I’ve spent a lot of time in this column talking about health disparities.
Higher rates of COVID-19 in Latino communities. Higher levels of pollution leading to asthma and illness in communities of color. A history of medical racism leading to distrust of vaccines. A dearth of culturally appropriate mental health care providers.
We often talk about health care systems that are not set up to serve marginalized communities, but rarely do we talk about what could be possible if we looked beyond current paradigms and imagined something different.
Imagining something radically different is the vision of the Tubman Center for Health & Freedom. Launched in 2020, the South Seattle-based nonprofit believes it is not enough to address health at an individual level, you also must go further upstream to change the social determinants that lead to poor health in the first place.
Danisha Jefferson-Abye, founder and chief operating officer of Tubman Health, said the goal is to build a health care system that first listens to the community and then centers the needs of marginalized people.
“In every aspect of health care delivery, we’re going to flip it and examine it and re-imagine it,” Jefferson-Abye said. Examples range from how electronic health records are managed and how appointments are scheduled to the look and feel of exam rooms and what is included in an annual exam.
To serve its goal, Tubman Health is in the design phase of planning for a health center slated to open in 2025. The center will include a 25,000-square-foot health clinic and a research arm, as well as a home base for community programs to change systems and advance health for marginalized communities. The organization was recently allocated $4.5 million from the Legislature for the purchase of land for the center. The clinic will be the only one in the region that is independent, Black-led, Black-run and serving all ages.
In her many years of community organizing, Jefferson-Abye said she has never seen the level of “momentum and energy” that she has seen around Tubman Health. While some might want the clinic to open sooner rather than later, the founders are approaching the project deliberately and carefully, to ensure they are truly “operationalizing our mission.” The planning process includes community visioning, design labs and service simulations.
One of Tubman Health’s programs illustrates its unique method. I first came across the “Blaxinate” COVID vaccination clinic at the Juneteenth celebration at Seattle’s Jimi Hendrix Park last year and wasn’t quite sure what I was seeing.
There were comfortable couches, chairs, plants, music, snacks, water and people greeting and welcoming visitors into the space. It looked nothing like the sterile and institutional community centers where I got my vaccines.
All of that was by careful design.
Knowing that generations of medical racism had created distrust around vaccines — particularly in the Black community — the Blaxinate team offered a safe, welcoming environment for people to get vaccines as well as ask questions about it.
The “VIP lounge” approach literally centered patients in the space. Instead of the typical routine where vaccine recipients go from one booth to the next, the Blaxinate clinics allow patients to stay in one comfortable spot while their clinical partners moved around to serve them where they were. They even found ways to put sharps containers out of sight, so that those who were nervous about shots weren’t fearful.
Jefferson-Abye said Tubman Health has held more than 20 clinics so far and provided hundreds of vaccines. In the process, she said, it received feedback from clinical partners who said, “Wow, we didn’t know it could be done like this, we should have been doing it like this the whole time.”
Barbara Baquero, an associate professor of health systems and population health at the University of Washington, said efforts like Tubman Health to transform systems are critical if we want to change outcomes. “Health disparities are produced by the oppression and the structures that we have,” she said.
“What I’m excited to see of this different model is that intentionality,” Baquero said of the design and planning process that put the reins in community hands. “Staying there for the long run like this. This is going to take generations to change the way that we think about health.”
Inequitable systems didn’t happen overnight and won’t change overnight. But organizations like Tubman Health can help create a model for disrupting the failed status quo, city by city, community by community.
“The solution lies with us. We have the knowledge within our communities,” Jefferson-Abye said. “We need it resourced, so that we can build an alternative.”