2019 Greater Lowell Community Health Needs Assessment in partnership with 295 Varnum Avenue, Lowell, MA 01854-2193 978-937-6000 • TTY:978-937-6889 • www.lowellgeneral.org 2019 Greater Lowell Community Health Needs Assessment Conducted on behalf of: Lowell General Hospital Greater Lowell Health Alliance Authors: David Turcotte, ScD Kelechi Adejumo, MSc Casey León, MPH Kim-Judy You, BSc University of Massachusetts Lowell September 17, 2019 295 Varnum Avenue, Lowell, MA 01854-2193 978-937-6000 • TTY:978-937-6889 • www.lowellgeneral.org ACKNOWLEDGEMENTS We would like to acknowledge and thank the Members of the 2019 Community Health Needs following individuals and organizations for their Assessment Advisory Committee (see Appendix E) assistance with the 2019 Community Health Needs and Greater Lowell Health Alliance, for their advice Assessment and this report: and guidance. Krysta Brugger, UMass Lowell graduate student The Cambodian Mutual Assistance Association for her help with scheduling listening sessions, (CMAA), Center of Hope and Healing, Elder participant recruitment, and project management; Services of Merrimack Valley, Greater Lowell Interfaith Leadership Alliance, Hunger and Hannah Tello, a University of Massachusetts Lowell Homeless Commission, Lowell’s Early Childhood doctoral student who designed the Greater Lowell Council, Lowell Community Health Center, Lowell Community Needs Assessment survey, compiled House, Lowell Housing Authority, Lowell Senior the results, and wrote the summary section for this Center, Non-Profit Alliance of Greater Lowell (NPA), report. UMass Lowell students Mollie McDonah, Portuguese Senior Center, RISE Coalition (Refugee Jared Socolow, Shirley Archambault, and Larissa and Immigrant Support & Engagement), Youth Medeiros, and Lowell High student Andrew Nguyen Violence Prevention Coalition, Upper Merrimack and Innovation Charter School student Joshua Cho Valley Public Health Coalition for hosting for assistance with conducting survey outreach and listening sessions. inputting survey data. Natalia Melo from the UMass Lowell Saab Center for Listening session facilitators and note takers listed Portuguese Studies who connected us to members in Appendix D. of the Portuguese Senior Center and Frank Sousa and Patricia Martinho Ferreira from the Saab Center Paul Oppedisano, MassCHIP Director from the for Portuguese Studies for editing the Portuguese Massachusetts Department of Public Health for translations of listening session questions and providing public health data. consent form and Luz Vasudevan from the Latinx Community Center for Empowerment (LCCE) UMass Lowell Professor Leland Ackerson and his for assistance with organizing and hosting the undergraduate Community Needs Assessment listening session with members of the Spanish students who conducted key informant interviews speaking community. with first responders. We also thank all individuals who participated in UMass Lowell undergraduate students Naike Saint- the listening sessions and interviews and all who Pierre, Veronica Mukundi, and William Hanlon provided assistance with the community health for assisting with data gathering and analysis of needs assessment. secondary public health data. CONTENTS Acknowledgements Executive Summary 1 Process and Methods 3 Introduction 3 Population 7 Determinants of Health 11 Built Environment 12 Social Environment 16 Housing 20 Violence 23 Education 24 Employment 26 Greater Lowell CHNA Survey Results Summary 29 Findings about Community Health and Needs from Listening Sessions and Interviews 32 Overall Perception About Community Health 32 Top Health Problems in the Community 33 Types of Residents at Greatest Risk 34 Major Strengths of the Health System 37 Major Unmet Needs in the Health System 38 Barriers to Obtaining Health Services 39 Analysis of Public Health Data 40 Figures – Death 40 Figures – Cardiovascular Disease 41 Figures – Diet/Obesity 44 Figures – Diabetes 47 Figures –Smoking 49 Figures – Respiratory Diseases 50 Figures – Mental Health 53 Figures – Substance Use Disorder 55 Figures – Cancer 59 Figures – Infectious Diseases 61 Recommendations to Improve the Health System 65 Next Steps: Identifying Top Priorities and Action Plans 66 References 68 Appendix A – Potentially Available Community Resources 71 Appendix B – Evaluation of Impact of Preceding CHNA 77 Appendix C – Focus Group and Interview Questions 79 Appendix D – Focus Group and Interview Note Takers and Facilitators 88 Appendix E – 2016 Community Health Needs Assessment Advisory Committee 89 Appendix F – Community Health Needs Assessment Advisory Committee 90 EXECUTIVE SUMMARY Lowell General Hospital, the Greater Lowell Health hours, inability to afford mental health services, and Alliance, and the University of