Interview by Jeanne Dasaro and Rob Hanna
Codman Square Health Center in Dorchester, Mass. serves as a resource for improving the physical, mental, and social well-being of the Boston community. The Health Center was conceived by a group of neighborhood activists in the 1970s, including Bill Walczak, who joined together to improve the neighborhood and deliver badly needed health care services. Today, more than 275 employees, most of whom reside in the neighborhoods surrounding Codman Square, record over 120,000 client contacts annually.
In addition to serving as CSHC’s CEO, Bill Walczak is the founding president of Codman Academy, a school on the CSHC campus which opened in 2001. In this interview, we talk with Bill about what makes Codman Square Health Center so unique, the health center’s community partnerships (including one with The Healthworks Foundation for Women), and what he’s learned over the course of his career as a leader in healthcare and education.
NPi: How is the work you do different from organizations in the same field?
BW: It’s tough finding organizations that do similar work… Most health centers are medical facilities that provide a very limited array of services beyond doctors, dentists, or mental health professionals seeing patients. Some offer special public health programs or outreach on chronic diseases, but it’s all very medically orientated. We see ourselves more in line with a settlement house, which were organizations developed 130 years ago. They were efforts to build community—vehicles to create opportunity for people so communities could become better places. People were able to support one another as they worked to achieve success.
The way success is defined by Codman Square Health Center is much different than it is defined by other organizations. Most health centers across the country—there are 1,200—would define success as seeing X number of patients and providing some kind of quality of service that’s measurable. Codman Square Health Center defines its success as providing services for sure, but also making an impact in the community, making a difference, creating more opportunity for people… increasing what could be defined as success by individuals. A better life, a better job, more education, a better understanding of what ills affect them, an understanding of what they need to do in order to be healthier and more successful in life… I think all nonprofits should consider their role as that of building stronger community, and unfortunately in the siloed world we have created, most organizations see their role as performing a particular task well. There’s nothing wrong with that, but often those tasks don’t add up to a stronger individual or community.
In some cases this is OK. A homeless shelter provides a roof over the head of a person who would otherwise be in the cold or under the rain. But that homeless person is going to be homeless forever unless some other thing happens. And it’s that some other thing that needs to happen. That can be done either by the organization or through partnerships. Until we get our society to a place where people really do see the benefits of a holistic approach to making people’s lives better, helping people make their own lives better, we are really just shoveling the tide back. It’s just going to keep coming back.
NPi: Can you give an example of some of those partnerships you’ve just alluded to? Those that go beyond the measurables, that you have here at CSHC?
BW: Collaboration, partnership, outreach, affiliation—these words are charged with meaning. I’m not sure this is true beyond the nonprofit sector, but in the nonprofit world there is a big difference between collaboration and partnership. Collaboration is a term that can mean anything, and usually means people apply for a grant together because they are required to by the funder. They’ll say they’re collaborating on a particular project, but it’s not anything more than something outlined on paper. The two organizations work together, but very minimally. A partnership implies a much deeper relationship, an active working together through all aspects of a particular project or program. We have a number of genuine partnerships.
Codman Square Health Center last year created a partnership with Healthworks for Women. Healthworks is a high-end gym typically in upper class areas that happens to have a philanthropic arm. We partnered with the Healthworks Foundation to create a fitness center for women and children in Dorchester that is truly accessible. Why a fitness center? Well, fitness centers are the way many people—middle class people in today’s society—exercise… Low-income people don’t have access to these fitness centers, mainly because they are expensive. I think my daughter pays $80 a month for her membership. The ability to bring something like Healthworks into a largely low-income community is something that doesn’t typically happen.
The first thing that’s interesting is we’ve connected fitness to the medical world. Doctors can write a prescription for free memberships at the fitness center. Meaning, we’ve allowed doctors a direct way to promote a healthy lifestyle. Up until last October they could say you’re really overweight, you need to get some exercise… Now our doctors can write a prescription for a free three-month membership. After those three months it’s based on the person’s ability to pay. The price goes from $0 to $25 per month. That’s an opportunity for low-income individuals. There are other deals, too. For example, if you volunteer you can receive a discounted membership… It’s the kind of partnership everyone should try to do, but there are very few organizations like Healthworks for Women that see their role as providing access to fitness regardless of a person’s ability to pay.
Our other partnership is with Codman Academy Public Charter School. Codman Square Health Center has been in the business of training medical professionals since the 80s. Overwhelmingly the people involved in those training programs are white and suburban, and that’s just because white people have better access to educational opportunities and are more likely to get into medical fields, nursing school, dental school, or social work school. Lower-income, Latino or black, urban kids generally go to schools that don’t prepare them to go to college. If you stop and ask what are we going to do about that, one answer is to say at least we’re training the next generation of health professionals so they at least understand low-income communities. Or we can try to get low-income kids to succeed so they can get into college and into these programs. Now this is a long-term, generational opportunity. We started Codman Academy so we could get kids from this community—African-American, Latino, Korean kids—into college. Not so they just get into college, but so they graduate from college.
