Community Health Assessment Highlights The Need For More Affordable Housing, Better Food Access In Amherst

Report On The Meeting Of The Amherst Board Of Health, June 8, 2023

The meeting was conducted over Zoom and was recorded.  The recording can be viewed here.

Present
Nancy Gilbert (Chair), Lauren Mills, Premila Nair, Timothy Randhir,  Absent: Maureen Millea
Staff:  Jennifer Brown (Health Director), Kyle O’Connor (Public Health Program Assistant)
Also: UMass Community Health Assessment Team of Emily Conners, Kyle O’Connor, Catherine Grella, Neha Rahalkar and James DiSilvo.

Highlights

• A team of UMass public health students presented a summary of the board’s 2022-2023 Community Health Assessment
• Vacancies: Gilbert and Mills will leave the BOH on June 30 when their terms expire. Health Director Jennifer Brown has resigned effective July 31.
• The board approved two permits – one for a geothermal well on Owen Drive and one for a drinking water well on Market Hill Road
• BOH adopted a statement on LGBTQ equity
• BOH declined to renew the COVID vaccine mandate for schools adopted in 2021
• Health Director’s Report discussed the Mosquito Control District, monitoring air quality, and incoming opiate settlement money
• Departing remarks of retiring BOH Chair on the need to support public health work in town

Public Comment
Jill Sherman asked that the Health Department give more publicity to the fact that COVID is still around and that booster immunizations are available and advisable.

Community Health Assessment
The health assessment team provided a PowerPoint presentation, offering a comprehensive summary of the 2022-2023 community health assessment that they conducted over the last year with the support and assistance of BOH chair Nancy Gilbert and Amherst resident Anita Sarro. The PowerPoint can be found here.  Access the final report below.

The assessment was expansive. A general conclusion was that, while the town offers several features that enhance health, considerable health disparities exist. Among the most significant were challenges for many residents in finding affordable housing, groceries, and medical and dental care.  These difficulties contribute to an array of health challenges. The assessment also emphasized that racism, classism, and other forms of discrimination have a substantial impact on overall health (see also here). Some of these health challenges could be ameliorated with relatively simple interventions, while others require major changes in policy or budgeting. The report offers recommendations for addressing each disparity and ends with a reminder that the health and well-being of the town is the responsibility of all town departments, organizations, and businesses, not just the Public Health Department and the Board of Health.

Community assessment: The assessment involved a year-long process of identifying key health needs, challenges, and assets through systematic, comprehensive quantitative and qualitative data collection and analysis. The totality of this information should enable the town to prioritize decisions concerning health, identify ways to reach at-risk, disenfranchised populations, address systemic health problems and concerns of community members, promote equity, and  guide advocacy efforts and policy development.

The investigation centered on the social determinants of health (SDOH). The SDOH are non-medical factors that influence health outcomes. These are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. The study emphasized five SDOH:  economic stability, the social and community context, neighborhoods and built environments, availability and quality of health care, and education access and quality.

For each of the five SDOH, the team drew on federal demographic data sets to establish the context and offer a general picture of the conditions in Amherst that impact health.  For example: regarding economic stability, contextual observations included. 

• 10.1% of those 16 years or older within the workforce were unemployed: the unemployment rate is over three times higher than the current unemployment rate of Massachusetts (3.3% as of April, 2023)
  
• 55.6% of renters in Amherst paid 35% or more of their household income on rent. Paying more than 30% of one’s income on rent is considered cost-burdened by the Department of Housing and Urban Development
  
• 43.5% of ARPS students qualify as high needs

• Amherst spends 25% of what Northampton spends on its health department staff, and less than 50% of what Easthampton spends.

For Neighborhood determinants: contextual observations included:

• Amherst is built with a lot of natural green space and areas providing a pleasant natural environment and ample space for recreation.
  
• 97% of Amherst residents live in a USDA-designated food desert. One in four Amherst residents are low income and live more than a mile from a supermarket.
  
• Residents lack consistent and stable bus service during times when students are not in town. The bag limit on PVTA hinders the ability to use public transportation for shopping.

Findings : The team added interviews with a diverse swath of Amherst residents to explore ways that the SDOH specifically impact people’s health. Among key findings the team found that:

Housing is strongly tied to health status in Amherst. Overcrowding on college campuses produces:

• An influx of student renters (easy targets)
• Landlords increase rent prices 
• Cost of housing relative to yearly income skyrockets

Vulnerable populations cannot afford housing, quality food, health care, transportation, etc. Food is hard for many to access easily.

Finding healthcare services and accessing PCPs and dentists is difficult for many.

