On a recent Sunday afternoon, downtown Lawrence, Massachusetts, became a ciclovia, Spanish for cycleway. While orange traffic cones kept cars off eight blocks around City Hall, kids on bikes, teens on scooters, and mothers pushing strollers made loops around Essex and Common Streets.
"Ciclovia is about community," says Vilma Lora, coordinator of the Lawrence Mayor's Health Task Force. "It is a very unique way for us to say, ‘Come out and play.'" At the same time, the physical activities also create those social connections that are so important for health. "We're trying to promote physical activity to address the issues of obesity, diabetes, and chronic diseases," Lora says.
This city of 78,000 embodies the notion that from pain comes power. In 2012, the state had just taken over the city's chronically low-performing public schools, where only about half the high school seniors graduated. Boston magazine parachuted into Lawrence to discover problems that the community knew all too well: a high crime rate, a drug problem, and overwhelming poverty. The ensuing piece, titled "The City of the Damned," painted a simplistic picture of this complex community.
The residents of Lawrence knew that the turnaround had already started. So the community rallied under the banner, "We are Lawrence," and began to rewrite their story. Community groups began collaborating on the shared goal of making Lawrence a healthier city. A spirit of resiliency, built on a legacy of activism stretching back a century, spurred neighbors on.
Wendy Barr is a family physician who trained in Lawrence. After working in New York City, she returned to become assistant director of the medical residency program at the Greater Lawrence Family Health Center. "Lawrence is a hidden jewel," she says. "Yes, it has issues. Yes, it has challenges. But there is an amazing breadth of community groups that have come together to create a sense that we're going to make Lawrence a better place, a healthier place."
'Health is in all policies'
Long a gateway community for immigrants, Lawrence has the largest Latino population in New England, with 74 percent of the city's residents coming from the Caribbean or Central America. Residents face formidable health issues, including high rates of asthma, heart disease, tobacco-related illness, and diabetes. About 45 percent of children and 69 percent of adults are obese or overweight. Thirty-nine percent of children live in poverty. Leaders in Lawrence recognize that it will take a concerted effort on multiple fronts to see improvement.
"There's really a renaissance on how we build a community around this idea of a healthy place to live," says Mayor Daniel Rivera, who, with the Mayor's Health Task Force and the Board of Health, launched the Healthy Active Living Resolution and companion wellness campaign in 2014 to support active lifestyles. The community won a Robert Wood Johnson Foundation Community of Health Prize.
"Health is in all policies, and when you truly understand that, then you can create a Culture of Health," says Lora, who is also director of social justice initiatives for the YWCA. "Unless you work in a collaborative manner, you really can't influence change. That means everyone matters. Residents, local government, public safety, nonprofits, environmentalists, planners, state legislators: Everyone has a voice."
ACTIVISM, then and now
Twenty-five miles north of Boston, Lawrence grew up around the textile trade. Industrial tycoons in the 19th century built brick mills on both sides of the Merrimack River, harnessing the power of the waterway to create a wool-making capital.
Residents draw great pride from Lawrence's history of labor activism. In 1912, workers by the tens of thousands walked off their jobs after mill owners cut wages. The "Bread and Roses" strike — named for a popular labor movement slogan at the time — dragged on for 63 days and ended with improved workplace safety, higher pay, and additional worker benefits.
The mills began closing after World War II, leaving the city haunted with vacant buildings. Developers are gradually beginning to convert abandoned brick structures into apartments and offices. The city, too, has made it a priority to transform industrial wasteland into open space and parks.
The revitalization has taken many shapes. A blighted mill on the Merrimack River has been gutted and rehabilitated into Union Crossing, offering affordable housing for 60 families. It's one of nearly half a dozen mill conversions adapting historic structures for modern uses.
