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THE CONTEXT
Boston is at the forefront of public health innovation. It birthed the nation’s first Department of Public Health, launched the national conversation about incorporating public safety into the health arena, and is home to world-class medical institutions, neighborhood-based health centers and exemplary health prevention initiatives. Boston has 22 inpatient hospitals — 16 of which are teaching hospitals — 3 medical schools, 25 community health centers, dental schools, schools of public health, and community-based health initiatives. One of the nation’s largest centers of medical research, Greater Boston has ranked first in National Institutes of Health (NIH) grant awards over the past 8 years. The health services sector is also a significant contributor to the city’s economy, employing 106,989 people in 2003 — or 1 out of 6 city jobs. Boston and the region are widely considered healthy places to live: Boston was ranked as the healthiest city for men by Men’s Health in 2001, and Massachusetts has been among the top ten states for 14 of the 15 editions of United Health Foundation’s annual State Health Rankings. However, high rankings and a multitude of resources tend to mask disparities in access to health services and health outcomes.
KEY TRENDS AND FINDINGS
Boston’s comprehensive public health network and initiatives achieved major progress over the past decade.
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Boston’s teen birth rate declined by 46.3% for adolescents ages 15-17 years between 1992 and 2002.
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Self-reported maternal smoking during pregnancy decreased by 70% to 4.5% of all births between 1992 and 2002.
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HIV/AIDS incidence rates (new cases per 100,000 population) dropped by 71% between 1992-2002, from the decade high in 1992.
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Asthma hospitalization rates for children under age 5 dropped by 23% between 1994 and 2002.
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Elevated blood lead levels among Boston children declined by roughly 90% since the early 90s, falling from 42% in 1991 to 3% in 2003.
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Infant mortality rates declined by 32% from 1992 to 2002, from 10.3 deaths per 100,000 births in 7.0.
Sources: Data cited by Boston Public Commission, 2004 Natality Report and the Health of Boston 2004 Chartbook.
In response to constrained state budgets, public health funding in Massachusetts was reduced by 24% in real terms from $551 million in fiscal 2001 to $417 million in fiscal year 2005, according to the Massachusetts Budget and Policy Center. These state budget cuts led to budget reductions in Boston’s public health programs and services. As a result, rates of preventable disease are rising. Hepatitis A infections in Boston doubled after elimination of state funding for the vaccine in July 2003, marking the worst rate in a decade, according to a report by the Boston Foundation and Massachusetts Health Policy Forum. Whooping cough among Boston public school students in first quarter 2004 increased six times over each of two previous years, and active TB appeared in the classroom following cuts in school health clinics and services. Asthma hospitalization rates rose almost 5% in 2002, according to the BPHC, and The Boston Globe reports that Boston now has the sixth highest syphilis rate in the nation.
While public health funding declined, state spending on medical care increased dramatically. According to the Massachusetts Taxpayer’s Foundation, not adjusted for inflation, public state spending on Medicaid & other non-DPH health care increased from about $4.9 billion in 2001 to about $6.4 billion in 2004 to an estimated $7 billion in fiscal year 2005. (Half of these expenditures are reimbursed by the federal government). The Massachusetts Budget and Policy Center explains that while MassHealth appropriations grew faster than the rest of the state budget after 2001, various MassHealth programs, eligibility and benefits were actually scaled back, and the increase reflects higher health care costs.
Health insurance premiums are rising, and fewer employers offer benefits in Massachusetts. The amount paid by the average Massachusetts worker for health insurance premiums has risen nearly 50% between 2000 and 2004, while average earnings only rose by 14% according to Families USA. The number of non-elderly individuals with employer-sponsored health insurance fell by 27,872, and those with individual insurance rose by 52,506 in Massachusetts between 2000-2003, according to the Kaiser Family Foundation, based on Current Population Survey estimates. A consensus is emerging that health care coverage for all residents is a critical and shared objective, and state legislators, business leaders and health care advocates are working together toward this possibility.
Racial/ethnic health disparities persist. Disparities by rac
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