Roxbury Center Targets Health Disparities In Boston's Poorest Neighborhoods

By Marina Renton
CommonHealth Intern

When it comes to health in Boston, it's hard to deny there's a great divide across neighborhoods.

Need proof? A 2013 Boston Public Health Commission report found that, from 2000 to 2009, the average life expectancy for Boston residents was 77.9 years. But in the Back Bay, it was higher — 83.7 years — compared to Roxbury, where the average life expectancy was 74.

If you want to get even more local, you can analyze the same data by census tract, where life expectancy varies by as many as 33 years: 91.9 years in the Back Bay area between Massachusetts Avenue and Arlington Street, and 58.9 years in Roxbury, between Mass. Ave. and Dudley Street and Shawmut Avenue and Albany Street. That's according to a 2012 report from the Center on Human Needs at Virginia Commonwealth University in Richmond.

The Whittier Street Health Center in Roxbury is trying to tackle the disparities in a very concrete way. With the launch of a new fitness club and community garden, the center is trying to make healthy food and exercise opportunities available and affordable to all, despite geography.

“What we’re trying to do is to remove those social determinants and barriers that are causing these [health] disparities,” said Frederica Williams, president and CEO of the health center.

'If I Sweat, I’m Doing Something Right'

The fitness club and garden initiatives just launched June 27, but the Whittier Health and Wellness Institute is already drawing in community members.

Eight months ago, Wanda Elliott weighed 256 pounds. On a visit to her Whittier Street physician, she learned her blood pressure was high -- high enough that she had to start taking medication. That was the wake-up call that motivated her to change her diet and start exercising.

“I was dragging,” she said.

Elliott began exercising at a local Y but joined the Whittier Street fitness club when it opened. In eight months, she has lost 52 pounds, leaving her 4 pounds shy of her 200 pound goal weight.

“I have two knee replacements, so I have to keep active every day,” she said. Trainers at the center helped her learn to use the exercise machines, and now it feels like a routine, she said.

“I feel addicted to working out. I feel like if I sweat, I’m doing something right,” she said. “From 256 to 204, I feel like a model. I can walk the runway; that’s how energized I feel now.”

Elliott is now off her blood pressure medication. She is working on making changes to her diet “slowly but surely,” drinking more water, eating more salad, and cutting back on red meat.

Josline Cespedes has been coming to this fitness club for about a week, after leaving a gym where the environment didn’t work for her. "I wanted something quiet,” she said.

Before Cespedes joined, she said, “I had a lot of health problems. My job is all day on my feet…and by the time I got home in the afternoon, I was tired, my legs were swollen.”

Now, “I have more energy,” she said. “I’m up all the time…I want to do more stuff with my kids.”

Prescription For Healthy Behavior

The Whittier Street Health Center currently serves around 28,000 residents (up from 18,000 in 2012) and hopes to reach 40,000 by 2017, president and CEO Williams said. Its patients, all living in socioeconomically disadvantaged and urban communities, are predominantly African-American and Hispanic. The center offers medical and public health programs, including primary, eye and dental care, podiatry, endocrinology, smoking cessation, mental health care, substance abuse counseling and urgent care, in addition to community education programs, Williams said.

“We believe that a significant portion of what comprises good health is our behaviors and lifestyles and, of course, access to quality health care,” she added.

The center takes an integrated, coordinated approach to providing care, “because you cannot separate a diabetic person that has depression, you cannot separate their depression from the diabetes,” Williams said. “We’re sensitive to the many social factors that hinder our residents...You have to be really patient-centered and community-centered to really get people to be engaged and activated in taking care of themselves.”

Obesity is a major issue in these communities, Williams said; only about 20 percent of adult patients and 35-40 percent of children had a healthy body mass index (BMI) in 2012. By 2017, the center hopes to be at 70 and 80 percent healthy BMI for adults and children, respectively, which would help reduce the incidence of weight-related chronic conditions, she added.

Hence the launch of the Whittier Health and Wellness Institute, including a new level of health care coordination, the wellness and fitness club and the community garden.

The fitness club, a $1.2 million investment, is over 6,000 square feet and includes the equipment you’d expect in a gym, along with space for people who need to exercise at a slower pace and studios for aerobics, yoga and Zumba classes. The center will also offer classes on stress reduction and fall prevention (for seniors).

Paging The Health Coach

A pivotal figure in the fitness club is the health coach, a nutritionist and fitness trainer who will work with patients to develop their personal goals. “They serve as the motivator,” Williams said.

Patients are referred to the fitness center via a "Prescription for Health" from their primary care physician, psychiatrist or other clinician at Whittier. Thus, a fitness regimen becomes incorporated into a patient’s medical record, and physicians can track clinical outcomes at the same time, to get clearer information about the effects of increased exercise.

“Your doctor will see the information and track how you’re doing...what type of progress you’re making,” Williams said. “And after your first visit with the health coach, they will work with you to develop your self-management goals.”

Fitness club membership for Whittier Street Health Center patients costs $10 per month; the fee is meant to encourage accountability, Williams said. Members of the community who don’t frequent the health center are permitted to join as well.

The fitness club is “not going to be a moneymaker,” Williams said. The membership fees aren’t enough to fund its operation. About half the money to build and equip the facility came from grants, and the other half from the Whittier Street Health Center’s operating funds. To keep the club open, they will have to raise money through annual fundraisers and additional grants.

Community Garden

In addition to addressing the physical fitness of community members, the center wants to address their nutrition.

“We are in a food desert. People don’t have easy access to affordable fresh fruits and vegetables,” Williams said.

That’s where the community garden, managed by a nutritionist, comes in. Patients of the health center can help tend their own plots. The produce grown in the garden -- including tomatoes, peppers and cucumbers -- will be given away to community members when they attend a nutritionist-led cooking demonstration, Williams said.

The goal is that patients who benefit from the fitness club and community garden will take their newfound self-management skills back to their communities, Williams said.

“We’re looking to not only impact the patients we serve, we’re looking to impact their immediate and extended families, their friends and their neighbors, and we envision that ultimately this will contribute to wellness and fitness in this community,” Williams said.

As part of its Boston Health Equity Program, the Whittier Street Health Center has a series of outcomes it uses to measure the success of its programs, including patients getting regular checkups and improving BMI. Those clinical outcomes -- for instance lowering blood pressure -- will be achieved in part by individuals visiting the fitness club and community garden and making improvements in their fitness, stress level and nutrition, Williams said.

Avoiding The New Year’s Resolution Effect

A big challenge is not only getting patients to start making lifestyle changes, but encouraging their maintenance, Williams said. In other words, how do you avoid the tapering-off that follows the Jan. 1 rush to the gym?

Because health care providers coordinate the changes and track their patients’ progress, the hope is that it will be harder for the patients to stop coming back, Williams said.

If a patient receives a referral to the fitness club and they don’t come to work out within two weeks, the health coach will follow-up with him or her, Williams said. Similarly, if a patient stops showing up, someone from the Whittier Street Health Center will get in touch.

“The key for us to get people engaged and to maintain it is for us to stay connected to them,” Williams said. “Our job is to make sure we keep that connection and that excitement and empowerment and look for creative ways to keep them focused on changing their lifestyles.”

In a pilot program a couple years ago, the Whittier Street Health Center hosted Zumba classes, and around 600 people came and stuck with it, Williams said, making her feel optimistic about the fitness center’s retention rate.

While some people do stop coming regularly after an initial period of enthusiasm, “I’m just motivated to do it because I love myself," Elliott said. "And I hate high blood pressure.”