Boston Medical Center Community Health Needs Assessment Final Report July 2016 Contents EXECUTIVE SUMMARY ...................................................................................................................... i BACKGROUND .................................................................................................................................. 1 Overview of Boston Medical Center ............................................................................................................. 1 Previous CHNA .............................................................................................................................................. 1 Review of Initiatives ...................................................................................................................................... 1 Purpose and Scope of Assessment ............................................................................................................... 2 Definition of the Community Served by BMC ............................................................................................... 2 PROCESS AND METHODS ................................................................................................................. 3 Social Determinants of Health Framework ................................................................................................... 3 Quantitative Data: Reviewing Existing Secondary Data................................................................................ 4 Qualitative Data: Focus Groups and Interviews ........................................................................................... 4 Qualitative Analyses .................................................................................................................................. 5 Information Gaps .......................................................................................................................................... 5 FINDINGS ......................................................................................................................................... 6 Community Social and Economic Context .................................................................................................... 6 Demographic Characteristics .................................................................................................................... 6 Education and Employment ...................................................................................................................... 9 Poverty and Income ................................................................................................................................. 12 Housing .................................................................................................................................................... 13 Violence and Neighborhood Safety ......................................................................................................... 15 Community Health Issues ........................................................................................................................... 17 Leading Causes of Mortality .................................................................................................................... 17 Chronic Diseases and Related Risk Factors.............................................................................................. 18 Mental Health and Substance Abuse ...................................................................................................... 35 Sexual Health, Teen Pregnancy, and Birth Outcomes ............................................................................. 56 Health Care Access .................................................................................................................................. 63 Existing Health Resources and Community Recommendations ................................................................. 67 Community Engagement ......................................................................................................................... 67 Community Outreach and Marketing...................................................................................................... 68 Healthy Living and Disease Prevention ................................................................................................... 68 Culturally-competent care ....................................................................................................................... 68 Health Literacy......................................................................................................................................... 69 Enhanced Collaboration and Greater Awareness of Existing Services .................................................... 69 CONCLUSIONS................................................................................................................................ 71 HEALTH NEEDS OF THE COMMUNITY ............................................................................................ 73 APPENDIX A-REVIEW OF INITIATIVES ............................................................................................. 74 EXECUTIVE SUMMARY Background Boston Medical Center (BMC) is a private, not-for-profit, 496-bed academic medical center located in Boston’s historic South End. The hospital is the primary teaching affiliate for Boston University School of Medicine. The largest safety net hospital in New England, BMC provides a full spectrum of pediatric and adult care services, from primary care and family medicine to advanced specialty care. It is also the largest and busiest provider of trauma and emergency services in New England. Emphasizing community-based care, BMC is committed to providing consistently excellent and accessible health services to all. In 2015, BMC partnered with Health Resources in Action (HRiA), a non-profit public health organization, to conduct its community health needs assessment. This report describes the process and findings from this effort. The 2016 community health needs assessment was undertaken to achieve the following goals: • To identify the perceived health needs and assets in the community • To gain an understanding of people’s barriers to health and how these barriers can be addressed • To understand to what extent cancer is a concern in the community and perceived risks, behaviors, and barriers regarding cancer prevention and screening Although BMC serves residents from across the City of Boston, the largest proportion of its population represents the traditionally underserved, including low-income residents, the homeless population, and those who do not speak English as a primary language. For this CHNA, the community served by BMC was defined as the vulnerable populations residing in the approximately 17 neighborhoods of the city of Boston, highlighting specific neighborhood differences where appropriate. Process and Methods This CHNA aims to identify the health-related needs and strengths of BMC’s priority communities through a social determinants of health framework, which defines health in the broadest sense and recognizes numerous factors at multiple levels— from lifestyle behaviors (e.g., healthy eating and active living) to clinical care (e.g., access to medical services) to social and economic factors (e.g., poverty) to the physical environment (e.g., air quality)—which have an impact on the community’s health. Existing social, economic, and health data were drawn from national, state, county, and local sources, such as the National Cancer Institute, the U.S. Census, U.S. Bureau of Labor Statistics, Massachusetts Department of Public Health, Boston Public Health Commission, and the Boston Police Department. Over 62 individuals, representing healthcare providers, community stakeholders, and residents were engaged in focus groups and interviews to gauge their perceptions of the community, priority health concerns, and what programming, services, or initiatives are most needed to address these concerns. Findings The following provides a brief overview of key findings that emerged from this assessment: i Community Social and Economic Context Demographic Characteristics. Population. The approximately 17 neighborhoods of Boston vary by size, wealth, and diversity of residents. The most populated neighborhood in Boston was Dorchester (122,598 residents), followed by Roxbury (49,028), Brighton (44,883), and East Boston (44,512). • Age Distribution. The median age of Boston residents was 31 years, compared to the state median of 39 years. Quantitative data indicate that largest segment of Boston’s population was between the ages of 20 and 54 years, making up 59% of the population. • Demographic Diversity. Participants engaged in the assessment described their communities as “very diverse”, mentioning wide racial, linguistic, and cultural diversity. While White residents comprise less than half of the city’s racial and ethnic composition (46%), there is substantial variation in the racial and ethnic diversity by neighborhood; Jamaica Plain, Mission Hill, and Roslindale exhibited greater resident diversity than other neighborhoods, including the North End (91% White) and Beacon Hill (86% White). • Language. According to the U.S. Census the most common non-English language spoken in Boston homes was Spanish (16%), followed by French, and Chinese (5% and 4%, respectively). Focus group participants in East Boston and Dorchester reported language