new bedford health depar tment in par tn e rshi p w i t h
un i versit y of massac huse t ts dartmouth’s college of nursing
table of contents
execut i ve summary
overv iew of prior it y are as
pr iorit y area: sub stance abuse
pr iorit y area: mental he alth
pr iorit y area: access to car e
pr iorit y area: econo m ic oppor tunt y
pr iorit y area: housing
pr iorit y area: education
pr iorit y area: phys i cal activit y an d nutrit i on
pr iorit y area: safet y
pr iorit y area: cultur al responsiveness
references
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3
executive summary
e New Bedford Health Department proudly presents
the New Bedford Community Health Improvement
Plan (CHIP). e foundation of the CHIP was formed
through a Community Health Needs Assessment
(CHNA) that presented city data based on health indi-
cators along with social determinants of health. e
CHIP identies the current health priorities in New
Bedford based on data from the CHNA as well as
fteen key community informant interviews and focus
groups. As part of the nal phase of the CHNA, the
CHIP helps to reveal community needs in addition to
dening priority areas to focus strategic action. Rec-
ommendations from the CHIP include interventions
through education, policy implementation, and collab-
oration with local organizations for the promotion of
health throughout the community. is CHIP will be
an ongoing process for the residents of New Bedford
and will provide realistic plans with achievable out-
comes and goals for the betterment of the entire com-
munity.
We greatly appreciate the insights of many key infor-
mants in the New Bedford community that assisted us
in this process. Community organizations that partici-
pated in interviews or focus groups include:
New Bedford Health Department Nursing Division
New Bedford Public School Department
New Bedford Waterfront Personnel
Economic Development Oce
Immigration Services
New Bedford Housing Authority
Greater New Bedford Opioid Task Force
Greater New Bedford Community Health Center
Coastline Elderly
People Acting in Community Endeavors (PACE)
City of New Bedford’s Human Resources Oce
City of New Bedford’s Mayor’s Oce
4
substan c e abuse
economic opportun it y
hous in g
mental health
ac cess to care
overvie w of priorit y are as
Each day, more than 130 people in the United States die
from an opioid overdose (National Institute on Drug Abuse, 2019).
e city of New Bedford has been signicantly impact-
ed by this national crisis. Massachusetts has enacted
legislation to reduce opioid dependence in the state,
and New Bedford has developed its own initiatives. e
Greater New Bedford Opioid Task Force has imple-
mented multiple eective strategies along with other
community partners. However, substance abuse remains
a prevalent issue in New Bedford, and key community
informants have voiced their concerns on the impact of
this epidemic. Healthy People 2020 includes objectives
not only to increase access to substance abuse treatment,
but also to focus on upstream preventative interven-
tions.
Economic opportunities gravely impact the health status
of a population. Individuals with less education and low
skill levels are more likely to have job insecurity, little or
no health benets, low wages, and physically demand-
ing jobs (Burgard & Lin, 2013). Healthy People 2020 identies
employment as a key issue in social determinants of
health and has developed objectives to increase econom-
ic opportunities.
Housing instability signicantly impacts the health of a
population. Cost-burdened households are forced to for-
feit basic needs and limited rental markets force people
to live in substandard housing (Joint Center for Housing Studies,
2016). Healthy People 2020 identies housing as a key
social determinant of health in their Economic Stability
area and provides objectives for improvement.
Mental health has many negative impacts on individuals
in every stage of life. e World Health Organization
(2013) states, “Multiple social, psychological, and bio-
logical factors determine the level of mental health of a
person at any point of time” (par. 4). Mental health is
vital to the overall well-being of individuals. Socio-eco-
nomic pressures, traumas such as violence, discrimina-
tion, unhealthy lifestyles, poor physical health, societal
changes, and genetic factors are associated with poor
mental health (WHO, 2013). Healthy People 2020 identies
mental health and mental disorders as a priority topic
and includes multiple objectives for mental health status
improvement and treatment expansion.
People who do not have access to healthcare are at
greater risk of having poor overall health and negative
health outcomes (New Bedford CHNA). Access to healthcare
has a direct impact on a person’s quality of life. Quality
healthcare services include promoting and maintaining
health, preventing and managing disease, reducing un-
necessary disability and premature death, and achieving
health equity for all (Healthy People 2020).
5
physical activ i t y and nut r ition
safe t y
Obesity has been linked to many serious diseases and
health conditions including but not limited to high
blood pressure, high cholesterol, type 2 diabetes, coro-
nary artery disease, stroke, sleep apnea, mental health
and many more (CDC, 2015). Overweight or obese children
and adolescents are at a greater risk for the develop-
ment of these diseases (Healthy People 2020). Data from the
New Bedford CHNA found that the rate of obesity in
New Bedford is 33.8% compared to 23.9% in the state
of Massachusetts and 28.7% of adults nationally. Find-
ings also showed that 36.4% of New Bedford residents
reported no physical activity in their leisure time in the
past month (NB CHNA). Regular physical activity, good
nutrition, and maintaining a healthy body weight are
noted to be the backbone of health in every stage of life
(Healthy People 2020).
