Driving Change: How Johnson & Johnson Is Using Mobile Healthcare to Help Address Health Inequities Across the U.S.

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f it were any other year, Bernard Williams would have taken his favorite leather boots out from his closet and polished them for annual Mardi Gras celebrations this month. If it were any other year, Williams would have been busy doing what the 57-year-old New Orleans native says he does best: 'showing people a good, good time.'

Ever since he was a teenager growing up in the city's Ninth Ward, Williams says he wanted to work in hospitality and share with people the unique magic of New Orleans. Even after Hurricane Katrina, which devastated the city and his neighborhood in 2005, residents still came out in droves for the city's famous Carnival season.

But 2020 was unlike any year Williams has known.

In 2020, Williams buried both of his parents and attended virtual funeral services for three uncles, twos aunts and four cousins-all of whom fell victim to what he calls 'the big killer.' In 2020, Williams wasn't able to visit close friends who spent days on end in the hospital. In 2020, Williams lost his beloved job at a hotel where he had worked for nearly 20 years, showing thousands a 'good, good time.' His wife, a home health aide, took a leave from her job because she was scared to tend to high-risk patients. The couple saw a significant amount of their life savings dry up within 10 months.

It will be a while, Williams fears, before he polishes his favorite boots again.

'We all thought Katrina was hard on our community, but COVID-19 came for us even harder,' he says, remembering how his entire neighborhood was nearly underwater when the hurricane hit. At many points during the pandemic, New Orleans has had the highest COVID-19 death rate in the country. And according to an analysis from the University of Louisiana at Lafayette, more people in the state are currently on unemployment rolls and more have died than when Hurricane Katrina made landfall.

'We've risen up before ... and I would never say this in front of my kids ... but I'll admit that I'm scared,' he says as he waits in line for a COVID-19 test at Franklin Avenue Baptist Church in New Orleans East, where the New Orleans East Hospital has set up a mobile health clinic with support from Johnson & Johnson. 'Black people like me ... we are dying every day.'

The Race to Health Equity

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Free COVID-19 testing at the Franklin Avenue Baptist Church in East New Orleans

Photo: Cheryl Gerber

One of the most harrowing aspects of the coronavirus outbreak has been the disproportionate toll it has taken on communities of color in cities across the country, laying bare long-ignored structural racism within the healthcare system.

According to the Centers for Disease Control and Prevention (CDC), Native Americans and Black and Hispanic Americans are dying of the virus at nearly three times the rate of white people. Such stunning statistics are born from a web of systemic inequities, including a dearth of accessible and affordable quality healthcare, a lack of diversity in the healthcare workforce and implicit biases in the medical management of people of color.

And while the pandemic has cast a much-needed spotlight on racial disparities when it comes to COVID-19, the reality is that racially based inequities are far more pervasive. According to the CDC, Black adults under the age of 50 are twice as likely to die of heart disease as white adults. Younger Black Americans also live with health conditions, such as type 2 diabetes and high blood pressure, that are more typically found in white Americans at older ages. And non-Hispanic Black women are over three times more likely to have a maternal death than white women in the United States.

When it comes to COVID-19, there's also a lack of access to adequate testing within communities of color, where it is not uncommon to experience longer wait times and under-staffing at testing centers.

We have crucial race to health equity work planned for many years to come as part of our five-year commitment. For instance, we're focusing on making sure there's greater diversity and inclusion in clinical trials. And we're working to provide support to Black innovators in order to generate inclusive solutions. We're fully committed to help bring about change.

- Lauren Moore, Vice President, Global Community Impact, Johnson & Johnson

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Last November, Johnson & Johnson announced plans to help drive much-needed change in the healthcare industry with a commitment of $100 million over the next five years to help promote health equity solutions for people of color in the U.S. by investing in programs that provide equitable healthcare for underserved communities, forging partnerships and alliances that address racial and social health determinants and working to ensure a diverse and inclusive workforce.

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C.J. Marbley readies a mobile healthcare unit

Photo: Cheryl Gerber

'Despite COVID-19 being in the news every day, many people still don't have easy access to testing or basic education about the disease,' says Lauren Moore, Vice President, Global Community Impact, Johnson & Johnson. 'We need to go where these people are and help support them. So we've been focused on bringing mobile health units to high-density urban neighborhoods that have a high percentage of Black or Hispanic people to provide testing.'

As part of this initiative, Johnson & Johnson is collaborating with partners across the country to offer mobile testing via vans and at sites like churches and schools in underserved communities, including the Henry Ford Health System in Detroit, LCMC Health in New Orleans, Louisiana State University in Shreveport, Fort Defiance Indian Hospital Board, Inc. in Arizona (to service the Navajo Nation, which has also been disproportionately impacted by COVID-19) and Partners in Health in North Carolina and Immokalee, Florida (to provide community healthcare support for migrant workers).

'This is just one aspect of crucial race to health equity work we have planned for many years to come as part of our five-year commitment,' Moore explains. 'For instance, we're focusing on making sure there's greater diversity and inclusion in clinical trials. And we're working to provide support to Black innovators in order to generate inclusive solutions, as well as providing college scholarships to Black students who want to go into science and healthcare. These are just a few examples of how we're fully committed to help bring about change.'