An unused section of a city playground is now the Costello Urban Farm, where 50 high school students work part-time raising vegetables to sell to neighbors who otherwise have little access to fresh produce. As the culmination of nearly 20 city park projects undertaken, the historic Campagnone Common has been upgraded with better lighting, a new playground, better walkways and new game tables for dominos. What was before a 3-mile stretch of trash-strewn riverfront is now a greenway along the Spicket River for runners, cyclists, and families walking to school and work. A forgotten one-mile stretch of a defunct railroad is slated to transform into a walking and cycling trail. And a two-story, manmade hill is the centerpiece of the new Ferrous Urban Wild Park.
The Ferrous Park at the confluence of the Merrimack and Spicket Rivers is a good example of this Cinderella story of urban transformation. Motorists used to drive past the vacant site and pay no notice to the towering, weed-covered mound in its the middle — a former foundry dumping ground. In 2015, with government funding, the nonprofit Groundwork Lawrence began clearing the site. Workers stripped away dense brush, added soil over the mound, planted trees and meadow flowers, and built a circular path to the hill's top.
"It's a model for regenerating brownfields," says Lesly Medina, community engagement director for Groundwork Lawrence, which changes places — and lives — by improving the environment. The improvements include parks, greenways, and urban farms. Medina calls the finished Ferrous Park "a natural balcony" for people to enjoy panoramic views of Lawrence and the Merrimack River.
PHYSICAL and fiscal health
Next door to the park is Union Crossing, a rejuvenated mill on the Merrimack that's now a mixed-use housing and commercial site. Just over five years ago, Lawrence CommunityWorks, the site's nonprofit developer, surveyed hundreds of neighbors about the challenges they faced. Money worries were the top source of stress; not only was there a critical need for safe and affordable homes, but also for help with employment and finances.
"There's a connection between physical health and fiscal health," says Jessica Andors, executive director of Lawrence CommunityWorks. "When somebody doesn't have some level of economic stability, it impedes their access to getting good health insurance and preventive healthcare, or being able to care for their children."
With support from the United Way, the nonprofit included a Financial Stability Center when it opened Union Crossing. The center offers residents help with employment, education and finances. More than 2,000 people have used its services since it opened in the summer of 2013.
The model is also being used by the Lawrence School District, which last year opened a Family Resource Center to help the parents of students meet financial and employment goals. "If we're not promoting the economic self-sufficiency of our families, particularly our new immigrant families, then we're missing the boat," Lora says.
A medical center leads the way
As the city and community groups mobilized to address the economic, environmental and social factors that influence health, they found a strong partner in the Greater Lawrence Family Health Center.
People in Lawrence speak of their community health center with the same degree of civic pride as when they recall the defining Bread and Roses strike. They view it not just as a place for a doctor's visit or an X-ray, but as emblematic of the city's resiliency. Started in 1980, the health center had a difficult time recruiting and retaining primary care physicians for its mostly immigrant patients, many of whom had limited English proficiency and a high prevalence of chronic disease. Doctors who were assigned to the center through the National Health Service Corps usually left Lawrence once they fulfilled their commitments.
In 1994, the health center made the strategic decision to train its own primary care physicians by starting a residency program, the first of its kind in the nation for a federally funded clinic. "The decision was made to grow our own, so to speak," says Joseph W. Gravel Jr., chief medical officer of the health center and residency program director.
The family medicine program, which extends for four years instead of the usual three, emphasizes building ties in the community from the first day of training. Each doctor is paired with a local organization and given time to work on health issues. It could be holding a group meeting on managing diabetes or working with the YWCA to increase mammogram visits for Hispanic women. Residents also staff health centers at two high schools and are given work time for other forms of community service, such as cleaning up a river near the clinic or mentoring students.
Of more than 150 program graduates, at least 30 have stayed in Lawrence. The city that could not attract enough doctors 20 years ago is now inundated with 800 applicants a year for eight spots in the family medicine residency.
Barr, the assistant residency director, says the health center's unique approach of embedding doctors in the community means physicians are not just learning about the social and economic determinants of health in the abstract — they are witnessing them firsthand. "It's not a class," she says. "It's what you do day in and day out."
If your community is on a journey to better health, be sure to apply for the Prize. The application deadline is November 12.