Crime rate in New Bedford is overall 28% higher than
the national average, and out of 100,000 people, there
are 9.65 crimes that occur daily (NB Area Vibes). e chanc-
es of becoming a victim of a violent crime in New Bed-
ford are 1/150 compared to the state average of 1/279 (New
Bedford CHNA). New Bedford community residents have
a violent crime rate that is 86% higher than the Massa-
chusetts average (NB Area Vibes). According to the surgeon
general, “health and wellness are inuenced by the plac-
es in which people live, learn, work, and play”. Support-
ive structures, such as violence free places to be active,
are vital for the health and safety of a community.
education
cultur al responsiveness
Education has a profound impact on the health of a
population. Educational status has been consistently
identied as a major predictor of health outcomes (Zim-
merman et al., 2015). Healthy People 2020 highlights educa-
tion as a key social determinant of health and includes
multiple objectives to increase educational attainment.
Racial and ethnic minority groups in the United States
are at a disproportionate risk of lacking access to health
care, being uninsured, and experiencing worse health
outcomes (Healthy People 2020). Culturally competent care
is a foundational step towards reducing these health
disparities (AHRQ, 2016).
overvie w of priorit y are as
6
priorit y area: substance abuse
“drugs have been an issue in our community”
“there is not enough substance abuse treat-
ment or counseling available”
ai m
overv iew
r ati onale
ob ject i ve 1
st r ategies
Reduce substance abuse in New Bedford to create
a safer and healthier community.
Each day, more than 130 people in the United States die
from an opioid overdose (National Institute on Drug Abuse, 2019).
e city of New Bedford has been signicantly impact-
ed by this national crisis. Massachusetts has enacted
legislation to reduce opioid dependence in the state, and
New Bedford has developed its own initiatives. e
Greater New Bedford Opioid Task Force has imple-
mented multiple eective strategies along with other
community partners. However, substance abuse re-
mains a prevalent issue in New Bedford, and key com-
munity informants have voiced their concerns on the
impact of this epidemic. Healthy People 2020 includes
objectives not only to increase access to substance abuse
treatment, but also to focus on upstream preventative
interventions.
Decrease the annual number of opioid overdose deaths in New
Bedford by 15% (Healthy People 2020).
Fishing industry workers are at high-risk for work-related injuries
that may put them at an increased risk of developing substance
use disorders (Walter et al., 2018).
Decrease the annual number of opioid overdose deaths in New Bedford
by 15% (Healthy People 2020).
Collaborate with the Greater New Bedford Opioid Task force to
increase the number of naloxone trainings in the community by 10%.
Partner with at least two neighborhood groups to provide overdose
education and naloxone distribution (OEND) programs (SAMHSA, 2018).
Establish a fully immersed health care provider in the shing
community who is able to respond to the specic needs of those in
this community and their families.
qu o t e s f ro m
ke y i n fo r m a n t s
7
r ati onale
ob ject i ve 3
st r ategies
Alcohol, marijuana, and tobacco are substances most commonly
used by adolescents. e National Youth Tobacco Survey (2018)
showed a 78% increase in e-cigarettes use among high school
students from 2017 to 2018. Key community informants are
concerned at the sudden and alarming increase in e-cigarette use
among students in New Bedford.
Focus on prevention of substance abuse through education and out-
reach to New Bedford youth.
Support the initiation of mindfulness programs for students in
New Bedford Public schools to reduce stress and promote healthy
coping strategies. (Healthy People 2020)
Provide education on the dangers of e-cigarette use to New
Bedford youth and parents through in-school class presentations,
informational sessions or health fairs at schools.
Support and enforce policies that restrict the sale of e-cigarettes to
minors.
r ati onale
ob ject i ve 2
st r ategies
In 2016, approximately 20 million people age 12 or older reported
needing treatment for substance abuse, but only 3.8 million people
actually received treatment (American Addiction Centers, 2018). ere
are many barriers to accessing substance abuse treatment such as
reluctance to seek treatment, lack of health insurance, or lack of
available treatment options. Multiple key community informants
noted the lack of resources for substance abuse treatment in New
Bedford compared to the growing need for these resources.
Increase the number of people who report needing substance abuse
treatment and receiving this treatment by 10% (Healthy People 2020).
Train additional multilingual recovery coach(es) to support people
recovering from substance addiction and prevent relapse.
Increase the number of mental health providers by funding tele-
health consultation services (American Addiction Centers, 2018).
