Health and Wellness report card finds slow progress in Massachusetts

June 24, 2014

Healthy People/Healthy Economy Coalition adds new focus on early childhood education to 4th Annual Report Card

  HPHE 4thReport Card cover
  Click to download a PDF of the report.
Boston – Massachusetts is continuing its slow progress on a number of public health-related areas, but still has work to do, particularly when it comes to sugar-sweetened beverages, according to the 4th Annual Healthy People/Healthy Economy Report Card, which was released Tuesday morning at an Understanding Boston forum at the Boston Foundation.

The annual report card examines progress in 12 issue areas that can be linked to improvements in public health. Massachusetts scored higher in two areas than it did in 2013, but the overall “GPA” on the indicators was again dragged down by the state’s failure to address the sales tax exemption for candy and soda –the only F on the report card. The state’s grade in one other area, Youth Physical Activity, also fell, reflecting a failure of policymakers to advance legislation that would strengthen physical activity even as evidence of its importance grows.

The Coalition changed its methodology in 2014, consolidating some older categories and introducing a new element, Quality Early Childhood Education, a reflection of the growing body of research that shows the powerful connection between early childhood education and lifelong health and wellness. For 2014, the Commonwealth receives an incomplete grade in that area.

The state’s “GPA” in the other 11 areas of the report card is 2.45, marginally higher than the 2.44 in those areas in the 2013 report. (The overall 2013 GPA was 2.33 across all areas. See the end of the release for explanation of grades.)

“Expanding early childhood education has been a key piece of education discussions this year, but we know its impact isn’t limited to academics,” said Paul S. Grogan, President and CEO of the Boston Foundation and co-chair of the Healthy People/Healthy Economy Coalition. “Adding this as a category in this and future report cards underscores the needed commitment we must make to extend early childhood programs to more four year-olds, and to strengthen the nutrition and physical activity standards for our youngest children.”

“The report card underscores the continued challenges we face in addressing two critical factors in youth obesity – reducing the consumption of sugar-sweetened beverages and expanding youth physical activity to needed levels,” said Valerie Fleishman, co-chair of the Healthy People/Healthy Economy Coalition and Executive Director of NEHI. “But there has been noteworthy progress, especially in improving health considerations in the design and planning of transportation, housing and business developments.”

Both of the grades that showed improvement in 2014 came in the category of Healthy Living By Design, where Smart Growth and Healthy Transportation Planning moved from a B- to a B+, and Health Impact Assessments rose from C+ to B.


Early Childhood:

Quality Early Childhood Education: I (first year in report card) -- Massachusetts has disinvested in early childhood services—an important factor in future health—over the last 15 years, but policymakers have begun a focused effort to find ways to create universal pre-K in the Commonwealth.


Body Mass Index (BMI) Reporting: A- (unchanged from 2013) – Despite controversy over the now-eliminated BMI letter from school to home, BMI data collection remains an important tool for policymakers in the overall effort to formulate effective obesity-prevention and health- improvement programs for vulnerable Massachusetts schoolchildren.

Healthy School Meals: B (unchanged) – Massachusetts is now striving to demonstrate measurable statewide results from the introduction of higher standards for school lunches and “competitive” foods sold in school vending machines.

Youth Physical Activity: D (down from C in 2013) – Massachusetts has yet to join the 12 states that now implement evidence-based practices for physical activity in the schools. Pertinent legislation has been languishing at the State House for years with no legislative champions calling for change.


Sugar Sweetened Beverages: F (unchanged) – Massachusetts remains one of the few states that grant a tax preference for sugar-sweetened beverages, a known health risk.

Food Access: B- (unchanged) – The growth of farmers’ markets has expanded access to healthy foods across the Commonwealth, and more comprehensive action is planned. While measures to expand healthy food retailing are still largely in the planning stage and are subject to debate at the State House, the policy landscape is promising.

Healthy Living By Design:

Biking and Walking: B (unchanged) – The state has instituted many innovative policies to expand biking and walking opportunities, with the recently authorized transportation bond demonstrating the state’s support for complete streets. While Boston does a good job of achieving high-quality active transport, other areas continue to lag behind. Equity remains a concern.

