On May 1^st MACDC hosted a webinar for property owners on how to identify and address lead paint in their homes and in rental units they own. The need for this webinar came out of intensive conversations with community leaders in Massachusetts Gateway Cities. The webinar featured speakers from the MA Department of Public Health, local rehabilitation agencies, lenders, and others. You can check out the recording of the webinar here (note that you can listen to the webinar in English or Spanish through this link). Please be in touch with Elana Brochin (elanab@macdc.org) or Don Bianchi (donb@macdc.org) with any questions.

Health Equity Updates, by Elana Brochin

Health Equity Committee

At our most recent Health Equity Committee meeting we continued our conversation about the intersection of Health Equity and Environmental Justice with partners from the Massachusetts Environmental Justice Round Table. The Health Equity Committee will be meeting next on Monday June 16th at 2pm. Please contact Elana (elanab@macdc.org) if you’d like to join us.

Massachusetts Healthy Homes Program Briefing

We partnered with the Massachusetts Environmental Justice Roundtable to hold a legislative briefing focused on two indoor air quality bills and funding for the Massachusetts Healthy Homes Program (MHHP). MACDC’s Director of Health Equity, Elana Brochin, and Revitalize CDC’s Assistant Manager of HRSN Healthy Homes, Aneida Molina Flores, were among the speakers at this well-attended briefing. Please see attached press release. Please contact Elana (elanab@macdc.org) if you'd like to join our next MHHP Coalition meeting.

Housing Quality and Health Equity Initiative Expanding Focus to Lynn, New Bedford, and Worcester

For the first two years of our Housing Quality and Health Equity Initiative we focused our community engagement efforts on an initial cohort of Gateway Cities: Brockton, Springfield, and Holyoke. For the next two years we will be working in a second cohort of Gateway Cities, including Lynn, New Bedford and Worcester. We are excited to be collaborating with CDCs, community members, and municipal officials in each of these cities. 

Lead Paint Webinar

The Massachusetts Association of Community Development Corporations (MACDC) is hosting a webinar for property owners on how to identify and address lead paint in their homes and in rental units they own. This webinar will be provided in an online format and will feature speakers from the MA Department of Public Health, local rehabilitation agencies, lenders, and others. The webinar is free, but registration is required.

Please note the webinar is strictly educational in nature, not regulatory. MACDC will not share the names or email addresses of registrants with anyone.

Date and time of the webinar: May 1st 6-8 pm EST

Registration link: Healthy Homes Webinar

For outreach materials (in Spanish, Portuguese, and Haitian Creole) or general questions about the webinar, you can reach out to Grace Dowling from MACDC, at graced@macdc.org

Press Release 03.27.25.pdf

On June 27th eight individuals took a trip to the Hilltowns to learn about the health related work happening out of Hilltown CDC and in the surrounding communities. This was the second time the Health Equity Committee took a trip to learn hands-on about important work going on throughout the state. This trip was largely coordinated in collaboration with Joan Griswold who is Hilltown CDC’s Rural Public Health Project Manager – big thank you to Joan!

We began the day by meeting up for a weekly walk in Cummington. This walk used one of Hilltown CDC’s walkability maps that they designed with funding from DPH’s Community Health Fund. Hilltown CDC came up with 9 maps for walks around the Hilltowns and used the creation of these maps as a jumping off point for advocacy regarding creating more walkable areas (e.g., installing crosswalks). This advocacy is being funded by MassDOT’s Complete Streets program. This walk was open to the community but aimed at elderly Hilltown residents. While safe, much of the walk was in areas without sidewalks, making clear the need for such maps. If you’re interested, you can check out the walking map here. The walking maps project was funded via a grant from HRIA (Health Resources in Action) and it has allowed engagement with partners including, Healthy Hampshire, Walk Boston and MADOT to increase the safety for all modes in the Hilltowns. A small grant from American Walks has allowed us to walk in a couple of different Hilltowns who have created the maps. Hilltown CDC held these events to encourage anyone from the town, not just elders, to come out and walk!

We then met up at Hilltown CDC in Chesterfield where we chatted a bit about their work. Dave spoke about the ways in which the Hilltown CDC has been supporting small businesses. Here is an example of one of their recent projects.

