Professional Documents
Culture Documents
Common Health
for the
Commonwealth
2010
Massachusetts Health Council
Common Health
for the
Commonwealth
Massachusetts Trends in the
Preventable Determinants of Health
2010
Supported by
Alcohol ............................................................................10-13
Asthma .............................................................................14-17
Education..........................................................................22-25
Oral Health.......................................................................30-33
Poverty ..............................................................................34-37
Tobacco .............................................................................38-41
Violence ............................................................................42-45
Notes ......................................................................................46
Message from the Executive Director and President
"C ommon Health for the Commonwealth” is here for 2010. This report is the 6th edition of the
Massachusetts Health Council’s report on critical, costly, and preventable factors affecting the
health of the residents of Massachusetts. We are pleased to bring this important information to the forefront
of Massachusetts health policy and hope it stimulates not only debate but action on the items that negatively
affect health status. The Council is dedicated to promoting prevention as this is the best way to avoid health
care problems and their associated high costs. Since 1999, the Massachusetts Health Council has released this
biennial report tracking costly and preventable public health problems. These include societal issues, such
as poverty and lack of education, that have a real and profound impact on the health of our residents. The
Council reiterates its commitment to prevention and wellness as the way to improve the health status of the
residents of the Commonwealth.
This report again provides evidence based research as a means to measure and propel activities to address
health care trends both as individuals and as a state. The Massachusetts Health Council’s sixth edition
corroborates that our “common health” continues to be affected not only by access to health care, but also
by social, economic and environmental factors.
You will find information on health care trends, a compilation of the progress made in our public health
goals, and a series of focused perspectives provided by experts in each field highlighted in this report. These
determinants of health and their measures should continue to guide the dialogue with policymakers,
academicians, researchers, clinicians, providers and others in creating programs to support improving our
collective health.
One goal of the report is to support the enhancement of the public health infrastructure and to focus on the
disparities that exist between those who have access to care and prevention and those who do not. We must
change our priorities from a predominately “sickness response system” to one that supports an increasing
and effective investment in prevention and wellness that can reduce the utilization and costs of the health
care system, save lives and reduce suffering.
This report continues to measure rates of poverty, access to care, lack of education, air pollution/asthma,
tobacco use, obesity, violence, poor oral health, alcohol use, infectious blood-borne disease; all preventable
indicators that affect the health status of Massachusetts residents. Our report provides a context and series of
benchmarks for policymakers on Beacon Hill when they consider health care matters. Obviously, no single
issue can be considered in a vacuum and the fiscal challenges created by the country’s economic problems
make new state funding or programs extremely difficult in the near future. However, not all preventive
action requires new money as demonstrated in the recommended policy directions.
The Massachusetts Health Council encourages the use of this report and its expanded policy perspectives. It
can be a guide to concretely address those initiatives that reduce and eliminate poor health, especially among
our most disadvantaged communities. A common theme running through our policy recommendations
is prevention. We need to do a better job of getting the prevention message to the public — that lifestyle is
closely linked to health and that individuals can take steps to improve their health and the health of their
loved ones. We need to find creative ways to deliver that message in schools and workplaces — by providing
toolkits to teachers and employers for example. Every indicator we track is preventable; the solutions to
these problems are documented in the report. We just need to get the word out. Prevention today for a
lifetime of health!
Editors
Susan Servais
Nanette Vitali
Principal Investigator
David Allan Levine, Ph.D., has written widely on management, health care issues,
and history. We greatly appreciate the numerous hours he spent compiling and ana-
lyzing input from numerous data sources and contributors to produce a report that
is relevant and readable.
Research Advisor
Bruce Cohen, Ph.D., Director of Research and Epidemiology, Massachusetts
Department of Public Health, has given innumerable hours to ensure the accuracy
and timeliness of the data in this sixth edition. He provided invaluable support for
and was instrumental in the implementation of the first five editions as well.
Research Collaborators
Michael Botticelli
Director, Bureau of Substance Abuse Services Jenny Caldwell Curtin, MPP
MA Department of Public Health Coordinator of Alternative Education and
Rachelle Engler Bennett Trauma Sensitive Schools
Director of Student Support MA Department of Elementary and Secondary Education
MA Department of Elementary and Secondary Education
Elaine Kirshenbaum
Vice President of Policy, Planning, and Member Services
Massachusetts Medical Society
Publisher of the New England Journal of Medicine
Special Thanks
The Massachusetts Medical Society deserves special Novartis generously funded the report’s research and
recognition for publishing the report. The Massachusetts compilation. The Massachusetts Health Council is grateful.
