The Push Toward Health Equity in New Bedford, a City of Immigrants
“Marathon” work adapts to cultural, linguistic needs of community, improves access to care
Posted on Dec 21, 2021
In May 2020, as health officials gathered for a press conference with Massachusetts Governor Charlie Baker on the importance of a newly launched COVID-19 Community Tracing Collaborative, two strangers began to chat. Soon enough, they realized they had a similar vision for transforming public health to better address the needs of communities.
“It was an unplanned meeting of the minds,” said Damon Chaplin, director of the New Bedford Health Department, recalling his first encounter with Dr. John Welch, director of Partners In Health’s COVID-19 response in the state. “We just had a common interest in what happened in Massachusetts and the country and the world around COVID-19.”
A New Partnership is Born
While the Massachusetts Community Tracing Collaborative—the pandemic-driven contact tracing venture between PIH and the Commonwealth of Massachusetts—will end December 30, the partnership in New Bedford endures. What started as a single conversation between Chaplin and Welch evolved into regular discussions about the need for local health departments to add staff dedicated to contact tracing and connecting people in need with basic resources; and to eliminate health disparities for marginalized populations.
In the spring of 2020, as PIH began responding to requests for technical support in hard-hit regions across the United States—from Montgomery, Ala., to Chicago, Ill.—Chaplin and Welch continued talking and planning. Those conversations evolved into a formal agreement for PIH to provide in-depth technical support to the New Bedford Health Department.
In early 2021, PIH-US, now a formal arm of the global health and social justice organization, recruited, hired, and trained a five-person team embedded in New Bedford. The team’s full-time epidemiologist, contact tracer, community liaison, health equity specialist, and senior team leader support all aspects of the city’s COVID-19 response – from strategic planning for vaccine clinics to conducting door-to-door community outreach. Beyond the pandemic, PIH-US is partnering with New Bedford and local community organizations to establish a broader health equity agenda in this culturally diverse city that has weathered decades of economic and demographic shifts.
“Health equity and racial equity are hard,” said Melissa Mazzeo, PIH-US’s senior project lead in New Bedford. “There’s so much good work being done to target symptoms, but we need to address the root causes of inequity; we want to elevate equity in a formal way.”
Shifting Demographics and Wealth
In the mid-1850s as the whaling industry boomed, New Bedford was deemed “the richest city per capita in the nation” and immortalized in Herman Melville’s Moby Dick.
These days, New Bedford is still a key player in the fishing industry; it’s the number one fishing port in the U.S. when measured by the dollar value of catch, and it’s the center of the global scallop market. As the pandemic escalated, New Bedford moved to protect local workers and industries: it was the first city in the country to provide a free mask to city residents and mandated stringent safety requirements at the seafood processing plants.
Still, the city faces significant challenges. More than 20% of the city’s 100,000 residents live in poverty—significantly higher than the state average of 11.4%. About 10,000 New Bedford residents are immigrants without documentation, and, like many U.S. cities, New Bedford has been devastated by the opioid epidemic. The COVID-19 pandemic only exacerbated these inequities, disproportionately impacting Latinx residents, who comprise about 20% of the population. Throughout the pandemic, New Bedford’s caseload has been consistently high, said epidemiologist Shanon Smith During each COVID-19 surge, from March 2020 to the present, New Bedford's highest 14-day average incidence rate was nearly double that of Massachusetts.
Improving Access to Health, Investing Locally
Removing barriers to access has always been a priority for PIH. As vaccines became available, the PIH-US team, working alongside the New Bedford Health Department and community organizations, supported a local block-by-block vaccination strategy that deployed mobile vaccine clinics and trusted messengers to canvass high-need neighborhoods and accompany residents to get vaccinated. At the same time, team members have also kept a close eye on cultural and language needs among New Bedford’s thriving multi-ethnic population, where nearly 40% of residents over 5 speak a language other than English at home.
Rosa Matos, the contact tracing liaison on PIH-US's New Bedford team, and Solange Anderson, the community outreach liaison, are well-versed in the immigrant experience. Matos arrived in the U.S from Cape Verde when she was 8, attended high school and college, and became a medical assistant in Brockton, Mass. Anderson grew up in Brazil and came to the U.S in 2016 as a part of an au pair cultural exchange program, then trained as an interpreter and translator, eventually working with legal interpretation and translation in Boston. Both women worked for the Massachusetts CTC, joined the PIH New Bedford team, and will ultimately transition to become health department employees. Their work includes supporting immigrant communities with health information on COVID-19 while also seeking to increase vaccine uptake.