Smart Growth and Healthy Transportation Planning: B+ (up from B-) – The Commonwealth’s strong policies and sustainable funding are being used to implement healthy living by design through Smart Growth and healthy transportation planning.

Health Impact Assessments: B (up from C+) – Massachusetts has helped set a national standard for use by incorporating HIAs into its transportation planning process. A number of public agencies are now employing HIAs to inform an increasingly diverse array of public policy and project planning decisions.

Public Health and Health Care:

Primary Care: B+ (unchanged) – The Commonwealth continues to score high marks for the quality of its primary care. It has made a major commitment to expansion of the Patient-Centered Medical Home (PCMH) model, which is expected to prevent more illnesses and minimize health risks through improved coordination of care and integration with community resources.

Employee Health Promotion: B (unchanged) – Massachusetts continues to experiment with innovative approaches to bring health promotion benefits to employees, including employees of smaller firms. Historically, smaller firms have had limited access to employee health and wellness programs or the in-house expertise to launch them.

Public Health Funding: D (unchanged) – The creation of the Prevention and Wellness Trust Fund and the release of its first round of grants this year was a major step forward, but it is not enough to make up for cuts at the federal and state level. Public health spending in the Commonwealth and elsewhere remains near historic lows and there is little to no effort to increase it significantly.

The Scale:

The Healthy People/Healthy Economy Report Card uses an A-F scale to help Massachusetts residents and policy makers track progress in implementing policies and practices that promote health. This Report Card assigns grades to 12 policies and practices that are important elements of a comprehensive effort to improve health and wellness in Massachusetts. More precisely, it grades the progress of state and local government, the public and private sectors and state residents in bringing these measures to fruition.

A: Positive Change Throughout the Commonwealth – Appropriate policies, programs and practices are not only in place, they are also driving positive change in health in Massachusetts.

B: A Good Start – Innovative or best practice policies and programs are now in place and could drive positive change in health in Massachusetts.

C: A Start – Innovative or best practice policies and programs are under active and serious consideration or are part of promising demonstration projects, and could drive positive change in health in the future.

D: Barely a Start – Appropriate policies or programs to address major health problems are only starting to receive active and serious consideration.

F: No Progress – Appropriate policies and programs are not receiving active and serious consideration, despite advocacy.

I: Incomplete – Policy or programmatic activity is at a very early or experimental stage.


The Healthy People/Healthy Economy Coalition was launched in 2010 by the Boston Foundation and NEHI with the goal of shifting our state’s focus from “health care” to “health” and making Massachusetts the national leader in health and wellness. In addition to developing these annual report cards, the Coalition has advocated on a number of public health issues, including increased funding for public health programs, an end to the sales tax exemption for sugar-sweetened beverages and for the return of daily physical activity for all students, tax credits for healthy food businesses, health impact reports for public capital building projects and the inclusion of body mass index (BMI) in student physical exams.

The Boston Foundation, Greater Boston’s community foundation, is one of the largest community foundations in the nation, with net assets of close to $900 million.  Founded in 1915, the Foundation is approaching its 100th Anniversary.  In 2013, the Foundation and its donors made nearly $98 million in grants to nonprofit organizations and received gifts of $130 million. The Foundation is a partner in philanthropy, with some 1,000 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 that address the region’s most pressing challenges.  The Philanthropic Initiative (TPI), an operating unit of the Foundation, designs and implements customized philanthropic strategies for families, foundations and corporations around the globe. Through its consulting and field-advancing efforts, TPI has influenced billions of dollars in giving worldwide. For more information about the Boston Foundation and TPI, visit or call 617-338-1700.

NEHI is a national health policy institute focused on enabling innovation to improve health care quality and lower health care costs. In partnership with members from all across the health care system, NEHI conducts evidence-based research and stimulates policy change to improve the quality and the value of health care. Together with this unparalleled network of committed health care leaders, NEHI brings an objective, collaborative and fresh voice to health policy. For more information, visit