Health Council was founded through the efforts of the
Society in 1920 and continues to enjoy its significant
support.
����������������������������
Cardiology 16% 17% ��
15.7% 12
14%
800 ��
Gastroenterology 12% 10
��
10% 8 600
��
Family Medicine/GP 8%
6
��
6% Mass. Overall U.S. Median 400
4 ��
Internal Medicine 4%
2 200 ��
2%
OB/GYN
���� ���� ���� ���� ���� ���� ���� ����
0% 0
0
����
2003 2004 2005 2006 2007 2008 2009 2001 2002 2003 2004 2005 2006 2007 2008 2009
0 10 20 30 40 50 60 2001 2002 2003 2004 2005 2006 2007 2008 2009
High Risk Groups: Hispanics White teenagers School-age children Black and Hispanic males Adolescents and young
Hispanic children Young adults (ages 18-24) Adults ages 18-24 Gay, bisexual and other adults
Children with disabilities Adult males in higher Multi-racial & Black adults males having sex with male IV drug users
income brackets Adults with lower
Adults with less than a education, lower income population
college education level individuals IV drug users
Key Issues: • Although 97% of MA resi- • Binge drinking more prevalent in • Environmental irritants are • Disparities in mode of trans- • Growing proportion of new
dents have insurance, physician higher income & educational groups risk factors associated with mission: White males through cases are adolescents and
shortages negatively impact onset of asthma male-to-male sex, Black males young adults
• Binge drinking and heavy drinking
patient access to care through male-to-male sex and
above the national average • COPD, cardiovascular dis- injection drug use; Hispanic • Distribution shifted: two
• Only 44% of MA internists ease and depression often males through injection drug cohorts primarily infected: age
• Rates of unmet alcohol treatment
accepting new patients comorbid with asthma use 27 and age 51
need above national average for all
• Primary health services age groups • Current asthma prevalence • Younger, less educated people • Surveillance difficult because
increasingly being provided in rose 27% from 2000-2009 more apt to seek testing than most people with HepC are
• Alcohol abuse linked to cirrho-
emergency departments older age groups unaware they carry it
sis of liver, kidney failure, diabetes, • Multi-racial & black adults
• 23% of Hispanics had no high blood pressure, cardiovascular with highest rates of asthma • Estimated 8,000 MA residents
personal doctor disease
unaware they are infected
• Individuals with disabilities •Adolescents fail to understand the
more than twice as likely as link between alcohol and risks
those without to forego needed
health care
Policy Directions: •Health care stakeholders • Train vendors of alcoholic • Continue the Environmental • State & federal health care • Provide prevention services
must work collaboratively on products to eliminate sales to Public Health Tracking System to reform will increase access to younger injection drug users
key issues to secure a strong minors, rewarding salespeople monitor pediatric asthma to testing, care and treatment as they may be at highest risk of
physician workforce who identify fake IDs services seroconversion
• Reduce exposure to mold and
•Physician workforce policies • Work with law enforcement and other asthma triggers in schools • Increasing access to non- • Multi-component programs
must be fair with an equitable conduct compliance checks with and child care settings medical support services are (prevention, education, coun-
payment system alcohol retailers critical elements of an effec- seling, screening, access to
• Address asthma epidemic tive HIV care system (case drug treatment and methadone)
•Administrative simplifica- • Review policies on the adver- through collaboration between management, housing, peer may be required to control
tion through standardization is tising of alcoholic products and public health and environmental support, and mental health transmission of HCV
essential to ease the burden on limit alcohol advertising to youth regulatory agencies services)
physicians • Expansion of screening and
• Increase sales taxes on • Increase comprehensive asth- • Ensure access to treatment medical management programs
•Professional liability must be alcoholic beverages to support ma education for all HIV+ residents regard- needed
addressed, especially with pay- prevention programs, substance less of income, incarceration,
ment reform abuse treatment and education • Promote reimbursement for • Increase resources to
comprehensive asthma manage- or citizenship status
