“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.

On June 12^th, Mayor Walsh declared racism a public health crisis in Boston and announced that he would reallocate $12 million of the Police Department’s overtime budget to fund programs to reduce racial disparities, including $3 million on public health initiatives. This $3 million was reallocated to the Boston Public Health Commission in the Mayor’s final budget, which passed on June 26^th.

Declaring racism as a public health crisis is a bold statement. It echoes growing awareness in the public health community that racism itself is a major social determinant of health. At the same time, I wonder what exactly this declaration can do to accelerate change since others in the city and the state have previously established the connection between racism and public health.

The Boston Public Health Commission (BPHC) is an independent public health agency which is governed by a board appointed by the Mayor of Boston. According to their website, “BPHC has been committed to racial justice & health equity in Boston since 2000.” In 2019 BPHC made ‘Racial Justice and Health Equity’ its priority in its strategic plan.

Massachusetts has additionally recognized racism as a public health issue in several ways. In 2017 as part of the Massachusetts Department of Public Health’s (DPH) revisions to their Determination of Need regulations, DPH created a Statewide fund of which the intersection of racism and public health as a defining characteristic. MACDC served on the fund’s advisory task force that recommended this focus on racial equity. Applicants to the fund were required to articulate how their project works to dismantle “policies, systems, and social/physical environments that are historically based in structural and institutional racism and other forms of oppression.” According to the Department of Public Health, “these forms of oppression need to be understood and disrupted to eliminate health inequities.”

Building on the Department of Public Health’s Determination of Need updates, the Massachusetts Attorney General clearly identified racism as a public health issue in her updated Community Benefits Guidelines for hospital in 2018 (MACDC also served on this Advisory Task Force!). Citing the BPHC (again – which has a board appointed by the Mayor of Boston), the Attorney General declared that racism both has an independent impact and also impacts other social determinants of health. The Guidelines recommend that “hospitals and HMOs should consider this framework and continue to recognize and address the role that racism and institutional bias play in impacting health outcomes in their communities.”

So, what is new about the Mayor’s announcement? First of all, an announcement from the top City official is an important statement – even if it’s one that reiterates something that’s been said before. It’s also important the Mayor’s term “Public Health Emergency” connotes appropriate seriousness and urgency. This is particularly noteworthy in the midst of another public health crisis – the COVID-19 pandemic. By using terminology that evokes this international crisis, the Mayor is signaling the importance of acknowledging the profound impact of racism on population and individual health. Lastly, it is important that this is a statement that is coming from a non-public health entity nor from explicit public health guidance. Mayor Walsh’s announcement makes clear that it is not just the people who think day-in and day-out about population health who are making the connection between racism and health. I hope that the Mayor’s declaration will influence people at all levels of government, across all industries and sectors, and across demographics to recognize this connection. Additionally, all levels of government, as well as hospitals and other healthcare institutions should follow Mayor Walsh’s lead and invest money in racial equity work. In addition to being the right thing to do, investing in racial equity work will lead to improved health outcomes and a reduction in health disparities.

One of the many reasons that I appreciate working at MACDC is that our work is, by definition, responsive to current events in our communities as well as in the larger world. While many people are struggling to transfer their “normal” work to a virtual platform, at MACDC, we are looking to re-evaluate our priorities in the context of the current situation.

On March 11^th, our President and CEO, Joe Kriesberg shared a story with and issued a challenge to the MACDC staff:

In 1986, Joe was a junior staff person working for Ralph Nader at the Critical Mass Energy Project in Washington, DC focused on nuclear power issues when the Chernobyl nuclear power plant exploded.  Joe asked his boss what he should do? How should his work priorities change? His boss responded, “you work on safe energy issues; a nuclear plant just blew up; figure out how to do something productive.”  As Joe tells it, that was the end of the guidance. Joe reached out to Ralph Nader to schedule TV appearances for him and brief/prepare him for those appearances.  It was Joe’s first opportunity to work directly with Ralph and see him in action. It was an amazing learning experience for him that left him with stories and lessons that he calls upon to this day.

Through sharing this story, Joe made clear to me and other MACDC staff that the world has changed and that the status quo no longer applies. Joe emphasized that it is each of our responsibilities to figure out how best to leverage our particular role, skills, and knowledge to support our mission, our members, and the larger community during this time.

Joe’s challenge was both exciting and unsettling – and it has been particularly interesting for me as the “public health person” on staff at MACDC. In the midst of a global pandemic, everything is related to health. Accordingly, my days these last few months have involved keeping my ear to the ground on many different conversations, including:

• A weekly gathering of large affordable housing managers in Boston, in which they discuss concerns surfacing at their properties;
• An offshoot of the group of housing managers who have recently convened to discuss issues particular to mental health issues in our communities;
• A weekly call in which folks surface issues specific to elderly populations;
• Concerns specific to immigrant populations that have surfaced among our members;
• Ways in which our members are involved in food distribution in their communities.