Improve follow-up after inpatient or outpatient substance abuse
treatment programs through the use of peer support workers
(U.S. Department of Health and Human Services, 2018).
Advocate for state and federal legislation that will improve access
to substance abuse treatment, such as insurance reimbursement
incentives and insurance reform (U.S. Department of Health and Human
Services, 2018).
Increase access to medication (assisted) treatment in the Greater
New Bedford Community Health Center.
priorit y area: substance abuse
8
Reduce substance abuse in New Bedford to create
a safer and healthier community.
ai m
priorit y area: mental he alth
overv iew
“Immigrants are living in constant fear and
self-medicate”
“I’d say that mental illness is the core of the
opioid problem”
“If they don’t x the mental health crisis, they
aren’t going to x the opioid crisis”
“ere’s not enough clinicians or recovery
coaches”.
qu o t e s f ro m
ke y i n fo r m a n t s
Mental health has many negative impacts on individu-
als in every stage of life. e World Health Organiza-
tion (2013) states, “Multiple social, psychological, and
biological factors determine the level of mental health
of a person at any point of time” (par. 4). Mental health is
vital to the overall well-being of individuals. Socio-eco-
nomic pressures, traumas such as violence, discrimina-
tion, unhealthy lifestyles, poor physical health, societal
changes, and genetic factors are associated with poor
mental health (WHO, 2013). Healthy People 2020 identies
mental health and mental disorders as a priority topic
and includes multiple objectives for mental health status
improvement and treatment expansion.
9
priorit y area: mental he alth
r ati onale
ob ject i ve 2
st r ategies
Participants in key informant interviews revealed there are not
enough emergency response treatment programs in place for men-
tal illness crisis. Key informants have said, “ere are not enough
behavioral and mental health services for students. Students
are waiting up to three months on a waiting list to receive these
services”. “e shing industry is in need of fully immersed health
care providers”.
By 2024, increase access to rapid and emergency mental health treat-
ment that services 20,000 individuals.
Partner with Southcoast Hospitals Group to extend hours and ex-
pand the community sites of their mobile health van care delivery.
Devise a plan to increase prompt and professional response to
mental illness crisis for workers on shing boats by collaborating
with Fishing Partnership Services.
Implement workplace mental health support programs by training
employers and employees how to recognize employees in distress
and react accordingly (National Prevention Council, 2010).
Collaborate with the New Bedford School Department to implement
an evidence-based training for parents on how to recognize signs
of mental health crisis in their children and how to provide support.
r ati onale
ob ject i ve 1
st r ategies
In 2015, 18.3% of New Bedford adults reported poor mental health
for at least 14 days compared to the national average of 11.6% (New
Bedford CHNA). A number of participants in key informant inter-
views revealed there are many barriers that limit access to mental
health such as long waiting times, lack of mental health providers,
and limited knowledge in mental health treatment. e World
Health Organization’s Mental Health Action Plan 2013 – 2020
includes one strategy that suggests preparing informal mental
health providers and health professionals with the skills they need
to better manage mental health illnesses (WHO, 2013).
Increase the number of culturally competent mental health providers
and counselors by 10% by 2024.
Support and promote the New Bedford Education Department’s
trauma-informed school program to train more teachers and
school nurses in helping students cope with trauma.
Partner with the Greater New Bedford Community Health Center
to develop training programs that integrate mental health services
into primary care (SAMHSA; WHO, 2013).
Promote careers within the mental health eld by partnering with
community organizations to educate and train more local mental
health counselors.
10
r ati onale
ob ject i ve 3
st r ategies
Key informants expressed many concerns regarding mental health
stigma especially in the immigrant population and the workers in
the shing industry. e WHO Mental Health Action Plan 2013
– 2020 suggests informational campaigns to reduce stigma and
discrimination surrounding mental health.
Engage 20,000 residents in a training to reduce stigma surrounding
mental health by 2024.
Develop and implement a school-based evidence-based training
targeting all young children and young adults in New Bedford
public schools to increase knowledge of mental health and reduce
stigma (Adapted from the Worcester CHIP)
Partner with community organizations to implement a public
awareness campaign that focuses on reducing mental health stig-
ma for the adult population (adapted from the Worcester CHIP)
priorit y area: mental he alth
11
r ati onale
ob ject i ve 1
st r ategies
Multiple key informants emphasized the need to establish a
school-based health center in New Bedford. is school-based
model can improve health equity among children and adolescents
by reducing barriers to accessing preventative care and treatment
(School-Based Health Alliance, 2018). Other key informants highlighted
the ability of the health department to enhance the health of the
community through provision of immunization services. Accord-
ing to the CDC (2019), local health departments are key resources
for this essential preventative service.
