Community Assessment Paper (Shelburne) Part 1

COMMUNITY ASSESSMENT OF SHELBURNE Introduction Shelburne, Massachusetts is a small town in Western Massachusetts. Located in Franklin County near Greenfield and Deerfield, the community is largely rural and boasts many natural resources and attractions. Like any small town, Shelburne does have some challenges, including infrastructure issues, a large aging population, and of course, the recent COVID-19 pandemic, which is affecting every community across the country. Shelburne’s public health initiatives, however, in collaboration with local and state efforts, are working to address these obstacles appropriately. Overall, despite its small size, Shelburne is a well-functioning community with much to offer its residents. Environment Shelburne is a small, 23.4 sq. mile, community in western Massachusetts surrounded by hills, the Deerfield river and Salmon falls. It is bordered by other Franklin county towns such as Buckland, Heath, Conway and Greenfield. Today, the air quality index in this area is 15. An AQI less than 50 poses little or no risk to the health of residents (Department of Environmental Protection, 2020). If this number raises above 50, it could cause respiratory concern for people sensitive to ozone or particulate pollution. This small population should try to reduce time outdoors to avoid exacerbation of any respiratory condition. According to Shelburne Fire Department, the town receives its water supply from two wells that draw from the North River aquifer in Colrain and is then stored in a tank in Shelburne. This water is not treated with chlorine and has monthly checks for bacterial levels. Since the water has an pH of 6.7, it has a tendency to corrode through the metal pipes it is transported in. COMMUNITY ASSESSMENT OF SHELBURNE In order to raise this pH and prevent corrosion, sodium hydroxide is added to the water (Shelburne Falls Fire District, 2006). If the pipes in this water system corrode, metals, such as lead and copper, could be released into the water, which will have negative health impacts. Luckily, the fire department in Shelburne tests water frequently and results show that the sodium chloride treatment has been effective at reducing copper and lead concentrations. All of the chemicals that go into the water are approved by the National Sanitation Foundation or UL and meet the standards of American Water Works Association (Shelburne Falls Fire District, 2006). The land in Shelburne is occupied with orchards, sanctuaries, recreational buildings, a senior home, restaurants, small businesses, glacial potholes, residential homes and parking areas. While this seems like a scenic town for tourists and residents, its small community brings health implications. It is quite a long drive away from any health centers and large hospitals. It is also far from any large industry or grocery store, restricting access in times of crisis. Finally, the population in Shelburne is an important aspect to inspect when looking from a public health standpoint. The population density in Shelburne is 81 people per square mile, which is less than most towns in this area. The female median age is 56.3 whereas the male median age is 51.8, this median is much higher than the state and national average. 96.4% of the population is white, 1.1% is African American, 1.7% is Asian and 0.4% is Hispanic or Latino. Finally, the male population takes up 43% of the population and the female population takes up 57% (“Shelburne Massachusetts Population Charts”). COMMUNITY ASSESSMENT OF SHELBURNE Public health workers may have concern for an aging population, such as those that live in Shelburne. With increasing age, comes increasing comorbidities and the need for healthcare access. While the environment in Shelburne, MA has some health implications that public health workers may closely follow and intervene, it does not deviate much from the national average and there is no outlier that poses a large health threat for this community. Transportation Shelburne is a rural community, relatively isolated from main cities and more populated areas of the state. Thus, the issue of transportation can be challenging for residents. There are a few options in the community that Shelburne locals can utilize. The Franklin Regional Transit Authority is the most prominent mode of public transportation utilized in Shelburne and surrounding areas. The bus system has 10 fixed routes throughout Franklin County. The buses do not run on nights or weekends, which is a drawback. The bus route has stops in accessible locations, including the Mohawk Trail Regional High School in Shelburne, and the Shelburne Falls Senior Center. Prices are on the lower side, with each route listed as $1.50 (Franklin Regional Transit Authority [FRTA], 2020). A program that increases the accessibility of transportation