September 15, 2020

Nikhil Rao

Nikhil Rao

UNC Gillings School of Global Public Health student Nikhil Rao, along with teammates Preeyanka Rao and Raleigh Cury, won a recent COVID-19 Policy Hackathon organized by the Stanford Economics Association, the Massachusetts Institute of Technology Undergraduate Economics Association and the Business Association of Stanford Entrepreneurial Students. The team’s winning policy proposal, titled “Need for Care Navigation Program for Inmates within North Carolina Public Carceral Facilities,” called for the N.C. Department of Public Safety and Department of Health and Human Services to intervene to alleviate COVID-19 burden on one of the state’s most vulnerable populations.

“When we’re creating policies or dealing with crisis situations, it’s important to think about how we’re going to protect and uplift the most vulnerable members of our society,” said Rao. “It’s also important to realize that in a pandemic, an outbreak anywhere presents a threat everywhere.”

Data collected by The Marshall Project reveal that the prevalence of COVID-19 cases in North Carolina’s prisons is 477% higher than among the state’s total population. This establishes a greater need for COVID-19-related care in these facilities generally, and a rate of fatality among these cases that is an eye-opening 51% higher than average makes the need for patient advocacy and guidance even more clear. Incarcerated populations have an increased prevalence of risk factors and are less likely to have access to family and community support to help with care navigation. Rao asserts that their combination of vulnerability, increased likelihood of exposure and limited agency to make medical decisions create a gap in quality of care.

The team proposes to address this gap by providing access to a care navigator for all inmates in N.C. carceral facilities diagnosed with COVID-19. The proposal calls for health care professionals to provide a service that is “trauma informed, culturally competent and responsive to patient needs,” which are often complex. Through education and effective coordination, care navigation increases the likelihood that inmates’ care needs will be met and that they will have good health outcomes both during and following incarceration — which will likely impart cost savings for the state. Rao notes that though diversion and compassionate release can help mitigate risk, many will still receive care in carceral facilities.

Studies support a strong track record for care navigation. It helps cancer patients make complex medical decisions and removes barriers to care, and care navigation programs have proved cost-effective. However, few of these programs help those transitioning out of the carceral system, and none exist for the incarcerated. Though evidence about care navigation programs in carceral contexts is limited, widespread deficiencies in infrastructure and abundant need support policy intervention. Further, evidence of public will – in the existence of social movements focused on the Unite States criminal justice system along with public scrutiny – point toward their increasing feasibility.

The need is not limited to prisons and jails. Health care facilities across the U.S., overwhelmed by the number of coronavirus cases, have taken the precaution of banning visitors — meaning a side effect of the pandemic is a general absence of the care navigation typically provided by friends and family members.

“It’s important to think about the implications of care navigation for the pandemic in general,” said Rao. “It’s not just inmates; a lot of people are navigating complicated care decisions, and most people don’t have a lot of medical knowledge.”

Rao is currently seeking a Bachelor of Science in the Department of Health Policy and Management (HPM) at the Gillings School and is a senior advisor for the Undergraduate Executive Branch of UNC Student Government. He says this training gave him the tools to write a winning policy memo.

“Being a student at Gillings, particularly in the bachelor’s HPM program, equipped me with a public health lens that allows me to examine problems and systems at multiple levels and understand the relationships between them,” said Rao. “A care navigator would have to operate within a wider landscape that includes state and federal policies while being able to make personal connections with the people they are advocating for.”

To address the lack of trust in the medical establishment that exists among incarcerated populations, the team recommends user-centered design principles that engage inmates, staff and officials in developing care-navigation programs. They also suggest circumventing the difficulty of establishing public funding for the program by kick-starting it with private funding.

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