Report sounds alarm over impact of ‘rising tide of disease’ on regional health, healthcare economy

June 18, 2007

Boston – Despite its status as a world-class healthcare hub with unparalleled assets—universities, teaching hospitals and research facilities routinely hailed as setting a global gold standard—a rising tide of preventable chronic disease threatens not only the physical health of Greater Boston residents but is already beginning to crowd out public and private investment in a wide range of regional priorities — including healthcare itself. That is the news contained in a groundbreaking report released today by the Boston Foundation and the New England Healthcare Institute titled  The Boston Paradox: Lots of Health Care, Not Enough Health .

The report juxtaposes for the first time the state of our health care economy and the state of our physical wellbeing, identifying a serious and growing regional and national issue.

“We are the canary in the coalmine,” said Wendy Everett, President of the New England Healthcare Institute. “Until now, the focus of the regional and national health care conversation has been on universal access to care. This report makes a compelling case that we need a new and different conversation. Unless we focus on health status and costs, we will create an unsustainable system that will overwhelm the local — and ultimately the national — economy.”

At the same time, the report underscores a historic opportunity for Greater Boston. Because of its reputation as a global healthcare center with a tradition of innovation, this region has an opportunity to lead a revolution in culture of health.

Paul Grogan, President and CEO of the Boston Foundation, stressed the impact this trend will have on the region if it continues without fundamental change.

“Already businesses and families are hard-pressed by the high cost of health care and the impact of chronic illness—asthma, diabetes, childhood obesity,” said Grogan. “Today Boston is the most expensive place in the nation for a family of four to live, encouraging young people to settle elsewhere and businesses to grow where costs are lower. This report spells out in no uncertain terms that the entire regional agenda could be drowned by ever increasing healthcare costs, while we suffer the additional consequences of declining health.”

The report includes data that lay out the determinants of health, indicators of health status, the significance of Greater Boston’s health care sector on the regional economy, trends in health care funding, and the role of related industries, including insurance, medical education, health-related research and industries grouped together in the life sciences sector. For the first time, it includes a review of 30 critical Indicators of health care, health, and competitiveness in Greater Boston to connect the issues raised by the report and place them into context.

Highlights from the Indicators include:

    • Exercise and fitness: A decline in exercise for students in the past decade predicts lower levels of physical fitness for them in later years, a pattern accentuated by racial and ethnic disparities.

    •  Diet and nutrition: fruit and vegetable consumption has declined among adolescents in Massachusetts. As less nutritious snack foods have become cheaper than healthy foods, important income disparities in diet have emerged and intensified.

    • Overweight and obesity: Poor diet and less exercise are contributing to a surge in obesity—leading to an estimated 400,000 deaths a year nationally, second only to tobacco as a public health threat. Locally, the rate of adult obesity reached a new high in 2005 and the trend continues upward.

    • Health status: The overall health status in Greater Boston is high compared to the rest of the country—judging by life expectancy at birth, as well as such indicators as infant mortality and “premature death” rates. However, there are important warnings as specific diseases, including heart disease, diabetes and hypertension show increasing impact.

    • Low birth weight: One important health status indicator, low birth weights, is a predictor of future obesity, diabetes and potential cognitive impairment. Low birth weights are on the rise in Massachusetts—particularly for African American and Hispanic women. Because the area’s Hispanic population shows robust growth, this is an important indicator of health care issues for the future.

    • Diabetes: A rise in diabetes in the United States — including a 39 percent spike in Massachusetts from 1996 to 2005 — in all racial and ethnic groups is a significant driver of healthcare costs and poses a threat to the future solvency of the Medicare system. Because diabetes is rising fastest in disadvantaged populations, a sharp increase in financial costs is predicted for the state’s new Commonwealth Care program.

    The report also notes that health is influenced by a range of socioeconomic factors, including:
    • Educational attainment: While education may be the single most influential factor on a person’s lifetime health status, college attainment among Greater Boston residents is slipping.

    • Income stagnation: Real (inflation-adjusted) incomes have barely grown over the last decade in Greater Boston; poor income growth and income equality are known negative influences on health status.

    • Community safety: Violent crime has increased dramatically in Boston itself, even while the rising costs of health insurance reduces city funds for policy protection and emergency services.

In addition to a detailed review of the components of health status and healthcare, the report underscores the growing financial issues sparked by the Boston Paradox. Already the costs of healthcare have outpaced wages in the region.. The cost of an average health insurance plan in Massachusetts has increased sharply from 12 percent of median family income in 2000 to 16 percent in 2005. It is expected to exceed 20 percent of median family income within the next five years. This is a national trend. Family insurance has risen across the country from about 13.6 percent of median family income to 18.6 percent in 2004.


The Boston Foundation, Greater Boston’s community foundation, is one of the oldest and largest community foundations in the nation, with assets of over $830 million.  In 2006, the Foundation and its donors made more than $70 million in grants to nonprofit organizations and received gifts of $71 million.  The Foundation is made up of some 850 separate charitable funds established by donors either for the general benefit of the community or for special purposes.  The Boston Foundation also serves as a major civic leader, provider of information, convener, and sponsor of special initiatives designed to address the community’s and region’s most pressing challenges.  For more information about the Boston Foundation, visit   or call 617-338-1700.


Founded in 2002, the New England Healthcare Institute (NEHI) specializes in identifying innovative strategies for improving health care quality and reducing health care costs. NEHI conducts independent, high-quality research that supports evidence-based health policy recommendations and the regional and national levels. Member representatives from the academic health center, biotechnology, employer, medical device, payer, pharmaceutical, provider and research communities bring an unusual diversity of talent to bear on NEHI’s work. NEHI collectively addresses critical health issues through its action-oriented research, education and policy initiatives. For more information, call 617-225-0857 or visit