in the town of Shelburne is the FRTA Demand Response service. This program is “curb-to-curb” service for people 60 and older, eligible LifePath customers, nursing home residents, and eligible disabled veterans (FRTA, 2020). This program offers a more accessible alternative for transportation. Another option for residents who are looking to travel longer distances is the Amtrak train station located in Greenfield, Massachusetts, less than 30 minutes from Shelburne. While COMMUNITY ASSESSMENT OF SHELBURNE tickets vary depending on location, Amtrak offers discounts for seniors, children, military personnel, and people with disabilities to make the cost more affordable (National Railroad Passenger Corporation, 2020). Aside from more modern modes of transportation, upon driving through the town of Shelburne, one can see that it is a walkable area. Sidewalks are utilized in most areas of the town, including busier parts like Shelburne Falls’ downtown area and around the Bridge of Flowers. Transportation, and its accessibility, can affect public health. Better access to transportation means improved access to health services, fresh foods, educational opportunities, and employment opportunities (Del Rio et al., 2017). Additionally, improved access to transportation such as walking, biking, and public transit, can help the environment by decreasing automobile usage/traffic. This can have a positive effect on air pollution, as well as the individual effects such as respiratory illnesses that are seen with those that are frequently exposed (Centers for Disease Control and Prevention [CDC], 2020). Overall, there are some concerns over the isolation of this small community and the potential implications for public health, but the town of Shelburne and its surrounding communities do provide some transportation programs that help address some of these issues. Health Services In Shelburne, a few providers and facilities provide health services to residents. The closest hospital is Baystate Franklin Medical Center, which is about 11 miles from the town. Baystate Franklin is a community hospital with 89 beds, including services such as surgery, emergency, cancer, obstetrics, mental health, amongst other specialties (Baystate Health, 2020). COMMUNITY ASSESSMENT OF SHELBURNE As part of the Baystate Health system, patients at Baystate Franklin have access to providers from Baystate Medical Center in Springfield and all across the healthcare system. Closer to Shelburne, there are a few other small practices that provide healthcare to residents. One highlight is Trailside Health, located in Shelburne Falls. According to their website, they provide healthcare including house calls, free clinics, and office hours to individuals and families regardless of employment status or insurance coverage (2020). This type of accessible healthcare is important in a community such as Shelburne Falls, where residents may feel more isolated and less likely to seek out quality healthcare. Lastly, public health initiatives in Shelburne are important to address as part of the town’s health services. The Board of Health includes a public health nurse, a food safety agent and regional health agents. They help organize sanitation in the town, ensure food and water safety, and connect with residents (Town of Shelburne, 2020). Lisa White, the public health nurse, holds walk-in clinics in multiple locations, including one at the Shelburne Falls Senior Center, where residents can have blood pressure screening, glucose checks, amongst other services (Franklin Regional Council of Governments, 2020). Shelburne’s residents do have access to both private and public health services, which greatly benefits health on an individual level and a community level. Community health efforts and access to quality healthcare is of great importance when it comes to promoting and maintaining the general well being of a community. Social Services In Shelburne, there are several resources for residents to improve their nutrition. In terms of provided services, the local school is able to offer free breakfast and lunch to any child in COMMUNITY ASSESSMENT OF SHELBURNE need. Additionally, The Senior Center provides lunch for seniors every Tuesday and Thursday free of charge and for a reduced fee on other days. The community center coordinates potlucks and samplings of local businesses' food for town members according to their website. The Cooperative Public Health Services aids the town by providing a regional health director that frequently inspects programs, policies and businesses surrounding food in Shelburne to ensure safety in the town as well. The West County Food Pantry is a very important resource that residents have directly within the town of Shelburne. However, this resource is only open 11am-5pm on the 2nd, 3rd, and 4th Wednesday of every month. This results in