“We need to realize that what happens in 2020 is the result of what happens now.”  

(Quote from a workshop participant)

“The needs of older people can’t be met if the needs of young families aren’t met.”  

(Quote from a workshop participant)

Accessible Services Powerpoint Introduction

Summary of the workshop’s vision for Accessible Services on Cape Cod:   In 2020, Cape Codders will work together in a cooperative process to ensure: a preventive health care system with comprehensive community based healthcare and health programs for children; reliable and affordable child-care; preventive programs such as Head Start; mixed use village centers and a range of housing types; adequate affordable housing; local food production; nutritious, affordable and accessible food; and adequate wastewater infrastructure.

Breakout Group 1 Discussion

Imagine Cape Cod in the year 2020:   What does our social service system look like?   Is housing affordable and available?   Can families easily access child care and education services?   Is healthcare (including dental and behavioral health services) available, affordable and accessible? Is nutritious food available and plentiful? How has this affected the Cape’s economic health?   Has it impacted the environment, and if so, how?   What does our community look like in terms of demographics, development, etc.

The breakout group noted that we already have a good start in working cooperatively, as many groups already work on issues together.   The group envisioned this process being strengthened until Cape Cod was a leader in working together to provide healthcare to every resident, until ultimately, by using Cape Cod’s model, every person in the country would have healthcare.  

When discussing providing adequate healthcare for everyone, it was noted that the cost of healthcare was a barrier, and that to lower future costs, it is important to focus on the prevention of illness and injury.   An investment in prevention would help reduce the overall cost of healthcare in the future.   It was noted that individuals should also take responsibility for their own health, including prevention of injury and illness.  

• good health-related education for children
• community based health care
• attracting and keeping highly qualified healthcare providers and subspecialists
• providing multi-service health care
• comprehensive health care for everyone, including the at-risk population

The group noted that changing to a system of community based healthcare and health-related education for children would require a mindset change.

The discussion moved to child-care.   It was noted that the lack of affordable child-care affects everyone (through education and workforce impacts), whether they need the service or not.   The group envisioned that in 2020 we would recognize the importance of providing reliable and affordable child-care, and provide adequate funding.  

It was noted that the cost of child-care today consumes much of the earnings of the person who is using child-care to enable him/her to work, and that the cost of child-care should be subsidized.   It was noted that the cost of providing responsible subsidized child care reduces the cost of remediating problems that occur at a later point in life.  

It was agreed that there is a need to raise public awareness of basic needs, such as child-care and healthcare.   A participant noted that we need to break the vicious cycle of low-paying jobs without benefits, which makes it hard for people to afford to live here, which results in a transient and non-permanent workforce, which results in low-paying jobs without benefits.

It was noted that the public needs to recognize that preventive programs for health care and programs such as Head Start are investments in our community that will reduce costs in the future, both monetarily and socially.  

The discussion moved on to housing, with a vision of adequate affordable housing for everyone.   It was noted that there is a gap between what is considered “affordable” and what a family can really afford.

It was noted that providing housing in mixed use village centers and downtowns bring these areas a vitality and liveliness that don’t exist when housing is absent, and that to make this happen, towns need to be proactive and pass creative zoning that makes it possible.   It was noted that we need to have a range of housing types that allow people to buy an affordable “first home”, and then move up as they are able.   To make this goal happen, the breakout group noted that we need political will and resources.

The conversation moved to on to affordable and accessible food and nutrition, with a member of the group noting that we should use our productive agricultural land and fisheries to provide a local market.   It was noted that Cape Cod should encourage a “slow food” movement, as opposed to our “fast food” culture.                                    

It was suggested that:

• the Cape form a farmers market for local produce that is accessible by local transportation.
• we encourage Cape Cod schools to serve nutritious meals and eliminate junk food vending machines
• that we revise land use regulations so that it becomes more attractive to keep valuable
• agricultural land in production rather than subdivided and developed.

Regarding all of these issues, a participant noted that we can accomplish more working together collectively than we are able to do as individuals.

Breakout Group 2 Discussion

Imagine Cape Cod in the year 2020:   The Cape’s population has grown 50% more than it is now, to 375,000 year-round residents.  

Are the Cape’s transportation services adequate to meet our needs?   Do we have clean water to drink?   How are we disposing of our wastewater?   Do residents have affordable and readily available communications services?   How are we meeting our energy needs?