Next, we took off for Sawyer farm in nearby Worthington MA where Hilltown CDC supports a Mobile Market where we met Hunt, Director of Community Programs and Hannah the farm manager, and Lincoln, the farm owner. This farm was very rural – think no cell phone service, let alone Broadband access. We learned that the majority of Mobile Market participants are SNAP recipients and that the Mobile Market is the only establishment within about a 30-mile radius that accepts SNAP benefits. The market also has the option for customers who can afford to supplement others’ groceries to “pay it forward” as part of their transaction. Hunt said this was a popular option and allowed the community to support one another. We learned that while much of the produce comes from the farm itself, they also source from other local farms, providing an important source of income for those farms. This week they will be kicking off a home delivery service which they emphasized is unique and not to be taken for granted in the Hilltowns. The home delivery service also allows for increased efficiency because the market workers can pick up produce from local farms while making deliveries. This is important because many of the local farms are small, meaning that otherwise picking up or dropping off small amounts of produce would not be efficient for either the market workers nor the farmers. They told us that 85-90% of the profits go directly to the farmers – which is significantly higher than other models.

Still on the farm, we next trekked up to the clover fields. The clover was being used as a cover crop for different vegetables. In addition to growing vegetables, the farm is engaged in doing trials around sustainable agricultural practices. While Lincoln explained that they have been experimenting with sustainable agriculture at Sawyer for a long time, they are now partnering with other farms to investigate what this could look like for different crops, in different regions, etc. in order to scale up this work. In order to do this work, they are partnering with various universities and an organic farming organization. Lincon showed us how they had different experimental and control patches of crops to better understand the best and most sustainable technology.

As we were leaving the farm, we learned that the next visitor coming up after us was State Representative Lindsay Sabadosa who represents part of Hampshire County. She had been invited to take a farm tour to better understand and communicate the importance of maintaining state earmarks for sustainable agriculture projects, like the one we were visiting.

After enjoying lunch together, participants went their separate ways, agreeing that we were able to learn so much hands-on that we could not have learned on Zoom!

Is there exciting health-related work going on in your community? Please email me at elanab@macdc.org if you’d like us to consider a health equity field trip to your area!

“Where are you here from?” I asked the person behind me in the registration line at the National Rural Health Association’s Annual Conference, in Albuquerque, New Mexico.

“Montana,” he answered, “how about you?”

“Boston,” I said, and, noticing his confused look, I added, “I work in all of Massachusetts – we have a lot of rural areas.” After that initial conversation, I started answering “Massachusetts” to that ubiquitous question.

While I live and work in Boston, MACDC works with CDCs in communities throughout the Commonwealth, and about 17% of our members work in rural areas of Massachusetts. In fact, according to the Census Bureau, well over half of Massachusetts’ land mass is considered rural. However, my instinct to say I’m from “Boston” reveals more than the zip code where I live. My instinct indicates my association with this urban area of the state, despite my efforts to represent the breadth of urban, rural, and suburban communities in Massachusetts.

Fortunately, my attendance at the National Rural Health Association’s conference gave me the opportunity to immerse myself in the diverse experiences of residents of rural America. The following were a few themes that stuck out to me:

The Importance of Telehealth – Telehealth is a familiar concept to many of us, being well into the third year of the COVID-19 pandemic, in which many health services were delegated to the virtual realm. In my experience, a telehealth option can be more convenient than traveling to see a clinician in-person and is of course safer in the context of a highly contagious disease. At the National Rural Health Association conference, I learned how clinicians in Minnesota deliver specialized emergency care to remote areas of the state in situations where it would be impossible to deliver in-person care in time to save someone’s life. In this model, specialists connect with less specialized physicians in smaller, local hospitals to collaboratively diagnose and treat patients undergoing cardiovascular events. Learning about this use of telehealth broadened my understanding of the ways in which this technique can be used.

The Unique Mental Health Concerns – Mental health care is crucial in all geographies and takes on added challenges in rural areas. One presenter described how stigma around mental health takes on added meaning in a rural area where everyone knows each other: “People in my town know when I go to get my haircut, they will know if I am seeing a therapist!” In addition to stigma, the challenge of having enough practitioners for the residents who need care is significant in many rural areas of the country. The lack of sufficient mental health support can be particularly challenging in smaller populations where, in many cases, it can be confounded by lack of peer support, such as in the case of LGBT youth.

Challenges and Innovations in Clinician Recruitment – One challenge which I am familiar with intellectually, but which my life in Boston is often divorced from, is the challenge of recruiting physicians and other clinicians to rural areas of the country. A high patient-to-physician ratio leads to physician burnout and less physician availability. I learned about several creative solutions to this challenge. One is an effort to recruit new doctors who have not matched for clinical residencies to spend time in rural areas before re-entering the matching process. Another innovative program around the corner from my Boston office: At Massachusetts General Hospital (MGH) a number of physicians participate in 3-month rotations treating patients on a reservation in South Dakota.

