What does a healthy community look like to you? Some people picture a community where obesity rates are low, where vaccination rates are high, but most picture a community where everyone can feel safe, active, and productive. When asked, community members tend to talk about a healthy community as one where jobs are readily available, where their voice and values are respected and appreciated, and where navigating services is simple. In 2015, the City of Worcester Division of Public Health as the lead agency of the Central MA Regional Public Health Alliance, in partnership with UMass Memorial and Fallon Health, sought to answer this question and others about the health status of the communities of Greater Worcester through a Community Health Assessment (CHA). That process revealed a number of priorities our community needs to address in order to best improve health. Some of those priorities were more immediately apparent such as substance use. Some were more complicated, like economic opportunity. Using the information that was gathered in the CHA, including the input of over 1,500 individuals who live, work, learn, or play in the Greater Worcester region, a process began to create this Community Health Improvement Plan (CHIP). A CHIP is used as roadmap for health improvement over a 3-5 year period and guides the investment of resources of not only the health department, hospitals, and health plans, but of any and all organizations that have a stake in improving health for the residents of Worcester and the surrounding communities. This CHIP for the towns of Grafton, Holden, Leicester, Millbury, Shrewsbury, West Boylston, and the City of Worcester, was developed using a 6-month planning process. Shortly after the completion of the 2015 CHA, the planning process for the 2016 CHIP began. The CHA identified 9 priority areas. Subsequently, 8 working groups were established each with 2-3 conveners who volunteered or were nominated as leaders of a four session planning process. Conveners and staff of WDPH recruited members of those groups who went through a standardized process to set actionable objectives and strategies using the data in the CHA. Once completed, the Worcester Partnership for Racial and Ethnic Health Equity convened two roundtables to assess all proposed objectives and strategies through a lens of health equity. After refinement from the staff of the Worcester Division of Public Health and members of the Coalition for a Healthy Greater Worcester, 9 overarching aims, 31 measurable objectives, and 100 actionable strategies, within the framework of 1 overarching goal and 3 core principles were finalized. A brief summary of those follow.
One Goal: Health Equity
The Robert Wood Johnson Foundation defines health equity as meaning “that all people, regardless of ethnicity, socio-economic status, sex or age, have equal opportunity to develop and maintain health through equal access to resources.” At the outset of the CHA and CHIP process, partners agreed that success in community health improvement is defined as equity, and therefore all initiatives under the CHIP must work towards this shared goal. Community members who participated in the CHA and partners alike agree that every member of the community deserves the opportunity to be healthy. To that end, health equity is not one goal among many, it is the goal.
Three Core Principles
Invest first in the community. Whether access to food, the built environment, or job readiness; over and over, the solution to many of the barriers to health appears as investing first in the community. This means that in order to improve health, jobs should be available first to those who live in the community; food should be bought first from growers from the area; and gaps in the workforce should be addressed through training and education of local residents, rather than attracting professionals from elsewhere.
Empower, listen to, and respect community voice. In every discussion of how to improve health, residents and partners discussed the critical need to allow more input from all members of the community into health-related decisions as broadly as transportation planning and school lunch menus. In order to drive an equitable and responsive public health system, community voice must be at the center of all decisions.
Eliminate gaps between services. The greatest strength of the Greater Worcester region identified through this process is the abundance of high-quality social, health, and associated services in the area. One of the most frequently cited frustrations, however, was the difficulty in navigating between these services. For that reason, a “no wrong door” approach to services is needed, meaning that when an individual presents in one place for one service, that person should be seamlessly connected to a different needed service regardless of the scope of the agency’s services.
9 Priority Areas
Racism & Discrimination. Aim: Improve population health by systematically eliminating institutional racism and the pathology of oppression and discrimination by promoting equitable access to, and use of, health promoting resources in the community, and significantly reduce the structural and environmental factors that contribute to health inequities. This priority area seeks to meet its aim by ensuring that all objectives in the CHIP specifically address health equity and by building a common language around race and racism throughout the community.
Substance Use. Aim: Create a regional community that prevents and reduces substance use disorder and associated stigma for all populations. This priority area seeks to meet its aim through environmental, systems, and policy change targeted toward reducing the use of alcohol, marijuana, nicotine, opioids, and other emerging drugs with abuse potential.
Access to Care. Aim: Create a well-coordinated, respectful, and culturally-responsive environment that encourages prevention of chronic disease, reduction of infant mortality, and access to quality comprehensive care for all. This priority area seeks to meet its aim by increasing the number of providers in the region, better coordinating services, and enhancing and expanding culturally responsive practices in clinical settings.
Mental Health. Aim: Foster a community responsive to the mental health needs of all populations, considerate of all ages and cultures, and resilient to changing environments and demographics. This priority area seeks to meet its aim by increasing the number of providers, ongoing assessment, training, and the promotion of a collaborative care model.
Economic Opportunity. Aim: Improve population health by providing all residents with opportunities to engage in meaningful work with living wages and healthy, safe, and family-friendly working conditions. This priority area seeks to meet its aim through policy change, increasing employment resources, and engaging community members in planning and decision-making processes.
Cultural Responsiveness. Aim: Enhance the capacity of health and social services agencies to provide culturally-responsive and culturally-appropriate services to CMRPHA residents to improve health equity. This priority area seeks to meet its aim by increasing culturally-responsive services such as the use of interpreters, community health workers, and broad promotion of self-assessment in providing culturally and linguistically appropriate services.
Access to Healthy Food. Aim: Ensure all people have equal access to healthful foods by building and sustaining communities that support health through investment in the growth, sale, and preparation of healthy foods. This priority area seeks to meet its aim through a combination of education about food from farm and garden to table and a targeted reduction of the long-standing barriers to accessing healthy food.
Physical Activity. Aim: Improve health for those who live, work, learn and play in the region through safe, equitable access to opportunities for physical activity, with special emphasis on youth, vulnerable, and underserved populations. This priority area seeks to meet its aim by making active transportation a safe and reasonable option for all populations.
Safety. Aim: Ensure that all residents regardless of age, race, ethnicity, class, gender identity, sexual orientation, housing situation, family status, or religion will feel safe, secure, respected and live a life free from violence. This priority area seeks to meet its aim by improving the built environment, reducing violent incidents involving youth, ongoing assessment, and increased opportunities for police to participate in community-building.
The CHIP is intended to be a living document, with adjustments and course corrections being made on an annual basis to maximize impact and success of implemented initiatives. The Coalition for a Healthy Greater Worcester, in partnership with the Worcester Division of Public Health, holds the responsibility for ensuring implementation of this Plan, though success will not be achieved without the commitment of hundreds of organizations and decision-makers. The objectives of this CHIP are intended to provide a framework for health improvement through 2020, providing a roadmap to becoming the healthiest city and region in New England by 2020.
To read the full report view it here