improve and enhance viral
•The payers and the state must • Create avoidance/prevention ment by health payers • Expand HIV testing, care hepatitis surveillance
work openly and collabora- programs that directly involve and support programs to bet-
tively with physicians to secure young people • Promote the use of Asthma • Develop and transmit infor-
Action Plans for children with ter serve the African-American
success in electronic health and Latino/a population mation to the public and pro-
records, registries, and access • Eliminate exemption on 6.25% asthma at school and childcare viders on HepC prevention and
to timely accurate data. sales tax for off-premise loca- centers • Continue to expand access screening
tions to routine HIV testing in medi-
•Medical student debt must • Increase capacity of statewide
cal settings while preserving
be addressed to encourage • Educate parents on the impact & local partnerships to provide essential civil liberties and
young physicians to remain in of alcohol on adolescent brain education and advocate for patient protections
Massachusetts and long-term negative conse- change
quences from early alcohol con-
sumption
Percentage of MA adults Who are Overweight or Obese, Current Adult Smokers in MA and US 2000-2009
2001-2009 ��������������������������������������������������������������������� Percentage of People in Poverty, MA & US 2005-2008
���������
25%
���
14%
24.5
��� 13.3% 13.3% 13.2%
24 12% 12.5% 20% Violent Crime Trends – Boston and Massachusetts – 2009* vs. 2008
���
23.5 All Violent Crime Murder Forceable Rape Robbery Aggravated
��� 10% 10.3% Assault
9.9% 9.9% 10.0%
23 Boston 2008 6,676 62 237 2,398 3,979
��� 15%
8% Boston 2009 6,192 50 269 2,227 3,596
22.5
���
% change (7.2%) (19.4%) +13.5% (7.1%) (9.6%)
(improvement)
22 6%
��� 10%
Mass. 2008 29,888 167 1,744 7,071 20,906
21.5
��� 4% Mass. 2009 30,136 172 1,701 7,427 20,836
MA US % change +0.8% +3.0% (2.5%) +5.0% (0.3%)
���
21 US MA (improvement)
5%
2% *All 2009 data are preliminary and may reflect somewhat different reporting standards among agencies.
��� 20.5
Source: FBI Uniform Crime Report
��� 20 0%
���� ���� ���� ���� ���� ���� ���� ���� ���� 2000 2001 2002 2004 2006 2008 2005 2006 2007 2008 0%
2000 2002 2004 2006 2007 2008 2009
Annual High School Dropout MA Adults Who Are MA Adults Who Did Not Visit
Rate, Massachusetts
Poverty Rate Current Adult Smokers Violent Crime in MA
Overweight or Obese The Dentist In The Past Year
• Adults with least education are • Correlations exist between • 24% of MA residents do not • At the present time (2010) • Tobacco-related deaths • MA is statistically the most
apt to have the worst health overweight/obesity and hyper- have access to dental benefits there is only 1 job available include cancers of lung, larynx, violent state in the Northeast
tension, diabetes, heart disease, for every 5 people seeking throat, esophagus & mouth region.
• Improved “health literacy” will stroke, osteoarthritis, respiratory • Disparities in rates among employment
positively impact individuals problems, and certain cancers racial and ethnic groups in dental • Nonsmokers exposed to sec- • Aggravated assault & forcible
health disease • Educational level highly cor- ond hand smoke increase risk rape are the highest of any state
• Disparities present with gender related with poverty status of heart disease & lung cancer in the region
• High churn rates appear to and racial/ethnic groups • 48% of surveyed 3rd graders
be linked to underachieving aca- had dental disease • 50% of Hispanic children • Students who smoke more • Nearly 1 in 5 MA high school
demic performance • More than one-third of all chil- live in poor families likely to engage in other risky students reported being bullied
dren screened in public schools • MA ranks 36th in nation in behaviors (i.e., substance in past year.
• Third grade reading proficiency were either overweight or obese % of residents with access to • Lower income individuals abuse)
a key predictor of high school fluoridated water are more likely to die prema- • 15% of MA youth said they
dropout rates • MA School Nutrition Bill turely due to unhealthy eating • Steady increases in smoke- seriously considered attempting
passed in 2010 • Less than 50% of MA cities and environment less tobacco use and cigar suicide in past 12 months
• Disparities in on-time gradua- and towns have a MassHealth smoking offset decrease in
tion rates among racial and ethnic dentist provider cigarette smoking statistics
groups significant.
