingness to collaborate with health department staff on several issues.
Using the model to both fund and support communities to identify and enact solutions to complex public health issues is of critical importance. The work of the NYCDOHMH Public Health Corp can be found here: https://www.nyc.gov/site/doh/health/neighborhood-health/public-health-corps.page