County Population: Hennepin County is Minnesota's largest county, with 1.27 million people calling it home, or about 23% of the state's entire population. Over the next 30 years, the Minnesota Demographic Center estimates that the county's population will increase by an additional 30%. Hennepin County anchors the western side of the Twin Cities metro, the 16th largest metro area in the US and the third largest metro area in the Midwest. Hennepin County's most populous cities include Minneapolis (the largest city in the state), Bloomington, and Brooklyn Park.
According to the 2020 US Census, of Hennepin County's residents, 21.8% are under the age of 18, 15.1% are over the age of 65, and 50.3% are female. Hennepin County is the most racially diverse county in the state, with 32.3% of residents identifying as BIPoC (14.2% Black/African-American, 1.1% Native American, 7.6% Asian, 7.1% Latino, and 3.5% two or more races). In addition, 13.8% of residents were born outside of the United States, 10% live in poverty, and 18.1% speak a language other than English at home. While there is no official governmental data on the number of LGBTQ+ people that live in Hennepin County, 12.5% of Minneapolis residents identify as LGBTQ+ according to the American Community Survey, making it the fourth highest LGBTQ+ per capita population in the country.
Population Focus: As the CBID team is designed to respond to any infectious disease outbreaks, the specific target group for each incident will be different. The CBID team understands this and thus secures strong partnerships across the county and communities, so they are prepared to act quickly. Additionally, CBID monitors indications of potential outbreaks and communicates with partners for possible preparation.
With Mpox, it was clear from national data that the outbreak was disproportionately impacting the MSM community and thus they were the initial focus population. This target group expanded in time to include transgender and non-binary individuals, people who exchange sexual acts for money or basic needs, and people experiencing homelessness. In the last six months, the CBID team reached over 4,000 people from these communities. As the exact number of individuals meeting these criteria in Hennepin County is unknown, the percentage cannot be calculated. Instead, CBID concentrates on reaching as many people as possible through existing connections with organizations and businesses and outreach efforts. CBID also measures its reach by the demographics of those served to analyze whether the racial demographics mirror the overall population representation.
The CBID team continues to expand its partnerships and connections to various communities so it can respond to future outbreaks regardless of impacted population.
Health Equity: Health inequities and infectious diseases are deeply historically intertwined. Devastating diseases can spread easier and faster when they attack those with barriers to care, limited resources, historic mistrust of health care institutions, and higher rates of comorbid conditions. Thus, for the CBID team to be successful, addressing health inequalities must be at its core.
Nearly half of the team's staff members identify as people of color, mirroring impacted communities and experiences. All staff are highly trained on difficult conversations, trauma-informed care, accessible communication styles, and trust building. As the team is focused on this work, their knowledge and practices only increase over time with each day, disease stage, and outbreak. Community members see their familiar faces, understand they will continue to show up, and know they can address vulnerable concerns.
Most importantly, the CBID team knows that many community leaders and partners have spent decades building the trust of county residents. To work side by side with these leaders and partners gives the CBID team a stamp of approval so they can more quickly and easily get the care to those who need it the most. Additionally, when the team shows up right at the beginning of an outbreak, the community sees that they are a priority and will have the resources they need if they access them.
Throughout every outbreak, data is collected on patients which creates an up-to-date dashboard of demographic information. This allows every team member to see what is working, what is not working, and who is being left behind. Within a day, care sites can shift and outreach strategies can change so inequities can be faced immediately instead of well after the outbreak is over.
Innovative Practice: The CBID team represents an acknowledgement that infectious diseases are an unfortunate constant in our lives and deserve a dedicated team that is not only experienced health care professionals, but also community focused. COVID showed that effective responses to infectious diseases rely on two crucial components – medical tactics and community activation. Community activation includes neighborhood-based care sites, trusted messengers to disseminate accurate information, and staffing that is both prepared and knowledgeable. This all must be paired with health equity practices, which takes significant upfront strategic work that could delay an adequate response if not done beforehand. By pairing prepared professionals with a health equity lens, future infectious disease outbreaks can be quickly hampered.
Important Factors: The most important factor that has set up CBID as an innovative practice is the community-based” portion. The history of infectious diseases clearly shows that outbreaks seek out communities historically underserved due to racism, sexism, classism, homophobia, and xenophobia. From HIV to COVID to STIs, the trend is clear. Thus, CBID puts community first so those who have been marginalized in the past are now centered with communication approaches, care locations, and strategic partnerships. CBID built on relationships that HCPH already held with non-profit organizations, community centers, businesses, and social gathering spots like LGBTQ+ bars. CBID went to the community with on-site vaccinations at the bars, neighborhood centers, and community clinics. By partnering with organizations that both already had the trust of the community and posed fewer access barriers, CBID went to where the community was.
In addition, the CBID team is not only designed to respond quickly, but also with the cumulative knowledge it holds from outbreak experiences. The staff who answered the Mpox emergency carried with them their recent lessons from COVID. For the next outbreak, they will take understandings and best practices from both. This continuation of staff, records, procedures, and partnerships builds a stronger team with every emergency.
COVID also showed how truly difficult it could be for health care workers to show up every day at the front lines of a crisis. Most times, they were not originally hired for such a role. They left behind their everyday jobs, leaving the public receiving less attention in other areas and staff stressed about coverage. Neither the health care workers nor patients are fairly treated in this situation. With the CBID team, the nurses and community health workers join the project because that is where their passion lies. That is their focus. During times where the whole team is not needed to respond to a crisis, members can help fill in for staff in other areas of public health – parental leave, staff shortage, etc. Instead of creating staff shortages during crises, this team flips it and fills in for staff when possible.
Design Basis: Currently, Hennepin County Public Health is not aware of other counties with this team model. As discussed above, the model was designed based on crucial lessons that the COVID response provided. HCPH used its years of experience and data to evaluate what would make a true difference for future outbreaks and balanced it with both financial and staffing resources available. Thus, while it may not be evidence-based in a traditional sense, it is experience-based.
Other government agencies and organizations do have similar emergency response teams, but they tend to rely on volunteers. While the CBID team is open to using volunteers in the future, it will always rely on staff so it can move quickly with established procedures and team cohesion. The CBID team is also unique as it enriches public health staff coverage instead of creating shortages during emergencies.