6.1.1

Obesity Rates by State

Obesity is a major contributing risk factor for high-cost, preventable chronic diseases such as Type II Diabetes and Hypertension, the costs of which are projected to triple over the next two decades.

Massachusetts is losing ground in obesity.  As of 2010, 24% of adults in the state were obese, ranking as the seventh-lowest rate in the nation.  However, in 2009 Massachusetts had the third-lowest obesity rate in the US at 22%.  Though Massachusetts obesity rates remain low compared to many US states, since 1995 obesity rates have more than doubled from less than 12% of adults.  When combining the percent of adults who are overweight and obese, 60% of Massachusetts’ adults were at an unhealthy weight in 2010.

6.1.2

Cost of Premiums by State

• Average Monthly Health Insurance Premiums by State

6.2.1

Access to Healthy Foods and Exercise

• Access to Healthy Foods
• Food Deserts
• Open Space per Capita and Child
• Population by Census Tract
• Access to Bike Paths

According to the CDC, a person’s health is determined by a nexus of individual circumstances and behaviors and community health conditions.  These “determinants of health” include: economic stats and educational attainment; home, workplace and community safety; lifestyle factors such as diet, exercise and tobacco use; and exposure to bacteria, toxins and other environmental hazards.  Together, these factors account for about 70% of individual health status.

Historically, low-income neighborhoods have not been afforded the same level of access to fresh foods and open spaces as higher-income neighborhoods, contributing to worse health outcomes for lower-income residents.  Universal access to high-quality options for physical activity and healthy foods is essential to ensure equal opportunity for all to live a healthy lifestyle.

Farmers Markets: as of 2011 there were 247 farmer’s markets across Massachusetts, a 6% over 2010 and the number of winter farmers markets doubled to 36.  More than one-third (98) participate in the Supplemental Nutritional Assistance Program (SNAP) that allows for the use of food stamps at farmers markets, up from 53% in 2010.  Boston’s Bounty Buck Program, which doubles the dollar amount of SNAP Food Stamps up to $10 is available to the more than 80,000 Boston families using the program.  In 2010, the Boston Public Market Association was designated as the operator of a new, year-round farmers market that will open in 2014.

Food Deserts: Research conducted by the Food Trust found that in 2011 Boston’s neighborhoods with the lowest access to grocery stores were East Boston, Roxbury, Mattapan, Jamaica Plain and Roslindale.  Small locations in Roxbury, Dorchester, Mattapan and East Boston had low access to supermarkets, were low income and had high rates of diet-related deaths.  According to USDA standards, approximately 170,000 Massachusetts residents live within a food desert with some of the most affected areas in low-income urban communities in Boston, Worcester, Fitchburg, Lynn and Lawrence.

Healthy Bike and Walkways: Boston ranks as the number one biking and walking city in the percent who bike (1.5%) and walk (13.9%) to work and have the lowest fatality rates for cyclists (1 per 10,000 daily cyclists) and pedestrians (0.9 per 10,000 daily).  However, large portions of Roxbury, Dorchester and South Boston have fewer designated pedestrian walkways and bike paths as compared to the rest of the city.  In 2011, Boston released the New Balance Hubway bike sharing system, which logged more than 140,000 rides among 3,700 annual members and nearly 30,000 casual riders.  Expansion is planned for Roxbury, Jamaica Plain, Charlestown and Dorchester.

6.2.2

Access to Community Health

• Community Health Centers

6.3.1

Maternal Health

• Mothers Smoking
• Women Receiving Adequate Prenatal Care

A lifetime of healthy outcomes begins before birth with good prenatal care.  Women receiving adequate prenatal care are more likely to deliver a full-term baby at a health birth-weight which reduces the risk for developmental delays and long-term health problems.

6.3.2

Healthy Birth

• Low Birthweight by Race/Ethnicity

Preterm births: the percent of Boston babies born premature (less than 37 weeks gestation) was 9% in 2009 and has not exceeded 11% over the decade.

Low birth-weight: the percent of babies born at a low birth-weight (less than 5 pounds 8 ounces) has remained between 8.5% and 9.5% from 2000 to 2009.  However, rate of low birth-weight babies born to African American mothers has been consistently higher than all others: 28% higher than Asian, 34% higher than Latino and 38% higher than white rates.

Infant mortality rate: Boston’s infant mortality rate was 6.5 per 1,000 live births, down from a high of 8.4 per 1,000 in 1997.  Though the rate for African Americans has consistently been the highest, the rate fell from about 15 per 1,000 in 2008 to 7.7 per 1,000 in 2009, roughly equivalent to the Latino rate but still 1.5 times higher than the white rate.

6.3.3

Healthy Childhood & Adolescence

• Percent Children with Elevated Lead Levels
• Percent of Boston Teens Who Have Ever Been Diagnosed with Asthma
• Percent of BPS High School Student Who are Overweight or Obese

The percent of Boston's children with elevated blood lead levels fell to less than 1% in 2010, down dramatically from 13.5% in 1995.  However, the highest rates for children were in Allston/Brighton (1.5%), Mattapan (1.4%) and North Dorchester.

