Q&A with Dr. Jeffrey Ecker: Community Health Today

In February, Jeffrey Ecker, MD, chief of the Department of Obstetrics & Gynecology, was named chair of the Executive Committee on Community Health (ECOCH). ECOCH works to promote community health improvement throughout Massachusetts General Hospital to ensure greater health equity across all the hospital’s work.

Dr. Ecker has a long-standing commitment to community health. During his tenure as chief of OB/GYN, he has been a leader in improving care for pregnant women affected by substance use disorders and their families. In this Q&A, he reflects on the importance of community health for Mass General today and the role it has played in the OB/GYN Department.

Q: What are the most important issues to address in community health today?

A: ECOCH has identified three areas of focus. The first is identifying and providing resources to ameliorate the social determinants of health. We are looking at things like housing, food insecurity and health literacy, and recognizing they can affect patients. It’s often said that about 20% of health care is genetics, and 80% is where you are born and live and what access that gives you to things like healthy foods, healthy environments and safe, affordable housing. The social determinants of health help us think about that systematically.

The second is about access—making sure that all patients have access to the resources at Mass General. Some of that is about bringing providers to the community, but it is also about being sure that when patients need things that can't appropriately be offered in the community, we break down barriers to their coming to the main campus. It also involves advocacy work to make sure patients have access to appropriate insurance coverage and health opportunities.

The third is about creating a system that embraces diversity. To truly provide a place where we treat patients equitably and they feel welcome. A place where employees feel welcome regardless of race or first language or sexual orientation. We want patients to find that those caring for them reflect their own diversity and bring appropriate sensitivities to their care.

Q: What does community health mean in the context of OB/GYN care?

A: For us, this is about providing care in the communities where people live. We do that by supporting care at Chelsea HealthCare Center, Revere HealthCare Center, in the North End Waterfront, Charlestown, and other communities around the state. We have been providing great multidisciplinary care for a long time, with doctors, midwives and subspecialists going out into the communities to provide care. For example, we send specialists to Nantucket so that patients there don't have to get on a boat to come see us. We provide subspecialty care out west in Northhampton, Massachusetts, so those the patients don't have to drive hours to see us.

In each of those communities, we are sensitive to the needs and challenges they face. Different communities bring different social determinants of health. We were one of the first departments to more universally and rigorously collect that information.

Different communities bring different populations with different risks and languages. We need to be willing to focus on all of that. The goal is to make sure our patients, regardless of where they live, have the best health outcomes.

Q: What has drawn you to working in community health?

A: It's very important to our faculty in OB/GYN. For many, these are the issues that drew them to medicine. It's why they're in OB/GYN. Communities are about families, and having families is OB/GYN. So my job as chief of the OB/GYN Department is to help advance the interests of our faculty and help them address important clinical needs and goals.

And, like so many groups around Mass General, there are a lot of passionate and creative individuals who are working in this space and thinking about important research, solutions and innovations. To be able to be part of that group and leverage their wisdom and experience is terrific. It allows me to connect people around the system with our faculty and vice versa!

Medicine is about providing care. And when we're talking about community health, we're often talking about individuals and groups that have some of the greatest challenges in finding care.

Q: You’ve done a lot of work to lead efforts to improve care for women with substance use disorders during pregnancy. Why is this an important issue to address?

A: For years, substance use in pregnancy was a growing problem, and now it’s very common. It is also associated with adverse outcomes in every aspect of health, including pregnancy.

A place like Mass General is about helping people with health challenges reach their health goals. What's unique about what we've done in this realm is that it's not just about a focus on babies and their health, but recognizing that for babies to be healthy, moms need to be healthy. And for babies to be healthy, families need to be healthy.

In starting the HOPE Clinic, we recognized that we really need to focus on the whole family so that everyone stays healthy. Too often, we stop focusing on a mom after the baby is born. We can use the opportunity of someone being pregnant and coming into our care to help her be healthy, to get her the best care possible and access medically-assisted therapy for substance use.

What we knew when we started the HOPE Clinic, but have now experienced in providing care for patients over the last few years, is that these patients and families have a lot of medical challenges. But by bringing together a dedicated group and working hard together, outpatient and inpatient challenges for these families really can be overcome.

Q: What else would you like to accomplish in the community health space both as chief of OB/GYN, and more broadly as a representative of Mass General?

A: Of course, we want to have a positive impact on the health of individuals in the community and the health of communities as a whole. We can do that by being innovative in the way we provide care. But it’s also important how we advocate for care and begin to think about things like anchor strategies, in which a big place like Mass General can offer job opportunities and other investments that will positively impact the health of communities.

I would look for us to grow as a place that embraces diverse populations, both as employees and as patients. Much like my job in the OB/GYN Department, I see my role at ECOCH as helping a lot of really smart, creative and passionate individuals advance their goals.