Cape Verdean Creole, Portuguese and Other Translations Needed
When Matos and Anderson began working in New Bedford, almost all the written health material was in English. They quickly sought to remedy that -- ensuring that all of the flyers and handouts related to COVID-19, from vaccine clinic information and registration forms to guidelines on isolation and quarantine, were available in Cape Verdean Creole and Portuguese, as well as Spanish. Anderson, continues to translate for people at mobile vaccination clinics; Matos is working with the local Cape Verdean Association to get the word out about the importance of vaccination. The two have helped organize clinics at a Brazilian church, an outdoor Cape Verdean festival, outside grocery stores, at an industrial park, and various housing blocks. To reach young people, the team helped organize a vaccine challenge competition on social media—TikTok and Instagram—offering cash gift cards for the winning picture or video.
Obstacles remain. Only about 50% of residents are fully vaccinated. Many undocumented immigrants don’t trust government officials of any kind to take care of their health needs, the two women said. Translated materials have not helped the small population of Guatemalans in New Bedford who speak Kʼicheʼ, a Mayan language not widely known outside this community. And, like in many other regions, young people are still skeptical of the vaccines.
“It’s challenging work,” Matos said. And it’s all about putting in the time with the people who make up this diverse city. “With so many different communities here, the only way for anything to happen is to understand all of the different perspectives before you make a move,” Anderson said. “So we’re trying to understand the dynamic of each neighborhood and learn about the trusted people in each community who can spread the word.”
A Health Equity Agenda
With a view toward elevating the perspective of communities of color, PIH-US has partnered with the city on an equity agenda that continues to deepen. It has sponsored two intensive health equity trainings, run by the Racial Equity Institute, to focus on the historical underpinnings of racism in the U.S. More than 50 people attended from all corners of New Bedford, Mazzeo said, including city workers, representatives from community organizations, and both emerging and established leaders.
PIH-US has also been invited to take on a convening role within The Greater New Bedford Allies for Health and Wellness, a health equity group, to coordinate and track activities and to help prioritize the equity work, Mazzeo said.
In addition, the PIH New Bedford team has recently stepped in to help manage a new grant on “equitable approaches to public safety,” a partnership between the health and police departments exploring alternative approaches to criminal justice.
When it comes to health equity, Chaplin, the health department head, said: “PIH has been in lock step with me on this -- it’s a marathon, not a sprint, and we are moving along toward equity, step by step.”
What does that look like on the ground? “It looks like the people who need the resources the most, get them,” Chaplin said. “If we need better health care access for the Latinx community, we get that; if we need more linguistic support for Cape Verdean or Portuguese communities, we get more language services; if we need more housing, we get more affordable housing.”
Chaplin also knows firsthand about the needs of families living in tough economic conditions. “I do the work that I do because public health is my life,” he said in a 2019 interview with the National Association of County and City Health Officials.
As a child growing up in a rough Boston neighborhood, Chaplin said in the interview, he suffered from asthma, yet his mother, a smoker, was unaware that her smoking was worsening his condition; nor did his grandmother know that incinerator smoke was also exacerbating the asthma. For many years, he dealt with an undiagnosed learning disability which led to difficulty reading and performing in school. Chaplin said some members of his family had been in jail or killed as a result of gang violence, or drug users. "All those experiences I had are directly aligned with what we know now as the social determinants of health," he said. "Those weren’t conversations we were having in the 70s and 80s. It was nearly 10 years ago that I began to look at my life through a public health lens and adopt my public health story as the foundation for my pursuit for social justice and public health reform."
Broadening Partnerships Across Massachusetts
As the work in New Bedford, and throughout the U.S., begins to transition from acute COVID-19 response to long-term health system strengthening, the team is mapping out a broader, regional strategy.
Mazzeo said that PIH-US’s work in New Bedford can be a model for other Massachusetts cities facing major social and economic challenges. The Massachusetts Department of Public Health has designated 20 regions as “vaccine equity” communities; they have suffered from high COVID-19 case rates, low vaccination rates, high poverty, and social vulnerabilities metrics.
“We believe these conditions provide a profound opportunity for sustained engagement and improved collaboration across multiple high-need areas,” Mazzeo said. “A multi-city accompaniment strategy in the Commonwealth could have a transformative regional impact. As cities share and adapt best-practices, they could demonstrate the power of a collaborative health system,” Mazzeo said. “Through this strategic collaboration, and working side-by-side with state and local partners, we can reimagine public health service delivery in Massachusetts for years to come.”