Child hospitalizations due to asthma fell slightly from 2008 to 2009--most recent year available--but with persistent racial/ethnic disparities.  Hospitalizations for all children ages two and under fell from 13.2 to 11.7 per 1,000 and for children ages three to five fell from 8.8 to 8.4 per 1,000.  However, among children two and under hospitalizations per 1,000 were much higher for African Americans (16.5) and Latinos (12.3) than among white (8.3) and Asian (4.0) children.  Similarly among three to five year olds, the rate per 1,000 was 13 among African Americans and 8.2 among Latinos compared to 5.4 among Asians and 2.7 among white children.

6.3.4

Healthy Behaviors

• Percent of BPS High School Students without Physical Education
• Percent of BPS High School Students Without 60 Minutes of Weekly Physical Activity
• Percent of BPS High School Students Who Consume at Least One Soda Per Day

The percent of Boston's high school students not receiving in-school Physical Education has increased from 37% in 1993 to 68% in 2011. White students had the lowest participation rates with 73% not participating in Physical Education. 

The percent of BPS high school students not participating in at least 60 minutes of out-of-school physical activity declined slightly from 27% in 2007 to 25% in 2011.

The percent of BPS high school students consuming at least one soda per day fell from 27% in 2007 to 24% in 2011. Latino students had the lowest consumption rate of 20.4% while African American teens had the highest at about 28%.

6.4.1

Consumption of Nutrition and Vegetables

Healthy food and physical activity are essential for combating obesity, reducing preventable chronic diseases and promoting overall healthy living.

In 2010, just 26% of adults in Boston reported consuming five servings of fruits and vegetables daily.  Also 26% of those with some college reported healthy eating compared to 22% of those with a high school diploma and 16% of those with less than high school.  Twenty-two percent of those earning less than $50,000 reported healthy eating compared to 30% of those earning more than $50,000.  Latino adults reported the lowest rates of fruit and vegetable consumption at 19% compared to 24% of African Americans, 25% of Asians and 28% of white Bostonians.

6.4.2
Engagement in Regular Physical Activity

As of 2010, 57% of adults in Boston reported engaging in regular physical activity, defined as vigorous activity for more than 20 minute a day 3 days per week or moderate activity for more than 30 minutes a day on 5 days per week, according to the Boston Public Health Commission.  There were differences by educational attainment and income and, to a lesser degree, race and ethnicity.

• 61% with any college reported regular activity compared to 50% with a high school diploma and 37% with less than high school.
• 64% earning more than $50,000 reported regular activity compared to
• 54% of those between $25,000 and $50,000 and 48% earning less than $25,000.
• Only among Latino’s was the physical activity rate less than 50%

6.5.1

Obesity

Obesity is a risk factor for largely preventable hypertension, asthma, Type 2 diabetes, heart disease, strokes and some cancers.

Residents of Massachusetts and Boston have healthier weights than Americans overall but rates are climbing. In 2010, 23% of Massachusetts residents were obese—9% higher than in 1997 and a 2% gain since 2008. In Boston, obesity declined by 3% from 2008 to 2010, but with stark variations by income: 15% of Bostonians earning more than $50,000 were obese in 2010, down 3% from 2001, while obesity rates for those earning less than $25,000 and between $25,000-$50,000 have increased by 9% since 2001, to 27% and 25%, respectively. Among high school students in the Boston Public Schools in 2009, 18% were overweight and 15% were obese.

6.5.2

Asthma Diagnosis

As of 2010, 11% of adults in Boston reported having asthma with a large gender gap: 15% of women compared to 7% of men.  Overall, African American women had the highest rates at 19% followed by 16% of Latino women and 12% of white women.  By comparison, African American, Latino and white men reported rates between 6% and 7%.

6.5.3
Diabetes

The percent of Bostonians with type II diabetes has remained between 6% and 7% between 2001 and 2010.  As of 2010, 7.8% of adults in Metro Boston had type II diabetes, up from 5.8% in 2004.  Statewide, the percent of adults with type II diabetes increased from 3.8% in 1995 to 7.4% in 2010.   Type II diabetes rates vary widely by race/ethnicity, educational attainment and income.  As of 2010:

• 9% of African American adults and 7% of Latino adults had diabetes compared to % of white Bostonians;
• 15% of those without a high school diploma had diabetes compared to 8% of those who finished high school and just 5% of Bostonians with any college;
• 9% of adults earning less than $25,000 reported having diabetes compared to 7% of those between $25,000 and $50,000 and just 4% of Bostonians earning more than $50,000.

6.5.4
Hypertension

6.5.5

Cardiovascular Disease

• Cardiovascular Disease Hospitalizations by Type

6.5.6
Sexually Transmitted Diseases

6.6.1

Level of Spending on Public Health

• Funding for Public Health
• Funding for State Employee Health Insurance

Funding for the determinants of health—such as education, the environment and public health—have a greater impact on well-being by reducing high-cost preventable disease, but is often crowded-out by the high-cost health care. 

Health care costs have grown at a rate well beyond overall spending, crowding out all other investments in key determinants of health.  Between FY01 and FY12, total health care spending increased by 64% while total spending increased by only 13% after inflation.

Over the same time, the Massachusetts Department of Public Health budget was cut by 25%, funding for public higher education was reduced by 28%, funding for environment and recreation declined by 33% and the 2% increase in K-12 spending was completely absorbed by school districts’ rising health care costs.