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Home My WebLink AboutWS2 - Handout • [Handout to Council at 4/16 Work Session from Escucha Mi Voz, UI College of Nursing & JC Public Health] SALUD , TECHO, Y TRABAJO A HEALTH EQUITY REPORT FOR POLICYMAKERS, COMMUNITY ORGANIZATIONS, WORKERS, AND EVERYDAY PEOPLE 1 �v SUMMARY Working with the UI College of Nursing and Johnson County Public Health, Escucha Mi Voz Iowa members conducted a needs assessment and whole worker health survey of 481 immigrant and refugee residents of Johnson County. This report analyzes the results of the October/November 2023 survey, identifies the structural barriers to vaccine access and health equity, and offers recommendations to policymakers and the public. Salud, Techo,y Trabajo:A Health Equity Guide for Policymakers, Community Organizations, Workers, and Everyday People Emily M. Sinnwell, DNP, ARNP, FNP-BC, PMHNP-BC, University of Iowa College of Nursing Clinton Dimambu, Escucha Mi Voz Iowa Author Note Dr. Sinnwell is an assistant clinical professor at the UI College of Nursing. Mr. Dimambu is a Representative Organizer with Escucha Mi Voz Iowa. Additional Contributions by Johnson County Public Health and Hegemony Strategies. Funding provided by United Way of Iowa and Johnson County Public Health. Escucha Mi Voz Iowa is a grassroots community organization with members in five counties. The mission of Escucha Mi Voz Iowa is to advance whole worker health equity and address the structural determinants of health by building the power of working-class immigrant and refugee communities to fight and win justice and dignity in society. Contact Escucha Mi Voz Iowa at 913 S Johnson St, Iowa City, IA 52240. Email: in o escuchomivozia.or _Z _ Introduction The Whole Worker Health Survey was conducted in Spanish and French by trained Community Health Organizers over seven weeks in October and November 2023. The survey was conducted by phone and in-person with 481 respondent-residents of Johnson County. Of the 481 responses, 240 were conducted in-person, either at the Escucha Mi Voz Iowa office in Iowa City, or in the private mobile homes and apartments of the respondents. The other 241 responses were completed over the phone. All data was recorded, stored, and secured in Escucha Mi Voz's EveryAction database. The findings reveal that the working-class, immigrant and refugee communities who were hit hardest by the Covid-1 9 pandemic continue to face entrenched structural barriers to vaccine access and health equity. The structural determinants to health identified include: 1) Low-wage working conditions in essential industries without the benefits of a strong union contract like livable wages, health insurance, and paid sick leave. 2) Expensive, overcrowded, and substandard housing. 3) Immigration status and primary language other than English. 4) The limited planning of policymakers and service providers to effectively implement a proactive and coordinated outreach program and education campaign. 5) The lack of power directly impacted communities currently have to change the economic and social conditions affecting their pay, working conditions, housing, and education. Based on these findings, the report recommends: 1. For city and county policyrnakers fully fund innovative community health partnerships and new permanent supportive housing developments for immigrant and refugee workers. 2. For statepoJ iQtmaker , pass legislation guaranteeing paid sick leave, drivers licenses, and Medicaid for all workers, regardless of immigration status. 3. EQr foundations and fund-ars, focus grantmaking on dynamic, base-building organizations with a real strategy to scale up through grassroots leadership training and 1 onl relational organizing. Literature Review A dangerous new variant of the Covid-19 virus - known as the jN.1 variant- emerged in September 2023 and quickly spread across the country, becoming the dominant strain in the United States by January 6, 20241.At the same time, less than 10 percent of U.S. adults report being inoculated with the new Covid-1 9 vaccine'. While the rate of Covid-1 9 infections and mortalities in immigrant and refugee communities has declined since 2020, public health data from Iowa and across the country continues to highlight the racial disparity and disproportionate impact of the pandemic on immigrant and refugee workers. According to an August 20, 2022 report by the Organization for Economic Cooperation and Development,: Immigrants are disproportionately affected by COVID-19[and are)much more likely than their native-born peers to catch the disease, to develop severe symptoms, and to face higher mortality risks. This