• General lack of knowledge and understanding of the Musante Health Center, a FQHC (Federally Qualified Health Center). Musante is currently underutilized, although it has hired a new DEI director who has begun to work on this.
• Need for diverse language representation in health services
• Concern over the next pandemic, snow storm, climate change
• Uptick in substance abuse
  

The town of Amherst’s health spending  is considerably lower than in neighboring towns. This results in fewer available health staff and resources and prohibits lower-income groups from receiving adequate care.

There are many obstacles for unhoused people who lack access to resources and support. There are also major holes in the recreation programs for children and adults.

Amherst has many valuable social services available for residents, but services are fragmented and difficult to identify and coordinate. How individuals relate and interact with town resources is affected by race, ethnicity, socioeconomic status, and age.

Classism, especially in schools, produces  stress, anxiety and depression.

Equity gaps hinder marginalized students’ access to educational opportunities.

• Non-college track students lack support. 
• Budget cuts limit opportunities.
• Teachers and educational staff lack support
• COVID-19 has heavily impacted student learning

Recommendations and Conclusions:
For each of the findings in the report the team offered recommendations – many of which are well beyond the capacities of the health department and the BOH, but require substantial changes in policy and or budget priorities. Some general conclusions follow.

• This community health needs assessment for the Town of Amherst highlights both the challenges and the opportunities for improvement of the health and well-being of town residents
  
• Through addressing the identified recommended actions, the community can work together to create a healthier and more equitable Amherst community
  
• The recommended actions aim to provide a roadmap for key stakeholders, community groups, and town government to collaborate and prioritize efforts that will positively impact the overall health of the Amherst Community

• The health and well-being of the town is the responsibility of all town departments, organizations, and businesses, not just the Public Health Department and the Board of Health.

• Vulnerable populations are weary of telling their stories to different investigators while seeing little action come of it.

The Team
Emily Conners just graduated from UMass with a MPH.  She was the team leader for Phase 3. She will begin her new position as Assistant Director of the Milton (MA) Health Department later this month.
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Kyle O’Connor just graduated from UMAss with a BS and will pursue an MPH this fall. He joined the Health Department this past winter as the Public Health Program Assistant.
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Catherine Grella just graduated from UMass with a BS and will continue working toward a MPH program this fall.

Neha Rahalkar just graduated from UMass with her MPH.

James DiSilvo will be a Senior in the UMass Public Health program this fall.

Emily, Kyle, Catherine and Neha are in the 4+1 program which is an accelerated master’s degree program.  The program allows students to take graduate courses during their senior undergraduate year and complete their master’s degree in just one additional year of full-time graduate work.

LGBTQ Equity Statement
While the function of the BOH is largely regulatory, Gilbert suggested at a previous meeting that the board adopt a statement on LGBTQ+ equity, much as they had done for racism and public health and  given the proliferation of anti-gay, anti-trans legislation in the country, and it’s substantial consequences for LGBTQ+ health and also given the ongoing concerns about the safety of LGBTQ+ students at Amherst Regional Middle School.  The board adopted the following statement unanimously (4-0 with Millea absent).  The statement will be posted to the BOH web site.

The Board of Health of the Town of Amherst recognizes that LGBTQ+ individuals face systemic discrimination barriers and experience health-related challenges and disparities. 

 The Board denounces any policies that would strip people who identify as lesbian, gay, bisexual, transgender, or queer of equal rights. It is our position that discrimination in any form – racism, sexism, or on the basis of sexual orientation or gender identity – is a significant threat to the health of the public and must be addressed.

Research suggests that LGBTQ+ individuals face higher rates of injuries, illnesses and deaths linked to years of societal stigma, discrimination, and denial of civil and human rights. According to Healthy People 2030, the American Public Health Association (APHA) and the National Association of County and City Health Officials (NACCHO):

• LBGTQ+ adolescents are especially at risk for being bullied, thinking about and dying from suicide and using illegal drugs.

• Transgender youth experience disparities in violence victimization, substance use, suicide risk, and sexual risk compared to their cisgender peers.

• LGBTQ+ youth are 2 to 3 times more likely to be homeless.

• The percentage of US adults who identify as LGBTQ+ has increased to 7.1%.

• Lesbians are less likely to get preventive services for cancer.

• Lesbians and bisexual females are more likely to be overweight or obese.

• Transgender individuals have a high prevalence of victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual individuals.

• Elderly LGBTQ+ individuals face additional barriers to health because of isolation and lack of social services and culturally competent providers.

• LBGTQ+ populations have higher rates of tobacco, alcohol, and other drug use.

• LBGTQ+ individuals are at a greater risk for HIV and other sexually transmitted infections (STIs).