Both before and during the conference, I also had the opportunity to think about how, in addition to direct medical care, social determinants of health, and in particular, community and economic development, uniquely impact rural health, and how CDCs are stepping up to meet these challenges. For example, in areas where there isn’t a tax-base for public transportation infrastructure, residents rely on services such as the Quaboag Connector, which the Quaboag Valley CDC runs in collaboration with the Ware Council on Aging and other local social service agencies. The impacts of housing type and quality on health is unique in an area like the Hilltowns of Western Massachusetts, where single-family homes predominate, creating a dearth of accessible housing for seniors and people with disabilities. Hilltown CDC addresses this issue through building and renovating homes for seniors, and through the Hilltown Elder Network, which pays local people to provide in-home chore services and transportation for low-income elders. Lower wages in rural communities mean less income available for health-supporting goods and services, like healthy foods and medication. The CDC of South Berkshire assists in mitigating this issue by providing support for small businesses. I appreciated the opportunity to connect these themes of the conference with the work in which our rural members are engaged in.

In addition to learning about these specific issues, I appreciated the opportunity to absorb myself in thinking about the unique challenges and opportunities connected with living and working in areas of the country that are less dense than the urban area with which I’m familiar. The conference highlighted the importance of creating and taking advantage of opportunities to better understand landscapes and experiences that are not a part of my everyday life – to truly “work in all of Massachusetts.”

In the context of progressive health policy, Massachusetts is an exciting place to live and work. It is well-known that in 2006, Massachusetts was the first state to mandate that each resident have health insurance – predating the Affordable Care Act by three years. Massachusetts’ role as a frontrunner in the health policy space, however, is far from limited to this one landmark achievement. Massachusetts is a thought-leader in hospital payment oversight, in addressing social determinants of health, and in hospital Community Benefits guidance. A recent Massachusetts innovation was the Department of Public Health’s (DPH) creation of the Determination of Need Statewide Fund as part of DPH’s update to its Determination of Need Regulations.

Determination of Need, or DoN, is the process by which hospitals gain approval for large capital expenditures. DoN approval requires a hospital devote funds toward programs that improve health in the community in which it is located (“Community Health Initiatives”). While this process results in much needed funding for community health programs, prior to 2017, it also meant that this influx of funding was limited to areas in which, often well-resourced hospitals, were undertaking major projects. As part of the updated regulations, DPH created the Statewide Fund into which hospitals embarking on large projects would contribute (this contribution represents a portion of the overall Community Health Initiative dollars committed by the hospital). The Statewide fund would then re-distribute to communities that had not recently benefited Community Health Initiative dollars associated with a large hospital project.

Following the 2017 update, the Department of Public Health convened an Advisory Committee to advise DPH regarding the type of programs that these contributions should fund. Along with individuals representing fourteen organizations, Joe Kriesberg, MACDC’s Executive Director, served on DPH’s Advisory council which ultimately created three funds:

• Policy, Systems, and Environmental Change Fund
• Community Health Improvement Planning Processes Fund
• Healthy Aging Fund

Because the goal of the fund is to distribute funding to areas of the state that have not recently benefited from Determination of Need investments, the funds prioritized projects that benefited communities outside of Boston that have high rates of health inequities. The following six Massachusetts CDCs received funding through this innovative fund: Lawrence CommunityWorks, VietAID, Franklin County CDC, Hilltown CDC, Quaboag Valley CDC, and Harborlight Community Partners. These CDCs, which have relationships in communities across Massachusetts, are in many ways, ideal organizations to partner with DPH in addressing health.

Check out our press release to learn more about the funds CDC projects that DPH will be funding in our press release.

Artwork: "Minerva" by April Jakubec

“Minerva” is named after the Roman goddess of wisdom and the arts. 

This portrait captures a Latina woman enjoying the outdoors as the wind blows through her flowing hair. Flowers are clustered together to form a face mask, hiding her smile, but showcasing strength in her exposed eyes. The blooms represent what good can stem from these strange and difficult times (innovation, connection, kindness, etc.). 

Women of all ages and backgrounds have strongly identified with my bright and positive portrait style, and have been able to see themselves in the pieces. I intend for this piece to show that compliance with health and safety regulations is strong, fashionable, and even fabulous.