limited accessibility to the pantry and free food as a result. However, the Center for Self-Reliance located in Greenfield is open every Monday, Wednesday, and Thursday (“Food Pantries”). However, this requires transportation to Greenfield. Finally, there is also a local company located in Shelburne, titled Dharma Nutrition, that teaches people about meditative nutrition, which could serve as a valuable resource to those who are able to afford it. In Franklin County, there are about 20 day care centers to provide childcare services for parents. One of these day care centers is conveniently located in Shelburne Falls, called Valley Play School. There is also a Franklin Adult Day Health Center that can provide attentive services to a more expansive range of ages. Additionally, there are two local Shelburne based child care programs run by Shelburne residents in their homes as well(“Franklin County Day Care Centers”). In assessing the use of Masshealth in the town, it was reported in December 2016 that 1,058 town members were enrolled in masshealth. In the state, there were 1,903,835 Masshealth recipients. Therefore, Shelburne comprises only .06% of Masshealth recipients. Within the COMMUNITY ASSESSMENT OF SHELBURNE population of Shelburne, which is 1,888 people, the recipients of Masshealth comprised about 56% of the town which is a significant population(“MassHealth Data and Reports”). Shelburne is fortunate to have many non-profit organizations aimed at improving community health and wellness needs. Franklin county has provided a Community Action Family Resource Center which provides education classes and workshops for parents and children, counseling services, family events, a community closet, transportation assistance, childcare services while people are participating in groups, support regarding court, DCF, or schools, and many other supportive services. Additionally, Healthy Families is an in-home support program for pregnant or first time parents or parents with two or more children under three to provide additional education on how to manage(“Community Assessment Report and Strategic Plan”). Additionally, the Franklin Land Trust based out of Shelburne is a non-profit geared at protecting their local environment and wildlife. Finally, one of the most important non-profit organizations serving community needs is the Franklin County Hunger Task Force. Together, this force is formed by a group of local organizations that are working together to address the lack of understanding and decrease the stigma of food insecurity, provide services to create a proper safety net for those that need it, and encourage policy change to address food insecurity on behalf of their local area (“Franklin County Day Care Centers”). Housing Shelburne is a rural town and thus is estimated to have only 975 total housing units, 87.8% of which are occupied (United States Census Bureau, 2018). Of those that are occupied, 70.3% of the housing units are occupied by their owner with 29.7% being renter-occupied (United States Census Bureau, 2018). COMMUNITY ASSESSMENT OF SHELBURNE In general, the housing in Shelburne is fairly affordable. Of the housing units being rented, 95.2% paid less than $1,499 for rent, with the median being $845 (United States Census Bureau, 2018). Owners with a mortgage pay an average of $1427 per month while those owners without a mortgage pay an average of $759 per month (United States Census Bureau, 2018). This affordability is right in line with the rest of Franklin county. In addition, those with low income have help from the Shelburne Housing Authority. They offer other options such as Highland Village, which provides affordable housing to low-income seniors and those with disabilities (Shelburne Housing Authority, 2020). In terms of quality, 73.8% of the housing units had a property value between $150,000$499,000, with the median at $273,800 (United States Census Bureau, 2018). As a comparison, the median property value in the U.S. is $229,700 (DataUSA, 2018). The majority (58.8%) of housing units are fairly old, having been built in 1939 or earlier. Still, 68.4% of the housing units had 2-4 bedrooms, none of the housing units lacked complete plumbing facilities and only 0.9% lacked complete kitchen facilities (United States Census Bureau, 2018). Therefore, the majority of housing units have been there for decades but are at or above national average in property value and have the necessary components for safe living. The housing profile of Shelburne demonstrates that the residents of the town in general have access to adequate housing, although it may not be luxurious. Those who struggle financially have resources to obtain safe housing, especially the elderly population. Nutrition and Exercise Shelburne is a desirable destination for those that enjoy the outdoors and hiking. In the area, there is