Increase the capacity of the health department and the school system
to provide comprehensive health services to New Bedford youth.
Collaborate with the school system to advocate for and work
towards establishing a school-based health center in New Bed-
ford that will comprehensively address the needs of students by
providing preventative care, screening services, mental health care,
and referrals.
Increase the capacity and resources of the nursing division at the
health department to allow for provision of vaccine clinics that
will support the needs of the entire community.
priorit y area: access to care
Create an accessible environment in New Bedford that
provides and promotes health services for all residents
that are culturally responsive and adaptive to the needs
of the community.
ai m
overv iew
“We need accessibility to health when it is needed”
“Families need health access”
“Healthy students graduate”
“ere are not enough nurses to go around”
“School-aged children do not have primary care
physicians or get preventative care”
qu o t e s f ro m
ke y i n fo r m a n t s
People who do not have access to healthcare are at great-
er risk of having poor overall health and negative health
outcomes (New Bedford CHNA). Access to healthcare
has a direct impact on a person’s quality of life. Quality
healthcare services include promoting and maintaining
health, preventing and managing disease, reducing un-
necessary disability and premature death, and achieving
health equity for all (Healthy People 2020).
12
ob ject i ve 3
st r ategies
Incorporate multilingual community health workers and patient
advocates into the public health system for the residents of New Bedford.
Develop a formal cadre of culturally immersed and competent
community health care workers in New Bedford to engage resi-
dents’ participation in health care and education.
Provide health education and rst aid training for the current and
future front-line community health workers based on the health
care trends and priority areas of New Bedford residents.
priorit y area: access to care
r ati onale
ob ject i ve 2
st r ategies
New Bedford is a culturally diverse city and is in need of cultur-
ally competent care. According to the Census Bureau, as of July
1, 2018, 20% of New Bedford residents are Hispanic or of Latino
descent and 4% are a combination of two or more race categories.
37.4% of the population of New Bedford speaks a language other
than English at home (U.S. Census Bureau).
Increase multilingual primary care clinician availability for the
residents of New Bedford.
Develop initiatives that support the current workforce and develop
strategies to enhance recruitment and promote retainment of
primary care providers (SHRM, 2019).
Provide culturally competent education for the current and future
healthcare workforce including physicians, nurse practitioners,
nurses, dentists, and mental health clinicians based on the needs
of New Bedford residents.
Promote culturally diverse awareness of free screening services
throughout the community to encourage preventative care.
13
priorit y area: access to care
r ati onale
ob ject i ve 4
st r ategies
e role health literacy plays within access to care is profound.
Health literacy is dened as “the degree to which individuals have
the capacity to obtain, process, and understand basic health infor-
mation and services needed to make appropriate health decisions”
(U.S. Department of Health and Human Services). According to the U.S.
Department of Health and Human Services, only 12% of adults
are procient in health literacy. One-third of adults in the United
States have diculty following directions on a prescription bottle
or keeping up with an immunization chart. Key informants with-
in the culturally diverse city of New Bedford cited several ideas for
collaboration with programs in the community.
Improve communication through the enhancement of health literacy
for the residents of New Bedford and by attending to literacy level of all
health education programs.
Improve cultural and linguistic competency of healthcare profes-
sionals to contribute to health literacy (U.S. Department of Health and
Human Services).
Build partnerships within the community to help develop and
provide culturally diverse guidance and support.
Provide accurate and accessible health and safety information
throughout the community to promote good health and life-long
learning (National Action Plan to Improve Health Literacy).
14
ob ject i ve 1
st r ategies
Increase the number of employment resources to population of New
Bedford.
Develop a formal cadre of culturally immersed and competent
community health care workers in New Bedford to engage resi-
dents’ participation in health care and education.
Provide health education and rst aid training for the current and
future front-line community health workers based on the health
care trends and priority areas of New Bedford residents.
priorit y area: economic opportunit y
r ati onale
New Bedford lags behind the region as a whole in most socioeco-
nomic metrics” (from the New Bedford CHNA). In 2017, Massachusetts
had a 4.0 % unemployment rate, while New Bedford had an
unemployment rate of 5.7% (U.S. Census American Community Survey,
2018). Participants in key informant interviews said, “ere are job
opportunities and skill attainment programs out there, but people
don’t know where to nd them”.
Improve population health by providing residents with
more job opportunities that include healthy and safe
conditions and provide stable and livable working wages.
ai m
overv iew
“We need to get more people interested in a trade and
get more people comfortable with preparing for work”
“Economic opportunity is the key to improving the
community”
qu o t e s f ro m
ke y i n fo r m a n t s
Economic opportunities gravely impact the health
status of a population. Individuals with less education
and low skill levels are more likely to have job insecurity,
little or no health benets, low wages, and physically
demanding jobs (Burgard & Lin, 2013). Healthy People 2020
identies employment as a key issue in social determi-
nants of health and has developed objectives to increase
economic opportunities.
