Twenty-four years ago, as a young doctor fresh off her residency at Children’s Hospital Boston, Shari Nethersole, MD, took a job as a pediatrician at a Roxbury community health center.
At that time, many community health centers struggled with scarce resources, and clinicians had to get creative to care for their poor, underserved patients. But the biggest challenge, recalls Nethersole, was the isolation. “It felt like you were alone, without much support from the teaching hospitals or even the other community health centers,” she says. “You had to deal with all these problems and work it out yourself.”
Much has changed over the past two decades, as community health centers have become increasingly valued for their ability to provide people with access to quality care and close gaps in health disparities between patients of different ethnic groups and class status. “There’s been a sincere effort for hospitals to partner and collaborate with health centers,” she says. On behalf of Children’s, that charge is led by Nethersole. As Children’s medical director for community health, she’s devoted to finding sustainable ways to improve the health of Boston children. It makes sense, then, to engage community health centers, as that’s where it’s estimated 50 to 60 percent of all Boston children receive their primary care.
When Nethersole became medical director six years ago, one of her first actions was to ask community health centers what they urgently needed and how Children’s could help. Loud and clear, the strongest call for assistance was around childhood obesity. “Currently, there are over 30,000 kids in the city that are overweight or obese,” she says. “We heard from health centers that they were seeing a growing number of children with obesity and didn’t have a system to adequately care for them.”
According to Nethersole, fighting obesity effectively requires a community-based, public health model. “The fact is, with this number of kids, you can’t send them all to specialists and there’s not a lot of evidence that’s what the majority of them need,” she says. She, along with a group of Children’s nutrition, specialty and primary care staff, got together to brainstorm. The result was Fitness in the City, a program that provides support for a nutritionist and case manager at each community health center affiliated with Children’s. Currently, the hospital has relationships with 10 health centers, as well as Martha Eliot Health Center, which is the hospital’s own health center.
Fitness in the City works as such: Kids who come in for a regular check-up have their height, weight and body mass index (BMI) assessed. If they’re overweight, they are referred to the program, where the nutritionist offers family counseling around healthy eating and lifestyle changes, and the case manager connects the family to no- or low-cost physical activities in the community. Nethersole points out that the approach is not actually medical in nature. “It’s not realistic to have overweight children come back to a physician every three months,” she says. “What they need is a health coach.”
Now five years since the launch of the program, preliminary results are promising. “We’ve seen statistically significant changes, with families eating more fruits and veggies, drinking less sugar-sweetened beverages, eating more as a family, cutting back on TV time and increasing physical activity,” says Nethersole. “This includes mild improvements in BMI—which are small but important shifts.” Community health centers are also pleased with the program. Just last month, South End Community Health Center recognized Nethersole as their “Health Care Hero.”
Since her early days of residency, Nethersole has worked in various roles at Children’s. After four years at the health center in Roxbury, Nethersole returned to the hospital as an attending physician in Children’s Hospital Primary Care Center (CHPCC). For over a decade, she divided her time among caring for patients, directing medical student education, and running the general pediatric consultation clinic. When the job of medical director for community health became available, it seemed like a perfect evolution of her career. “I’ve spent years working with individual patients to manage their health problems, and I felt that there was a need to address some of those same problems in a larger, population- based public health fashion,” she says. Her experience treating patients one-on-one was invaluable when she began thinking about how to produce broader change. “You have to shift your thinking when you approach illness and health from a public health perspective. Things you might normally do for an individual patient might not make sense for a group,” she says.
Tackling obesity is just one of Nethersole’s missions. She’s also spearheading programs to address other issues for the city’s children, from asthma to promoting child development and mental health. She’s particularly concerned with the continuing disparities in Boston kids’ health. “If you look by neighborhood and race and ethnicity, you see wide differences in rates of asthma and most other health problems,” she says. And while she’s got a lot on her plate, she doesn’t feel alone anymore. “We’re building buy-in and ownership of these issues within communities,” she says. “Together, we’re figuring out the solutions.”