Mobile Healthy Places: Ensuring Mobility & Health Justice of the Covid19 Vaccine Distribution
Imagine a world where anyone who was eligible could access a Covid vaccine within a safe, convenient, and pleasurable walking (or biking) distance of their homes? Imagine a world in which anyone was able to access critical health services in their local communities? Imagine a world in which you didn’t have to be a technology and social media mastermind to ensure your and your communities’ health and wellbeing? Well, we proposed such a world over a year ago - before Covid19 had (seemingly) hit U.S. shores - as a finalist in Ford’s CityOne Austin Challenge, which aimed to address health disparities among those most vulnerable. Unfortunately, we were not chosen.
But the good news is that this future can still (must) be reached now, via what we called “Mobile Healthy Places” - activations of under-utilized community spaces to equitably deliver health services. Essentially, they are a fantabulous mashup of the lighter, quicker, cheaper techniques employed by tactical urbanism, the limberness of food trucks, and community-driven traveling health fairs. Mobile Healthy Places are key to facilitating a more equitable, accessible, and efficient vaccine roll out.
But first, some context...
A few weeks ago, I, like many of us with older parents, was in a frenzy trying to navigate multiple technical challenges to ensure my 81-year-old mom was able to get the Covid19 vaccine. She lives in my hometown, Miami and is decidedly not digitally literate. I can barely get her to text me back or even answer her cell phone (though she’s somehow managed to figure out bitmojis?). She also doesn’t own a working computer. So when she told me not to worry, that she was waiting for Walgreens to call her to get the vaccine (um, what?), I knew I needed to swiftly step in.
After spending some quality time on Google search, I came across the Miami Dade website, where there was a dedicated page with information about where you could get the vaccine. (Great, but no way my mother would’ve been able to navigate to this page, no less decipher what to do if she did). On this page, there were several different links to venues offering up the vaccine. Some had web portals, others you had to reach via telephone, some you had to email. I was unsuccessful at securing a vaccine via any of these routes, despite multiple attempts. I was at a loss. After so many months of social distancing and precautionary measures, it was devastating that we could see the light at the end of the tunnel, and yet, logistical paralysis stood in the way of getting there.
Meanwhile, my friends’ Facebook posts were proudly displaying pictures of their older parents getting their vaccines - in Miami. While overjoyed for them, I couldn’t help but wonder what I was doing wrong. While obviously frustrating from a personal perspective, as a professional at the nexus of urban design, technology, and quality of life, I was especially indignant. The same spatial injustices and structural inequities that led to disproportionately higher Covid19 transmission, hospitalization, and fatality rates within vulnerable, marginalized communities, were now rearing their vicious heads and making it less likely that those who need the vaccine the most could access it. Thankfully, a Facebook friend who had successfully secured a vaccine for her parents coached me through the extraordinary measures she took to get an appointment.
Start following the Mayor of Miami on Twitter. She regularly tweets indicating when new vaccine slots are being released. Log on to the site of whatever facility she indicates five minutes before the release time. Start refreshing the site until the appointment link shows up. Appointments are going in less than 20 minutes, sometimes less than 10, so you cannot wait. Have all the information you need to book the appointment handy: name, DOB, email, phone number, address, and insurance info (if applicable). Only answer required questions. If you don’t get it the first time around, refresh and start over. Do not go for the first available slot. Choose the second or third available date, as earlier dates go quick. If you’re trying to book joint appointments, have two pages open side by side and refresh both.
If this sounds nuts, it’s because it IS! Can you imagine anyone in this critical age group managing to do this? Or those lacking digital prowess - at any age? It’s like you’re trying to get U2 concert tickets (purposely dating myself because we might as well be back in the 90s, without the dial-up, with how this is being managed). Nevertheless, I followed my friend’s advice, not just following @MayorDaniella, but also setting an alert for every single tweet she sent out. And it played out basically just like my friend had laid out.
While I am incredibly grateful that I was able to help my mom get a potentially life-saving vaccine, this process is not right. It’s not efficient. It’s not equitable. It’s not just. This is about more than just my mom, more than just my friend’s parents. This has been the experience for many of my family members, friends, and acquaintances, having heard multiple instances of experiences that echoed mine. And countless news accounts relay similar hurdles to accessing the vaccine, despite being in the third month of this rollout.
The thing is, it’s not just about the difficulty people have encountered getting an appointment - it’s also about getting to the appointment. Luckily, I was able to secure an appointment for my mother on a weekend, at which point my brother could drive her there. While she still drives, she’s ever more reticent to do so - as are many others her age. Access to a car should NOT be a requirement to access the Covid vaccine. A disproportionate amount of elderly, low-income people, and minorities do not have ready access to vehicles. And yet, so many of the large vaccine facilities that have been rolled out are either quite far-afield or have been designed as “drive-thru” facilities (similar to Covid testing sites). I understand that being in a car facilitates social distancing, but we must think about mobility (literally and figuratively) when we think about health. There’s never been a more poignant example that mobility is justice.