15
ob ject i ve 3
ob ject i ve 4
st r ategies
st r ategies
Increase support and services in transportation and childcare that al-
low New Bedford residents to stay employed.
Implement institutional and city-level policies to increase employment
opportunities and retainment.
Encourage local businesses and employers to provide more on-site
childcare (Gullekson, 2014).
Lobby at the political level for the city councilors and the mayor
to advocate for more livable wages.
Partner with the Southeastern Regional Transit Authority advisory
board to develop a plan for transportation services for underserved
populations (adapted from Worcester CHIP).
Partner with local businesses to adopt policies that hire local resi-
dents (Anchor Institutions, 2018).
priorit y area: economic opportunit y
r ati onale
r ati onale
In 2017, 70.3% of New Bedford parents of children under 6 years
old are in the labor force (U.S. Census American Community Survey, 2018).
Key informants have said that child care is a huge issue for work-
ing and single parents. “Some are eligible for free childcare for up
to one year. After the year is up, they pay market value which is a
huge expense”. “We need night time bus services”. “All long-term
care and rehabilitation facilities have no bus services after 6”.
In 2017, while the Massachusetts mean household income average
was $74,167, the median household income of New Bedford resi-
dents was $40,626. Increasing livable wages can reduce reliance on
government welfare programs. Many families rely on government
assistance because employers don’t pay enough to sustain their
family’s basic needs (Konigsburg, 2017). Key informants have said,
“Many New Bedford residents are working two or three jobs to
provide for their families.”
r ati onale
ob ject i ve 2
st r ategies
In 2017, New Bedford had the highest percent of residents in the
region reporting limited English prociency at 17.4 % (U.S. Census
American Community Survey, 2018). Participants in key informant inter-
views said, “ere are many people here from other countries that
want to work but can’t because of the language barrier”.
Increase the number of participants enrolled in English as Second Lan-
guage educational opportunities by 25% by 2024.
Partner with and support the New Bedford Economic Develop-
ment Oce and local community colleges in promoting more
English as a Second Language programs to the public.
Distribute a translated resource guide of ESL classes to parents
of children in public schools and to families and patients at local
hospitals (adapted from Worcester CHIP).
16
ob ject i ve 1
st r ategies
Improve substandard housing available to the New Bedford population.
Collaborate with local landlord associations to educate landlords
on the importance of complying with health codes to ensure a safe
housing stock (adapted from New Bedford 2020 City Master Plan).
Promote the importance of safe lead removal and provide more
resources to lead removal.
priorit y area: housing
r ati onale
In 2017, 102 occupied housing units did not have complete plumb-
ing facilities and 302 did not have complete kitchen facilities (U.S.
Census Bureau, 2019). Participants in key informant interviews have
said, “Some landlords do not comply with housing rules unless
they are forced to by the courts and even then, they still don’t
comply 100%”.
To collaborate with more organizations that provide
housing assistance to increase access to safe and aord-
able housing and enforce building codes of substandard
housing.
ai m
overv iew
“We have a waiting list of over 4,000 people to get
housing. Waiting time could be anywhere between
from six months to ten years.”
“People can’t aord their rent.”
“ere aren’t enough homeless shelters and programs
in place. It is really dicult to access shelters without
having gone through the channels.”
qu o t e s f ro m
ke y i n fo r m a n t s
Housing instability signicantly impacts the health of a
population. Cost-burdened households are forced to for-
feit basic needs and limited rental markets force people
to live in substandard housing (Joint Center for Housing Studies,
2016). Healthy People 2020 identies housing as a key
social determinant of health in their Economic Stability
area and provides objectives for improvement.
17
ob ject i ve 3
st r ategies
Decrease the rate of homelessness in New Bedford by 10% by 2024.
Collaborate with community organizations, such as New Bedford
PACE and Coastline Medical, to identify households that are at
risk for losing their housing.
Support and promote homeless prevention programs such as the
Continuum of Care developed by the New Bedford Homeless
Service Provider Network (New Bedford Homeless Service Providers
Network, 2019).
Collaborate with the New Bedford Housing Authority and other
local organizations to transform and expand emergency response
systems that provide rapid rehousing to people at risk for becom-
ing homeless.
priorit y area: housing
r ati onale
“In 2015, in the New Bedford Continuum of Care, the total count
of homeless people was 437” (Southcoast Urban Indicators Project, 2018).
Key stakeholders have said, “You can’t access homeless shelters with-
out calling the hotline. It gets people on list and helps nd commu-
nity resources to help, but that process can take a long time”.
ob ject i ve 2
st r ategies
Increase accessibility to more aordable housing in the New Bedford
community by 2024.