• Create a positive school • MA needs a statewide cam- • Increase public education • Continue to access ARRA • Continue to increase ciga- • Re-establish a coalition of
climate in which students can paign to prevent childhood about the importance of dental funding available for direct rette excise taxes. public and private agencies,
succeed with positive relation- obesity hygiene and prevention pro- benefits to families and indi- community groups, human ser-
ships with school staff and moting oral health as an essen- viduals (Making Work Pay • Continue the Massachusetts vices, police, health care, men-
peers • Improve availability of tial part of overall health credit, Economic Recovery Tobacco Cessation and tal health, schools, and clergy
medications and devices that Payments, extended and Prevention Program (MTCP) around violence prevention
• Create smaller class sizes help control obesity and over- • Increase number of commu- to reinstate programming to
with individual academic sup- expanded Unemployment
weightness nities with water fluoridation Insurance benefits and high risk populations • Improve lighting in commu-
port nities with increased walking
• Provide access to fresh, • Increase number of school expanded Food Stamp pro- • Educate parents on latest patrols
• Local, state, and regional healthy, nutritious foods and sealant programs in MA gram) trend of use of other nicotine
partnerships are needed to physical activity to promote containing products (gum, • Toughen the laws against
stem dropout rates • Oral health needs to be an • Creation and preservation
healthy living in schools, of jobs through ARRA support candy) rapidly increasing people caught with an illegal
workplaces, and within the integral component of health among young people firearm
• Use early warning dropout care reform and an essential and increase access to work-
indicators in school districts community force training programs
component of any health pro- • Increase funding to the Dept • Increase mentoring programs
including attendance rates, • Require safe walkways and gram of Public Health’s Tobacco so at-risk young people have a
mobility rates, and MCAS • Increase access to adult
better lighting in community basic education and higher Control Program to educate strong relationship with a car-
middle school scores development including bike • Maintain the adult Mass the public, especially youth, ing adult
Health Dental Program education
• Use and promote the paths through a comprehensive anti-
• Advocate for access to smoking campaign • Reduce access to firearms
Behavioral Health and Public • Increase opportunities for • Expand community health
center dental programs affordable and quality early
Schools Task Force online physical activity in schools education and childcare • Better enforcement of laws • Change social norms that
assessment tool to provide and workplaces • Increase the number of prohibiting the sale of tobacco support violent attitudes and
guidance and a structure for • Maintain Social Security products to minors behavior
• Provide incentives to MassHealth dental providers
improved practices in schools. programs to prevent increased
employers for workplace well- • Create an Oral Health Plan senior poverty • Increase the availability of • Address sexism that under-
• Implement ESE and MA ness programs for MA, 2010-2015 which free or low cost smoking ces- lies gender-based violence,
Alliance on Teen Pregnancy should form the basis for oral • Maintain Unemployment sation services and medica- homophobia and hate crimes
implemented pregnancy pre- • Ban use of trans fat in res- Insurance benefits tion against GLBT communities
taurants health promotion activities
vention programs.
Elaine Kirshenbaum
Vice President of Policy, Planning, and Member Services
Massachusetts Medical Society
Publisher of the New England Journal of Medicine
92
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Source: Massachusetts Department of Public Health, Behavioral Risk Source: Massachusetts Department of Public Health, Behavioral Risk
Factor Surveillance System Factor Surveillance System
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The National Center for Chronic Disease Prevention and Among Massachusetts high school students, the number
Health Promotion’s yearly BRFSS survey of Massachusetts who reported ever having at least one drink of alcohol in
adults (ages 18 and older) asks respondents about their their lifetime decreased again, from 81% (2001) to 71% (2009),
consumption of alcohol in the past month. “Binge” drinking and current alcohol use also dropped, from 53% (2001) to
is defined as males having five or more drinks, and females 44% (2009). In 2009, 25% of high school students statewide
having four or more drinks, on one occasion. “Heavy” reported binge drinking in the past month (in Boston, 18%);
drinking is defined as males having more than two drinks per 4% reported having had at least one drink of alcohol on
day and females having more than one drink per day. school property within the last 30 days; and among students
who were currently sexually active, 24% (females 20%, males
In 2009, as in previous years, the survey found alcohol
28%) said they drank alcohol or used drugs before their last
abuse in the Commonwealth to be spread broadly across
sexual intercourse.
