Originally published at the Institute for Public Health website and reposted with permission.

Melissa Chapnick

RD, MS, MPH Research Manager – E3 Nutrition Lab

Haiti is among the most recent countries hit by COVID-19. The Haitian government moved swiftly to respond to the emerging pandemic, closing the border with the Dominican Republic and halting all incoming international flights. These travel restrictions may have delayed the arrival of coronavirus, but significantly burden Haiti’s already strained economy. 

This is yet another blow to a country which experienced significant political unrest during the past two years. Without strong healthcare systems or a stable economic foundation, like other low-resource settings, Haiti is likely to bear a disproportionate burden of damage due to the outbreak.

In 2017, Université Publique du Nord au Cap Haïtien (UPNCH) collaborated with Washington University in St. Louis to launch the first undergraduate degree program for public health in the country.  Students from this program stepped forward to initiate efforts to respond to the COVID-19 pandemic. Understanding the importance of prevention, their efforts focus on timely communication of accurate information about the virus and prevention strategies.  Even before Haiti identified its first case, students worked together with the UPNCH administration, the local Washington University research coordinator and the Ministry of Health to organize a panel presentation with experts from public health, medicine, and nutrition.

The work continues as this dynamic team mobilizes to address COVID-19 prevention and treatment in a variety of ways. They developed informational radio, and mobile announcements for 11 areas in and around Cap Haïtien, Haiti’s second largest city. The informational radio announcement, currently set to air eight times per day, addresses basic information about identifying symptoms and the importance of prevention strategies like social distancing. Students distribute posters generated by the United States Centers for Disease Control in Haitian Creole, as well as WhatsApp communication from the World Health Organization.  They also prepare to volunteer with the Ministry of Public Health and Population. In the coming days, the team will work with experts at Washington University to derive homemade solutions for hand sanitizers and masks for use in both the healthcare system and by the public.

UPNCH public health program has three cohorts and over 100 students enrolled in 2020. Students come from across the country to attend the program, and recently they formed Haiti’s first student association for public health. Students in their third year are now entering practicum placements within the Ministry of Public Health and Population, as well as local non-governmental organizations.

Under the leadership of  Lora Iannotti, Brown School associate professor and Institute Faculty Scolar, and Sherlie Jean-Louis Dulience in Haiti, several faculty, students, and staff from Washington University have designed and co-instructed public health courses with Haitian counterparts. Research collaborations have also emerged in public health nutrition, environmental sustainability, air quality and engineering, enteric disease, child development, and radiology.

Covid-19 first impacted middle- and upper income countries with more extensive infrastructure, population mobility, and urban density.  As it threatens low-income countries, the devastation could be monumental. These public health students in Haiti have stepped forward to an enormous challenge and in doing so, set an inspirational example for many around the world.

To learn more about this project, contact Lora Iannotti and visit the E3 Nutrition Lab website.

Acknowledgements: Sherlie Jean Louis Dulience, Lora Iannotti, Delide Joseph, Lourdena Antenor, Henry Claude Saintelmond, Jean Ednor, Ailze Julonet, Michael Galvin.

A new report from the Brown School’s Clark-Fox Policy Institute focuses on the impact  high-quality early childhood care and education can have on children, families and communities. It’s an issue whose importance has been brought home dramatically by the COVID-19 pandemic.

The report, Launching Lifelong Success: Ensuring St. Louis’ Kids are Ready by Five, highlights the evidence for early childhood care and education (ECE) as an effective policy investment that can reduce inequities in social support and help the most vulnerable in our communities. The report proposes three evidence-based policy recommendations:

• Increase access to ECE through sustainable public and private investment
• Prioritize the funding for children most affected by poverty
• Increase the quality of care and education through a coordinated system supported and administered by a single regional entity

“Research demonstrates that investment in high-quality early childhood care and education yields significant long-term returns,” said Gary Parker, Associate Dean for External Affairs and the Director of the Clark-Fox Policy Institute. “An investment in our kids is an investment in the future of the region. Children and the adults who care for them deserve every opportunity to thrive in St. Louis.”

Parker said the report is especially timely given the effects of the pandemic.

“The rise of COVID-19 has exposed glaring inequities in our social support infrastructures, and our most vulnerable populations are experiencing the greatest hardship,” he said. “Now more than ever we are aware of the inequitable resources available to working families, and limited access to quality childcare is one of the greatest obstacles.”

The report notes that high-quality ECE can lead to better education outcomes, such as high school graduation; better health, including lower rates of chronic disease and substance abuse; and higher employment rates later in life. Those outcomes are particularly important in St. Louis, which has low intergenerational mobility and wide disparities, as white children are 38% more likely than black children to be enrolled in pre-kindergarten programs.

