We think of going to doctors and taking medicine as things we do to maintain our health. But as much as 80 percent of what affects health is determined by social and economic conditions where we live and work, says Joan Quinlan, MPA, vice president for community health at Massachusetts General Hospital. “Poverty is a major hurdle to health,” she says.
“As much as 80 percent of what affects health is determined by social and economic conditions where we live and work.”
The MGH Center for Community Health Improvement (CCHI), which she directs, was founded 20 years ago to partner with low-income communities the hospital serves, including Charlestown, Chelsea and Revere, where MGH has health centers. Together with these and other communities, they’ve been addressing some of the nonmedical factors that shape people’s health, such as access to healthy foods, substance use and education.
“We don’t have all the answers, but we’ve made great progress,” Ms. Quinlan says. CCHI runs more than 30 community programs that tackle such hurdles to health as substance use disorder, obesity and domestic violence, to expanding educational opportunities for youth as a path out of poverty. She cites reductions in teen alcohol use and increases in healthier eating and physical activity in these communities as notable examples of progress.
CCHI works alongside community leaders. They identify and update priorities by surveying community members every three years.
An Award-Winning Coalition
For example, when teen alcohol use was identified as a concern in Revere, CCHI convened what became an award-winning coalition called Revere CARES. The coalition unites police, government and school leaders, local business owners, physicians, church leaders, parents and teenagers themselves—all who have a stake in helping teens make healthier choices. Teen alcohol use is down in Revere and continues to drop annually, Ms. Quinlan reports. As with all their programs, CCHI provides staff expertise, ideas from academic literature, assistance in grant-writing and follow-up to assess if community health programs are succeeding.
CCHI runs more than 30 community programs that tackle such hurdles to health as substance use disorder, obesity and domestic violence, to expanding educational opportunities for youth.
Other programs address the obesity epidemic. Nationally, one in every three youth between ages 6 to 19 is overweight or obese. In Chelsea, 48 percent of school children are overweight or obese and in Revere, 44 percent are. Since 2011, CCHI-inspired programs have helped high school students in Revere and Chelsea steadily increase their physical activity and eat healthier foods.
Chelsea schools, for example, now have “bursts of activity,” announced during the day, when students get up and move around. “The superintendent of schools is committed to the program, believing that it will ultimately improve concentration and boost academic achievement,” Ms. Quinlan says.
Community Health and Education
Other efforts aim to create a healthier environment, where people can safely exercise and find affordable, healthy foods. Their efforts have resulted in local cities and towns building walking and bike trails, starting community gardens where people can grow their own vegetables, and farmer’s markets. Corner stores that didn’t before now carry healthy foods.
Charlestown, Chelsea and Revere have all identified substance use as their priority issue. Among older teens and adults, heroin and prescription drugs are serious problems. In 2012, heroin and other opioid overdoses contributed to 2 to 11 deaths in these communities. “Substance use is a treatable disease, but we want to stop it before it starts,” Ms. Quinlan points out.
Another CCHI strategy is to foster interest in health and science careers among the youth in Boston, Chelsea and Revere. Low educational attainment predicts low economic status, the strongest predictor of health.
“We view it as a way to promote educational attainment as a pathway out of poverty,” Ms. Quinlan says. CCHI works with about 650 kids each year, grades 3 through college, providing activities, employment, mentoring and scholarships related to science, technology, engineering and math (STEM).
Low educational attainment predicts low economic status, the strongest predictor of health.
A More Holistic View
CCHI also works directly with vulnerable populations of people, such as those who are homeless, immigrants or refugees. Chelsea, for example, is a hub for immigrants and refugees. Using community health and outreach workers, “we help connect people to medical care and to housing or other things that may be affecting their health,” she says.
A program for new moms in Chelsea provides home visits to help them bond with their babies, reduce parental stress, and promote healthy childhood growth and development. Almost all moms demonstrate parenting competency after completing the program.
With pressures on the health care industry to reduce costs, health improvements in the community are critically important. “If only 20 percent of health is related to what happens within the walls of a hospital, then we have to take a more holistic view of these other factors contributing to health,” Ms. Quinlan says. “I view this as a tremendous opportunity to have a big impact on people’s health.”
If you’d like to learn more about the Center for Community Health Improvement and how you can help further its progress, please contact us.