gender, racial/ethnic, educational, and economic lines with
overall rates of binge drinking and heavy drinking consistently
above the national average. In 2009, 17.5% of Massachusetts’
Groups at Risk
adults reported binge drinking in the past month (virtually In 2009 as in previous years, the most reliable predictor
unchanged from 17.7% in 2008 and 17.6% in 2007), and 6.2% of excessive drinking among Massachusetts adults was
reported heavy drinking (compared to 6.7% in 2008 and 6.0% younger age. Binge drinking was reported by 34.5% of
in 2007). The U.S. median for adult binge drinking was 15.7% individuals in the 18-24 age group, and for each successive
in 2009, for heavy drinking 5.1%. older group the numbers declined in stepwise fashion
— ages 25-34 (26.4%), 35-44 (19.7%), 45-54 (16.1%), 55-64
Among demographic subgroups, 22.6% of adult males
While the report clearly outlines the seriousness and enduring nature of the issue, it also makes a very clear and optimistic
statement: “Underage alcohol use is not inevitable, and schools, parents, and other adults are not powerless to stop it.” In
Massachusetts, we have made progress over the past several years by increasing the age of first use and reducing use at both the
middle and high school level.
We can continue to achieve success and prevent underage drinking only if all of the facets of our society; the federal
government, the state, cities and towns, local communities, schools, adults, parents, and youth work collaboratively,
consistently and relentlessly together to change attitudes and remove or limit access to alcohol. Multiple strategies that reduce
or eliminate access to alcohol and foster attitudes to prevent early use are necessary.
Prevention providers can train servers/vendors of alcoholic products to eliminate sales to minors, but, if we fail to look
at where many underage youth get their alcohol, from older siblings, friends, or from home, and we do not target strategies
that will address this access point, we limit our chances of success. If we work with law enforcement and conduct compliance
checks with alcohol retailers and implement appropriate sanctions against those unwilling to abide by the law, we can achieve
success. If we widely publicize, via the local and regional press, these compliance checks and outcomes, both negative and
positive, we can achieve greater and more far reaching success.
At the federal, state, and community levels, we need to take a look at our policies on the advertising and taxation of
alcoholic products. Research shows that even modest price increases on alcohol products decrease underage drinking. These
policy changes are the most powerful and effective tools we can use to combat alcohol access.
Continued success against underage drinking is not only possible but likely if we implement strategies that change the
environment and the norms regarding underage alcohol use. Policy changes limiting advertising, raising prices, requiring
server training and retailer compliance checks will mean that adolescents will have greater opportunities to reach higher
educational achievement, lower future rates of substance abuse problems, and attain healthier futures.
Michael Botticelli
Director, Bureau of Substance Abuse Services
Massachusetts Department of Public Health
18%
18.3%
17.7% 17.5% 17.7% 17.5%
16% 17%
15.7%
14%
12%
10%
8%
6%
4%
2%
0%
2003 2004 2005 2006 2007 2008 2009
45% 42%
40% 37% MA US
35% 34%
32%
30%
25%
20%
15%
10%
5%
0%
% Alcohol Related % .08+ BAC driver
Source:
Source: National National
Highway Highway
Traffic Traffic Safety Administration
Safety Administration
Alcohol
Alcohol UseUse
andand Abuse,
Abuse, 2009:
2009: MA MA andUS
and USAdults,
Adults,ages
ages 18-24
18-24
70%
60%
50%
MA
US median
40%
30%
20%
10%
0%
Alcohol Use* Binge Alcohol Use Heavy Drinking
Groups at Risk
Trends Lifetime and current asthma affects all demographic
When asthma is well controlled, people can sleep segments of the Massachusetts adult population, though
through the night, go to work and school, and live normal disparities exist between sexes, age groups, race/ethnicities,
active lives. However, in Massachusetts a startlingly small
educational attainment, and household income. In 2009, Bay
portion of people with asthma report having good control
State women (18.0%) were more likely than men (13.3%) to
18
16
14
12
0
2001 2002 2003 2004 2005 2006 2007 2008 2009
Source: Massachusetts Department of Public Health; U.S. Centers for Disease Control
and Prevention
14%
12%
11.4% 11.7%
11.0% 11.3% 11.1% 11.1%
10% 10.8%
10.2%
9.3%
8%
0%
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2The National HIV/AIDS Strategy: Federal Implementation Plan, July 2010, pg.21
The IOM report on viral hepatitis and liver cancer that in the years following initiation of injection practices.
