COVID-19 Special Edition: Building from Strengths: Post-Pandemic Partnerships in Health Care

The devastating toll of the pandemic has underscored the critical importance of connecting what science is telling us to the lived experiences of people and communities. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. Now, a year later, we wanted to continue these conversations and discuss what we’ve learned, what needs to change, and where we go from here.

In the third episode in this 4-part special series, host Sally Pfitzer speaks with Dr. Renée Boynton-Jarrett, the founding Director of Vital Village Networks at Boston Medical Center and an Associate Professor of Pediatrics at Boston University School of Medicine. They discuss the cost of failing to address structural inequities with sustainable and comprehensive policy changes, the vital role community leaders played during the pandemic, and why health care systems need to demonstrate trustworthiness.

Episode Transcript

(00:00):
Welcome to The Brain Architects, a podcast from the Center on the Developing Child at

(00:04):
Harvard University. I'm your host, Sally Fitzer. In March of 2020, we recorded episodes exploring
the impact the coronavirus pandemic could have on child development. You may remember
we discussed the importance of self-care for caregivers and the importance of physical
distancing, not social distancing. And now a year later, we wanted to continue those
conversations and discuss what we've learned, what needs to change, and where we go from

(00:26):
that. On today's podcast, we have Dr. Renee Boynton-Jarrett, who is the founding director
of Vital Village Networks at Boston Medical Center and an associate professor of pediatrics
at Boston University School of Medicine. So good to have you with us, Renee.
Delighted to be here. Thank you, Sally.
Renee, in March of 2020, we spoke with Dr. David Williams, who explained that many of

(00:46):
the disparities that we saw in the early stages of the pandemic were predictable and the result
of longstanding social policies and systemic racism. From your perspective as an expert
in the field, in the past year, what have we learned about these disparities?
I think what Dr. Williams shared is absolutely correct. What we saw happen with the COVID-19

(01:07):
pandemic is it took advantage of the existing inequities and just widened those. So actually
our existing structural racism created a broader opportunity for the pandemic to disparately
impact the lives, the wellbeing, and the health of communities of color and communities that

(01:34):
are disproportionately impacted by structural racism. And so I think one of the things that
we have learned or relearned is the tremendous cost of failing to truly address structural
inequities with sustainable and comprehensive policy changes. And as importantly, because

(02:01):
we know structural racism is around these interconnected systems and institutions, but
there are also these ideologies, mindsets, ways of thinking and being. And if we think
about it, those ideologies and mindsets about who's okay to remain at risk, to not have

(02:23):
the luxury of physical distancing, to not have the luxury of having water to wash hands
and do the hygienic practices, we've learned that we also have mindsets that truly impact
the way in which we view humanity and human dignity and human rights. And that this pandemic

(02:48):
has completely taken advantage of the ways in which those mindsets, ideologies, and systems
create structures of inequities.
Could you give us some examples of what changes you think need to happen in the field, particularly
how communities and neighborhoods could help?
I think your question actually hits on where I see the biggest opportunity for change.

(03:10):
So one of the things we saw happen over and over during the pandemic is in the absence
of plans, strategic plans and responses are being created in real time. And often those
decisions, whether they were decisions being made about how vaccines would roll out, whether

(03:32):
there were decisions being made about what economic supports and resources will come
to families or what will happen with early care and education, childcare, school. We
saw time and time again, decisions being made that were not being made with true engagement,

(03:54):
not just engagement of communities, but engagement of community leadership. So really in partnership
with in conversation with those who were closest to the inequities, experiencing them most
directly, we're not being engaged or brought to the table. And time and time again, we

(04:16):
also saw that the ideas, the wisdom, the strategies that were actually happening within communities
were thoughtful, were creative, were real time responsive. And actually when we begin
to get behind them, we see more protection happening for communities. So we also saw

(04:41):
tremendous community leadership. And in the absence of that leadership, I think that we
would have all fared much worse in this pandemic.
Just anecdotally, I've seen that even in some of the work we've done at the center too,
and often finding that bringing in members of the community actively from the beginning
of projects has been the thing that has made those projects so much more successful and

(05:04):
authentic. Could you share some examples of your work with the Vital Village Network?
So Vital Village Networks is based at Boston Medical Center. We promote child wellbeing
and address structural and systemic inequities in systems of care and education in early
childhood. By doing a couple of things, we really work around establishing sustainable,

(05:30):
authentic, and equitable partnerships between caregivers, parents, and community residents,
and community-based organizations, and cross-sector institutions, healthcare, education, advocacy,
social service. In this work, we all really focus on expanding leadership trajectories

(05:52):
and pathways for community leaders. And that can be through trainings and certifications
and expanded opportunities. But we also really think about how do we work to build capacity
and enhance existing community-driven solutions? So how do we build capacity within a community

(06:13):
to promote wellbeing? And often that involves helping institutions and organizations within
the community work with community leaders in a different way. And we use a model called
co-design. So how do we create and design things together? We really work to think about