April Jakubec's art is published through the Punto Urban Art Museum, a program of North Shore CDC. Learn more about the museum's programs and their "Free COVID Resources."

Starting in March, we began hearing story after story about ways CDCs were responding to the COVID-19 health crisis and the economic repercussions that reverberated throughout their communities. More recently, we surveyed our members to better understand the ways in which Massachusetts CDCs are responding in aggregate to this unprecedented crisis. What follows is a description of a few of the stories that we heard, as well as what we learned as a result of our Member Survey.

Back in March, we learned that many CDCs noted food security as a top concern in their communities and responded through food distribution efforts:

• Allston Brighton CDC mailed out Stop & Shop cards, so that their tenants could buy food.
• The Coalition for a Better Acre's Youth Development staff, who usually run its after-school program, became its food distribution team.
• Groundwork Lawrence launched "virtual" markets, to replace its in-person farmers market.
• Franklin County CDC responded to the crisis with a new outlet for frozen produce.

We also heard about the many ways in which CDCs are shifting their key services online, such as Island Housing Trust which held its first remote homeownership lottery via video conference. Inquilinos Boricuas en Acción (IBA) adapted its culture-driven youth workshops to an online format and turned their annual Festival Betances into an online event.

Early on we also learned that many CDCs were establishing emergency relief funds to help families with rent, food and other necessities. For example, Housing Assistance Corporation established the Cape Cod COVID-19 Workforce Housing Relief Fund to assist with past due rent, mortgage payments, and other housing-related expenses for current, year-round Cape Cod and Island residents who are losing income.  We have also been working with CDCs across the state, like Dorchester Bay Neighborhood Business Loans (DBNBL), which is serving as a resource hub for small businesses in need of COVID-19 resources and guidance.

As we moved into month five of the crisis, MACDC sought to understand the cumulative nature of the work in which MACDC members are engaged. At the beginning of July, we sent a survey to our members. You can see some of the results of the member survey on the graph below.

Number of Members providing Specified Responses to COVID-19 in Their Communities, Out of 47 Total Respondents

Our anecdotal observation that many of our members engaged in food distribution efforts was supported by the survey responses indicating that more than two-thirds of MACDC members reported providing food assistance in their communities. We also learned that more than half of CDCs worked with community members to secure assistance to cover rent, or mortgage payments and over half helped small businesses to obtain financial assistance and other support.

In addition to these responses to economic challenges in their communities, we learned that many MACDC members stepped up to help mitigate disease spread. Half of respondents indicated that they partnered with public health organizations, close to a third of respondents indicated that they connected residents to COVID-19 testing, and close to a quarter of respondents said that they provided PPE to community residents.

Massachusetts CDCs’ have succeeded in slowing the spread of COVID-19 in their communities, as illustrated in a recent New York Times article highlighting the work of the Neighborhood Developers in Chelsea. Despite Chelsea being designated as a COVID hotspot, The Neighborhood Developers only had eight reported cases which is about a tenth of the rate of surrounding community.

Beyond the efforts to mitigate physical health concerns, many CDCs engaged in efforts to reduce potential negative mental health impacts of social isolation. Eighteen out of the forty-seven survey respondents reported that they connected residents to mental health resources. Additionally, close to a third of respondents said that they had established opportunities for socially distant connectivity. These opportunities included virtual exercise and art classes, participation in the Front Steps Project, and hosting outdoor events.

We know that while every CDC in Massachusetts is stepping up to support their communities, each CDC is doing this in a unique way suited to their community’s strengths and needs. For example, just last week, we learned that North Shore CDC and the Punto Urban Art Museum recently released twenty-five free artistic educational resources to raise awareness of COVID-19 safety measures in low-income, primarily Spanish-speaking communities.

In years past, individual CDCs have had to respond to local disasters like the tornados in Western Mass in 2011 and the Columbia Gas explosions in Lawrence last year. Each time, the local CDCs rose to the occasion to help residents with emergency shelter, food and relief while also helping those communities rebuild.  Now, in the face of a global pandemic that is impacting the entire Commonwealth, CDCs across the state are showing that community development is a core component of our disaster resilience, response and recovery system.  Unfortunately, it looks like this could become a permanent feature of community development across the United States. Fortunately, CDCs are demonstrating that they are up to the challenge.

You can read about more stories from Massachusetts CDCs by checking out our Notebook archive and the special newsletter that we published in collaboration with LISC Boston featuring stories from the field.