Support and promote the New Bedford YouthBuild Program and
the City of New Bedford Oce of Community Development to
build more aordable housing units.
Create one resource center that provides information on commu-
nity outreach programs (Mass.gov, 2018).
Partner with New Bedford PACE to provide nancial assistance
and housing search assistance through the Housing Services Pro-
gram (adapted from PACE Strategic Plan).
r ati onale
Key informants have said that New Bedford residents are living
paycheck to paycheck to aord a roof over their heads. In 2017,
49.9% of New Bedford residents paying rent paid more than 30%
of their household income on rent (U.S. Census Bureau, 2019). House-
holds are considered income burdened when they spend more than
30% of their income on housing costs (Baily et al., 2015).
18
ob ject i ve 1
st r ategies
Increase the proportion of New Bedford students who graduate high
school four years after starting 9th grade by 10%.
Support and promote programs for family engagement, such as
the Family Institute for Student Success.
Provide internships, vocational training, and career building
opportunities for students to encourage the pursuit of higher
education and earn certications for employment (Siegel Robertson,
Smith, & Rinka, 2017).
Increase access to after school programs that provide creative and
engaging academic enrichment opportunities (Massachusetts 21st
Century Community Learning Centers, 2018).
priorit y area: education
r ati onale
New Bedford’s high school graduation rate was 76% in 2018,
which is the highest it is has been in 12 years (Massachusetts Depart-
ment of Elementary and Secondary Education, 2019). However, this rate
is still lower than the statewide average of 87.8% in 2018. e
National Dropout Prevention Center encourages strategies such
as family engagement, school and community collaboration, and
alternative schooling to increase graduation rates.
Support the eorts of the New Bedford Public School
Department and other local organizations to promote
student success and increase educational attainment for
all members of the community.
ai m
overv iew
“We need to change the way we deliver education. If
there is a key out of poverty it is education, but it has
to be across the board for every child regardless of race,
neighborhood, or disabilities”.
qu o t e s f ro m
ke y i n fo r m a n t s
Education has a profound impact on the health of a
population. Educational status has been consistently
identied as a major predictor of health outcomes (Zim-
merman et al., 2015). Healthy People 2020 highlights educa-
tion as a key social determinant of health and includes
multiple objectives to increase educational attainment.
19
ob ject i ve 3
st r ategies
Increase the presence of nurses in the community and within the
schools to promote wellness through health education.
Increase sta in the nursing division of the health department to
allow time for community-wide health education.
Collaborate with New Bedford Public Schools to provide health
information clinics to parents and students on topics relevant to
the needs of the community.
priorit y area: education
r ati onale
e knowledge and competencies of the public health nurse
“allows them to take a leadership role to assess assets and needs of
communities and populations and propose solutions in partner-
ships” (Kulbok et al., 2012).
ob ject i ve 2
st r ategies
Increase the accessibility of higher education in the
New Bedford community.
Establish an academic health department partnership with the
University of Massachusetts Dartmouth to enhance public health
education and training.
Collaborate with New Bedford PACE to increase access to GED
preparation classes and vouchers for certication programs and
college courses.
r ati onale
New Bedford has an overall lower educational attainment level
compared to surrounding towns and state averages. Approximately
73% of New Bedford residents age 25 and older have a high school
diploma or GED equivalent, compared to 90% in Massachusetts
overall. Approximately 17.1% of New Bedford residents age 25 and
older have a bachelor’s degree or higher, compared to 42% in Mas-
sachusetts overall. (Data retrieved from U.S. Census American Community
Survey, 2018)
20
priorit y area: physical activit y and nutr ition
Ensure access to good nutrition and physical activity to
promote and maintain healthy body weight to decrease
the risk of developing serious health problems.
ai m
overv iew
“We have an issue with obesity in the schools.”
“ere is a lot of food insecurity, a better screening
process is needed.”
“People don’t know about programs likes SNAP
(Supplemental Nutrition Assistance Program)”.
“e only time some kids eat is while they are at school.”
qu o t e s f ro m
ke y i n fo r m a n t s
Obesity has been linked to many serious diseases and
health conditions including but not limited to high
blood pressure, high cholesterol, type 2 diabetes, coro-
nary artery disease, stroke, sleep apnea, mental health
and many more (CDC, 2015). Overweight or obese children
and adolescents are at a greater risk for the develop-
ment of these diseases (Healthy People 2020). Data from the
New Bedford CHNA found that the rate of obesity in
New Bedford is 33.8% compared to 23.9% in the state
of Massachusetts and 28.7% of adults nationally. Find-
ings also showed that 36.4% of New Bedford residents
reported no physical activity in their leisure time in the
past month (NB CHNA). Regular physical activity, good
nutrition, and maintaining a healthy body weight are
noted to be the backbone of health in every stage of life
(Healthy People 2020).