This is the big scandal in American education. It’s not that difficult to get an African-American kid into college, but the failure rate is astronomical. And the reason it’s astronomical is the kids are not well-prepared… It’s a huge cultural shift when kids enter into college two years behind. Our goal is to catch the kids up. We do this by having extended days. We have extended six-day weeks and an extended year curriculum. We’ve proven that after two years [at Codman Acamedy] our students are up to the median of where kids should be in the 10th grade. They take the MCATs and they score well. They get into college and succeed at a rate almost 20 times that of the typical district high school in Boston. And 82% of our students graduate from a four-year college. The first part of the goal is to get them into college. The second part of the goal is to get them interested in math and science and to consider going into health professions. In Boston there is no quicker way to go from poor to middle class than by working in healthcare since one in six jobs is in healthcare and health care jobs pay pretty well. Our goal is give our students multiple opportunities—get them into a school that promotes high achievement, get them into college, and follow them until they graduate from college. We have a dean of alumni that follow Codman Academy graduates until they graduate college and help them with [the job search]. It’s a unique partnership. There is no other heath care and school partnership in the country.
We have other partnerships as well. FAMILY is an organization that has been working on two fronts: 1) working with elementary school children providing the support they need to succeed 2) running the Codman Square Health Council, which has brought about the Codman Square Farmer’s Market as well as violence prevention and fitness programs. That’s a partnership with an existing community group, which gives us access to the youth and residents in the community… Lastly, we have our partnership with DotWell and the Dorchester Multi-Service House. We’ve been able to merge many back-end functions like IT and finance so we can save money for other services and merge together several smaller programs like youth programs, HIV and Diabetes prevention programs, and financial literary programs. We can build stronger programs with more depth and go across both organizations’ communities—southwestern Dorchester and northeastern Dorchester. The DotWell partnership is not unique; there are a few others like it in the country. The Codman Academy partnership is unique. The FAMILY partnership isn’t unique, but it is unusual. The Healthworks partnership may not be unique, but if there are others like we’re just not aware of them.
NPi: What has Codman Square Health Center, the organization, learned from its community and what have you learned from this community?
BW: I think over time we’ve learned how to reconstruct the health care system to be able to deal with very complicated circumstances that our patients bring in the door, whether its poverty or immigration or social circumstances that lead to bad health outcomes. I think some of our doctors are absolutely excellent providers to our population… Just playing around with some ideas like the group visit. Can you build a peer-pressured group that promotes healthy attitudes and healthy behaviors as a way of getting people to change their behavior? You would never think of getting all your diabetic patients to come in on a Tuesday and spend four hours together, but that’s something that works here. Peer pressure is something that works and it’s needed. So that’s just an example, but have we figured it out? Not fully. But I think the community has taught us over a long period of time how to best interact with them and what kinds of things they need in order to succeed and have healthier lives. Some of that has resulted in the different directions this organization has gone. I know the infant mortality rate in the black community in Boston is lower than almost every other city in America. I would say that’s a direct result of the fact that we have staff across the health centers who really know how to best serve their communities.
What has the Codman Square community taught me? Basically my experience growing up was that of a kid in a working class, ethnic white, Catholic community. Then within seven or eight months of leaving that environment, I am married and living in a community that’s undergoing racial turmoil and change. That was an education. I learn more all the time about what it’s like to be a white person in our society, about issues of immigration and poverty. I didn’t grow up in poverty. I didn’t know anybody who was impoverished. Nobody had money, nobody went on vacations or anything like that when I was growing up, but nobody was hurting either. I don’t remember anybody getting evicted from a house. I don’t remember anybody going to jail.
You can walk into a community with an attitude. You can walk in and think if people here only did this or that. Luckily I was too young to have that attitude. I was too young to think I knew everything. So I learned a lot and continue to learn a lot about the non-wealthy parts of America. There is something absolutely, drastically wrong with our government and the way in which we tax people if there’s that much wealth allowed to exist… It warps your brain when you think about it. There’s this enormous wealth and enormous poverty existing in the same culture. I would say my life’s learning has been about income disparity and what America represents now versus what it could represent. For me, being able to participate in creating a health center and a school that deal with issues of poverty is one of the most rewarding things I could ever imagine a person doing. This is such a gift for me to be able to do this kind of work.
NPi: Where could CSHC use help?
BW: There are two areas. The first is sort of selfish because we’re about to hit a wall financially. The state health reform law has not been kind to the safety net for low-income people. There’s never been enough money allocated to fund services for low-income people and they’ve switched the way in which they fund those programs. That reform is going to leave CSHC with a 3 million dollar operating gap two weeks from now. Having people understand that what we are doing is proving to be a great value to the Commonwealth and what they need to do is fund us within the next two weeks would be useful.
