In anticipation of expansion to five members, the Board of Health regularly discusses strengthening the public health services through an initiative known by the acronym CAHM for Creating A Healthier Marblehead.
CAHM is designed to provide baseline data on the health and wellness of the town today. That baseline will be used to help make strategic decisions about what programs are needed and eventually to document (and be held accountable) for the outcomes of those programs. The BoH raised external funds to support the CAHM initiative. As a result, no Marblehead tax dollars will be required to support this effort.
The first major element of CAHM has been to ask Marblehead residents about their health and wellness today and to hear from them where we should be investing future energy and resources. We saw the data acquisition phase as critical. We contracted with a team from UMass Boston headed by Dr. Caitlin Coyle because that team has great experience in developing health and wellness surveys for municipalities (including our neighbors in Salem and Swampscott).
Initially, our UMass colleagues shared that we should expect about a 10% response rate. The fact that we got a greater than 15% rate suggests that the town would like to see a stronger public health portfolio and that the residents are eager to help shape the direction of those efforts.
On Sept. 29, we mailed postcards to 16,793 residents inviting them to complete the CAHM Wellness Survey. More than 2550 residents responded. The BoH is very grateful to those who completed the survey.
Survey design
Wellness analyses generally explore eight dimensions of wellness (emotional, environmental, financial, intellectual, occupational, physical, social and spiritual). UMass had provided a basic template of 50 questions drawn from their previous surveys, but six Marbleheaders from our CAHM Leadership Council spent more than five hours each over two days to customize the survey design. The final version contained 43 questions reflecting, as much as possible, the uniqueness of Marblehead.
Many of the 43 questions contained multiple parts. Virtually all required checking boxes and 21 contained an “other” option where the respondents could write in answers.
Marblehead is the first of the 80 UMass wellness studies to include residents down to 18 years of age. This table indicates populations in each age group and the percentage of that group to complete the survey. (The 18 to 29 age group probably contains a significant number of individuals who use their parent’s address while they are at school or working elsewhere. So, we lumped the below 40 into one larger age group.)
Mental health, sidewalks, cycling safety
Even in the early stages of review, we have seen the potential power of this volume of data. The first question asked about quality of life in Marblehead. Eighty-four percent of all respondents checked either the excellent or very good boxes.
However, the 40-49 age group checked only 78%. That group expressed greater concerns in other categories as well. Eighty-eight percent of this group had children under 18 living at home, and 76% indicated parenting was one of their primary sources of stress. In addition, 88% of that group indicated that child and adolescent mental health services were needed in Marblehead. Pedestrian and bicycle safety are important to all age groups but again, the 40-49 group showed somewhat stronger concerns than the other age groups. If this initial assessment is confirmed, one long-term goal of CAHM should be to help relieve the stress and anxiety of raising a family in Marblehead today. We anticipate that other similar observations will become obvious as we dig deeper.
The final question asked what else the responder would like the BoH to know. There were 492 written responses to that question! Sidewalk and road quality received considerable attention as did teen substance use.
What’s next?
The next step for CAHM will be to establish a small number of focus groups to drill down on particular issues which came up in the survey but where more detailed information
may help with developing strategic plans for solutions. That process should begin in March.
Better communication important
There were several questions that basically asked, “What would you like to see in Marblehead
about …” Quite often, the responders were suggesting things that already existed. That tells us that we need to do a much better job of information sharing and providing navigation support to individuals seeking information about services available. Improving navigation systems should be seen as low hanging fruit and relatively inexpensive to improve. The BoH should begin to attack this issue without delay.
Collaboration key
We always expected the results would be applicable beyond the BoH, but the number and the breadth of the responses surprised some of us. Many concerns expressed will require collaboration and interaction among other town departments and agencies. That will be a challenge in our traditionally very siloed environment.
For example, improvement in infrastructure received great attention. Repair of sidewalks was probably the biggest single item in the write-in answers. Respondents clearly want Marblehead to become a better walking city. Many commented that being able to easily walk around our beautiful town would impact several dimensions of wellness.
Mental health particularly of the young was another very common issue in both checked boxes and write-ins. (The concern about teen substance use was documented in the surveys well before the recent debate about social hosting had begun.) Progress will be most significant in this area when public health, public education and public safety elements in town are all working closely together.
Investing in changes
And finally, it is also clear that improving wellness to the level outlined in the survey
will take money. In some cases, big money. Given the current situation, we will have to prioritize the least expensive options first. And hope to raise money for others as we move forward. The survey itself cannot contribute to the debate about overrides and future budgets, but perhaps the idea that delaying necessary infrastructure eventually costs more than doing it when the need first becomes apparent may be a valuable lesson to be drawn from the survey responses.
Dr. Tom Massaro is chair of the Board of Health and also serves on the Town Charter Committee. He is an emeritus professor at the University of Virginia where he practiced medicine and taught public health, health law and the business of medicine for many years. He lives in Marblehead with his wife and son. He is not writing for the Board of Health.