Breakout summary : Participants wondered whether the Cape could support anticipated population growth – and worried that such growth is inevitable.   Political, financial, physical, environmental, social, and other barriers will challenge Cape Cod’s future ability to accommodate growth while delivering the services required to both support this growth and address the problems created by previous growth patterns.

• If the boom includes a larger aging population – more retirees – we will need a new level of elder services.
• Where will the workers live who serve larger population?
• We support that population with year-round use of existing housing stock – the boom is inevitable.
• The roads can’t handle it.   Transit requires local density – village centers; we need to direct growth to appropriate areas.
• The average year-round home generates 15,000-20,000 miles annually.
• Seasonal homes have more cars than they used to.
• We must stop “strip” housing and single residences; instead we need cluster homes and multifamily housing.
• Something has to change – the infrastructure is inadequate, especially wastewater treatment.
• Will there be a crisis point, or is growth a self-limiting factor?
• Can our natural systems support 375,000 people year-round?
• Will the tourists go away because the environment has been ruined or because cost of living/visiting is too expensive?
• Will a decline in the quality of life slow growth?
• The environment can’t handle the growth, infrastructure can’t be delivered efficiently if growth is spread out.
• What will the summer population be if the year-round population is  like that just before/just after the current summer peak?
• Can hospitals/health services cope?
• Some workers will need to be imported.
• People will need to work where they live (or vice versa).

Suggested Action Items

• Alternatives to septic systems: cluster systems, composting toilets.
• Government structure might collapse.
• Tighter integration of disparate government structures; accelerated integration required – this will require leadership instead of provincialism.
• Need to change (reduce) ecological footprint.
• Not just redevelop, but undevelop through Transfer of Development Rights.
• Government needs to act as partner, facilitator, convenor of smart growth.
• Density done right is environmentally and economically beneficial.
• Employers must step up to the plate to provide services: workforce housing, infrastructure investment, health services.
• Growth must pay for itself and the past.
• Promote natural landscaping – less water, less chemicals, reduced lawn size.
• Policies are needed that regard waste as a resource – reusing water, biosolids, trash, etc.
• We need to require septic maintenance – Tri-town system used to require scheduled pumpouts.
• Boards of Health: use their powers to control growth, require septic maintenance, control fertilizers, control air emissions.
• Rail – we never should have pulled up the tracks.
• Promote land use policy and legislation that is needed to accomplish our vision, even if it is not popular (for example, the National Seashore).
• Promote laws and regulations that are creative solutions for child care, health care, housing, etc.
• Examine access to health care from the providers perspective, and ask if we have the infrastructure they need.
• Implement comprehensive wastewater treatment to protect and improve water quality.
• Increase the use of technology to integrate health providers information and reduce duplication.
• Increase density in village centers via village center zoning.
• Encourage economic development that links to quality of life issues (the “underlying economy”).
• Work to provide job opportunities for people with broad and diverse skills.
• Encourage the creative economy.
• Create a health plan for artists and other entrepreneurs.  

Suggested Indicators of Progress

It was recommended that each issue be measured from two viewpoints, i.e. where will people live so they can work, and what work opportunities will be available that would allow them to live there.

• Measure the income needed to afford to rent or buy a home – measurement of the gap between what people make and what it really costs
• Measure how many affordable units are created per year versus how many market rate units are created per year
• Measure what our workforce needs are and what jobs are unfilled
• Measure vehicular accessibility to healthcare – what means of transportation is available
• Measure appropriate use of the emergency room versus use of the emergency room for “non-emergency and routine” care
• Measure healthcare providers on the Cape as a percentage of the population
• Measure air quality and water quality
• Measure the number of EMT runs
• Measure the number of emergency room visits
• To determine per capita land use, measure the number of people per developed acre, the number of acres per person (this could be done overall, or by village centers)
• Measure an ecological footprint
• Measure the number of people living in village centers and downtowns
• Have a quality of life indicator
• Measure where people who move to Cape Cod come from, and measure where those who leave move to
• As a measure of quality of life and the value of arts to the community, come up with a measure of the creative economy and creative types of employment
• Measure of the number of museums, libraries and cultural tourism
• Measure the number of entrepreneurs
• Measure the accessibility broadband communications, cable, and cell phones
• Measure the number of children in child care as a percentage of the population