Change Agents PHC Creates Campaigns to Improve Public Health

For the past five years, a “Go Fresh Mobile Market” has made 10 stops in low-income neighborhoods throughout Springfield, selling locally grown fruits and vegetables at cost to residents.
The market, which operates out of a van from June to October, is funded by a grant, and stems from a LiveWell Springfield coalition formed by Partners for a Healthier Community (PHC). Its purpose is to promote health equity by providing access to healthy food and increasing opportunities to exercise, including the development of a comprehensive plan for a more walkable and bikeable Springfield.
“More than 60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of adults and 40{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of children in Springfield are overweight or obese,” said Executive Director Jessica Collins, explaining that PHC brought people together from 25 leading organizations in the community to come up with solutions to the problem.
Its first strategy was to find a way to provide Springfield residents living in low-income neighborhoods with fresh produce, which was accomplished through the mobile market. In addition, physicians from Baystate Medical Center’s Brightwood Health Center wrote prescriptions for fresh vegetables and fruits to motivate their patients to change their diets, while Caring Health Center held cooking demonstrations in its kitchen on days the mobile market stopped outside its doors. “It was a coordinated effort that included handing out educational materials,” Collins said.
The group also focused on educating city officials about the need to provide more sidewalks and bicycle lanes on new and existing streets to increase individuals’ opportunities to exercise, and Collins said the Pioneer Valley Planning Commission played a critical role in that work.
As a result, two new bike lanes have been created on city streets, sidewalks are being upgraded when roadwork is done, and the City Council just passed a Complete Streets ordinance that will make Springfield eligible for additional funding.
The coalition also led to the creation of the Springfield Food Policy Council in 2010 and a community-gardening ordinance in 2012. The mobile market has also become more popular, and between 2012 and 2014 the consumption of fresh fruits and vegetables increased in the Mason Square neighborhood.
“During our first season, the market sold 5,000 pounds of fresh produce, and last season they sold 26,000 pounds,” Collins noted.
These measures contributed to a reduction in rates of obesity that have plateaued locally and nationally. Collins calls it “a start,” and said the LiveWell Springfield project is representative of work that PHC has been doing since it was founded in 1996.
The nonprofit, which became part of the National Network of Public Health Institutes in 2014, was formed to address a multitude of public-health issues and works in conjunction with the city of Springfield, local nonprofits, health organizations, and Springfield residents.
Collins sits at the helm and is aided by a board of directors that includes leaders from many sectors in the community dedicated to working on public-health initiatives.
“We convene coalitions to provide facilitated services for systemic issues that are a problem in the community,” she told HCN, adding that the agency also provides program evaluations and undertakes research assessments in areas related to public health.
The work is time-consuming and takes patience and fortitude since it involves education to inspire school systems, cities, and government agencies to make policy changes.
“It can take five to 10 years to change a system to ensure that everyone has proper access to healthcare,” Collins said. “There are often systemic issues such as healthcare providers who do not get reimbursed by insurance companies.”
But progress is occurring, and today, many organizations turn to PHC for help. For example, it has been hired as the lead consultant for the Coalition of Massachusetts Hospitals and conducts community-health needs assessments for that group every three years.
It also conducts research for a variety of organizations, and has a contract with Baystate Franklin Medical Center to evaluate nonprofits the hospital helps to fund.
“They want these organizations to succeed, and we’re able to provide technical assistance that helps them show the results of their good work so they can obtain more funding,” said Kathleen Szegda, PHC’s director of community research and evaluation.
She noted that PHC completed a Springfield Health Equity Report in 2014, which involved uncovering and compiling a large amount of data that was not easily accessible. The final version looks at health disparities by race or ethnicity and led to a number of findings, including the fact that rates of asthma and hospitalization for mental illness are higher in Springfield than the rest of the state.
“We knew differences existed in health status, but they weren’t documented in one place,” Collins said, adding that the report includes factors that led to the problems, including income, education, inadequate housing, and lack of access to healthy food.

Winning Strategies
PHC’s work is centered in four areas that often overlap.
For starters, it implements community-based research and assessments to understand gaps, needs, and best practices that will help people get what they need to live healthy lives.
The organization also focuses on building coalitions that address health challenges facing the community, and it evaluates outcomes of existing programs and community initiatives aimed at improving health and well-being.
Its fourth area of focus involves data analysis, community participation, and advocacy to forge policy changes that will sustain programming and result in better health outcomes.
“We’ve created a number of winning programs as a result of this work,” Collins said.
PHC’s accomplishments include a program for preschoolers called the Best Oral Health Program. It has become a national model, and Collins said work on it began because a child had an abscessed tooth and a school nurse told city officials her family couldn’t find a dentist that would accept their insurance.
Since that time, screening and treatment programs have been put into place in the community to decrease the incidence of oral-health problems in preschoolers, and the collaborative’s efforts contributed to the state’s decision that toothbrushing must take place in all preschools where children eat a meal or stay for more than four hours.
Collins said PHC and its partners have had many other successes, and the Pioneer Valley Asthma Coalition is among them.
Members worked with Springfield’s Department of Parks, Buildings and Recreation Management, as well as Springfield Public Schools, to implement policy changes that would improve indoor air quality to help children with asthma manage the disease and, in turn, lead to decreases in emergency-room visits and less missed class time for students with the condition.
Teen pregnancy rates in Springfield and Holyoke have also decreased, thanks to the YEAH! Network. A collaborative approach, initiated by PHC, was taken to allow public-school nurses to distribute condoms and include sexual education in these communities’ school curricula, which has led to the lowest rates of teen pregnancy in Holyoke in recent memory.
Over the past few years, a portion of PHC’s work centered around the proposed casino for Western Mass. It researched and prepared a report titled “The Health Impact Assessment on the Western Massachusetts Casino in 2013,” and its recommendations helped the Mass. Gaming Commission form policies and protocols for the gaming industry.
The report was paid for by a $75,000 grant from the National Health Impact Project Foundation, and looked at Springfield as well as other potential local host communities, including Palmer and West Springfield.
“There was an advisory committee that held community forums in every town and worked with partners including the Pioneer Valley Planning Commission and UMass Amherst. We also looked at literature and focused on employment, crime, public safety, traffic, and how casino access relates to problem gambling,” Szegda said.
The results were mixed. There is a real need for jobs in the area, so a casino would help lower the employment rate, which would have a positive impact on public health. But there is also the potential to increase gambling disorders, which would lead to the need for more trained professionals and facilities to treat problem gambling.
“We made recommendations to the city, the Gaming Commission, and the casino operators because they were the ones who were creating policies to mitigate potential negative impacts and increase the positive impacts, which can be done in part by providing funding for adult basic education,” Szegda continued, adding that there is a long waiting list for these classes.

Future Problem Solving
Collins says PHC is proud to be the public-health institute for Western Mass.
“We’re bringing needed services to the region through a network and have a significant number of policy wins as a result of our efforts,” she noted. “But we don’t do anything alone, and providing equal access to health involves more than just being able to go to the doctor. It’s a contributing factor, but it’s only one in a number that include poverty, education, and a framework of other social determinants related to where people work, live, and play.”
Szegda agrees. “Health equity is an issue of justice. It is about eliminating differences that are not only unnecessary and avoidable, but are considered unfair and unjust,” she said. “Extra efforts must be made to right these injustices and improve health in Springfield through opportunities. We hope that people will join us in learning, understanding, and finding solutions to improve health equity together.”