A well-known quality of life problem on the Island, housing insecurity also poses health challenges, according to a new community health needs report from the Martha’s Vineyard Hospital.

About half of year-round Island households meet the HUD definition of cost-burdened, spending more than 30 per cent of their income on housing. That is much higher than the statewide average of about a third of households, the report found.

About a quarter of Island households spend more than half their income on housing compared with 16 per cent statewide.

“People who are housing insecure, there’s mental health implications from that and there’s the stress of not knowing where you’re going to be in the next few months. It impacts your work life. It impacts your home life. It impacts your health,” said hospital spokesman Katrina Delgadillo, who spearheaded the report with hospital president and CEO Denise Schepici.

A community survey with almost 350 respondents, a public forum and phone interviews with 16 representatives from different Island communities were all used as a basis for the report, completed in July. The report also used secondary data from the U.S. Census, the Martha’s Vineyard Commission and other sources.

Nonprofit hospitals are required by the Massachusetts Attorney General’s office to complete a community health needs assessment every three years. Ms. Delgadillo said many of the identified issues are well-known, but the research still serves to guide hospital priorities.

“It’s fair to say that we weren’t actually completely surprised by the findings,” Ms. Delgadillo said.

In interviews and data, social determinants of health emerged as a prominent theme.

A seasonal community and the resultant year-round housing crisis is both a health concern from a patient and a provider standpoint, according to the report, causing instability for community members and making it more difficult to attract caregivers to live on the Island full-time.

According to data from the U.S. Department of Housing and Urban Development (HUD), 34.7 per cent of Dukes County’s 17,677 housing units were occupied year-round between 2013 and 2017. Almost half of year-round Island households have at least one of four major housing problems as defined by HUD: high cost, overcrowding, inadequate kitchen facilities or inadequate plumbing facilities.

Economic insecurity is also a reality for many Island families, the report shows. More than a fifth of students at each of the down-Island elementary schools received free and reduced lunch last school year. Almost 13 per cent of Island children were food insecure in 2017.

The Island’s population is aging, with more than 12 per cent of people between the ages of 65 and 74, compared to the state wide average of closer to 8 per cent. Meanwhile, according to the report, young people are leaving the Island to pursue opportunities elsewhere, leaving in a void of future leadership.

“Our community leaders are aging. Many are in the late 60s and 70s. When they retire, who will take over? There isn’t a next generation being mentored into these positions,” one interviewee said.

In the community survey, which was distributed last spring, respondents identified substance abuse issues as the second most prominent community concern on the Island after housing availability.

Rates of heavy drinking, binge drinking and youth marijuana use are all higher locally than statewide averages. The state Department of Public Health reports 22 opioid related deaths in Dukes County between 2010 and 2018, though numbers are likely higher due to reporting discrepancies.

More than 30 per cent of respondents to the community survey said they were worried, tense or anxious more than 10 days of the month. Rates of self harm mortality are higher than state averages for men and women.

“Mental health and substance use disorders are a growing concern in our community,” Ms. Delgadillo said. “The perception is — and it’s very likely accurate — that there are too few behavioral health clinicians available and services on the Island, especially for Portuguese speaking residents.”

Access to health care and services remains a concern as well, with many Islanders needing to leave the Island for some health services.

The Vineyard also proved a healthy place to live in several areas: there is ample community engagement and community pride, and people feel their neighborhoods are safe. Rates of obesity and sedentary lifestyles are also lower than the statewide average.

Ms. Delgadillo said more people filled out the survey for this year’s report than in the previous report, but she hopes to increase participation in the future. Surveys were available online, in councils on aging, at the hospital and at libraries. A version was also translated into Portuguese.

“We do wish we were able to capture a larger part of the community,” Ms. Delgadillo said. “On the next one, we will do our best to make the survey easier to digest.”

She said the next step will be to devise an implementation plan for action to address issues raised in the report. The report’s advisory committee includes representatives from multiple health care organizations, the schools and other agencies.