Mass General Brigham Partners Ambulatory Care – Westborough Service Area Community Health Needs Assessment October 3, 2020 TABLE OF CONTENTS EXECUTIVE SUMMARY ................................................................................................................................... i INTRODUCTION ............................................................................................................................................. 1 Purpose and Scope of the Community Health Needs Assessment ........................................................... 2 CONTEXT FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT .................................................................. 3 COVID-19 Pandemic .................................................................................................................................. 3 National Movement for Racial Justice ....................................................................................................... 3 METHODS ...................................................................................................................................................... 3 Social Determinants of Health Framework ............................................................................................... 3 Upstream Approaches to Health ........................................................................................................... 4 Health Equity Lens ................................................................................................................................. 4 Approach and Community Engagement Process ...................................................................................... 4 Community Engagement ....................................................................................................................... 5 Community Advisory Board Engagement .............................................................................................. 5 Secondary Data: Review of Existing Secondary Data ................................................................................ 5 Primary Data Collection ............................................................................................................................. 6 Qualitative Discussion: Key Informant Interviews and Focus Groups ................................................... 6 Community Priorities Survey ................................................................................................................. 7 Data Limitations ..................................................................................................................................... 8 POPULATION CHARACTERISTICS ................................................................................................................... 9 Population Overview ................................................................................................................................. 9 Racial, Ethnic, and Language Diversity .................................................................................................... 10 Racial and Ethnic Composition ............................................................................................................ 10 Language Diversity ............................................................................................................................... 12 Foreign-born Population ...................................................................................................................... 14 COMMUNITY SOCIAL AND ECONOMIC ENVIRONMENT ............................................................................. 16 Community Perceptions of Need ............................................................................................................ 16 Top Issues Affecting the Community ................................................................................................... 16 Community Assets ................................................................................................................................... 18 Income and Financial Security ................................................................................................................. 20 Employment and Workforce ................................................................................................................... 23 Education ................................................................................................................................................. 26 Housing .................................................................................................................................................... 27 Transportation ......................................................................................................................................... 32 Built Environment .................................................................................................................................... 33 Crime and Violence .................................................................................................................................. 36 Discrimination and Racism ...................................................................................................................... 39 COMMUNITY HEALTH ISSUES ..................................................................................................................... 41 Overall Mortality ..................................................................................................................................... 41 Chronic Diseases and Related Risk Factors ............................................................................................. 42 Overweight and Obesity ...................................................................................................................... 42 Heart Disease ....................................................................................................................................... 45 Diabetes ............................................................................................................................................... 48 Cancer .................................................................................................................................................. 50 Behavioral Health .................................................................................................................................... 50 Mental Health ...................................................................................................................................... 50 Substance Use ...................................................................................................................................... 55 Environmental Health .............................................................................................................................. 59 Asthma ................................................................................................................................................. 59 Air Quality ............................................................................................................................................ 61 Infectious and Communicable Disease .................................................................................................... 62 COVID-19 .............................................................................................................................................. 62 Sexual Health and Sexually Transmitted Diseases ............................................................................... 64 Injury ........................................................................................................................................................ 67 Maternal and Infant Health and Early Childhood .................................................................................... 70 ACCESS TO SERVICES ................................................................................................................................... 70 Access to Healthcare Services ................................................................................................................. 70 Access to Social Services or Other Essential Services .............................................................................. 73 COMMUNITY VISION FOR THE FUTURE ...................................................................................................... 73 Community Perceptions for Action ......................................................................................................... 73 Top Issues for Action ............................................................................................................................ 74 Suggestions for Future Programs, Services, and Initiatives ................................................................. 75 KEY THEMES AND CONCLUSIONS................................................................................................................ 76 COMMUNITY PRIORITIES FOR ACTION ....................................................................................................... 78 APPENDICES ................................................................................................................................................ 82 Appendix A: Community Advisory Board Members ................................................................................... 82 Appendix