The health priorities CCHI focuses on are determined by community health needs assessments conducted every three years.
Substance use disorders and violence/public safety have consistently been identified as the top two issues for communities for many years. Obesity and healthy living, cancer prevention and early detection, and access to care for vulnerable populations have also been priorities along with developing the assets of youth and promoting educational attainment to protect against multiple high-risk behaviors. Most recently, housing and financial security and mobility have emerged as top concerns.
CCHI oversees more than 38 programs and initiatives focused on these health priorities. We are carrying out the work in collaboration with committed leadership and medical expertise from MGH and together with community partners who share our vision.
Specific Health Priorities include:
Having secure housing is integral to people’s daily lives, health and well-being. Studies have shown that costs linked to unstable housing include increased hospitalizations, ambulatory visits, dental procedures, mental health care and special education services for children, just to name a few. In Boston and surrounding communities, high rents squeeze low-income residents and force them to move further outside of the area, which then jeopardizes social connections and access to public transportation to get to jobs, schools and health care. At CCHI, we are working helping to connect families to resources that help them meet the demands of insecure housing (rental assistance, housing search, application help) and partnering with organizations to identify housing needs.
Multiple studies have shown that individuals who are food insecure are at an increased risk of developing chronic health conditions such as diabetes and obesity. Lack of food also influences a person’s behavioral health as it can increase stress levels and the likelihood of using alcohol and tobacco. At CCHI, we are improving the health of identified MGH health center patients, by using upstream interventions that are patient-centered and equitable, by integrating evidence-based clinical and nonclinical interventions that reduce the prevalence of food insecurity, and by expanding access to healthy foods and improving nutrition.
Financial Security & Mobility
Income influences where people live and their ability to access resources. The ability to pay for every day expenses such as food, housing, prescription drugs, and healthcare are critical to overall health and well-being. We are working with patients who have identified as financially insecure by connecting them to resources that can help them decrease their financial burdens and increase income. We also recognize the strong connection between educational attainment and lifetime health and socioeconomic status. MGH Youth Programs makes long term educational investments in the lives of young people focusing on science, technology, engineering and math while exposing them to health careers. We also provide summer jobs and employment opportunities and work with high school youth to help them prepare for and succeed in college.
Substance use has long been identified by communities as the main priority issue of concern. This includes opioids, prescription drugs and heroin, as well as alcohol, marijuana and tobacco use. CCHI supports four multi‐sector coalitions that seek to prevent and reduce substance use by working toward policy and systems changes as well as working in collaboration with community partners to deliver programming. In 2014, CCHI redoubled its community-based prevention efforts when the hospital launched a new clinical initiative on substance use disorders (SUDS). This initiative became the leading clinical priority in the most recent hospital strategic plan, the first time MGH’s clinical priorities were community driven. This comprehensive new initiative was developed jointly by the Population Health Management and Community Health strategic planning committees to transform the design of clinical care for patients with substance use disorders.
MGH Community Health Needs Assessments (CHNA) have shown an increase in community concern about adolescent mental health as well as the stress and trauma for families and adults created by the social and economic environment, particularly, poverty, immigration, racism and housing and food insecurity. Issues surrounding mental health can disrupt school performance and employment, harm relationships and lead to substance use disorders and even suicide. We are working to address youth concerns by helping to create positive relationships with adults, increase extracurricular activities, provide leadership opportunities, and help youth find the tools to address and manage the stressors they face daily. We are also working to help our communities become trauma-informed by training community organizations to adopt trauma-sensitive practices and policies.
MGH has long understood the challenges faced by our patients who are survivors of violence at home or in the community. Nationally, one in four women and one in nine men have been affected by domestic abuse. In 1997, the hospital launched HAVEN, to help survivors of intimate partner abuse— patients, employees, or members of the community—access health and legal services and social support. MGH established the Violence Intervention Advocacy Program (VIAP) to help victims of violence in the community with physical and emotional recovery and developing skills to make positive changes in their lives.
Rapid societal changes call for a diverse workforce prepared to solve complex challenges. Young people, particularly those who are low-income, have substandard educational options and lack positive role models, may have a limited vision for their goals and future careers. For many, the impact can be debilitating and contribute to health disparities. To meet this challenge, we have implemented a continuum of programs that prepare youth for futures in and beyond their neighborhoods.
Many in our communities are disproportionately affected by higher than state rates of smoking, substance use disorders, cardiovascular diseases, cancer, asthma, infectious diseases, diabetes, and other chronic illnesses. We partner with MGH health centers to deliver innovative, evidenced-based programming to reduce the impact of chronic diseases on the health of the community, reducing health disparities and improving the overall health of our communities.
Access to Care
A disparity between communities in the distribution and quality of resources leads to persistent health inequities. And as health care is increasingly held accountable for cost, we must partner with other key stakeholders and together invest more in services that address social determinants and improve health. CCHI works with the MGH community health centers in Chelsea, Revere, Charlestown and Everett to extend the reach of health care beyond the exam room with the help of community health workers (CHWs) and cancer navigators.
Patients in our communities may need to overcome barriers--fear, low health literacy, language barriers, and logistics such as transportation, child care, or getting time off from work for appointments—to obtain appropriate cancer screening and treatment. Cancer navigators provide invaluable, skilled assistance to patients with complex health and social needs, including those who are overdue for breast, cervical, colon, or lung cancer screening, or who have had an abnormal finding and need help navigating what can be complicated diagnostic services.