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Chelsea has established multiple programs and strategies to help patients navigate the complex health care system, reduce disparities, improve access to care, address high rates of obesity and work within the community to address environmental factors leading to substance use and its public safety implications.
Home to a large population of immigrants and refugees, Chelsea is a small, culturally-diverse city whose local economy is largely defined by its proximity to Boston and Logan International Airport. Chelsea has long been a gateway city for immigrants from countries in Central America and refugees fleeing countries devastated by war and poverty including Bosnia, Somalia, Afghanistan, Iraq and Northern and Western Africa. In Chelsea, 46% of residents are foreign born and more than 58% speak a language other than English at home. The diversity in culture and language requires community resources to be responsive, culturally and linguistically competent, and highly accessible.
Recent economic development and capital improvement has lead to an influx of new businesses and services. However, poverty levels still are higher than twice the statewide average. Mortality rates for heart disease, diabetes, and stroke also are significantly higher, and violent injury rates are more than triple the state average.
To assess previous effectiveness and to identify emerging challenges, CCHI conducted a community health assessment in Chelsea during 2012 to 2013. Data was collected from the U.S. Census, MA Department of Education, MA Department of Public Health, the police department and community-based organizations. Under the guidance of the Chelsea Assessment Committee, a Quality of Life survey was distributed in multiple languages and completed by 959 residents. Ten focus groups were held in the city.
Based on the assessment, committee members believed the largest impact could be made in the community if stakeholders could collectively work together to address one issue, and recognized that focus on one issue could have a positive effect on many others. Given the overwhelming data supporting substance abuse and public safety as areas of concern, the assessment committee chose substance abuse and the effects it has on quality of life with a focus on crime and safety as their top issue. Often more than one strategy is needed to impact health and one strategy impacts various health outcomes, thus Chelsea will address substance use by working in multiple domains in the community and work on strategies that have the largest health impact.
Addressing barriers to careTo improve access to care and reduce racial and ethnic disparities, multiple programs offer “wrap-around” services that help patients navigate the complex health care system and address barriers to care ranging from linguistic differences to transportation and child care needs. The MGH Chelsea HealthCare Center also serves as a Refugee Health Assessment site, providing a variety of services to help refugees access health care and successfully resettle.
The Healthy Chelsea Coalition, with wide representation from across the city, was awarded an ACHIEVE (Action Communities for Health Innovation and Environmental Change) grant from the CDC to provide technical assistance to engage in a comprehensive needs assessment and develop an action plan to improve access to healthy and affordable food and physical activity. Programs addressing issues of violence aim to nurture healthy family relationships, respond immediately to family violence to minimize the psychological impact on children, and provide direct services to women experiencing violence.
In addition to addressing Chelsea’s priority health needs, MGH also works to meet the basic health care needs of the Chelsea community. The MGH Chelsea HealthCare Center provided comprehensive primary and specialty health services to its patients. The Community Health Improvement office at MGH Chelsea is often the first stop for patients arriving for appointments who, upon arriving for appointments, also seek medical interpretation services, assistance with navigating health care, and the general support and comfort they may need in caring for their own health. Staff is welcoming and representative of the patient population of MGH Chelsea, and includes members from countries such as Brazil, Nepal and Bosnia; African countries including Rwanda, and Somalia; several Arabic-speaking countries; and numerous Latin American nations.
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