is due to a range of factors such as poorer housing conditions with higher incidences of overcrowding; a higher dependency on public transport;overconcentration in areas with higher population density; fewer possibilities for teleworking and a higher incidence of frontline jobs; as well as language barriers and other structural obstacles to access health services and communications regarding prevention measures. Immigrants are also underrepresented among those who get vaccinated. "We consider immigration as a social determinant that has an impact on health and overall well-being and that puts immigrant communities at greater risk for COVID-1 9 infection while they are also less likely to access health care or have greater delays in entry into health care," a team of researchers wrote in a peer-reviewed article published by the American journal of Public Health'. 1 A new COVID variant is dominant in the US: Know these symptoms.Today,Jan 9, 2023.Accessed Jan 10, 2024. hnps:linews.vahOo.com/covid-variant-spreadine-fatt-u&014701360.htmI 'COVID-19 booster is`abysmal',only 7 percent of U.S.adults with shot.PBS News,Oct 27,2023.Accessed Jan to, 2024. ent-of-u-s-adults-with-shot 'What has been the impact of the COVID-1 9 pandemic on immigrants?An update on recent evidence. OECD Policy Responses to Coronavirus.Aug 20,2022.Accessed Jan 10,2024. https:liwwvv.oecd.org/coronavirus/policy-responses/what-has-been-the-impaLt-of-the-covid-I 9-pandemic-on-i ,M��-,,n��e-ion-recent-evidence-65cfc31 c Communities and COVID-19:Strengthening the Public Health Response.Am J Public Health. 2021 October; 111(Suppl 3): S224-S2311. 4 Hispanic, Latino and Black African Respondent Profile a Hispanic 0 Labor, 81aGKAdcam 250 Fifty-five percent of the 481 survey 200 respondents self-identified as 150 Hispanic or Latino, and 45 percent 100 identified as Black African. Fifty-three percent of 481 survey 50 respondents self-identified as EUrnicifty female, 47 percent identified as male. Female, 53 percent; Male,47 percent Fifty-seven respondents stated they 0 53%Female{255respondents} E 47pdmemMale(226raa,rmmz) 100% are naturalized citizens, 94 presented at the border and are in 75% asylum proceedings, 143 are 50% undocumented, and 187 are permanent residents. 25% 0% Gander Naturalized citizens and Immigration status permanent residents are overwhelmingly Black African Naturalized citizen refugees. In proceedings or Permanent resident at bonds, undocumented respondents are Pie primarily Hispanic/Latino. Only three respondents identified Undocumented imented English as their preferred language. Sixteen stated French was their preferred language, 237 stated Spanish was their preferred language, and 217 stated that multiple languages (such as French and Lingala)were their preferred language. Findings Summary: Jobs and Wages Below AMI Not working, Under $15, $15-20 and More than $20 N Not currently working 0 Under$151hr 0 $15-20fhr 0 More than$20 300 200 100 0 Hourly wage 86% of 481 immigrant workers do not have paid sick leave 0 414 Yes (86%) N 67 No(14%) 500 400 300 200 100 0 Do you have paid sick leave? 6 Findings Summary: Distribution of Occupations other 16 6% ineatpacking plant 256% unemployed worker warehouse worker Walmart worker domestic worker restaurant worker lJ-• 96% + hospital worker r hotel worker temp worker 77% 54% factory worker construction worker 69% 6.2% Survey respondents include: 123 meatpacking plant workers. ➢ 46 restaurant workers. s> 37 hotel workers. s 33 factory workers. s> 30 construction workers. > 26 temp workers. ➢ 22 hospital workers. 21 domestic workers. s> 12 Wal-mart workers. > 4 warehouse workers. $ 36 unemployed workers (including self-identified housewives, or'ama de casa'). > 80 other(including farmworkers, public school employees, maintenance, landscapers, etc). 7 Findings Summary: Affordable Housing Crisis More Severe for Immigrant and Refugee Workers According to survey results, 53 percent of respondents pay over$800 a month in housing, with more than 1/3rd living in double, triple, or quadruple occupancy households (including more than half of Hispanic respondents).' When controlled for hourly wages and the total number of people in each household, virtually all survey respondents qualify as low-to-moderate income, under 80 percent of the Area Median Income (AMI), with the majority under 50 percent AM16. People in household 125 100 Q 75 0 s c 0 50 a 0 a 25 0 0 1 2 3 4 5 6+ 5"In 2022, 19.1%of the population was living with severe housing problems in Johnson County, IA."according to httns:Adatauss.iolorofile/aeo/ichrison-county-ia 6 For 2023 estimates from the U.S. Department of Housing and Urban Development,see httosa/www.hudusergov/portal/datasets/home_datasets/files/HOME IncomeLmts,State IA 2023.ndf 8 Other families in house 4+ 1_._`i 3 1 99. 