The bigger, more long-term problem for us is the desiloization of American service delivery systems. We do not do a good job of having all of the delivery systems of our services work together. There’s no particular advantage to it. Funders don’t provide money for it; instead they look at it as a way to provide less money. As a result you wind up with many nonprofits hunting down a limited amount of dollars and all trying to do it on their own since there’s no particular advantage or benefit seen by society, funders, or government for partnering across sectors. I would say society needs a wake up call. Stop thinking that education is education, healthcare is healthcare, housing is housing, social services are social services, and none of these things ever meet in the middle.
A really extreme example of [this kind of thinking] comes from about 10 years ago. Codman Square Health Center participated in a project trying to link together 450 families in our area who at the time were served by the Department of Social Services, the Department of Youth Services, and the Department of Mental Health Services. These families had three different agencies servicing them, all with different goals, all with different social workers. Nothing was coordinated…You have a family where one child is seen by DSL, the husband and wife are seen by DSS, and the other child is seen by DYH. They come to the health center and are assigned another social worker, and none of the social workers are talking to each other. It’s bizarre, but in fact it might just be the most extreme example of something that’s categorical in our society. It seems like we don’t do a good job [of connecting all the different service providers].
I think there’s ways of dealing with that though. The most obvious example is the Harlem Children’s Zone. Now the Harlem Children’s Zone is not really applicable to any part of Boston that I’m aware of. There’s not a part of Boston where you could have one agency running everything, but organizations could partner with one another to coordinate all the different services individuals and families receive. First, such a partnership would have to be seen as valuable to society. Someone has to say we recognize that we’re basically only patching up problems by having families involved in all of these separate programs; what we need to do is have all these agencies talk to one another so that we can make sure people have access to opportunities in very real ways. Pull mental health service. So it’s going beyond service delivery methods and more about opportunity. Help people get into adult education, help kids get tutoring, help school systems figure out how to extend their days—figure out how to coordinate all the different services. s into every school so that there are opportunities to deal with the mental health issues that students live with in urban school systems… I think this is something that has to begin to happen otherwise we’re just going to be patching up problems and never dealing with the real issues.
NPi: What is a lesson you would pass on to other leaders or people who are looking to get involved in their community?
BW: American culture gives the impression that everything can be done immediately—that you [shouldn’t have to] wait for anything. There’s almost nothing that isn’t immediately accessible, except for maybe buying an automobile, which takes a few days to buy. Almost everything else is available immediately, but human conditions don’t change immediately… My general experience after being here for 35 years is that it takes a generation to make a difference. Anyone who comes into a low-income community expecting to turn around things quickly is dreaming. There are certain things that can be done. You can patch people together pretty well. It’s the triage system. On the battlefield people can be patched up and survive. You can patch people up in poor neighborhoods as well, but you’re not going to make a difference in terms of changing the cycle of poverty and giving younger people an opportunity unless you’re willing to transform from the start. That’s the opportunity we have. We can continue to flush money down the toilet to programs offering patch up services or we can start investing more in the individual—approaching things differently, more methodically, from the perspective that every child should be focused on from birth, especially in low-income communities.
We can provide schooling that doesn’t let out after only five and a half hours. This is one of the more ludicrous examples. [Dorchester High School] gets out a 1:30 PM, which is absolutely insane. We think it’s normal to ask kids to come school at 7:30 AM in the morning when they are teenagers and exhausted at that hour. We think it’s normal to send teenagers into the streets at 1:30 PM when most parents work at that time and won’t be home for another five hours. What is wrong with society when we can’t fix a problem like this? When you talk with the leadership in a school department they say you’re absolutely right. Then you ask, are you going to do anything about it and they say no.
Sometimes fixing a problem simply requires looking at things from a totally different perspective, a completely new angle. Some days I think the most value I bring to the Codman Square Health Center is the fact that I’m not a healthcare person and never was. I was co-founder of CSHC, but my orientation at the time was that of a community resident… Overall, I think we need to look at things with the end result in mind. What do we need? The question should be what are you trying to achieve? Are you trying to get a healthier population? If it’s education, what are you trying to achieve? I forget the line but it’s something like “you get what you design,” and it’s absolutely true. If you look at your outcomes, you find you’ve designed a system to produce those outcomes. So we’ve designed a system with complicated patchwork craftiness and profit motives that inevitably produce the most expensive healthcare system in the world with some of the worst health care outcomes in developed world… It’s the same at the individual and community level. Success for a person who needs housing should not be that they have a house over his/her head. If you really want that person to have a self-sustaining life you should also address the issue of their education. People can’t get good jobs without education. It should start from birth, and you need to know what you’re trying to accomplish. What I’ve learned is it takes a long time [to make significant changes in communities] and we need to redesign what we’re trying to accomplish as a society. Hopefully it will be wise people in positions of power making decisions to help us dramatically shift the ways we do things.
NPi: What keeps you coming to work every day?
BW: The potential to create a multi-cultural, multi-racial, multi-income community that works well. To me, this is an issue that America must deal with as we become more and more multi-cultural. There are so few places that are actually doing anything about it. My great fear is that instead of gated communities being an aberration in our society that they become the norm as society becomes totally segregated by a combination of race and class.
Click here to watch a short NPi video of Bill Walczak commenting on the value of partnerships and collaborations.