Massachusetts inability to find a provider accepting new patients. Lowell work together to conduct an assessment of community health needs for the communities The top health problems revealed from the listening of Greater Lowell every three years. This region sessions and interviews are mental health issues, includes the cities and towns of Billerica, substance use/alcohol disorders, obesity, diabetes, Chelmsford, Dracut, Dunstable, Lowell, Tewksbury, infectious diseases, respiratory diseases (e.g. asthma Tyngsborough, and Westford. This assessment and chronic obstructive pulmonary disease), cancer, evaluates the overall health of the community and cardiovascular disease. Populations recognized members, overviews the strengths and weaknesses in the community at greatest risk of health problems of the area’s health services, identifies health are people who identify as immigrants and refugees, barriers and social determinants of health, and the elderly population, people who earn low-wages, provides recommendations to improve the health people who are homeless-experienced, teenagers of its residents. and youth, and people who are part of the LGBTQ (lesbian, gay, bisexual, transgender, and queer) Information gathering for this health assessment community. included 20 listening sessions with over 200 participants, 19 key informant interviews, and The major strengths of the health system in the 1,355 surveys completed by community members. Greater Lowell area identified by listening sessions Secondary resources were gathered to provide and interviews are the availability of the Lowell demographic, socioeconomic, and public Community Health Center (LCHC) and Lowell health data. General Hospital. Both health entities provide wide ranges of services and collaborate with other health The top priority health issues identified by the professionals and agencies in the region to address Community Health Needs Assessment Survey the health concerns of the communities. Other respondents were mental health issues, substance strengths include the growing number of urgent care addiction, alcohol abuse/addiction, cancer, and facilities that reduce emergency room utilization nutrition. Other health issues included obesity, and the process of the Community Health Needs heart disease, diabetes, infectious diseases, and Assessment that allows community members to tick/insect illnesses. The top priority community communicate with key stakeholders about health. safety issues are domestic violence, bullying, drug trafficking, sexual assault/rape, and unsafe/illegal The major weaknesses identified from listening gun ownership. Additional community safety issues sessions and interviews include a need for culturally include human trafficking, discrimination based competent health care providers, shortages of certain on race, gang activity, discrimination based on types of health care providers, long wait times for immigration status, and discrimination based on appointments, and a lack of continuum of care. class or income. Lack of transportation and limited access to mental and behavioral health services were also stated. In The most frequently reported health issues for particular, residents that speak a language other Community Health Needs Assessment Survey than English face greater difficulties in accessing respondents themselves are anxiety; depression; transportation and optimal care. Community vision problems; bone, joint, and muscle illness; members also noted a lack of adequate proficient and high cholesterol. The most frequently reported interpreters and translators. issues for people participants know were cancer, alcohol abuse/addition, diabetes, high blood The most prevalent barriers to obtain health services pressure, and depression. The most frequently mentioned by listening sessions and interviews reported health barriers for the respondents are a participants are transportation, health insurance, negative healthcare experience from their provider, increase of medical related costs, and the stigma inability to afford medication, inconvenient office and discrimination related to those with substance 1 use disorders and mental health issues. The percentage of population who are Black, Asian, increase in minimum wage over time was found to Hispanic, and born outside the U.S. Compared to be a challenge for families to qualify for subsidized neighboring communities of Greater Lowell CHNA, health coverage. Income for some low-wage workers Lowell is the least affordable area for residents, with can put them just above the income eligibility limit, a Median Home Value to Median Household Income resulting in these individuals being unable to afford ratio of 4.5. health insurance. Listening session participants and interviewees Public health