2 16 6% 0 65 50,o Other families in house Hispanic only 4+ /8 6°t 3 s q°E 0 44 3", 2 1 258% 9 Findings Summary: Health and Food Security Lacking Nearly one in five respondents report having at least one serious medical condition such as asthma or diabetes, including 22 percent of Hispanic respondents and 7 percent of Black African respondents (see Appendix B: Data Tables). This variance between ethnic groups is also reflected in health insurance coverage. While 53 percent of all respondents stated they do not have health insurance, 83 percent of Hispanic/Latino respondents do not have health insurance compared to just 11 percent of Black African respondents. This is likely because a majority of Black African respondents have an immigration status that allows them to work legally in industries that offer health insurance to their workers, such as meatpacking and food production. One in five respondents reported they are not able to afford groceries every week, including 27 percent of Hispanic/Latino respondents and 11 percent of Black African respondents. Twenty percent of respondents stated they do not know where they can access free food in the Johnson County community, including 28 percent of Hispanic/Latino respondents and 8 percent of Black African respondents. Twerty percent of respondents scadl tey were food insecure 96 No(20%) 0 385 Yes (80%) 500 400 300 200 100 0 Can you afford to buy groceries every week? Findings Summary: Vaccine Demand High Despite Structural Barriers Contributing to Vaccine Hesitancy Survey results show that a majority of respondents have been previously vaccinated for both influenza and Covid-19, with sixty-three percent stating they plan to get the new Covid-19 vaccine. However, structural barriers to access continue to contribute to persistent vaccine hesitancy for 37 percent of survey-takers, barriers including: 1) Cost. 2) Work. 3) Transportation, and 4) lack of information, education, and training. Survey results show a clear demand for Covid tests & vaccines Yes No Have you ever been vaccinated for COVID 19? Were you vaccinated for influenza last season? Have you heard about the new once a year COVID vaccine? Do you plan on getting the new once a year COVID 19 vaccine? Do you know whereyou can get a COVID 19 or flu vaccine? Did you arrive in the U.S. within the last 12 months? Do you want to gget signed up for free COVID 19 test kits? 0 100 200 300 400 500 Cost M Knowledge/Information Other(fear, apathy, etc) M Transportation M Work 100 75 50 25 0 Sligoill M11MM M LI —L Was it difficult for What's stopping Was it difficult for What stopped What is stopping you to get a you from having you to get an you from getting you from getting COVID been vaccinated influenza an influenza the new 191influenza forCOVID? vaccine? vaccine? COVID-19 vaccine? vaccine? Findings Summary: Top Issues Include Immigration Reform, Affordable Housing, Health Insurance, and Higher Wages When asked, survey respondents identified immigration reform, health insurance, raising wages, and affordable housing as the top issues impacting their lives. While only four percent of respondents stated they had been the victims of wage theft in the last 12 months, 90 percent reported they have never attended a workers' rights training. The nine percent of respondents who chose Other Issue were Black African refugees who stated they were not timely notified about the 2022 Johnson County Direct Assistance Program', and did not have an equal opportunity to apply for the $1,400 household stabilization program. 'For more information see Tyson Foods employees demand additional relief funds from Johnson County Board of Supervisors, Daily Iowan, November 28, 2022,accessed 1/22/24. httnsy/dailyicwan.com/2022111/2$tson-foo_ds-employees-demand-additional-relief-funds-from-Johnson-coup tv-board-o f-supervisors/ 12 - - What issues are most important to you? Raising wages Affordable housing 22 Other Health insurance 22.34, Immigration reform 24,8% - Conclusion and Call to Action: Immigrant and Refugee Workers Need jobs, Housing, and Services The Covid-19 pandemic is ongoing, and while demand for new vaccines is high, structural determinants such as housing, work, transportation, insurance, and education all contribute to persistent vaccine hesitancy. Bold public policy is needed to improve health access and address the root causes of the social problems negatively impacting essential immigrant workers in Iowa. Promoting whole worker health equity is not only the right thing to do, it is also good economics. Immigrant workers fueled the U.S. economy through the pandemic and helped grow both the labor markeO and Iowa's populations. 