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Massachusetts is making progress on many public policies that contribute to health and wellness, but health care spending on preventable conditions still precludes vital investments in education, public health, recreation and public safety. That was a primary message of the Healthy People/Healthy Economy Coalition’s third annual Report Card, which was released June 18 at an Understanding Boston forum at the Boston Foundation.
“The escalating health care costs are crowding out investments in the social determinants of health,” said Allison Bauer, Boston Foundation Program Director, as she presented the report findings with co-author Tom Hubbard, Vice President of Policy Research at the New England Healthcare Institute (NEHI). The Coalition, led by the Foundation and NEHI, aims to make Massachusetts the national leader in health and wellness.
In addition, there's a real issue of equity. “The idea that the burdens of disease are not distributed equally is something we wanted to highlight,” said Ms. Bauer, noting that while cases of type 2 diabetes—a completely preventable disease—are soaring, the increase is most evident among low-income adults and people of color. “We want to keep attention focused on key policy issues that impact the ability of all residents to make healthier choices—creating a context change so the healthier choice becomes the easier choice.”
The Coalition gave the state higher grades than last year in eight issue areas, but flunked it once again for failing to remove the sales tax exemption for candy and soda. Massachusetts is one of only 16 states that do not tax sugar-sweetened beverages, which are the biggest source of daily calories for American children.
The state also needs to improve its grades for public health funding (D) and youth physical activity (C), Ms. Bauer noted. For the first time, the Report Card awarded its first A: An A- in the category of School-based BMI Reporting. The requirement that Massachusetts public schools document body mass index for students in grades 1, 4, 7 and 10 has made it possible for communities to educate families and measure changes in obesity, she said, highlighting Fitchburg’s success in dramatically lowering its childhood overweight or obesity rate.
Keynote speaker Tara Mardigan, the nutritionist for the Boston Red Sox, said she was struck by the inequity of the disease burden and the uneven progress documented in the Report Card. “Society is off track,” she said. “We need to explain that to people. I try to explain to my patients that it doesn’t have to be this way.” She told of disguising collard greens in a meal for Red Sox players at training camp, only to be surprised that the dish was a big hit. “Be creative,” she urged the audience.
A panel of experts from government, industry, academia and public health responded to the report’s findings, agreeing that coordinated action across sectors is needed to prioritize health over health care and control costs in the coming years.
“This is a very important document,” said Walter Willett, chair of the Department of Nutrition at the Harvard School of Public Health and a researcher who studies the link between diet and the development of different diseases. “My conclusion is we’re doing some wonderful things, but we’re not investing nearly enough to turn the tide. I don’t think we’re putting enough money into the system. I think we have to raise taxes.”
Coalition Co-Chair Ranch Kimball, who moderated the panel discussion, rued the fact that “there’s a 100-1 disparity between spending on health care and spending on health. We’re underinvesting in everything that is a determinant of health. Why do we act this way year after year, when we know the causality?”
State Representative Jason Lewis, Vice-Chair of the Joint Committee on Public Health, noted that “the need to spend on something that’s urgent will trump the need to spend on something that’s preventable.” He said legislators also need more education about sugar as a public health problem.
“It’s so obvious that the moment has arrived for public health solutions in a big way, and we keep cutting them,” said Boston Foundation President and CEO Paul S. Grogan.
Bill Holmes, Reebok’s Senior Vice President of Human Resources, who developed the company’s “Fit for Your Life/Fit for Your Career” wellness program, said companies can do many things to encourage good health, including providing healthy meals. “If you want to do one thing,” he advised, “fix the food in your cafeteria.”
Cheryl Bartlett, Acting Commissioner of the Massachusetts Department of Public Health, said she was “disappointed” by the Report Card’s findings. “I think we have a lot of homework to do.” But she noted the success of the Mass in Motion statewide anti-obesity campaign and affirmed the department’s commitment to “promoting health equity in our communities” through infrastructure improvements, expanding farmers’ markets and encouraging convenience stores to carry fresh produce and other healthy foods.
“Clearly we’ve got a lot to do, and one of the takeaways of this report card is that the cost of preventable chronic disease is unsustainable,” said Mary Jo Meisner, the Boston Foundation’s Vice President of Communications, Community Relations and Public Affairs. On behalf of the Healthy People/Healthy Economy Coalition, she urged passage of House Bill 2634, An Act to Reduce Childhood Obesity, which would:
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The Healthy People/Healthy Economy Coalition was formed in 2010 in response to two reports released by the Boston Foundation and NEHI. The first, published in 2007, acknowledged that Boston was not immune to the rising tide of preventable chronic diseases caused by the obesity epidemic. The second, released in 2009, set forth a plan to combat the problem, which required coordinated action across multiple sectors.