These conversations have enabled me to better understand issues that many of our CDCs are encountering and to understand what resources are available to address these issues. And they are pushing me and MACDC into networks, issues and challenges that are new for us.

The current situation has also highlighted importance of partnerships in the public health space, in particular MACDC’s partnership with the Massachusetts Public Health Association (MPHA). MPHA has been one of MACDC’s key partners for many years and in the last year since we’ve had a full-time staff person dedicated to health equity work (that’s me!), our partnership has deepened. When MPHA announced that it was convening an Emergency Task Force on Coronavirus and Equity this past March, it was a no-brainer that we would be actively involved.

The Task Force met for the first time on March 17^th. For many of us, this was our first week of working from home and convening over Zoom, so this virtual meeting which drew staff from over 50 organizations, was particularly noteworthy. At this first meeting, the group efficiently broke into groups according to issue area. Each group then identified two or three policy priorities for which they wanted to see action by the state in the next week. When participants re-convened as a whole, participants voted on the identified priorities, narrowing the list down to four priorities, which included:

1. Enacting a Moratorium on Evictions and Foreclosures
2. Passing Emergency Paid Sick Time
3. Providing Safe Quarantine for People Experiencing Homelessness
4. Ensuring Immigrants Have Safe Access to Testing and Treatment

Following the initial meeting, organizations interested in becoming members of the Task Force were asked to affirm their support for the mission of the Task Force to drive equitable policy change to combat the ways in which racism, poverty, and xenophobia are furthering marginalization in the face of COVID-19.

As of mid-May, the Task Force is comprised of close to 80 members, has added three new priorities, and has actively advocated for and tracked progress on the original four priorities. The Task Force saw early successes with the state’s moratorium on evictions and foreclosures which was enacted, and the emergency paid sick time legislation that was filed – both at the end of April. I am part of the Task Force’s Strategy Team which meets weekly to guide the work of the Task Force and plan full Task Force meetings.

Through the Task Force on Coronavirus and Equity, MACDC is pushing the state to act quickly on crucial policy issues that are outside of our traditional wheelhouse. The Task Force’s priorities are, however, in clear alignment with our mission and affect the communities in which our members work. Sitting on the Task Force on Coronavirus and Equity, together with participation in a broad range of conversations on COVID-related challenges, is my response to Joe’s invitation. During this devastating time, I am leveraging my role to strengthen MACDC’s relationships with partner organizations and the broader public health community, to effectively respond to issues affecting communities throughout Massachusetts.

The low- and moderate-income communities in which Massachusetts CDCs work are disproportionately affected by the current Coronavirus crisis. This disproportionate impact results from the same structural inequities to which economically disadvantaged communities are routinely subject. The current Coronavirus pandemic further highlights the ways in which structural inequity that impacts lower-income communities ends up negatively impacting all individuals and communities, regardless of income-level. While Coronavirus is wreaking havoc on population health and the economy, it also carries opportunities for CDCs to help keep our communities safe, and to advocate for economically progressive policies.

First, let’s establish the ways in which lower-income community residents are disproportionately impacted by the spread of the Coronavirus:

Poor Quality Housing

Poor quality housing quickens the spread of infectious disease when there is improper ventilation between units. Families who live in close quarters are at increased risk of spreading illness between family members.

Unstable Housing

Cuts to jobs and hours will put low-income tenants at increased risk for eviction and foreclosure as individuals and families fall behind on their rent or mortgage payments.

People Experiencing Homelessness

Individuals experiencing homelessness who are living in shelters are impacted by increased disease transmission due to overcrowding. Those living on the streets are at greater risk because of lack of access to clean water with which to wash their hands. Individuals living on the streets who fall ill due to the virus will suffer more because of exposure to extreme heat and cold, and they also don’t have an easy way to quarantine themselves.

Economic Impacts on Low-Wage Workers and Small Businesses

Low-wage workers without paid sick time have to make the impossible choice between going to work sick or losing wages needed for food and other necessities. Individuals who go to work sick are more likely to infect others, and healthy workers who are forced to work are more likely to be exposed. Individuals who are living paycheck-to-paycheck are not able to “stock up” on essential items, like medicine, food, and hygiene items that will be needed in case of illness or quarantine. If forced to wait to buy these items, individuals will have a greater likelihood of being exposed and exposing others as the pandemic worsens. Small business owners will disproportionately suffer from lost business while still needing to keep up with overhead costs.

Impacts of Quarantine

School closures disproportionately impact low-income families who have less access to affordable childcare options. Further many low-income children rely on schools for free or reduced-price meals.

Access to Health Care

Individuals who are underinsured or who lack access to health care will be less able to access quality and affordable health care as the demand on the health system inevitably increases. Undocumented immigrants may be afraid to access care or other services because of real or perceived concerns over repercussions resulting from their immigration status.

