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Economic Hardship, Housing, and Transportation Identified as Top Local Needs in New Report

Lynne Feldman, Director of Community ServicesLynne Feldman, Director of Community ServicesThe Patient Protection and Affordable Care Act of 2010 (ACA) requires tax-exempt hospitals to create a hospital Community Health Needs Assessment (CHNA) every three years. Baystate Franklin Medical Center (BFMC) recently completed its 2019 Community Health Needs Assessment, which is now available at

BFMC’s mission is to improve the health of the people in our communities every day with quality and compassion. Through its Community Benefits activities, it also works to reduce health disparities, promote community wellness, and improve access to care for priority populations.

LifePath and other community organizations serve on the hospital’s Community Benefits Advisory Council, which helps to guide and support the needs assessment process. The process includes collecting data from a variety of sources, such as census data, other regional assessment reports, focus groups with specific populations, interviews with people who work with community members with their basic needs, as well as public health leaders, seven “Community Chats” that took place during the research process, and more.

According to the report, “The 2019 CHNA was conducted with equity as a guiding value, understanding that everyone should have a fair and just opportunity to be healthy, and that this requires removing obstacles to health.“ The World Health Organization defines “health equity” as “the absence of avoidable, unfair, or remediable differences among groups of people.”

Contributors to the CHNA almost universally identified economic hardship, housing, and transportation as core problems for the community.

The report determined that, “through interviews, focus groups, and community conversations, contributors to the CHNA almost universally identified economic hardship, housing, and transportation as core problems for the community. They also drew attention to mental health and substance use disorders as key health concerns that were not being adequately addressed.”

Some people in the community have greater needs than others. “Populations of concern identified in this report are people with incomes below 300% of the federal poverty level; the area’s black and Latino residents; young people who identify as gay, lesbian, bisexual, or questioning; people re-entering the community after incarceration; transgender, non-binary, and gender nonconforming people; children who have experienced trauma; and older adults.“

Map of life expectancy at birth in our region, 2010-2015Source: BaystateHealth.orgThe new CHNA acknowledges the large role that social and environmental factors play in health. According to the Robert Wood Johnson Foundation, “Although medical care is critically important, things like the quality of our schools, affordability and stability of our housing, access to good jobs with fair pay, and the safety of our neighborhoods can keep us healthy in the first place.” They estimate that only about 20% of health outcomes can be attributed to the quality of medical care; the rest is determined by social factors such as income, health behaviors such as tobacco use, and physical factors such as housing and air quality.

For example, the CHNA finds that “in the Baystate Franklin service area, social isolation and loneliness are problems for many older adults, people with disabilities, people in remote rural areas, older teens and young adults who are not in school or employed, and people in marginalized groups who do not feel entirely welcome in the broader community.”

Housing is a persistent and serious concern identified in the report.  “About one-third of residents are housing cost-burdened, paying more than 30% of their income on housing. Typical households pay more than half of their income on housing plus transportation, whereas 45% of income is considered a manageable percent. Massachusetts has some of the oldest housing stock in the country, and local housing is older than housing statewide, meaning that it is typically less healthy, with issues of lead, mold, outdated wiring and plumbing, and inefficient heating systems. Homelessness is a persistent problem in the area, and area agencies are not able to meet the demand for shelter and services.”

The report finds that access to transportation, healthy food, places to be active, and broadband are also major barriers to health. “Most residents of Franklin County and the North Quabbin area are car-dependent, and the 7% of households without a car struggle to get to where they need to go. For many families, cars are simultaneously a necessity (to get to work, to school, to shopping) and a luxury (because budgets are stretched to keep them running). Pockets of the general population, such as Greenfield Community College students, have high rates of food insecurity, despite the many resources the community offers people experiencing hunger. Rural adults are typically less physically active than urban and suburban residents because they are car-dependent on roads that are not pedestrian-friendly, and they have less access to exercise facilities, due to lower income and/or distance. Broadband is gradually becoming available across the region, but as of the 2013-2017 period, one in five households did not have internet access, an increasingly essential element of our daily lives.”

Chart of determinants of healthSource: BaystateHealth.orgThe report also identifies a lack of resources to meet basic needs, lower educational attainment, and violence and trauma as significant barriers to health in our area.

The CHNA noted that some people have trouble accessing quality healthcare as well. People struggle with limited availability of providers, lack of care coordination, insurance problems, and the need for better cultural humility, transportation, and health literacy. Our area also falls short in several health care outcomes: chronic disease management, mental health and substance abuse, and infant and perinatal health.

These findings can help BFMC and other community organizations better address unmet needs in the community. For example, as a result of the last CHNA, several new programs were developed or continued, such as Community Action’s Look4Help directory of social services, BFMC’s Bridge Team to enhance care coordination for at-risk people, and MIGHTY (Moving, Improving and Gaining Health Together at the Y), a community-based multidisciplinary pediatric obesity treatment program. They also direct the hospital’s community investments, such as through its local grants program, which funded programs like the Communities that Care Coalition, which works to reduce youth tobacco, alcohol, and other drug use and more; and Just Roots, which makes fresh produce available to low-income families. In turn, this year’s report will also be used by BFMC and other organizations to guide their work in improving community health.

To view the full Community Health Needs Assessment, please visit and use the search box to search for “CHNA.”