• The LBGTQ+ community continues to experience exclusion, isolation, discrimination, injustice and worse health outcomes than their cisgender, heterosexual counterparts.

We support policies that promote equality for all people, including lesbian, gay, bisexual, transgender, and queer youth and adults in workplaces, schools, healthcare, housing, religious organizations, marriage, and all aspects of life.

We support NACCHO’s “Statement of Policy – LGBTQ+ Health” that encourages local health departments to act on the social injustices at the root of health inequities impacting lesbian, gay, bisexual, transgender, queer, intersex and other sexual and gender diverse individuals, families, and communities and honor diverse sexual orientations, gender identities, and gender expressions.

We support the American Public Health Association’s statement entitled, “Supreme Court decision on LGBTQ rights is [a] public health victory.”

Adopted by the Amherst Board of Health, June 8, 2023

References
Healthy People 2030 – https://health.gov/healthypeople/objectives-and-data/browse-objectives/lgbt

APHA Statement “Supreme Court Decision on LGBTQ rights https://apha.org/news-and-media/news-releases/apha-news-releases/2020/supreme-court-lgbtq

WH.GOV White House order on advancing equity for LGBTQ and Intersex Individuals (June 15, 2022 https://www.whitehouse.gov/briefing-room/presidential-actions/2022/06/15/executive-order-on-advancing-equality-for-lesbian-gay-bisexual-transgender-queer-and-intersex-individuals/

NACCHO Statement of Policy LGBTQ+ health (2023). https://www.naccho.org/uploads/downloadable-resources/00-10-LGBTQ-Health.pdf

BOH Succession
The terms of Chair Nancy Gilbert and BOH member Lauren Mills expire on June 30.  Also, Health Director Jennifer Brown has resigned effective July 31. Gilbert reported that the town will not begin interviewing to fill the vacancies  until the positions are actually vacated.  She expressed deep concerns about the ability of the board and the health department to continue its work with these vacancies unfilled.

Permits
The board approved a permit for a geothermal well at 39 Owen drive (3-0 wth Mills abstaining and Millea absent)and for a private drinking water well on Market Hill Road (3-0 wth Mills abstaining and Millea absent).

COVID Vaccine Mandate Discontinued

The BOH adopted a COVID vaccine requirement for students at Amherst Regional High School on September 9, 2021.  The board now broached the question of whether that requirement should be continued. The federal government has declared that the COVID emergency is over. The current bivalent vaccine is not required by the Massachusetts Department of Elementary and Secondary Education, nor does DESE plan to recommend it. Gilbert reported that there are apparently no national mandates for this vaccine which carries an emergency use authorization from the FDA. Gilbert recommended that the Board lift the mandate in favor of strongly recommending immunization and the booster. The board voted unanimously to lift the mandate and endorse the recommendation (4-0 with Millea absent)

Health Directors Report
Brown reported that Amherst was a partial member of the Pioneer Valley Mosquito Control District last year and will become a full member next year. The District conducts regular mosquito trapping/sampling from five sites in Amherst. Western Massachusetts has been designated a residual (i.e. very low risk area) for Eastern Equine Encephalitis and West Nile Virus and that risk is likely to be even lower because of dry/drought conditions across the state. No EEE or WNV were detected in Amherst last year.  Within the Pioneer Valley they were detected in Granville and Hadley. Read the full report here.

Opioid Settlement: Brown reported that Amherst will be getting $25,000-$30,000/year for the next 20 years in opiate settlement money to apply to harm reduction and prevention of substance abuse.  The funds will not be allocated to the Health Department’s budget and it is not yet clear how budgetary access will be managed or priorities determined.

A link to the latest air quality readings in Amherst can be found here. The health department’s web page has links to additional air quality sites. The air quality in Amherst on Friday June 9 at 11 AM is good with an AQI (air quality index) of 19.  The AQI the previous day at this time was 160 which is regarded as unhealthy.  Read more about the AQI here.

Brown’s Departure: Brown recounted her time working in the town’s health department and shared words of appreciation for her colleagues in the department and on the BOH noting that the board has done amazing work with very limited resources. Mutual words of praise and admiration were exchanged between Brown and board members.

Gilbert’s Departing Message
Gilbert concluded her final meeting of the BOH with a warning that, while the town has done amazing work, the health challenges faced by the town are substantial, (as indicated in the community health assessment), and that the town has not allocated the resources necessary to address those challenges. She noted that Northampton spends about $900,000 on public health and that Easthampton spends about $232,000 on public health.  Amherst, which has a larger population than either of those cities has an annual health budget of $184,561. She implored town government to consider how much they value the health department and to consider the costs of failing to address the town’s burgeoning health challenges.