21
priorit y area: physical activit y and nutr ition
ob ject i ve 2
st r ategies
Increase the daily consumption of fruits and vegetables by providing
education on healthful benets of good nutrition.
Increase access to fresh, healthy foods by providing strong incen-
tives to both producers and consumers.
Build an environment that provides the New Bedford community
with healthy food choices at lower costs.
Provide community education regarding portion control, what
healthy eating options are, and the impact of caloric intake.
r ati onale
Fast foods have been noted to have high fat and energy density
along with low ber, and they have been positively associated with
obesity risk (NIH, 2017). Children and adolescents who eat a health-
ful diet maintain healthier weights, reach normal growth, and de-
velop strong immune systems (Healthy People 2020). According to the
CDC, a healthy eating plan emphasizes fruits, vegetables, whole
grains, and is low in saturated fats, trans fats, cholesterol, salts,
and added sugars (CDC, 2019). Improving access to fresh, healthy
foods in the New Bedford community will enhance nutrition
while improving the overall health of the community.
Strengthen food insecurity screening assessments at schools and
primary care oces.
ob ject i ve 1
st r ategies
Increase accessibility to healthy foods by promoting participation in
programs such as SNAP, WIC, and the National School Lunch program.
Provide more enrollment opportunities for the residents of New
Bedford in programs such as SNAP and WIC.
Promote the use of SNAP and WIC programs at New Bedford
Farmers Markets (adapted from Worcester CHIP).
Increase access and aordability of fresh and healthy foods
(Mass in Motion).
r ati onale
e provision of food security programs such as SNAP, WIC, and
the National School Lunch program contribute to the decrease in
food insecurity. According to Healthy People 2020, adolescents
showed low vegetable and fruit intake averaging to less than 1.1
times a day (Healthy People 2020). Low fruit and vegetable consump-
tion paired with little to no physical activity has led to an increase
in obesity (Healthy People 2020). With alarming obesity percentages
linked to New Bedford residents, the use of programs such as
SNAP and WIC will provide healthier eating options to those
with lower incomes.
22
priorit y area: physical activit y and nutr ition
ob ject i ve 3
st r ategies
Promote physical activity within the town of New Bedford by provid-
ing safe access opportunities for the community.
Develop a walkable community and ensure public safety (South-
coast Urban Indicators Project).
Enhance safety and access to outdoor activity by improving walk-
ing, biking, and trac safety (Southcoast Urban Indicators Project).
Build an outdoor environment that promotes healthy activity
throughout the community, such as walking and biking.
r ati onale
Physical activity can help people stay at a healthy weight or even
lose weight if needed (Harvard T Chan School of Public Health). e
recommended amount of physical activity for those ages 6-17 is
60 minutes daily. For adults, 150-300 minutes of moderate aerobic
exercise weekly is recommended (Physical Activity Guidelines for Amer-
icans DPHP). Increased sedentary behavior has been linked to an
increase in heart disease, therefore, the rst guideline noted in the
Physical Activity Guidelines for Americans is “move more sit less”
(DPHP). Promoting physical activity in New Bedford would bring
overall benets to the community, including a decrease in preva-
lence of obesity along with an improvement in diseases linked to
sedentary lifestyles.
23
ob ject i ve 1
st r ategies
Decrease the violent crime rate by 10% by 2022 in the city of New Bedford.
Implement a neighborhood watch by engaging the residents and
collaborating with the local police department.
Execute recruiting practices for the police department to enhance
community policing presence in the community.
Increase police participation in the community to establish trust
and presence (NB Police Department Strategic Plan).
Create and build a positive community and law enforcement rela-
tionship for the residents of New Bedford (adapted from Worcester CHIP).
priorit y area: safe t y
r ati onale
A team eort is required in order to keep a neighborhood safe.
Neighborhood safety fosters a safe community (safehome.org). De-
creasing violent crime in the community of New Bedford will start
with modiable improvements in the environment. According to
Healthy People 2020, injury and violence prevention should focus
on changing social norms regarding the acceptability of violence.
Establish a safe and crime-free community environment
where all New Bedford residents, including school-aged
residents, feel secure and respected.
ai m
overv iew
“Middle school bullying is a particularly bad problem, no
one does anything, we need a robust after school pro-
gram.”
“Can’t call the police because they are afraid…”.
qu o t e s f ro m
ke y i n fo r m a n t s
Crime rate in New Bedford is overall 28% higher than
the national average, and out of 100,000 people, there
are 9.65 crimes that occur daily (NB Area Vibes). e chanc-
es of becoming a victim of a violent crime in New Bed-
ford are 1/150 compared to the state average of 1/279 (New
Bedford CHNA). New Bedford community residents have
a violent crime rate that is 86% higher than the Massa-
chusetts average (NB Area Vibes). According to the surgeon
general, “health and wellness are inuenced by the plac-
es in which people live, learn, work, and play”. Support-
ive structures, such as violence free places to be active,
are vital for the health and safety of a community.
