When you’re sick in Mattapan, where do you go?

When 69-year-old Vickey Siggers needs specialty medical care, she hops in her car and leaves Mattapan.

Most of her neighbors don’t have that option, she said.

Only one full-service primary care facility, the Mattapan Community Health Center, serves the entire Mattapan area, where over a third of residents are immigrants. When serious injuries or conditions arise, many residents have to spend 45 minutes or more on the bus or T to reach Boston Medical Center or Beth Israel Deaconess Medical Center, the nearest hospitals with full trauma and specialty units.

“This is where the different standards come in,” Siggers said. “Because I get to go wherever I want. I’ve got a car, and I’ve got health insurance.”

Many Mattapan residents are stranded in a health care desert. And despite decades of promises from city officials to address Boston’s racial health disparities, their options haven’t gotten better.

An energetic woman with a deep laugh, Siggers is a familiar face to many Mattapan residents: She runs the Mattapan Square Farmer’s Market and is a founding member of the Mattapan Food and Fitness Coalition. Since 2006, the grassroots organization has promoted access to nutritious food, green space and physical activity for families in Mattapan, a majority-Black neighborhood. Siggers knows her community well — and how limited its care options are.

In April, a 33-member working group — made up of health care providers, public health and government officials, and community representatives appointed by Mayor Michelle Wu and Gov. Maura Healey — released a set of recommendations for addressing the unmet health needs of the community previously served by Carney Hospital, which closed last year. In their recommendations, the working group emphasized the necessity of reinstating both emergency and preventative health care services on the former Carney site on Dorchester Ave.

While the report outlined key concerns and urged action to address health disparities, Boston’s leaders have been identifying some of those same problems for decades.

A history of inequity

Carney Hospital served residents of Mattapan and Dorchester until it shuttered in August 2024. Its sudden closure left Mattapan residents — already short on health care options — reeling, said Vivien Morris, founder and chair of Mattapan Food and Fitness Coalition and a member of the working group.

“It closed so quickly with little time for anyone to make any changes that were going to be needed,” Morris said.

The closure deepened longstanding health care disparities faced by Mattapan residents.

In the early 2000s, the Boston Public Health Commission committed to addressing the health inequities affecting communities of color. In a 2005 report, a task force created by then-Mayor Thomas Menino published a list of 12 overarching recommendations.

That report focused heavily on improving access to health insurance and increasing the diversity of the medical workforce in order to improve outcomes for people of color. It did not make recommendations about locating health facilities in minority communities.

But, two decades after those recommendations, Mattapan continues to face some of the city’s most severe health challenges. The neighborhood has the city’s shortest life expectancy: 77 years, compared to a citywide average of 80.

And while Boston as a whole has made major health gains over the past decade, the improvements have been uneven. In South Boston and Charlestown — two of Boston’s whitest neighborhoods — heart disease deaths have plunged nearly 170% since 2001. In largely Black Mattapan, the decline was just 43%, the smallest improvement of any neighborhood.

Stretched thin

There are no hospitals or emergency care facilities in Mattapan. With the closure of Carney Hospital, the nearest emergency room is at Brigham and Women’s Faulkner Hospital, over three miles away. Getting there can be difficult.

According to the Boston Planning & Development Agency, only 18% of Mattapan residents live within a 10-minute walk of a rail station, key bus route stop, bikeshare or carshare option, compared to 60% citywide. That gap makes it harder to reach care, especially in emergencies.

At Mattapan Community Health Center, medical director Aimee Williams sees these barriers firsthand. Nearly all of the center’s patients are racial or ethnic minorities, she said, and 91% live under the federal poverty line. “Many of our patients have long commutes to work,” Williams said. “They have to work long hours or multiple jobs. And so it’s hard to prioritize health care if you need to prioritize work to pay rent and to afford food.”

Mattapan Community Health Center has taken on the bulk of the preventative care, but the need is more than they can meet.

Currently, the center serves 9,000 patients annually from Mattapan and nearby neighborhoods like Dorchester, Roxbury and Hyde Park. That’s far fewer than the population of those neighborhoods; Mattapan alone is home to around 25,000 people.

The care that patients receive at the health center isn’t comprehensive, either, said its president and CEO Guale Valdez. While patients can get primary, dental and behavioral care at the center, they are referred elsewhere for specialty care like cardiology, orthopedics or internal medicine.

“When we do some referrals, if a patient really does have a hard time getting there, we make arrangements through Uber to get them there,” Valdez said. But even those rideshares can strain their budget.

The biggest challenge is staffing and retaining employees. According to Valdez, the center is actively recruiting, but it faces stiff competition from larger, more prestigious health centers and hospitals. The job requirements at the center are unique: clinicians are ideally drawn from the local community and fluent in Spanish or Haitian Creole to meet the linguistic needs of their diverse patient base.

Many patients are recent immigrants, often arriving with multiple severe health issues — which make for longer appointments. Still, they never turn anyone away.

“We’re dealing with patients who are sicker by the time they come to us,” Valdez said.

Promises revisited

The Carney working group report says wait times will drop if clinics — plus the old Carney site — add more urgent care, primary care and mental health slots. To make that happen, it calls for reliable funding, more staff, better care coordination and other fixes that widen access to everyday care.

“Funding is key,” Morris said of the working group’s recommendations. “We’re asking for a lot of the services that were provided at the hospital to be provided at more community health centers.”

The report, however, names no concrete funding source — whether state, city or philanthropic — and assigns no agency to carry out the work.

“A report is a report,” Morris said. “It’s not saying that these things are actually happening.”

The authors are all students in the Graduate Program in Science Writing at MIT.