“All children deserve a strong start in life,” said Atia Thurman, Associate Director of the Clark-Fox Policy Institute. “We need to prioritize quality ECE as a means to promote family well-being, economic prosperity and racial equity in our region.”

The Clark-Fox Policy Institute will be hosting a virtual panel discussion Wednesday, April 22 at 10 am: Early Childhood Education and COVID-19: The Immediate and Long-Term Impacts. Register here.

Child abuse and neglect hotlines around the country are reporting declines in calls over the past few weeks. While normally this would be welcome news, it does not bode well during COVID-19 stay-at-home orders, says an expert on child abuse and neglect at Washington University in St. Louis.

“Normally, a decrease in calls about alleged child abuse and neglect or maltreatment would be a welcome start to child abuse prevention month, but the context of current declines is worrisome,” said Melissa Jonson-Reid, the Ralph and Muriel Pumphrey Professor of Social Work Research at the Brown School.

“Both theory and data suggest that stress and poverty are powerful contributors to child abuse and neglect,” she said. “Unfortunately, the COVID-19 crisis is increasing both psychological stress and economic strain. The very few studies we have on the impact of disasters on rates of child maltreatment suggest that there may be a link.”

While recent reports raise the possibility that the declines might be due to school closures, Jonson-Reid thinks more is going on.

“The typical drop we see due to schools closing in summer is too small to explain the reported drops of 30% to 70% across various states,” she said. “During stay-at-home orders, children go unseen by a host of possible reporters.

“It is imperative that we do everything we can to be aware of the well-being of children in our communities. Social distancing need not prevent phone calls or emails to neighbors and family, help with groceries for those who cannot get out, and providing clear messages to families about where to get resources for parenting and meeting basic needs.”

In addition to the many regional efforts, she said, Prevent Child Abuse America has a number of tips and resources related to COVID-19 for parents, children, service providers and the community on their website.

After social distancing ends, it is likely we will experience a large surge in reports across the country as children return to daycares, visit relatives, see their doctors, attend schools and so on.

“It is critically important that sufficient funding be provided to states to assure we have preventative services in child welfare and other family support agencies that will be needed to support the preservation of families and address child safety,” Jonson-Reid said.

“Even before this crisis, the economic case for preventing child maltreatment was made clear,” she said. “After we have addressed the immediate needs of our families, we should use this as a catalyst to bring together science and practice to build an effective system designed to alleviate both the material and psychosocial needs that get in the way of positive parenting and child well-being.”

For more, visit the university’s Center for Innovation in Child Maltreatment Policy, Research and Training.

The Brown School’s Jason Purnell will lead a response team of over 40 St. Louis area nonprofits, social service agencies and governments to deal with the coronavirus pandemic.

The COVID-19 Regional Response team aims to help people navigate resources and get help with needs including employment, food, housing, child care and legal aid.

Purnell is an associate professor whose research focuses on how socioeconomic and cultural factors influence health behaviors and outcomes. He is the director of Health Equity Works, a Brown School initiative committed to translating research into community action to advance health equity in St. Louis.

“Our region’s most vulnerable populations are historically underserved and this pandemic requires us to provide care and services in ways that no individual agency can accomplish on its own,” Purnell said. “An equitable response to this pandemic requires that we focus our attention on those at greatest risk of contracting this virus and those whose lives were lived in risk before this crisis.”

Mary McKay, Neidorff Family and Centene Corporation Dean of the Brown School, said Purnell’s leadership of the response team was welcome news for St. Louis.

“Jason Purnell is the ideal leader for this effort to address the needs of our community at risk and deliver help to those who need it most,” said McKay. “Serving the St. Louis region is a top priority of the Brown School, and this effort is one of many our faculty are making to respond to this crisis.”

While it is clear that COVID-19 does not discriminate based on factors such as an individual’s race and economic status, we do know that it is disproportionately impacting those who are least likely to have the resources to fight it.

And recently, COVID-19 data from the City of St. Louis confirms it. In a map listing positive COVID-19 cases by zip code, we see a greater concentration of cases in low-income and highly segregated zip codes in the City of St. Louis. Sadly, that data is not surprising.

Low-income individuals are more likely to experience detrimental health and financial outcomes, and even more so for African American populations. COVID-19 has the potential to be particularly devastating in St. Louis, as St. Louis was ranked as having the sixth highest rate of minority residential segregation among the 50 largest metros in the United States.

Policymakers should keep the following in mind as COVID-19 continues to unfold in the city.