24
ob ject i ve 3
st r ategies
Increase after-school programs to promote youth safety and encourage
students to work together in safety issues.
Implement initiatives for after-school activities that promote
youth development.
Enhance and promote street outreach and community engage-
ment programs that encourage employment and education.
Continue work with the Safe and Successful Youth Initiative
(SSYI) to promote public safety (SSYI United Way).
Promote education and support employment to under-resourced
families to enhance opportunity and decrease crime (adapted from
Worcester CHIP).
priorit y area: safe t y
r ati onale
Empowerment of youth through after-school programs promotes
safety, physical activity, and health. Decreasing the amount of un-
supervised time youth have after school by providing after-school
programs can provide shelter from unsafe environments and de-
crease the amount of time spent in unsupervised settings (crimeso-
lutions.org). Safe and supervised public spaces like schools or parks
allows for free time to be lled with constructive activities (adapted
from Worcester CHIP).
ob ject i ve 2
st r ategies
Create violent-free places where the residents of New Bedford
can be active and feel safe.
Increase safety and access to public parks for all residents in the
city of New Bedford.
Promote the use of green space and public spaces to strengthen
community connection and encourage unison for the residents of
New Bedford.
Provide initiatives and funding eorts to support free activities
that promote healthy and safe behaviors.
r ati onale
Safe outdoor space within the community enhances livelihood
and promotes safety. Lack of access to safe spaces for outdoor ac-
tivities related to violence is linked to mental health problems and
poor physical health (NEEFUSA). As noted in the City Master Plan
of New Bedford 2020, “well-located and diverse open space and
recreational systems are essential” to the success and sustainability
of the community.
25
priorit y area: cultur al responsiveness
“New Bedford schools are culturally diverse and there are
many barriers for these children.”
“Immigrants are living in fear of getting deported. It is
causing increased stress.”
“Language is a huge barrier in New Bedford.”
“Cultural diversity exists and results in challenges to pro-
viding health care.”
“I believe there are around 10,000 to 12,000 undocument-
ed immigrants living in New Bedford.”
qu o t e s f ro m
ke y i n fo r m a n t s
ob ject i ve 1
st r ategies
Increase the number of interpreters at community health organizations.
Obtain funding to train two additional multilingual community
health workers.
Provide one multilingual health insurance coordinator to assist cul-
turally diverse children and families in obtaining health insurance.
Continue work with the Safe and Successful Youth Initiative
(SSYI) to promote public safety (SSYI United Way).
Increase access to interpreter training programs for members of
the community who are multilingual and have interest in provid-
ing this service.
r ati onale
Approximately 17.4% of New Bedford residents have limited
English prociency (New Bedford CHNA). e National Standards
for Culturally and Linguistically Appropriate Services (CLAS)
suggest that healthcare organizations oer language assistance to
all individuals with limited English prociency and promote these
services eectively.
Provide quality care and services that are “responsive to
diverse cultural health beliefs and practices, preferred
languages, health literacy, and other communication
needs” (National CLAS Standards, 2019).
ai m
overv iew
Racial and ethnic minority groups in the United States
are at a disproportionate risk of lacking access to health
care, being uninsured, and experiencing worse health
outcomes (Healthy People 2020). Culturally competent care
is a foundational step towards reducing these health
disparities (AHRQ, 2016).
26
ob ject i ve 2
st r ategies
Ensure immigrant residents of New Bedford have access to
the community services they need (Chang, 2019).
Collaborate with the Immigration Assistance Center to provide
vaccinations for the parents and children who utilize their services.
Increase the number of people utilizing services oered by the
Immigration Assistance Center by 10% by 2024.
Increase outreach to the immigrant population by collaborating
with neighborhood group leaders to promote awareness of services
oered by the health department (Chang, 2019).
Provide education on how to access preventative health services
through ethnic media sources (American Press Institute, 2018).
r ati onale
Non-white residents of New Bedford account for more than
one-third (34.8%) of the population (New Bedford CHNA). 12% of
New Bedford residents are citizens by naturalization and 9% are
not U.S. citizens (U.S. Census American Community Survey, 2017). is
number may be underreported due to fear of disclosing citizenship
status for legal reasons (U.S. Citizenship and Immigration Services). Mul-
tiple key informants expressed their concern that New Bedford
has a large immigrant population that may not be able to access
services due to fear or cultural barriers.
priorit y area: cultur al responsiveness
27
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