2022 Greater Nashua 
Community Health Improvement Plan  

Dear Community Partners: 

The past two years have been unprecedented as our entire public health system engaged in collective action with a priority focus on the emergency response to mitigate the COVID-19 pandemic. COVID-19 amplified the inequities and disparities that exist in our community and the gaps in our systems. We did not foresee that we would be lacking in personal protective equipment, run short of, and have to secure supplies, find resources and need to address workforce capacity issues through the reliance upon volunteers. I don’t believe anyone ever expected the magnitude of time, energy and effort that would be expended throughout the onset of this pandemic. Our early commitment in shared leadership and collaboration culminated into an ultimate community-supported public health response effort.

COVID-19 showed us that the strength of our community lie in our ability to work together, yielding the resiliency that was needed to protect the lives of our most vulnerable population groups with an imperative to preserve the economic stability and safety of our businesses, schools, hospitals, churches, municipal and social services agencies in our region. The long duration of the COVID-19 pandemic proved to be a disruptor of all things normal, challenging our hearts and spirits, yet also strengthening our resolve to do what was needed to protect our most valuable assets, people.

This Community Health Improvement Plan (CHIP) is the result of a cooperative investment of partner and stakeholder time and resources during the pandemic when many were stretched beyond capacity. Under the strategic leadership of the City of Nashua Division of Public Health and Community Services (DPHCS) a systems approach was utilized to address emergent public health issues in collaboration with stakeholders and community members. Informed by the 2020 Community Health Assessment (CHA) and a process involving the Greater Nashua Public Health Advisory Council (PHAC) Executive Committee, the 2022 CHIP will guide our efforts to achieve a healthier Greater Nashua Public Health Region (GNPHR).

The 2022 CHIP focuses on five public health priority areas:

• Behavioral Health (including Suicide, Mental Health, and Substance Use Disorder)
• Chronic Disease (including Diabetes, Depression and Hypertension)
• Communicable Disease
• Maternal and Child Health
• Public Health Emergency Preparedness

These priority areas are aligned with the state and national standards of the NH State Improvement Plan, Healthy People 2030 Goals, Foundational Public Health Services and the Public Health Accreditation Board Standards and Measures, to bring quality and excellence to our public health system. We have identified goals and objectives using a health equity and trauma informed lens based on adverse childhood experience (ACEs) intersecting with the social determinants of health to address conditions in our community that impact quality of life and overall population health outcomes for all residents of Nashua and the greater Nashua region.

As the Division Director, I am very proud of this community and the work that has been accomplished in the midst of the COVID-19 pandemic. I am grateful for the support of the Mayor, the Board of Aldermen, Board of Health, community partners and community members throughout the GNPHR. I admire and appreciate the commitment and dedication of the staff of DPHCS as we lead our communities in health improvements through prevention efforts, health promotion and service delivery across physical, mental, emotional and spiritual health and well-being.


Bobbie D. Bagley, RN, MS, MPH, CPH, Director
City of Nashua Division of Public Health and Community Services


As part of the ongoing process of community health improvement, every three years the City of Nashua Division of Public Health and Community Services (DPHCS), in collaboration with more than 20 partner organizations within the Greater Nashua Public Health Region (GNPHR), conducts a comprehensive Community Health Assessment (CHA). The CHA is a process of identifying, collecting, analyzing, and disseminating data and other information about the community’s assets, strengths, resources, and needs to be able to provide community members information about the health concerns and needs of the community. 

The City of Nashua and 12 surrounding towns make up the Greater Nashua Public Health Region (GNPHR)

A CHA is part of a larger, ongoing community health improvement process. The community health improvement process uses CHA data to identify and evaluate a community’s health needs and assets, prioritize needs, develop and implement strategies for action, and establish accountability to ensure measurable health improvement. The community health improvement process looks beyond the performance of a singular organization providing programs and services to a segment of a community. A community health improvement process looks at the whole of the community, analyzing how a network of organizations providing various programs and services, some focused at diverse sectors of a community, that contribute to community health improvement. This documentation of the process, including the workplan developed as a result of it, is known as a Community Health Improvement Plan (CHIP).

Following the CHA, the DPHCS and its regional partners continue the improvement process by developing a CHIP. The CHIP acts as a guidebook, prioritizes health topics and creates an action plan to address those issues over the next three years. It shares regional health priorities, goals, and objectives, agreed-upon during the planning process, with all members of the community and identifies the evidence informed strategies that can be used to reach identified targets. The CHIP gives structure for events, programs, marketing campaigns, interventions and conversations.  It also identifies efforts that need to be accomplished in order to achieve the long term policy, system, and environmental changes that will impact the selected CHIP priority health issues.