Artwork: “Essential: Student, Worker, and Parent” by Nicole Garcia

“Essential: Student, Worker, and Parent” depicts a student, nurse, and parent struggling with the effects of the pandemic. Students during the pandemic have had to deal with learning in a new remote environment, but also teaching themselves in under resourced homes. Many students are first generation Americans causing language barriers between their parents and school. Let alone students who may not be in a safe household, learning has become difficult. Medical workers are given a great responsibility with stress and heavy loads to carry. Patients in dying need and become emotional support for their families. They risk their lives to save others and risk the families they come home to as well. Parents who lost their jobs along with a source of income for their families are scrambling to provide, leaving some parents feeling like failures due to not being able to provide enough.

Nicole Garcia's art is published through the Punto Urban Art Museum, a program of North Shore CDC. Learn more about the museum's programs and their "Free COVID Resources."

Massachusetts CDCs, like so many others, are eager to return to “business as usual” in light of eased COVID-19-related restrictions while at the same time fully committed to keep infections low and people safe. Massachusetts CDCs are rooted in the communities in which they work and therefore recognize the importance – literally and symbolically – of re-opening their physical doors. As of mid-July, over half of CDCs who responded to a survey had at least partially reopened their offices. All but two CDCs surveyed indicated that they would be open in some capacity by mid-September.

As CDCs bring staff back to their offices, they are considering how to do so in a way that considers – and does not enhance – the disparate impacts of the COVID-19 crisis. Over the last several months, we have seen how COVID-19 and the concurrent economic crisis has disproportionately affected low-income, and Black and Latinx communities. In addition to disproportionate impact by race and ethnicity, COVID has affected many demographic groups in proportionally different ways: parents and other caregivers have had to respond to school closings in a way that others have not, individuals with pre-existing health conditions have had to take even more precautions to stay healthy than their healthier counterparts, etc. As CDCs and other offices begin to re-open, they are thinking about how to reopen in an equitable way that treats all members of their staff fairly.

One CDC Executive Director that we spoke with told us that decisions around reopening can have racial implications, this ED acknowledged that one factor that was considered when creating their reopening plan was the racial makeup of the staff structure. The ED found that the staff who could more easily continue to work remotely vs the staff that had a greater reliance on in-person contact to do their work often exposed potential disparate effects across racial lines.

Another issue that CDCs must consider is how the commute to work affects risk and how different commuting patterns correlate with demographic factors. Crowded busses and trains carry more risk for disease transmission than private vehicles. While CDC employees in smaller towns and rural areas may regularly drive to work, CDCs in Boston, Worcester, and Springfield must consider how employees who rely on public transportation will get to work. Further, Black and Latinx workers are more likely to commute to work via public transportation as compared with their white counterparts, putting them at increased risk for disease. In reopening offices, urban employers could consider arranging for increased parking or reimbursement of parking costs to encourage private transportation. In his Reopening Massachusetts Report, Governor Baker urges employers to consider staggering hours to allow employees to avoid popular commute times.

Employers and Employees need to work together to determine ways in which work can be completed productively and safely and should continually apply an equity lens to decisions around reopening. One way employers can achieve this is through a hybrid model: in addition to the 70% of CDCs that said that they were open to staff on a limited basis, close to 40% of members indicated that they plan to have a mix of online and in-person programs in fall. As CDCs consider reopening their offices and holding in-person programs, they could also consider:

• Working with employees who are parents and guardians on ways they can continue to be productive while ensuring their children are cared for. Among other considerations, this could include offering a flexible work schedule for these employees as well as a stipend to buy necessary home office supplies and equipment.
• Maximizing safety for older employees or employees with pre-existing conditions or who live with others who are older or have pre-existing conditions, while developing a system to ensure sensitivity to employee privacy.
• Considering ways that disparities in income and wealth might affect employees differently, e.g., it will be harder for an employee with a lower income or less wealth to cut their hours or pay for a new childcare or transportation arrangement than for a wealthier or higher income counterpart.
• Thinking about how office set-up affects employees differently (e.g., lower-level employees are less likely to have their own offices, making social distancing more difficult).
• Investing in technology that allows employees to be as productive as possible when working remotely.
• Considering the role that the organization plays in the community – how to provide maximum benefit to community members while protecting their health and safety.

COVID-19 has exacerbated challenges that existed long before the pandemic. Let’s commit to an equitable re-opening that does not further exacerbate these challenges.