Shelburne State Forest, Buckland Recreation Area, Flagg Mountain Wildlife COMMUNITY ASSESSMENT OF SHELBURNE Management area, High Ledges Wildlife Sanctuary and Mahican-Mohawk trail. There is no shortage of trails for hiking, biking, and getting out doors. Additionally, Bridge of Flowers and the glacial potholes in the town are desirable sight-seeing options located in the center of town. Shelburne is known for hosting the Bridge of Flowers 10k and Steve Lewis Subaru Charity 3k run/walk each summer, encouraging locals to get some exercise and enjoy the local beauty. Northfield Mountain is also in the local area and offers alternative forms of exercise such as cross country skiing, kayaking, canoeing and hiking. Finally, there is a YMCA in Greenfield that provides an option for a gym for residents. However, this as mentioned before requires transportation which may not be ideal for all residents(“Outdoor Recreation”). Franklin County and Shelburne in general is a farm friendly area which is a positive in this community assessment. There are frequent opportunities to attend the farmers Market in Shelburne on Fridays and in different surrounding towns on Wednesdays and Saturdays. Additionally, there are many CSA farms within ten miles of Shelburne. A CSA farm stands for a community supported agriculture in which community members purchase a share in the farm's crops. Each week, they receive a share of the crops so food goes straight from farmer to consumer keeping it local, direct, and more affordable. There are 9 local CSA farms in Franklin county, but Wilder Brook Farm +CSA is located directly in Shelburne. Other farms are not a shortage as well, as there are over 18 farms in the area that serve a range of fruit, veggies, meats, grains, sweeteners, pet food, and flowers. Some of the local farms include Apex Orchards, Bray farm, Davenport Maple Farm, Foxbard Farm and many more. Finally, in terms of grocery stores, there are two small general stores located in Shelburne for grocery items. However, according to prior community assessments, many residents prefer to trek to supermarkets in Greenfield for a COMMUNITY ASSESSMENT OF SHELBURNE bigger shop. While farms and fresh sources are not at a shortage, other groceries may be more difficult for locals to obtain (“Cultivating Resilience”). Demographic Factors In terms of the demographics of Shelburne, the median age is 52.3 and it is a predominantly white town (96.4%), followed by a small Asian population (1.7%) and an even smaller African American population of (1.1%). (Data USA, 2017). Mortality characteristics in this area are related to the chronic diseases prevalent in the town. The leading causes of death in Shelburne in 2017 were cancer, especially lung cancer, chronic lower respiratory disease (CLRD) and influenza and pneumonia. (Death Data, 2017). The chronic diseases in Shelburne and the larger Franklin County are as follows, 9% of the population has diabetes and 19% has pre-diabetes, 22% of the population is obese and an astounding 54% are oberweight, 4% of the population has cardiovascular disease and 12% of school-aged children have asthma. (Community Health Needs Assessment, 2016 ). These statistics of the chronic diseases present in Shelburne and all of Franklin County serve to explain the reasoning behind the leading causes of death in the area. Chronic diseases lead to chronic disabilities, especially for those with chronic lower respiratory diseases, like COPD or those with asthma. Also, with the higher than average median age range, chronic disabilities such as dementia become prevalent. Some behaviroal health issues in Shelburne incldue that a reported 14% of adults smoke, 22% are obese and 22% report physical inactivity. (Community Health Needs Assessment, 2016). These behavioral health actions lead to negative health implications, which will be discussed below. In terms of maternal child health, about 87.5% of pregnant women received adequate prenatal care, but that also leaves a little under 13% of pregnant women in the area not receiving adequate prenatal COMMUNITY ASSESSMENT OF SHELBURNE care. (Birth Data, 2018). Another negative aspect of maternal child health is that about 16% of mothers reported smoking during pregnancy. This is a reported percentage of mothers, and so it can be assumed that the percentage of mothers who are smoking during pregnancy is higher than this because some may not disclose this information with their health care providers, due to the sense of shame they may feel. Strengths of the community include that although obesity is an issue in Shelburne, there are several hiking and biking trails as well as other outdoor recreational areas for people to exercise and be physically active which can help to combat this issue of obesity that leads to other negative health implications. In addition, there are several farms in