Process for Community Health Improvement Planning

Through the evaluation of health data and issues identified in the CHA, the Greater Nashua CHIP process prioritizes health topics and creates an action plan to address those issues over the following three years. Community engagement is key to the CHIP process so that the resulting plan reflects not only the shared commitment to priority issues, but also considers the full community’s assets, strengths, resources and needs for bringing about positive change. In order to maximize health impact and gain widespread support for improvement, Greater Nashua CHIP initiatives are carried out in coordination with state level partners whenever possible. 

Public Health Advisory Council Executive Committee

The Greater Nashua Public Health Advisory Council (PHAC) is a network of organizations and individuals that work collaboratively to improve the health of the GNPHR and its residents. The PHAC advises, and is advised by, partners on essential matters related to public health, including the development of regional public health priorities and improvement plans based on community health and resource assessments. The PHAC Executive Committee, comprised of decision-makers from a variety of Greater Nashua PHAC partner organizations, provides leadership guidance to support health-related efforts in the GNPHR. 

CHIP 2022 Workgroup

City of Nashua
Dartmouth Hitchcock of Nashua
Greater Nashua Mental Health Center
Grow Nashua
Nashua Division of Public Health and Community Services
Nashua Regional Planning Commission
Public Health Advisory Council (PHAC)
Southern New Hampshire Services
St. Joseph's Hospital
United Way of Greater Nashua
YMCA of Greater Nashua
Smart Start Coalition
Southern New Hampshire Medical Center

Thank you to our partners!

CHIP 2022 Prioritization

Prioritization is a key step in the community health improvement process. Using findings from the Community Health Assessment (CHA), focus groups, surveys and other data collection methods, we identified five priority areas for our 2021-2024 Community Health Improvement Plan. Prioritizing health issues enables the health department and its community partners to focus efforts and funding on health areas where it is most able to make the greatest impact.

The GNPHR utilized four criteria (burden, prevalence, resources, and impact) to determine the scale and magnitude of each health topic and the likelihood that interventions can lead to change. Each criterion was ranked on a 3 point scale that was tailored to the specific criterion itself. A score of 1 corresponded to the priority being of the least magnitude and a score of 3 corresponded with the health priority being of the greatest magnitude. 

Overarching Goals

The 2022 Greater Nashua CHIP includes three cross-cutting priority issues that have been identified as essential lenses with which to view and examine the health of our community. By addressing these three issues across all of our initiatives, we work to improve overall health across the region. 

Health Equity

Health equity is achieved when all people have a fair and just opportunity to be as healthy as possible. Inequities are created when systematic barriers disproportionately impact minority groups. Racial, ethnic, linguistic, and sexual minorities have been historically withheld from obtaining resources that are needed to be healthy, which is a clear barrier to achieving health equity. 

In order to achieve health equity and ensure every person has equitable access to health and healthcare services, we must collectively address health disparities and injustices.

We asked our partners what their organizations do to address health inequities, access to care, and social determinants of health (SDoH). 

Social Determinants of Health & Barriers to Care

Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of-life outcomes and risks. Resources that enhance quality of life can have a significant influence on population health outcomes.

We asked our partners what they view as barriers to community members seeking care and services. 

Adverse Childhood Experiences (ACEs)

Traumatic childhood events can result in long-term negative effects on development. ACEs have consequences that affect families, communities, and society as a whole. We must use a transformative approach to foster collaboration across child health, public health, and community-based agencies to address the root causes of toxic stress and childhood adversity in order to build community resilience.

We asked our partners how familiar they are with adverse childhood experiences. 

Priority Areas

The Greater Nashua PHAC Executive Committee and CHIP Planning Team chose the following health priority areas for the 2021-2024 CHIP based on the 2020 Greater Nashua CHA (*indicates state requirement):

1. Behavioral Health*

2. Chronic Disease 

3. Maternal and Child Health 

4. Communicable Disease

5. Public Health Emergency Preparedness*

Explore the Priority Areas

Check out the links below to explore each priority area in the 2022 Greater Nashua Community Health Improvement Plan. 

Do you have questions or comments about the information on this site? Contact us.

Looking for resources in Greater Nashua? Get Connected. Get Help. Visit 211nh.org or dial 2-1-1.