was published in January, 2010 makes clear that despite the Furthermore, prevention of HCV infection in these
extremely high morbidity and mortality related to viral populations is complex due to the high infectivity of the
hepatitis infections, federal and state funding for viral hepatitis virus, the already high prevalence of HCV among IDU, and
services is extremely limited and there is no coherent federal the lower health care utilization of IDU. The IOM report
strategy. As a result, all states, including Massachusetts, states that multi-component programs (those that include
struggle to address the range of service needs of affected prevention education, counseling, screening, access to drug
populations. treatment and methadone, etc.) may be required in order
Given the recent trend of increasing HCV infections to effectively control transmission of HCV among IDU.
among adolescents and young adults in Massachusetts and However, prevention education and services to young, at-
the long-term consequences of undiagnosed and untreated risk people in Massachusetts have been limited since this
illness, prioritization to identify the scope of the problem trend has been noted, largely due to limited resources and
and implement prevention and screening programs for difficulties reaching this population. Transmission appears to
those populations is urgently needed. As noted in the IOM be continuing at a high rate.
report on viral hepatitis, it is of particular importance to The issue of limited to no resources for viral hepatitis
provide prevention services to younger injection drug services is not a problem limited to Massachusetts. In
users (IDU) as they may be at highest risk of seroconversion the previously cited IOM report on viral hepatitis (2010),
and communities), screening and medical management. 2009 Data are preliminary
These services are all specified in the IOM report as being Source: MA Department of Public Health, HIV/AIDS Surveillance
Program
critical to reducing transmission, morbidity and mortality
among affected populations. Given that there are new
treatments for HCV infection on the near horizon that may Percentages of 16,413 People Known
improve treatment outcomes and reduce the duration of to be Living with HIV/AIDS on
treatment, expansion of screening and medical management PeopleDecember 31,with
known to be living 2009 by on
HIV/AIDS Gender
July 31, 2010 by
programs will be increasingly indicated. While innovative Gender and Race/Ethnicity
and Race/Ethnicity
programs have been implemented in Massachusetts towards 60%
10%
0%
Rate
���� of Newly
�� ����� Diagnosed,
���������� ���������� ���Confirmed, HCV
��������� ����� �� ����
White non-Hispanic Black non-Hispanic Hispanic Other
��
2009byby Massachusetts
Massachusetts Health
Health Services Services Region
Region
��
��
��
��
BOSTON
��
N.EAST
�� METRO W.
���� ���� ���� ���� ���� ���� ���� ���� S.EAST
���� WESTERN
CENTRAL
Prison
Source: Bureau of Communicable Disease Control, MA OTHER
Department of Public Health
Carol Goodenow, PhD iThe Massachusetts Alliance on Teen Pregnancy (2010). Expecting Success: How
Jenny Caldwell Curtin, MPP Policymakers and Educators Can Help Teen Parents Stay in School. Retrieved Sep-
tember 2, 2010, from http://www.massteenpregnancy.org/sites/
Rachelle Engler Bennett default/files/expecting%20Success_1.pdf
iiKirby, D., Lepore, G., & Ryan, J. (2005). Sexual Risk and Protective Factors: Fac-
MA Department of Elementary and Secondary Education tors Affecting Teen Sexual Behavior, Pregnancy, Childbearing. Washington D.C.:
The National Campaign to Prevent Teen Pregnancy.
