Delivering Healthcare in Unlikely Places

Fabric Health is, you might say, working to do its part to wash away health disparities by offering residents in Philadelphia, access to healthcare services at laundromats. The idea behind Fabric Health is to “meet busy families where they are,” says co-founder Courtney Bragg, MBA.

Along with washing and drying their clothes, customers at five Philadelphia laundromats have been able to sign up for health insurance, get a mammogram, undergo a skin cancer screening or get a blood test for liver cancer or hepatitis B. Braggs says laundromats are “de facto community centers,” as many customers show up weekly to wash their clothes.

Fabric Health is one of a number of efforts that move healthcare communication and some service delivery to unusual settings. Other groups have found ways of using barbershops and churches.

Bragg and co-founder Allister Chang were introduced by friends over a year ago. They had both spent a lot of time at laundromats, and together, they dreamed up the idea for Fabric Health, a for-profit social impact startup. They then spent time talking to healthcare leaders to “understand their pain points,” Bragg says.

Bragg has experience in education and healthcare, and Chang is a member of the Washington, D.C., State Board of Education and has worked with various nonprofits, including four years as executive director of Libraries Without Borders. Over the years, the pair had gotten to know Brian Holland, co-owner of The Laundry Café, and they launched Fabric Health out of The Laundry Café’s five locations in North and West Philadelphia. The founders received grants and investments to start their venture.

Before launching, they visited laundromats and talked to people as they helped them wash and fold their clothes. “You can’t just parachute in and parachute out and expect people are going to trust you and talk to you,” Bragg says.

If healthcare inequity is the problem, then Philadelphia is a good place to test solutions. The city is the poorest large city in the United States. One in 4 of Philadelphia’s households lives below the federal poverty line.

The Fabric Health founders learned through their discussions with healthcare experts that more than 100,000 Philadelphians did not have health insurance. One of their first moves was handing out flyers to laundromat customers, asking whether they knew anyone who was uninsured. Bragg and Chang also directly talked to people — and got an earful amid the din of the washers and dryers. So, they connected with Pennie, the state’s health insurance marketplace, to provide information and help laundromat customers sign up for health insurance coverage.

Consumers are “inundated with information” about insurance, Bragg says, but they don’t know how to sort through it. Bragg and Chang recognized an opportunity to introduce Pennie to the uninsured and answer people’s questions. They even got Pennie’s Executive Director Zachary Sherman to attend an in-person question-and-answer session at the laundromat.

Sherman says he welcomed the chance to connect with those who may not be aware of their insurance coverage options. “Disproportionately, they tend to be in communities of color. They tend to be lower income,” he says. Many of the uninsured qualify for Medicaid or for coverage through Pennie at low or no cost, Sherman explains. Taking advantage of the time people have on their hands at a laundromat is a “really cool (and) interesting idea,” Sherman says.

Bragg and Chang also connected with Jefferson Health, a large health system that competes with Penn Medicine in the Philadelphia market. Jefferson Health has an RV that is equipped to do mobile cancer screenings, including 3D mammograms. With the RV, Jefferson Health has offered free mammograms and other cancer screenings at Fabric Health locations.

Amy Leader, Dr.Ph., M.P.H., an associate professor of public health at Thomas Jefferson University who leads the mobile cancer screening efforts, calls the RV “one of our crown jewels,” allowing the health system to do screenings at at libraries, churches and community centers. — and laudromats.

Fabric Health has started to expand. With a $500,000 grant from the Richard King Mellon Foundation, it is going to open up business in Pittsburgh.

Barbershops and churches

In 2019, The University of Texas at Austin School of Nursing, with support from the city of Austin, began providing mental health and wellness care at two Black churches in a program called African American Mental Health and Wellness Program (AMEN). Part of the goal is to combat the stigma surrounding mental health issues in the Black community. Initially, the program provided training for pastors who “sometimes felt ill-equipped to handle” church members with mental health issues, and they received information on when and where to refer people for further care, explains Jacklyn Hecht, managing director of the project.

When COVID-19 hit, the program became remote. As many people were left feeling isolated at home, the nursing school worked with the pastors to develop an outreach program. Healthcare workers also called congregants to see how they were faring. “With (COVID-19), no one has been immune from having some kind of mental health stress,” Hecht says.

“Members just wanted to talk,” says Angela Bigham, a community health worker the University of Texas, who is involved with AMEN at her church, Rehoboth Baptist, in Austin. If people were troubled, the pastor would be notified so he could reach out to them.

The university also set up mobile COVID-19 vaccination clinics at the churches, and church members were encouraged by their pastors to get vaccinated. “If they see someone they know and trust, they follow,” Bigham says.

Over time, AMEN has added discussion sessions and classes on topics such as grief, loss, racism, mindfulness and nutrition. Bigham’s church has a community garden where they offer tours to teach visitors about the food they grow and its nutritional value. AMEN aims to “build infrastructure within the church and sustain the program,” Hecht says.

Stephen B. Thomas, director of the Center for Health Equity at the University of Maryland School of Public Health in College Park, founded Health Advocates In-Reach and Research (HAIR). The program focuses on training Black barbers and hairstylists so they can offer customers health education and connect them with medical services. Why barbers? “They have the trust the medical community has lost,” says Thomas.

The HAIR program is now up and running in three Maryland counties. One program, supported by a grant from the state of Maryland, involves barbers and hairstylists who provide COVID-19 education and host vaccination events. Thomas received a call from the White House this past year, requesting the HAIR program be part of an initiative to recruit Black barbershops and salons to be part of a national vaccination campaign. The barbers and stylists involved with HAIR also promote and support screenings for colorectal cancer and other conditions. Televisions in the shops feature health programming.

“The message is important, (and) so is the messenger. Trust matters,” Thomas says.

Susan Ladika is an independent journalist in Tampa, Florida, who covers healthcare and business.