“Where are you here from?” I asked the person behind me in the registration line at the National Rural Health Association’s Annual Conference, in Albuquerque, New Mexico.

“Montana,” he answered, “how about you?”

“Boston,” I said, and, noticing his confused look, I added, “I work in all of Massachusetts – we have a lot of rural areas.” After that initial conversation, I started answering “Massachusetts” to that ubiquitous question.

While I live and work in Boston, MACDC works with CDCs in communities throughout the Commonwealth, and about 17% of our members work in rural areas of Massachusetts. In fact, according to the Census Bureau, well over half of Massachusetts’ land mass is considered rural. However, my instinct to say I’m from “Boston” reveals more than the zip code where I live. My instinct indicates my association with this urban area of the state, despite my efforts to represent the breadth of urban, rural, and suburban communities in Massachusetts.

Fortunately, my attendance at the National Rural Health Association’s conference gave me the opportunity to immerse myself in the diverse experiences of residents of rural America. The following were a few themes that stuck out to me:

The Importance of Telehealth – Telehealth is a familiar concept to many of us, being well into the third year of the COVID-19 pandemic, in which many health services were delegated to the virtual realm. In my experience, a telehealth option can be more convenient than traveling to see a clinician in-person and is of course safer in the context of a highly contagious disease. At the National Rural Health Association conference, I learned how clinicians in Minnesota deliver specialized emergency care to remote areas of the state in situations where it would be impossible to deliver in-person care in time to save someone’s life. In this model, specialists connect with less specialized physicians in smaller, local hospitals to collaboratively diagnose and treat patients undergoing cardiovascular events. Learning about this use of telehealth broadened my understanding of the ways in which this technique can be used.

The Unique Mental Health Concerns – Mental health care is crucial in all geographies and takes on added challenges in rural areas. One presenter described how stigma around mental health takes on added meaning in a rural area where everyone knows each other: “People in my town know when I go to get my haircut, they will know if I am seeing a therapist!” In addition to stigma, the challenge of having enough practitioners for the residents who need care is significant in many rural areas of the country. The lack of sufficient mental health support can be particularly challenging in smaller populations where, in many cases, it can be confounded by lack of peer support, such as in the case of LGBT youth.

Challenges and Innovations in Clinician Recruitment – One challenge which I am familiar with intellectually, but which my life in Boston is often divorced from, is the challenge of recruiting physicians and other clinicians to rural areas of the country. A high patient-to-physician ratio leads to physician burnout and less physician availability. I learned about several creative solutions to this challenge. One is an effort to recruit new doctors who have not matched for clinical residencies to spend time in rural areas before re-entering the matching process. Another innovative program around the corner from my Boston office: At Massachusetts General Hospital (MGH) a number of physicians participate in 3-month rotations treating patients on a reservation in South Dakota.

Both before and during the conference, I also had the opportunity to think about how, in addition to direct medical care, social determinants of health, and in particular, community and economic development, uniquely impact rural health, and how CDCs are stepping up to meet these challenges. For example, in areas where there isn’t a tax-base for public transportation infrastructure, residents rely on services such as the Quaboag Connector, which the Quaboag Valley CDC runs in collaboration with the Ware Council on Aging and other local social service agencies. The impacts of housing type and quality on health is unique in an area like the Hilltowns of Western Massachusetts, where single-family homes predominate, creating a dearth of accessible housing for seniors and people with disabilities. Hilltown CDC addresses this issue through building and renovating homes for seniors, and through the Hilltown Elder Network, which pays local people to provide in-home chore services and transportation for low-income elders. Lower wages in rural communities mean less income available for health-supporting goods and services, like healthy foods and medication. The CDC of South Berkshire assists in mitigating this issue by providing support for small businesses. I appreciated the opportunity to connect these themes of the conference with the work in which our rural members are engaged in.

In addition to learning about these specific issues, I appreciated the opportunity to absorb myself in thinking about the unique challenges and opportunities connected with living and working in areas of the country that are less dense than the urban area with which I’m familiar. The conference highlighted the importance of creating and taking advantage of opportunities to better understand landscapes and experiences that are not a part of my everyday life – to truly “work in all of Massachusetts.”

Growing up, I thought climate change was only about protecting the natural world – saving polar bears, hugging trees, and recycling instead of throwing it in the trash. Now, as I wrap up my bachelor’s degree in environmental science at Boston University and my year-long climate policy internship with MACDC, I have a very different perspective.    

The climate crisis is not an isolated issue. Our world does not operate in silos, and the greatest problems we are facing are no different. Housing justice, racial justice, economic justice, and environmental justice are all connected. My time at MACDC has revealed this to me even more. 