How Mobile Healthcare Can Help Drive Better Health

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Kristine New, the nursing supervisor for the New Orleans East Hospital mobile team

Photo: Cheryl Gerber

In New Orleans, Williams admits that he was hesitant to get tested initially but doing so at his church, where the New Orleans East Hospital (part of the LCMC Health network) set up a mobile van clinic one recent Thursday morning, made him feel more at ease with the process.

'Honestly, a lot of Black folks don't trust the system because they've never been there for us,' he says. 'But I heard about it through the church, so I told my wife, 'Why not?' I'm still trying to convince some of my friends.'

When discussing his skepticism, Williams refers to a long history of racism in medicine that has caused irreparable damage to Black people and their communities. For example, over the past six decades, significant medical advances have resulted from research done using the cells of Henrietta Lacks, a Black woman who died of cervical cancer in 1951. But Lacks never gave consent for the cells from a biopsy before her death to be used for research. Williams also mentions the Tuskegee study, which began in the 1930s and lasted for nearly 40 years. The study, which was conducted in Alabama with the approval of the U.S. government, withheld treatment from Black men infected with syphilis.

Building trust and meeting residents like Williams where they are is what the new mobile initiative is all about, says C.J. Marbley, R.N., Chief Nursing Officer, Chief Operating Officer and Vice President of Patient Care Services at New Orleans East Hospital.

Health equity is a process and an outcome. Mobile healthcare is one way we can combat the historical legacy of disadvantage in healthcare, where too often providers are separated from the disadvantaged population.

- Pierre Theodore, M.D., Vice President, Medical Affairs, Global Public Health, Johnson & Johnson

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'A lot of the patients we see from the Black and Vietnamese-American communities are service workers, so they need to know their COVID status quickly,' Marbley says. 'This means going directly to them, so they know they're not forgotten and being ignored, which is how a lot of them feel.'

As Sarah M. Bloom writes in her award-winning memoir, The Yellow House, this forgotten area of the city is not found in history-telling or tourism books about New Orleans: 'Mentions [of New Orleans East] are rare and spare, afterthoughts. There are no guided tours to this part of the city, except for the disaster bus tours that became an industry after Hurricane Katrina, carting visitors around, pointing out the great destruction of neighborhoods that weren't known or set foot in before the Water, except by their residents.'

New Orleans East Hospital opened in 2014 on the former site of Methodist Hospital, which was destroyed by Hurricane Katrina. Since last summer, the hospital's mobile nursing team has set up shop at churches, colleges and other locations in New Orleans East to offer free testing. With Johnson & Johnson's support, the hospital has also outfitted two vans that provide rapid testing with results in just 15 minutes. Marbley says they also hope to use the vans well after the pandemic to provide basic primary care services in underserved neighborhoods.

'Health equity is a process and an outcome,' says Pierre Theodore, M.D., Vice President, Medical Affairs, Global Public Health, Johnson & Johnson, who is spearheading the company's mobile health clinic program. 'Mobile healthcare is one way we can combat the historical legacy of disadvantage in healthcare, where too often providers are separated from the disadvantaged population.'

Partners in Health, one of the organizations that Johnson & Johnson is partnering with to offer mobile health testing in Florida and North Carolina, has done significant work in Haiti, where Dr. Theodore's family is from. 'I'm extremely passionate about reaching minority and indigenous communities who are underserved by medical systems,' says Dr. Theodore, who oversees the mobile van initiative. 'We must address the legacy of health disparity in the United States.'

While Dr. Theodore says there are of course limits to mobile healthcare, he's hopeful that mobile screenings and primary healthcare services through the program can help provide preventive care and thwart more serious diseases from developing. 'For instance, it wouldbe near-impossible to do a heart transplant in a mobile unit, but many of the factors that lead to heart disease, like nutritional management and lack of access to of primary care that could identify determinants to disease, can be addressed with mobile healthcare.'

Kristine New, the nursing supervisor for the New Orleans East Hospital mobile team, says being in and of the community is absolutely essential. 'They need to see us healthcare workers, who often don't look like them, as a part of the community and gain their trust because feelings of neglect are still so strong.'

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Darlin Rodriguez and her son

Photo: Cheryl Gerber

For his part, Fred Luter Jr., pastor of the Franklin Avenue Baptist Church, has been encouraging his congregation to get tested. 'COVID-19 is tearing us apart, worse than Katrina. This neighborhood has been hit so badly, so every bit of support helps.'

When 23-year-old Darlin Rodriguez moved to New Orleans a few years ago from Virginia, she hoped for a better life for her and herself and her 4-year-old son. With no health insurance, Rodriguez says she rarely sees a doctor, but after working a long shift at a restaurant, she came down with a fever. When she heard that New Orleans East Hospital had set up a free mobile clinic at the church through a friend's social media post, she rushed over with her son during his lunch break from virtual kindergarten classes.

'I have to stay healthy for him, because I'm all he has,' she says, fighting back tears. 'But that also means I have to work to pay for food and clothes. The risk is high in restaurants because people don't always wear masks.'

Her son watched cartoons on her phone as she got tested. If she tests positive, she says she will likely be out of work for two weeks and will be forced to convince her landlord to accept a late payment for rent.

'In church, we pray for a light at the end of a tunnel,' she says, guiding her son back to a car she borrowed from a neighbor to get them to the testing site. 'I hope we see it soon.'