The concept of “health” is no longer constrained to a medical silo—it’s present in every facet of people’s lives, from the stability of their housing to the ways they use social media to the air they breathe.
The Department of Health and Human Services and Cambridge Health Alliance (CHA) spent over a year putting together a wellness report that reflects this complex web of health factors affecting Somerville residents.
The report is chock full of data, trends, and recommendations for how to address the most prevalent health problems. The city will hold focus groups from January into early summer to get a sense of which issues the community wants to prioritize.
“This is step one of the process,” Director of Health and Human Services Doug Kress says. “We want to use this to help us springboard into using a community process, which we’re calling the Community Health Improvement plan process. Let’s dig a little bit deeper into these priorities, so that we have a better understanding of not only what we think are priorities, but what the community members also think are priorities, which will then help us shape our work plan for the next three to five years.”
The last wellbeing report, issued in 2011, was the first to address social determinants of health.
“Mostly what that report said was we’ve not really been looking at the full picture,” says Lisa Brukilacchio, director of the Somerville Community Health Agenda at CHA. “I’ve been in my job 10 years now, and I was not dealing with housing when I started. Now, healthcare in general is saying, ‘Oh, housing, food, transportation, utilities, education—these are things that are impacting the health of our population.’”
The interconnectedness of health factors has pushed CHA and the Department of Health and Human Services to work more cooperatively with resources throughout the city. Kress’s department now has a social worker and has partnered with the housing department. These connections aim to provide residents with holistic responses to their health needs.
“Can we train multiple people to talk about housing searches? I have talked to the library director, said what if we trained some of your reference staff. The libraries have partnered with CHA to put a part-time social worker in the libraries,” Kress says. “It’s changing a little bit of how we do our work as well, we’re working together to eliminate those silos.”
“A lot of our work is really about connecting different service providers or agencies that support community residents so that we’re better integrated, so that the individual experience, it doesn’t really matter which door they open—whichever door it is, that person can get connected,” Brukilacchio adds.
The major innovation in this year’s report is breaking data and recommendations down into different life stages. Kress and Brukilacchio explain that this structure illuminates how factors in early parts of life—all the way back to prenatal—impact health in later stages.
“It really talks about starting from equitable access early on in life,” Brukilacchio says.
The life phases model also shows how health factors in the different stages affect each other. For example, a child might live with a grandparent because their parent is suffering from drug addiction. Health factors from three different life stages are interacting in this scenario.
The report breaks the lifespan down into six age brackets: prenatal and early childhood (birth-4), school age and adolescent (5-18), early adult (18-24), young adult (25- 39), middle adult (40-64), and older adult (65+).
The city crafts both immediate and long-term solutions to the issues presented in the wellbeing reports. When the data showed that sexually transmitted infections were a problem in the public schools, the city took steps to make sure that students were getting the necessary information in middle school. The city also developed a homelessness task force in response to wellbeing report findings.
“We were trying to focus in on what are the direct actions or policy recommendations that we can be doing to try to change the dial a bit,” Brukilacchio says.
The Department of Health and Human Services and CHA will spend the coming months actively encouraging the community to engage with the report and to decide on next steps. Brukilacchio and Kress hope to reach people of all life stages—they once went into Artisan’s Asylum to get in touch with people in their 20s and 30s, an age group that they often have trouble engaging—and want to press people to think deeply about and digest the data.
“I tend to describe these reports as being purposefully provocative,” Brukilacchio says. “We are trying to stimulate discussion and dialogue about these issues. We mention topics in each chapter—race is right there, social networks and safety are right there, as part of this whole package of someone’s community.”
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