the area that provide fresh food that can serve as healthy options for people trying to maintain a healthier weight. Another strength of the community is the availability of support programs for those with chronic diseases or disabilities. One example is the Rural Medication and Chronic Disease Self Management programs which aims to maintain the independence of disabled people and also try to maintain quality of life. Challenges in the area include that 16% of women reported smoking during pregnancy. This is an issue that can lead to negative health complications for both the mother and the baby and is an issue that should be addressed. Another challenge is that in general, 14% of the population reports smoking. Again, smoking can lead to negative health complications and it is important to address this issue. Several of the leading causes of death in the area can be directly related to smoking, for example lung cancer and chronic lower respiratory diseases. Obesity can lead to many negative health implications. To start, as mentioned above, over COMMUNITY ASSESSMENT OF SHELBURNE half of the population of Franklin County is overweight and being overweight can lead to obesity. Another added factor to this overweight and obesity issue is the fact that there is a lot of reported physical inactivity in the area, which can lead to more people become overwieht and obese. An interesting finding is that Shelburne has the highest rate of stroke related hospitalizations in all of Franklin County. (Community Health Needs Assessment, 2016). Obesity can increase the risk of stroke. When an individual is obese, there is excess fatty tissue and that can become inflmed, which impedes blood flow, increasing the risk fo blockages and elading to stroke. It was also found that an estimated 24% of adults in Franklin County have hypertension and an estimated 31% have high cholesterol, both of which are risk factors for stroke. Data USA (2017). Education In terms of education, Shelburne’s population is well-educated. 88.7% of the population has a high school degree or higher and 45.6% of the population has a bachelor’s degree or higher (United States Census Bureau, 2018). This educational status is well-reflected in their occupations with the most common employment industries being Health Care & Social Assistance, Education Services, and Manufacturing (DataUSA, 2017). In terms of access to educational resources, Shelburne has two public libraries, the Arms Library and the Shelburne Free Public Library. Given the relatively small population of the town, two public libraries is a reflection of the importance placed on education. Shelburne is served by three public regional schools: Buckland-Shelburne Elementary School located in Shelburne Falls, Mohawk Regional High School located in Buckland, and Franklin County Technical School in Turners Falls (Town of Shelburne, 2020b). Additionally, there are a lot of colleges and COMMUNITY ASSESSMENT OF SHELBURNE universities in the area including Greenfield Community College, the Five College Consortium: UMass Amherst, Amherst College, Mount Holyoke, Hampshire College, and Smith College, as well as many other nearby colleges and universities in Massachusetts, Vermont, and New Hampshire. The diversity of type of institution and academic requirements is vast, giving a lot of opportunity for all different kinds of students. The topic of how these students transport themselves to school is more of a challenge for this town. Walking to school is not very feasible since the distance to the schools for most of the children who live in Shelburne is far too long. Additionally, the routes from Shelburne to the schools in the neighboring towns consist of many main roads without sidewalks which makes walking not a safe option. The Mohawk Trail Regional School District does have a bus system that serves each individual school and has several bus routes with many different stops along the way to transport the students (Mohawk Trail/Hawlemont Regional School Districts, 2020). However, it can be presumed that a large majority of children either get driven to school or drive themselves since 79.3% of the commuting population drives either alone or in a carpool to work (United States Census Bureau, 2018). Only 7.6% of housing units had no vehicles available to them and over half had 2 or more vehicles (United States Census Bureau, 2018). Thus, public transportation is not seen to be as big of a presence in Shelburne and most people commute to work and school by car. The health implications of the educational status of the town indicate that almost all residents will have at least some basic general health knowledge. Shelburne residents have access to elementary, secondary, vocational, and higher education opportunities and most are able to attain an education and a career that grants them health care coverage.