LOWELL — David Turcotte and a team of collaborators have compiled and published the Greater Lowell Community Health Needs Assessment every three years since 2013.
The lengthy document probes factors influencing residents’ health, like housing, education and employment. It analyses public health data and identifies residents in the community with the highest risk.
And when you ask health care professionals in Lowell about the relationship between race, ethnicity and health, this document is often referenced.
“It’s clear that there is an aspect of institutional racism that is connected to worse health outcomes for communities of color,” said Turcotte, who is a research professor at the University of Massachusetts Lowell specializing in sustainable housing, conflict resolution and environmental justice.
In Boston and Somerville, officials have declared racism a public health crisis. A petition signed by over 1,000 people urges the city of Lowell to follow suit and institute other reforms.
The Lowell City Council is expected to discuss the matter on Tuesday, as it moves through a bevy of motions on racism and equity with differing approaches and language.
But what are the links between race and health?
Health officials point to the prevalence of certain medical conditions, which are higher among certain ethnic or racial minorities than white residents. This has been documented locally and nationwide for COVID-19 rates, but it is not a phenomenon limited to the ongoing pandemic, officials say.
Chief of Community Health & Policy at Lowell Community Health Center, Sheila Och, listed asthma, diabetes, and hypertension, as examples, referencing numbers reported in the 2019 Greater Lowell Community Health Needs Assessment.
Hispanic children four and under in Lowell were hospitalized for asthma at almost twice the rate as white children in the city between 2002 and 2014, according to the report.
Hospitalization for diabetes in Lowell is “substantially” higher than in surrounding communities, according to the report. The report cited state level numbers, indicating 12.3% of adults who identify as Black, 11.7% of adults who identify as Hispanic and 8.7% of adults who identify as white have diabetes.
“When we say Blacks and Hispanics are three times more likely to have x, y and z disease — whether that’s diabetes or hypertension or chronic heart conditions — we’re able to close that gap, but we have to put the systems in place to impact that disparity number,” Och said.
These rates are influenced by what health officials call “social determinants” of health. Dr. Wendy Mitchell, president of the Lowell General Hospital Medical Staff, listed a few examples of these determinants ranging from housing instability to insufficient wages to neighborhood walkability to food availability to access to higher education.
“The racial injustice affects all of the above,” she said.
She said many countries in Europe that spend more on addressing social determinants, spend less on medical care.
Turcotte focused on the lack of affordable housing as a public health issue.
People in Lowell, on average, spend a higher percentage of their income on housing than Westford residents, even if housing is cheaper in Lowell, according to Turcotte. He argues this makes Lowell the less affordable community. When more of residents’ money goes toward housing, this leaves less for other determinants of health, like nutritional food and quality of life activities.
“It doesn’t leave much for the other necessities,” he said, noting race and income is often interconnected in the U.S.
However, “one sliver bullet” won’t solve the issue, he said.
“It’s not that everyone is racist,” he said. “Racism and barriers of race for opportunities exist.”
Och said the experience of racism also has direct health impacts, especially to mental health.
“We hear these stories every single day: the emotional toll of racism and discrimination … and the lifelong accumulation of the related stress around discrimination and racism for many of our communities of color,” Och said. “And how that manifests biologically, physically in someones body over time.”
A survey of 1,355 local residents — part of the 2019 Greater Lowell Community Health Needs Assessment — had participants rank community safety issues, like domestic violence, drug trafficking and different types of discrimination. Among all participants, “discrimination based on race” was seventh out of sixteen options. Among only non-white participants, “discrimination based on race” was ranked second, behind “bullying.”
Och said employees hear a common story at the LCHC Behavioral Health Services department, which offers mental health and substance abuse services.
“One of the stories that feels like it’s woven throughout, is this sense that not being included in a community and being always out of that circle,” she said.
Beyond “upstream approaches” requiring wider policy changes, Mitchell said she believes providers need to screen patients for social determinants of health. She said other shifts may be less obvious. For example, she said patients sent home with conditions like congestive heart failure are provided a list of dietary recommendations, though this list may not take into consideration cultural dietary differences.
“It may not be the foods or the meals that people eat,” she said. For some patients, a list of low-sodium Cambodian meals may be more useful than the list that is typically provides, Mitchell said.
LCHC created the Metta program about two decades ago to meet the specific needs of the city’s Cambodian population.
“It’s a prime example of how a community takes care of another community,” said Susan Levine, the chief executive officer of LCHC.
The city’s Cambodian population experiences higher than average rates of diabetes, hypertension and asthma, according to Och. Some who settled in Lowell as refugees are survivors of torture and experience post traumatic stress disorder.
“There are disparities that exist within our Cambodian community that also need to be talked about … and there’s also the aspect of resiliency that despite all these negative odds that some people have faced in their lives, they continue to rise and they continue to have the energy to improve the communities in which they live,” Och said.
As well as bilingual services, Och said Metta takes a culturally sensitive and appropriate approach to health care for this population.
Last month, the 19-member board at LCHC unanimously supported a letter requesting the declaration of racism as a public crisis in Lowell, according to Levine. She said LCHC is a community health center based on a model that emerged from the civil rights movement. Eliminating health disparities is part of its mission statement.
“It goes back to why we exist as a community health center,” she said.
Lowell Board of Health Director JoAnn Keegan — who also served as Lowell’s acting health director for a few months earlier this year — said she has been on vacation and has not been keeping up with the debate on declaring racism a public health crisis. The board does not have a July meeting and will next meet in August.
She said she believes there are health disparities by race, which have been documented in the Greater Lowell Community Health Needs Assessment.
“That’s a document I left right on the top of the desk when I left,” she said.
Turcotte said, while he doesn’t think Lowell is unique, racism is a public health problem in Lowell.
“Declaring it is the easy thing to do,” he said. “But what are you going to do about it?”
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