(06:33):
what builds equitable partnerships, what creates a table for truly equitable participation.
A lot of approaches to community engagement and community work begin with a deficit lens.
They begin with the idea that there's a problem in the community and we have a solution. We

(06:54):
want to bring a solution. Well, that starting point actually makes it very hard to partner
equitably with communities. Because if you think about, even if you were going to pick
someone for a team, would you pick someone or something that you had only framed in terms

(07:14):
of their weaknesses? Parents don't do that with their children, right? We all have our
strengths and weaknesses. Parents are really good at framing the strengths and uplifting
the strengths and building upon the strengths of their children. But we don't do that with
community engagement. We often view a problem and that's our primary way of understanding

(07:37):
a community. And that really creates an imbalance in power from the very beginning. Also, who
gets to ask the questions? Who gets to design the evaluation? What type of technology do
you need to participate virtually? So all of these things create barriers for equitable
leadership. So with co-design, we really begin first by understanding that there are solutions

(08:02):
that already exist within communities. And if we're not aware of those solutions, it's
because we're not seeing them, not because they don't exist. So really beginning by recognizing,
appreciating and valuing the strengths and the wisdom and solutions within communities,
which creates a much more level playing field for partnership.
The second piece is how do we plan? How do we design together? So how can we disrupt

(08:28):
tools and strategies that bias someone based on their training or education? And how do
we create opportunities to design things together that are centered around the diversity of
people in the room? That's also a particular invitation that no one is at the table only
as an expert, but everyone is at the table both with their expertise and their gifts,

(08:54):
as well as learners. And so creating that mutuality, that ability for us to be in both
roles, all of those factors really lead to the ability to partner with communities and
not on behalf of.
Why do you think there's a disconnect between health systems and the families they're supposed
to serve? I'm thinking particularly here about the COVID vaccine in relation to this.

(09:20):
What I would share is I think we've had a disproportionate focus on distrust about the
vaccine. So when we think about it, when we actually look at the real data that we have,
actually the majority of people who are, who have been surveyed or interviewed in communities

(09:42):
of color are along a continuum of interest in the vaccine and or very interested in getting
the vaccine or have already received it. It's a very, very small percentage that has said,
you know, an absolute no. So that is a strong signal that people are seeking an opportunity

(10:04):
to have their questions answered, to have a conversation and to engage around the vaccine.
Also what I think we haven't focused on enough is how do healthcare institutions demonstrate
trustworthiness? So we want people to trust the vaccine and that it's good for their health.

(10:26):
And we have like this, I think, an overemphasis or an over expectation that what we're hearing
from people is that they don't trust the vaccine. What we may be hearing from people that we
haven't focused on enough is how do institutions demonstrate that they are trustworthy, that
they're going to share updated information about concerns or warnings or emerging complications

(10:50):
or side effects that they are going to offer the vaccine in settings where you will be
able to get your questions answered, that you will have opportunities to hear from other
people who have received the vaccine. And so what I think that we need to really focus
on is also taking a hard look from a lot of current and historical lessons at the ways

(11:16):
in which despite what might be well-intentioned efforts, systemic racism truly exists within
our institutions, including our healthcare institution. And how that is experienced for
people is sometimes that the institution does not appear to be trustworthy because time

(11:37):
and time again, needs are not being heard or listened to or responded to with dignity.
So if we are expecting that we can change people's minds to make them do what it is
we'd like them to do, again, that only serves to reinforce I'm not wanting to hear your

(12:02):
concern. I'm wanting you to follow my guidance, my advice in a system that you have not been
invited to help design what this experience would look like. So that's why we're seeing
so much success of vaccines that are being administered at faith-based institutions in

(12:24):
partnerships with the faith-based community. That's why we're seeing so much success with
providers of color that are creating safe and brave spaces for people to learn about,
talk about and discuss the vaccine. And in our work with Vital Village Networks, we've
had what I would just consider led by community members. We've had love conversations, conversations

(12:50):
that aren't so much about all of the details, but are just creating a space for people to
be honest about any fears they may have or anxieties they may have. And time and time
again, they connect to what you have learned throughout your life around untrustworthy
medical institutions that have demonstrated that time and time again. So we must do a

(13:12):
better job and a different job of demonstrating trustworthiness.
Really appreciate that response. I'm your host, Sally Fitzger. The Brain Architects
is a product of the Center on the Developing Child at Harvard University. You can find
us at developingchild.harvard.edu. We're also on Twitter at Harvard Center, Facebook at
Center Developing Child, Instagram at Developing Child Harvard, and LinkedIn, Center on the

(13:36):
Developing Child at Harvard University. Brandy Thomas is our producer. Dominic Mithurin is
our audio editor. Our music is Brain Power by Mila from freemusicarchive.org. This podcast
was recorded at my dining room table.