Diagnostic Justice in Little Haiti: Why Early Diagnosis Is a Public Health Intervention
By Theresa Alphonse, DrPH Candidate, Rollins School of Public Health
When we talk about health equity, we often focus on access to treatment. But what happens before treatment? What about the critical moment when someone first recognizes that something is wrong, seeks care, and receives a diagnosis?
For many communities, particularly Black immigrant communities like Little Haiti in Miami, this pathway to diagnosis is riddled with barriers that delay care, worsen outcomes, and perpetuate cycles of preventable suffering. Diagnostic equity isn't just about clinical accuracy. It's about ensuring that every person has the knowledge, resources, and support to recognize symptoms early and navigate to timely care.
The Power of Early Diagnosis
There is profound power in knowing what's happening in your body. When birthing people understand their delivery options, they can make informed decisions that reduce unnecessary cesarean sections. When someone recognizes the early warning signs of hypertension, lifestyle changes can prevent the disease altogether. And when a person knows that numbness in their hands could signal a serious condition like transthyretin amyloidosis, they can seek diagnostic testing before irreversible organ damage occurs.
But knowledge alone isn't enough. The real power comes from being equipped to act on that knowledge, with support, guidance, and trusted navigation through often-complex healthcare systems.
Early diagnosis means:
Fewer emergency room visits
Lower healthcare costs overall
Better disease management
Reduced mortality
Most importantly: restored agency and dignity
Why Little Haiti?
Little Haiti is one of the most culturally vibrant Black immigrant neighborhoods in the United States. Home to approximately 34,000 residents, 74% of whom identify as Black, this community has built an extraordinary ecosystem of cultural institutions, small businesses, churches, and community centers over the past 70 years.
Yet this same community has endured structural neglect, political disenfranchisement, and racist public health narratives. During the early HIV/AIDS epidemic, inaccurate disease associations perpetuated violence toward Haitian communities. U.S. political and economic involvement in Haiti has shaped migration patterns and created vulnerabilities that persist in the diaspora today.
These historical traumas continue to shape trust, access, and perceived safety within the U.S. healthcare system.
The Numbers Tell a Story
Median household income: $25,000 (far below county and state averages)
English proficiency: Only 13% of residents report speaking English "well"
Linguistic backbone: Haitian Creole is the language of storytelling, proverbs, and community wisdom
Maternal mortality: Black women in Florida die at nearly four times the rate of white women
Haitian immigrants face significant linguistic and structural barriers that impede timely diagnosis. These barriers intersect with well-documented racial inequities: Black adults experience higher rates of delayed diagnosis and worse outcomes in chronic diseases like cardiovascular disease, diabetes, and rare conditions such as amyloidosis.
Little Haiti represents not just a geographic space, but a population disproportionately impacted by diagnostic inequity.
The Know-Do Gap
Here's what we know from evidence:
Community Health Workers (CHWs) dramatically improve health outcomes
Doulas reduce maternal morbidity and improve birth experiences
Culturally tailored, language-concordant education increases comprehension and trust
Warm handoffs between community and clinical systems prevent patients from getting lost
Here's what we don't see:
These models systematically applied to diagnostic pathways for Haitian immigrants
Early symptom recognition education reaching the communities most at risk
Trusted navigators helping people move from "something feels wrong" to "I know where to go for help"
This is the know-do gap that implementation science seeks to close.
A Community-Powered Solution
What if we embedded diagnostic education and navigation support directly into the places where people already gather, feel safe, and build community?
The Community-Powered Diagnostic Navigation Hub is designed to do exactly that, partnering with trusted institutions like Notre Dame d'Haiti Catholic Church and Sant La Neighborhood Center to:
1. Educate in Haitian Creole
Not just translated materials, but culturally grounded health information that uses the language of proverbs, storytelling, and familiar framing. Information presented in ways that honor how people actually learn and communicate.