Prejudice and Discrimination

Our Asian and Asian-American community members and businesses are also subject to the racism faced by many of Asian descent resulting from prejudice, fear and misinformation.

In addition to highlighting the ways in which lower-income communities are impacted by infectious disease, the Coronavirus pandemic makes it clear that what impacts lower-income community residents also impacts the general population.

CDCs can support their community residents in a variety of ways, including:

1. Taking precautions to limit the spread of disease, such as frequently disinfecting common spaces in their apartment buildings;
2. Checking in on residents with particular attention to those who are elderly and/or immuno-compromised;
3. Encouraging residents to use recommended hygiene methods, including frequent handwashing, and, if exposed, letting management know and self-isolating or quarantining;
4. Suspending evictions that are not essential to the protection of health or property;
5. Canceling community events.

Immediate steps to care for our communities needs to be our first priority. Emergency funding can help prevent evictions and foreclosures and lessen the financial pain to workers and small businesses. In addition to necessitating emergency response, this international crisis underscores the need for better social and economic policies when our world is not in crisis, including:

1. Expanding unemployment insurance;
2. Creating protections to prevent evictions/foreclosures;
3. Funding to support local businesses;
4. Advocating for paid sick leave for all employees.

In addition to advocacy on the policy-level, it is crucial that we continue our racial equity work to undo the racist attitudes and institutions whose legacy we encounter in the current crisis, as well as in so many areas of our work. As information and advice changes by the hour, let’s not lose sight of the larger context in which we find ourselves. Let’s continue to think creatively about strategies and policies to improve population health and to expand economic opportunities – both in the short-term as well as in the long-term.

Image courtesy of the Boston Public Health Commission’s Racial Justice and Health Equity Initiative.

Massachusetts recently opened the door for community organizations to engage with health care institutions in moving the needle on what are commonly referred to as “Social Determinants of Health.” Social Determinants of Health (SDoH) are the conditions in which we live, work, and age and which impact our health outcomes. The Department of Public Health’s (DPH) recently updated Determination of Need (DoN) regulations and the Attorney General’s Office’s (AGO) updated Community Benefits Guidelines both emphasize that investment in SDoH is necessary to move the needle on health care outcomes. In particular, the DoN regulations identified the following Social Determinants of Health (SDoH) as priority areas: built environment, social environment, education, employment, violence, and housing. These same priorities were adopted in the AGO’s Community Benefits Guidelines.

In addition to emphasizing SDoH, the DoN subregulations describe an opportunity for “the Commonwealth to address health inequities based on race, class, and other socioeconomic factors, which are a result of historical policies and practices.” The AGO Guidelines further assert that “Racism has an independent influence on all social determinants of health, and racism in and of itself has a harmful impact on health.” Together, these guidelines open the door for community advocates to move health care policy conversations towards explicitly addressing racism as a social determinant of health.

The challenge to organizations like MACDC is how to effectively push health care institutions to adopt racial justice as the primary lens with which to address health inequities. MACDC has been engaged in moving health care institutional focus toward racial equity through active engagement with:

The Boston Community Health Needs Assessment Collaborative – Several Boston area hospitals recently collaborated on a joint Boston Community Health Needs Assessment (CHNA) for the first time. MACDC recognizes this collaboration as an opportunity to help direct the more than $180 million these hospitals spend annually on Community Benefits Programs. In light of our recognition of the importance of this collaboration, MACDC engaged in the CHNA process through assigning two of our members to the CHNA Steering Committee, attending community forums to prioritize goals and craft strategic approaches to achieving these goals, submitting a detailed letter to the Boston Collaborative, and submitting a detailed strategy document to the Collaborative. Through these channels, MACDC expressed support for naming the achievement of racial and ethnic health equity as a core focus/aspirational goal in which specific health goals would be encapsulated. We were pleased to the see that the Boston CHNA Collaborative ultimately adopted a lens of racial equity in their completed Community Health Needs Assessment.

The Alliance for Community Health Integration’s Housing and Health Policy Work Group – Through our membership in the Alliance for Community Health Integration (ACHI), MACDC has been part of an effort to engage health care institutions around high-level housing policy issues. This effort has resulted in a statement of principles for which ACHI is in the process of gathering signatures and two webinars that provide a high-level overview of housing policy for health care providers and executives. Because African Americans and other communities of color are disproportionately affected by housing challenges and disproportionately bear the burden of poor health outcomes, our work is inherently rooted in racial equity. Furthermore, our ongoing challenge is how to use this platform to further push health care institutions to explicitly address structural racism in the way that they talk about and address health inequity in their communities.

Our engagement in the ACHI Health and Housing Policy Work Group and with the Boston CHNA Collaborative are important areas in which to challenge health care institutions to adopt a racial equity lens. As health care institutions continue to define their missions, agendas, and programs under the new state guidance, it is our job, as anti-racist community advocates, to continue to challenge health care institutions to tackle their community health work from a racial equity perspective.