1. The data clearly shows that this disease discriminates by income and race.

In cities like St. Louis, the zip code in which you live is a main predictor for future health outcomes.

Looking at the entire metro area, we anticipate that COVID-19 will affect some neighborhoods more than others. Even without a COVID-19 outbreak, we know babies in The Ville are six times as likely to have a low birth weight and twice as likely to die before their first birthday compared to babies in Clayton. And adults don’t fare much better. People living in the Ville are much more likely to be diagnosed with asthma, obesity, and diabetes—risk factors for COVID-19.

What makes the initial statistics about COVID-19 infections by zip code so alarming is that households without insurance or transportation are likely to go untreated and untested for the disease, so the real number of cases might be even higher than reported.

2. The disease discriminates because of the working conditions and living density of the poor.

Low-income individuals in St. Louis may live in crowded areas, utilize laundromats, rely on public transportation, and are less likely to afford getting grocery deliveries. These realities of day-to-day life increase their exposure to COVID-19 infection. Additionally, Brookings Institute research tells us low-income households are less likely to hold jobs that enable remote work while others may quit to care for children.

Research from Social Policy Institute highlights how frontline workers, such as those in home health agencies or warehouses, may lack personal protective equipment and face increased risks of contracting COVID-19. They also may not receive generous employee benefits, such as health insurance coverage, vacation time and retirement savings contributions from their employer.

3. Policy changes can ease the situation.

Disaggregated by zip code, these COVID-19 cases repeat a story we see too often in St. Louis—low-income communities of color are left with the greatest health and economic burden. Policymakers should look closely at not only this data, but the underlying social indicators exacerbating the strain on these households and community. This includes ensuring there is adequate testing in segregated zip codes and taking positive actions to benefit low wage workers.

We don’t need a map to tell us that policymakers, health officials, corporations, and St. Louis residents themselves must continue to break down economic barriers to create partnerships and solutions that support the most vulnerable in our city – those who were already facing a disproportionate social, financial, and health burden prior to COVID-19 entering their lives.

Michal Grinstein-Weiss is the Brown School’s Shanti K. Khinduka Distinguished Professor and director of Washington University’s Social Policy Institute. Brinda Gupta, is the Social Policy Institute Program Manager. This article appeared as an op-ed in the St. Louis Post-Dispatch on Friday, April 10, 2020.

A more in-depth version of this piece is available on the Social Policy Institute’s website. 

​Idled by the coronavirus, many public-service professionals are taking advantage of a new initiative from the Brown School faculty and staff: “Open Classroom,” a series of free, live webinars that are broadly applicable to the fields of social work, public health and social policy.

Offered mostly on Tuesdays and Thursdays at 12:30 p.m. via Zoom, the sessions are led live by faculty, but also recorded for later viewing. Upcoming topics include School-Based Mental Health, Translating Research for Policy, and Epidemiology 101. The school is also offering a free list of on-demand resources offering expert advice and training on COVID-19, responses to the pandemic, and related topics.

The idea was born when Brown School community partners notified Dean Mary McKay that staff were unable to do their core duties due to the virus and were looking for productive ways to use their time, such as professional development.  Working with Janet Gillow, director of professional development programs, McKay asked for faculty volunteers to lead the webinars.

“Response to the Dean’s request in March was overwhelming,” Gillow said. “Our faculty really know how to show up. Within a day, I had 10 faculty volunteers and had arranged a five-week series that began the following week.” 

Within the first week of registrations, more than 1000 RSVPS were received; by May, more than 5,000. The team now has access to a dedicated webinar license, which permits up to 500 participants in each class. Gillow also has the option to send overflow to the Brown School YouTube channel. The sessions are now scheduled well into the summer. 

McKay, the Neidorff Family and Centene Corporation Dean, was struck by the demand for the webinars.

“The Brown School is humbled by the dedication of social workers, public health professionals, social policy specialists, health care providers and other service professionals in these challenging times,” she said. “The most vulnerable among us are experiencing further increases to their levels of need, stress and uncertainty.  We’re pleased to open our doors virtually to the community of helpers to share information, resources and solidarity. We think that more than ever before, good information and thoughtful connection are vital to our well-being and ability to carry on our professional missions.”

Gillow added that the RSVPs have been in great part from those who work with community partners and agencies in St. Louis, but also from alumni, field instructors, students, prospective students, university staff and faculty, as well as graduate students from other institutions. 

“We want to welcome all who want to join our Open Classroomand participate in the Brown School virtual family,” she said.

Learn more about the webinars and view the list of on-demand resources. 

Suggestions for webinar topics or free resources may be emailed to profdev@brownschool.washu.edu.