2. Train Community Health Workers & Doulas
CHWs serve as cultural brokers who understand the language, norms, beliefs, and daily realities of the community. Doulas provide ancestral knowledge and advocacy for birthing people. Together, they bridge the gap between community contexts and clinical pathways.
3. Create Warm Handoffs
Structured referral processes with follow-up support ensure people don't get lost between community screening and clinical evaluation. CHWs accompany patients, providing confidence and reducing anxiety about engaging with health systems.
4. Build Sustainable Coalitions
Notre Dame d'Haiti, Sant La, Jackson Health System, and the University of Miami work together through quarterly meetings, shared protocols, and accountability structures that prioritize community voices.
The Pathways from Barrier to Outcome
Mistrust of healthcare systems → CHW-led education in Haitian Creole → Increased trust and comprehension → Earlier symptom disclosure and care-seeking
Low symptom recognition → CHW/doula training with culturally tailored materials → Improved ability to identify warning signs → Increased early referrals
Fragmented referrals → Warm handoffs with structured workflows → Clear expectations and documentation → Higher completion rates, fewer people lost to follow-up
Navigation anxiety → CHW accompaniment during appointments → Increased confidence and self-efficacy → Greater adherence to recommended evaluations
Goals That Center Community
By June 2030, this intervention aims to:
90% of Notre Dame d'Haiti parish members will have received culturally tailored education on early warning signs of key chronic conditions
70% of women engaged in parish programming will be connected with a church-based doula or CHW for perinatal health navigation
70% of parish members with chronic or rare disease symptoms will be connected to clinical evaluation pathways at Jackson Health System
These aren't just numbers, they represent individuals who gain the power to recognize what's happening in their bodies, understand what it might mean, and know exactly where to go and who will support them.
Why This Matters Beyond Little Haiti
Diagnostic inequity isn't unique to Little Haiti. It affects immigrant communities, communities of color, and economically marginalized populations across the United States. But Little Haiti shows us what's possible when we:
Center community wisdom rather than extracting from it
Build on existing trust rather than starting from scratch
Invest in community members as experts and navigators
Address structural barriers while honoring cultural strengths
Commit to sustainability rather than short-term projects
This model, grounded in implementation science frameworks like CFIR (Consolidated Framework for Implementation Research), EPIS (Exploration, Preparation, Implementation, Sustainment), and ERIC (Expert Recommendations for Implementing Change)—can be adapted for other communities experiencing similar diagnostic delays.
Toward Diagnostic Justice
Diagnostic justice means that early detection and timely care are accessible, understandable, and culturally aligned for everyone, not just those with privilege, resources, and proximity to power.
It means restoring agency to communities that have been systematically excluded from health-promoting knowledge and navigation support.
It means recognizing that diagnosis is not just a clinical moment—it's a public health intervention that requires community engagement, cultural humility, trusted relationships, and sustained investment.
In Little Haiti, we have an opportunity to demonstrate what diagnostic justice looks like in practice. With the right partnerships, resources, and commitment to community power, we can build pathways that have long failed Haitian families—pathways that lead to earlier recognition, timely care, and ultimately, healthier, thriving communities.
Theresa Alphonse is a DrPH candidate at Rollins School of Public Health, where her work focuses on implementation science approaches to health equity in immigrant communities. This blog post is based on her implementation science project, "Diagnostic Justice Pathways in Little Haiti."
Interested in learning more about this work or exploring partnership opportunities? Connect with the author or share your thoughts in the comments below.
References & Further Reading
Behforouz, H.L., et al. (2004). From directly observed therapy to accompagnateurs: Enhancing AIDS treatment outcomes in Haiti and in Boston. Clinical Infectious Diseases.
Kozhimannil, K.B., et al. (2013). Doula care, birth outcomes, and costs among Medicaid beneficiaries. American Journal of Public Health.
Saint-Jean, G., & Crandall, L.A. (2005). Utilization of preventive care by Haitian immigrants in Miami, Florida. Journal of Immigrant Health.
Viswanathan, M., et al. (2010). Outcomes and costs of community health worker interventions: A systematic review. Medical Care.