by Joan Quinlan, MPA, and Jeffrey P. Collins, MD
To grasp the depth of Massachusetts General Hospital’s commitment to the community, we must go back to the very founding of the institution in 1811 — to our roots. The document that declared the need for the hospital, referred to as the “circular letter”, was written by two young physicians and sent to wealthy citizens of Boston to ask for their financial support for the cause. The doctors declared in it, “When in distress, every man becomes our neighbor.” At the time, most rich Bostonians didn’t need a hospital — they could afford to pay for a doctor’s visit, medicine or surgery. A hospital would be utilized by the poor.
Mass General has continued this tradition of serving the underserved throughout its 200-year history. We were one of the first hospitals to offer a free pharmacy in those early years. We had one of the first dental clinics for the poor, and we had a special program for syphilis in those years, when the disease was common but those affected were often poor and considered pariahs by society at large. And we were among the first hospitals in the country to integrate social work into medicine, something now taken for granted.
About 40 years ago, Mass General established its first community health centers in Charlestown in 1968, followed by Chelsea in 1971, and then Revere in 1982, all medically underserved communities. We were not unique in that the community health center “movement,” as it were, was taking off across the country. But we were unique in establishing one of the first — if not the first — hospital-licensed community health centers in the country. Mass General underwrites the operations of these centers in a very substantial way. We are one of the region’s biggest safety net hospitals, so that before state health reform several years ago, almost 20,000 uninsured patients came to us every year. MGH is also one of the largest Medicaid providers in the state, and with reimbursements inadequate to cover costs, those losses come out of our own bottom line.
Unwaivering Commitment to the Underserved
But our commitment to serving the underserved has never wavered. That’s because of our underlying belief that all people, rich or poor, deserve access to high-quality care. Even though our services to the community abound, we continually strive to get closer and closer to that goal of healthcare equity. And as a research hospital, we have the mandate and the tools to evaluate what we’re doing well and what we could do better.
But we have always understood that the mere existence of medical services in poor communities wouldn’t alone improve outcomes in these neighborhoods; social and environmental factors absolutely play outsized roles. When a family does not have access to affordable healthy food or safe places to exercise, it is challenging to control weight. When a middle-aged immigrant can’t afford a car and doesn’t live near a bus line, how can he get to the doctor? When talking openly about a mental health problem is culturally taboo in some cultures, why would a person seek out care?
Each and every one of our programs takes these social determinants of health into account. After all, Mass General can’t control poverty, but we can partner with other institutions and communities to affect some of the health conditions around poverty.
For example, we’ve done a good job combating substance abuse among young people in Revere and Charlestown, where rates have historically been higher than average, by involving stakeholders throughout the community through coalition-building. And a new program to reduce childhood obesity takes the same approach by engaging restaurant owners, schools, town planners and more; doctors’ orders play just a small role, in fact.
We also work to reduce barriers to care. Screening for colon cancer among Hispanics was found to be lower than average — so we started a program of care coupled with outreach to turn those statistics on their head, at least in our patient group. Immigrants and refugees from developing countries, our doctors told us, didn’t always seek out care when they needed it — so our physicians, social workers and case managers are now proactively working in Chelsea to help these people navigate both cultural norms and the healthcare system to ensure they have the care they need and deserve. We really think Mass General is ahead of the curve nationally in terms of approaching medical challenges in a holistic way, and our community programs have really led the way in that respect.
The Needs of Communities Next Door
Our youth programs that focus on science, technology, engineering and math education have exploded throughout the city of Boston, and we have hundreds of students involved. Why do we do this work? Educational attainment is highly correlated with economic status which is highly correlated with health status.
It’s that simple.
But here’s our problem: while company foundations tend to appreciate our work and devote generous dollars to them, we are Mass General’s best-kept secret among individual donors. A growing number of individuals do care deeply about the global community and support treatments for malaria, HIV and other devastating illnesses in the developing world, which is truly a wonderful thing. So we would hope that the tremendous needs in communities just next door feel just as compelling and deserving once people become aware of this work.
We have some terrific programs, but there is so much more that we could be doing to bring our work to scale. We have three very ambitious goals in the coming years. One is to work toward making a measurable impact on the childhood obesity epidemic, which is disproportionately felt in low-income communities. A second is to reduce morbidity and mortality (illness and death) from cancer through prevention and early detection. And a third is to ramp up our youth programs in Boston. We hope that you can partner with us to reach these truly worthwhile goals.