From speaking with our members, to collaborating with LISC Boston and New Ecology, to having the opportunity to join policy coalitions, I have learned about the community development field and the important role it plays in making a better future. In particular, I have gained a deeper understanding of green buildings as a way of simultaneously remedying the housing crisis and the climate crisis. As we noted in our testimony in favor of the HERO bill, which would double the deeds excise tax to raise money to address both the climate and housing crises in MA, “Climate and housing are pressing, interrelated issues our Commonwealth is facing today. We have the technical solutions to build more resilient, affordable, and healthy housing; we just need the resources to scale up these efforts. CDCs and other affordable housing providers are leading the way.” 

Similarly, our coalition’s letter to the Legislature’s Joint Committee on Ways and Means, requesting $250 million in American Rescue Plan Act (ARPA) funds to create the Zero Carbon Renovation Fund, now has 104 organizational signatories, representing over 43,000 units of affordable housing. The two million existing buildings across the Commonwealth contribute almost one third of Massachusetts’ emissions. With this in mind, the Coalition is proposing an allocation of funds to support retrofits of existing buildings to reduce emissions, improve public health, and provide climate resilience.  

Through these coalitions and advocacy opportunities, I have been inspired, working with and learning from passionate experts like Emily Jones, the Senior Program Officer for LISC Boston's Green Homes and Green Jobs Initiative. “For me, climate action means advocating for all people to enjoy a safe, healthy, and beautiful environment where they can meaningfully contribute to a just society and regenerative economy. I advocate because I want everyone to be able to live in a healthy, green home they can afford, and work and play in ways that are healing to the earth,” Emily said. “At its core, I see climate action as a way of furthering racial justice and economic justice.” 

Knowing we have the solutions to decarbonize our building sector and provide healthier homes for more people gives me hope for the future, especially after having the opportunity to work with people across the Commonwealth who are dedicating their careers to this fight. As I go forward with my next steps, moving across the country to pursue my Master of Urban Planning at the University of Washington, I will forever be thankful to MACDC, our members and partners, and all I have learned from living and working in Massachusetts these past few years, for providing me a foundation to join them in creating a more equitable, sustainable tomorrow.  

On May 5th, the Baker-Polito Administration released its Five-Year Capital Investment Plan for 2023-2027, which includes its Fiscal Year 2023 Capital Budget. MACDC, as it does every year, reviewed the Capital Budget for housing and for other community development line items of interest to CDCs. You can see our analysis here.

In comparison to FY22, the top line housing budget for FY23 increased by just over $5 million, from $255.6 million to $260.8 million. This understates the increase, as the Legislature enacted, and the Administration signed last December, a bill allocating significant federal funding for housing, including $150 million for supportive housing, $115 for rental housing production, $115 million for homeownership production, $150 million for public housing maintenance, and other related spending. Bottom line- when it comes to the FY23 Capital Budget in relation to prior year capital budgets, we are not comparing apples to apples! 

Selected community development programs also received higher amounts in the FY23 Capital Budget than in FY22. Among these selected programs, the budget increased from just over $114 million in FY22 to just under $131 million in FY23, an almost 15% increase.  MACDC was pleased to see a significant increase in funding for underused properties but was disappointed that the Brownfields Redevelopment Fund continues to be inadequately funded with just $2.5 million. (There is $30 million of unused capital authorization for the Brownfields program). 

It is important to recognize that the small increases referenced above are far below inflation and even further below the increasing costs for construction.   

When it comes to affordable housing funding, we need more, much more, to meet the needs of the Commonwealth’s residents. This is why MACDC is advocating with the Legislature to use the once in a generation opportunity presented by the availability of the remaining ARPA funds to support the following: 

• $200 million for emergency rental relief, to prevent the displacement of the thousands of MA households still impacted by the economic devastation caused by COVID; 
• $320 million to expand homeownership opportunities and close the racial homeownership gap; 
• $150 million for rental housing preservation and development, and additional supportive housing for priority populations, to address the crisis in affordable rental housing; and 
• $100 million for a new MA Healthy Homes Initiative, to address the tens of thousands of homes in MA still containing dangerous levels of lead paint and address other housing conditions that pose a serious threat to residents’ health and well-being. 

MACDC is thankful to the Baker-Polito Administration for its funding of critical affordable housing and community development programs, and for being a partner to MACDC and CDCs in our efforts to create opportunities for all Massachusetts residents. It will be up to the next Governor, the Legislature, and all of us to ensure that we do everything possible to address the unmet needs for affordable housing and inclusive community development, on behalf of all of our neighbors across the Commonwealth.