8 Immigration!staking pressure off the job market, experts say.CNBC,March 2,2024 http,s:l/www.cnbc.com/2024/03/02/immii!ration-taking-pressure-off-the-[ob-market-us-ecoromy-expert.html 9 New report finds immigrants are a major factor in Iowa's future growth,July 13,2023, KWWL huosWwww kwwl.com/news/dubuQue/new-report-finds-immigrants-are-a-rnalor-factor-in-iowas-futLire-grovvrh/ article f53a4c68-21 a0-1 1 ee-ae62-07393e32102e.html Recommendations for Policymakers and the Public: 1) Fully fund innovative community health partnerships to communicate the latest pandemic and public health information to immigrant and refugee workers through trusted organizations with a mass base of support in the impacted communities. 2) Rezone city neighborhoods for multi-family development and allocate remaining American Rescue Plan dollars to affordable housing and permanent suaoortive housing initiatives. Housing is one of the most important structural determinants to whole worker health equity, and the acute scarcity of affordable housing in Johnson County can be addressed with multi-family zoning and more public investment in projects to scale. 3) Pass state legislation guaranteeing paid sick leave, drivers licenses, and Medicaid for all workers, regardless of immigration status. Immigrant workers are vital to the state's economy and Iowa businesses. Paid sick leave, drivers licenses, and Medicaid for all strengthen the frontline workers Iowa depends on for essential goods and services. 4) Focus government and foundation grantmaking on dynamic, base-building projects that address the core issues of jobs. housing, education. and services to scale.The whole worker health equity survey is one of the most comprehensive datasets available to policymakers, funders, and the public clearly articulating the expressed needs and priorities of hundreds of directly impacted immigrant and refugee workers. If You Build It, They Will Come Vaccine clinics in December,January, and February co-sponsored by Johnson County Public Health and Escucha Mi Voz Iowa succeeded in vaccinating dozens of immigrant workers, including many who received a Covid-19 vaccine far the very first time. 14 Organizations with a proven track record of success a) delivering accurate and culturally competent information; b) providing transportation, interpretation, and education; and c) pre-screening for social service eligibility; can move the needle to create vaccine demand, reduce vaccine hesitancy, and connect residents with the jobs, housing, and services they need to survive. Appendix A: Census Tract Summary Maps Sixty-three point six percent(63.6%) of geocoded respondents live in just five census tract neighborhoods, including four contiguous, racially diverse, and low-income census tracts on the southside and far east sides of Iowa City, and a fifth low-income and racially diverse neighborhood in Coralville. For more information, see Appendix A: Census Tract Summary Maps. Appendix B: Data Tables from Johnson County Survey For a detailed breakdown of the entire survey dataset analyzed in this report, see the three data tables attached as Appendix A. These data tables include 1) aggregate results, and for comparison, data tables by ethnicity, 2) Hispanic/Latino, and 3) Black African. 15 Appendix A Sixty-three point six percent (63.6%)of geocoded respondents live in just five census tract neighborhoods, including four contiguous, racially diverse, and low-income census tracts on the southside and far east sides of Iowa City and a fifth low-income and racially diverse neighborhood in inner-city Coralville. 1. Census tract 18.02, which includes the mixed-density, multifamily Broadway St, Taylor Dr, and Southgate Ave neighborhoods south of Hwy 6 E and east of the river, 2. Census tract 18.01, which includes the high-density, multifamily Lakeside Dr neighborhood south of Hwy 6 E and southwest of Industrial Park Rd. 3. Census tract 104.01, which includes mobile home parks south of Hwy 6 E on both sides of Riverside Dr. 4. Census tract 105.01, which includes mobile home parks east of Scott Boulevard. 5. Census tract 3.07, Coralville north of 2nd St between 10th and 22nd Ave. Census tract 18.02 98 respondents (24.9% of geocoded respondents) F c. Census tract 18.01 42 respondents(10.7% of geocoded respondents) 1 i I _g � I I i r Census tract 104.01 42 respondents(10.7% of geocoded respondents) �I low Hills Census tract 105.01 39 respondents (9.9% of geocoded respondents) I J K. 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