Just as with everything else, Covid19 merely serves as an unrelenting magnifier of previous wrongs, previous weaknesses, previous privilege. As I’ve mentioned before, those who were most vulnerable before Covid have disproportionately borne the burden of this virus, from who has contracted it, been hospitalized by it, been killed by it. And now seemingly who is inoculated from it.
Spatial inequities tied to Covid must, and can, be remedied. Now.
Here’s how Mobile Healthy Places can help do just that…
Again, Mobile Healthy Places are activations of under-utilized community spaces to equitably deliver health services. Below is a set of steps that help make these a reality:
Prioritize the vulnerable and marginalized
Spatially identify neighborhoods with highest concentrations of Covid19 burden, including transmissions, hospitalizations, and fatalities. Nearly all cities have access to this data. Sadly, this will map on to existing vulnerable areas, as I’ve written about before.
Make efficient use of under-used resources
Identify (an) underutilized and/or adaptable place(s) within those neighborhoods that can feasibly be “activated” into mobile healthy places, focused on Covid vaccine distribution (these can also be used for Covid testing and/or delivery of other critical medical resources). Ideally, these sites are in walkable, bikeable, or transit-accessible areas, however, many vulnerable places lack this kind of access. We believe State of Place can help with siting efforts by helping to assess the accessibility of potential locations (from a built environment perspective), as we outlined in the original Ford proposal. More here.
Act quickly, lightly, cheaply
Implement “tactical” urbanism techniques to temporarily transform these places into suitable vaccination sites, which can be employed on a rotating basis (site to site). These techniques should be applied both the site and the area surrounding it, to address issues of accessibility. These are essentially the same techniques implemented to quickly set up outdoor dining that allowed for safe, social distancing during the pandemic. Street-plans has been a leader in this regard, and have painstakingly documented such efforts nationwide. And State of Place can also help identify the specific interventions needed to increase accessibility. More here.
Meet the community where they are
Deploy community health ambassadors (focusing on existing community organizers and/or organizations with strong community buy-in and trust) to engage the community, provide information about the mobile healthy places in their neighborhood, and assist with vaccination sign-ups. I would recommend adapting Dr. Destiny’s Dignity Infused Community Engagement (DICE) technique here and/or the principles laid out in the Black Space Manifesto to facilitate this community-led process by building trust and addressing existing spatial and structurally-induced trauma that might be barriers to vaccine adoption
Institutionalize and scale the efforts
Now that the “infrastructure” has been put into place for mobile healthy places, these places can and should be used to continue to deliver critical medical resources post-Covid19 - and other needed community amenities. Moving forward, the roll-out of healthy mobile places should be based on both data-driven and community-led processes, to inform not just their siting, but also the services offered. Additionally, the objective built environment assessments (such as those conducted by State of Place) should be expanded city-wide. This street-level, urban design data should then be used to inform and prioritize investments to the public realm, especially those that have been linked to improved health outcomes, including those same comorbidities that put these vulnerable communities at higher risk of Covid to begin with (indeed, we are currently helping the City of Philadelphia do exactly this). By making investments in the areas around mobile healthy places, not only will you maximize the accessibility to needed wellness resources, but also facilitate healthy behaviors, improve health outcomes, and make vulnerable communities more resilient in the face of future threats - pandemics or otherwise. We laid this out in more detail in our original proposal.
Note that Massachusetts is currently piloting something similar, by bussing directly to senior living facilities. While this is a good start, we believe the concept of Mobile Healthy Places is more holistic, can have a farther reach, and could lay the groundwork for eradicating spatial inequities (at least around health), post-Covid.
Other pandemic-induced placemaking efforts successfully - and quickly - adapted the built environment to facilitate social activities, such as outdoor dining and the safe use of public space, and civic engagement, such as safe “voting streets.” We see a parallel, critical opportunity to leverage the concept of mobile healthy places to ensure those most vulnerable can get the Covid vaccine now, as well as access other life-saving resources post-Covid. In the past, some have (in many cases) rightfully levied critiques of some placemaking efforts as merely “cozy urbanism.” Indeed, at times, efforts around Covid “streateries” received such criticism, especially when an image surfaced of Covid “brunchers” juxtaposed with Black Lives Matter protestors. The issue is of course, not black and white (pun sort of intended) - but regardless, it is clear that mobile healthy places is an opportunity to address those criticisms, by implementing placemaking techniques to specifically tackle spatial inequities. It’s also practical, feasible, and necessary - for us all...
According to Dr. Fauci, we need anywhere between 70-85% of the population vaccinated to achieve herd immunity. We will NOT get there if our most vulnerable are forced to jump through near-insurmountable digital - and physical - hurdles to get there. If ever we needed to heed a call for “unity,” it is this one. Mobile Healthy Places are a way to indeed lift all boats…