The Fresno County Department of Public Health (FCDPH), Health Literacy Initiative will improve health literacy for the target population of rural and agricultural workers living in the westside of Fresno County, with an integrated and coordinated program that contributes to evidence-based public health strategies and incorporates the national standards for culturally and linguistically appropriate services (CLAS). Fresno County is in the heart of the San Joaquin Valley, one of the most productive agricultural regions in the country. Despite the bounty of food produced in this region, rural communities in Fresno County struggle with food insecurity and other social determinants of health (SDOH). The fruits and vegetables grown in Fresno County are harvested by a predominantly Latino workforce. COVID-19 has had a disparate impact on these essential workers, resulting in increased cases of COVID-19 related illnesses, hospitalizations, and deaths. To combat COVID-19 related health disparities amongst agricultural workers, FCDPH has partnered with community-based organizations (CBOs) through regular meetings and support of a network of dedicated peer community health workers (CHWs). FCDPH will utilize Office of Minority Health (OMH) funding to build on these experiences in the development of a health literacy plan that incorporates CLAS standards while targeting rural communities and agricultural workers in the westside of Fresno County. Bilingual Spanish-English health literacy materials generated by health educators addressing COVID-19, communicable diseases, chronic medical conditions, health promotion and disease prevention, and resources addressing SDOH will be produced. This health literacy plan will expand already existing collaboration with CBOs, governmental agencies, and health care providers including federally qualified health centers (FQHCs) and hospitals caring for rural and agricultural communities in west Fresno County by standardizi
ng and coordinating the education, training, and deployment of a network of CHWs. A network of CHWs working in coordination with a centralized team of health educators will ensure appropriate distribution of health literacy materials and a `warm handoff? to community health resources. A minority serving institution will support these educational efforts.This health literacy plan will benefit from the development of a HIPAA-compliant electronic information exchange system that will be funded by alternative sources. A robust electronic information exchange will facilitate the dissemination of health literacy materials, communication, and follow-up addressing SDOH. Funding for this information exchange is not requested from OMH. This health literacy proposal has also been developed and written in coordination with a parallel proposal from the City of Fresno, with careful attention to not duplicate any funding or staffing, and is part of a broader effort to implement a comprehensive care coordination program consistent with the Pathways Community HUB model described by the AHRQ.Performance measures will be based on CLAS standards and will include scores on standardized surveys such as CAHPS, and process measures to assess access to culturally and linguistically appropriate materials at each participating organization. Long term sustainability for this ambitious but realistic proposal will be achieved by connecting health literacy programs with planned efforts to reduce disparities and address SDOH that are contained in the State of California?s California Advancing and Innovating Medi-Cal (CalAIM) program. The combination of trained peer CHWs working with dedicated health educators, coupled with an information exchange infrastructure that supports not only exchange of information but also communication and follow-up for individuals impacted by SDOH, will enable FCDPH and its partners to address the root causes of disparities and improve the health of the communities it
serves.
