Improving Community Health through Engagement – Worcester, MA

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At the Worcester Division of Public Health, Zach Dyer, sought to ensure sure that all residents of the community in which he grew up had the opportunity to be healthy. As part of the 2012 Community Health Improvement Plan (CHIP) undertaken by the division, health equity was included as part of its five areas of focus and through all the other focus areas including healthy eating and active living, behavioral health, primary care and wellness, and violence and injury prevention. From farmers’ market access to gang violence reduction, the CHIP focused on closing gaps between racial groups. And throughout all of the efforts resident engagement played a critical role.

During the implementation of the 2012 CHIP, Zach championed several different initiatives that impacted health inequities. One such initiative was a joint use agreement that opened all school playgrounds to the public during non-school hours. Prior to this policy implementation, the decision on whether school playgrounds remain open after school hours, was left to the discretion of principals. Often, schools in the higher income areas of the city did not enforce a trespassing policy, while schools in the less-resourced areas of the city had the gates locked to the play facilities.

Zach convened a small group of key stakeholders and secured grant funding to ensure a uniform enforcement of a city-wide policy. Today, all new and future school playgrounds are open to neighborhood families from sunrise to sunset every day outside of school hours, essentially increasing access to play facilities for Worcester families by 50%.

Concerned by the inequitable distribution of power and resources in health improvement initiatives like the CHIP, Zach pursued a new structure for implementation that moved the control from such an initiative out of a government institution. Because CHIPs are meant to align resources, bring more partners to the table and encourage collaboration, the organization that oversees implementation of a CHIP maintains a great deal of influence.

In a rethought structure, a coalition of diverse individuals representative of the community, and diverse organizations or no organization at all, now oversees the implementation of the CHIP, including communications, evaluation, and funding distribution. He serves as a co-chair for the organization, known as the Coalition for a Healthy Greater Worcester.

In 2016, Zach oversaw the development and launch of the next iteration of the CHIP. The updated CHIP included nine priority areas with health equity maintained as the overriding goal of every objective and strategy within the CHIP. The 2016 CHIP includes the following priority areas: racism & discrimination, substance use, mental health, economic opportunity, cultural responsiveness, access to healthy food, physical activity, and safety. The framework of the CHIP ensures that all 33 objectives and 100 strategies under those areas are measuring success as moving towards health equity.

Driven by his experience and understanding that a Public Health department, particularly one that has historically not been reflective of its community, must be at the forefront of understanding and addressing the inequities faced by historically oppressed groups, Zach has also worked to enhance staff capacity in the Division to address health equity. Zach ensured that required skills related to cultural competency and institutional racism were integrated into the departmental workforce development plan for all staff. All staff have eight hours of cultural competency training and key staff have an additional 16 hours of anti-racism training and regularly report on their performance in engaging community voices as a benchmark of success. Additionally, engaging community-based organizations at a meaningful level and integrating community voices into existing initiatives were incorporated into performance management benchmarks for relevant staff. While not uniformly involved in health equity promoting strategies, staff now have a common language with which to share successes and challenges.

A testament to the impact that Zach has done at the Division in promoting health equity as the center of public health work is the increased number of partner agencies and city departments using a common language and values in promoting equity. Through the language officials and partners use, to real programmatic differences like the use of Health Impact Assessments in broad city efforts, Zach’s work over the past four years at the Division has resulted in success being measured through an equity lens, a critical shift in seeing more equitable outcomes.

Worcester, MA is a 5-time winner of the All-America City Award.  For more information about the All-America City Award visit: https://www.nationalcivicleague.org/america-city-award/