3.5%
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
2002–03 2003–04 2004–05 2005–06 2006–07 2007-08 2008-09
8%
7.5%
7%
6% 5.6%
5%
4%
3.4%
3%
2% 1.8% 1.7%
1%
0%
White African- Hispanic Asian Multi-Race
American Non-Hispanic
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
Low Income (82,718 enrollment) Non-Low Income (209,654 enrollment)
Classic gender differences involving actual versus Massachusetts Department of Public Health, Health of
Massachusetts, April 2010.
perceived overweight status were revealed by the YRBS
survey. Though adolescent males (14%) were twice as likely Massachusetts Youth Health Survey: 2009 (Massachusetts
as adolescent females (7%) to be obese, they were less likely Department of Public Health, 2010), pre-publication data.
than females to describe themselves as “overweight” (25%
Kenneth E. Thorpe, “The Preventable Causes of Rising
vs. 33%) and considerably less likely to be trying to lose
Healthcare Costs,” Emory University, Rollins School of
weight (31% vs. 60%). Perception of being overweight drove
Public Health, December 16, 2008.
a number of risky behaviors: 10% of females and 6% of males
said they did not eat for 24 or more hours to lose weight The Status of Childhood Weight in Massachusetts, 2009 (Massachusetts
or to keep from gaining weight during the 30 days before Department of Public Health, Essential School Health
the survey. Five percent of both female and males said they Services Program), September 2010.
took diet pills, powders, or liquids to lose weight; and 5% of
females and 4.5% of males said they vomited or took laxatives
in order to lose weight or keep from gaining weight.
Policy Perspective
Massachusetts ranks third lowest among the 50 states in rate of BMI-defined obesity, although obesity prevalence still
continues to increase in Massachusetts and elsewhere. However, since our state is a leader among states in halting the epidemic,
we should be thinking of the next frontier, which includes prevention, and specifically prevention of childhood obesity.
Michelle Obama has spearheaded the Lets Move Campaign to prevent childhood obesity, and she and her staff are hoping that
this campaign leads to change during the Obama administration and as well as longer term. The Obama Lets Move Team is
asking each community to bring the messages to their families so that a grassroots efforts will build and tie to the larger Lets
Move backdrop. For prevention, a message that combines healthy foods such as fresh fruits and vegetables, low fat dairy, lean
protein and whole grains with daily physical activity is necessary to support children’s healthy weight focus. We know that
the best time to educate parents is the perinatal period, when women seem most interested and empowered to make lifestyle
changes for the benefit of themselves and their families. Breastfeeding is associated with lower body weight for both mother
and child, and this should be a starting point. Teaching good nutrition in the school system and in the home can partner with
increased physical activity to help reverse the unhealthy practices that have governed the past 20 years and led to increases in
childhood obesity. The industry must change and is changing. More and more, healthier options are aligning themselves next
to less healthy options — i.e., in fast food restaurants. Now let’s make the right choice —not always easily done.
A study of Massachusetts students evaluated during the 2008-2009 school year showed that more than one-third of the
students were overweight or obese. Even more striking, the poorest cities in the state had the highest rates of students with
overweight or obesity. The differences between the poorest and the wealthiest are dramatic, at 47% versus 10% respectively of
students who were overweight or obese. This underscores the focus of Michelle Obama’s campaign, which is to provide fresh
fruits and vegetables to children and to educate children and their parents about good nutrition. Unfortunately our state
reflects the rest of the country in creating an economic milieu which deprives poorer families from access to the healthiest
foods. A change as big as what “Lets Move” implies is necessary to counteract this stark reality.
Even if strides are made in prevention, we still have 66% of Americans who are already overweight or obese. Treatment
options for the practitioner are few and far between. However, the field of obesity medicine is gaining ground as a subspecialty
and within it lies the cornerstone of treatment, diet, exercise, and lifestyle change. Medications and surgery are more aggressive
treatment options, and we are finally seeing several drugs and devices going before the FDA for approvals this year and in
the next few years. Perhaps one or two drugs will be approved along with one or two devices so that the obesity specialist
will have a few more tools to help individuals with weight loss and more importantly, weight maintenance. There are still
treatment gaps for those currently suffering from obesity, and the main gap lies in insurance coverage for office visits and
medications for obesity. The Obesity Society (TOS), the society for the prevention and treatment of obesity, is made up of
scientists and practitioners interested in a solution for our nation’s number one epidemic. TOS has proclaimed that obesity is a
disease. Let’s act like we believe this and fight for coverage not only for bariatric surgery, but for diet and exercise therapy and
pharmacotherapy.
41%
2004 70%
Asian 31% 2006
38% 2009 60%
65%
50%
Hispanic 61%
63%
40%
71% 2009
30%
Black 71% 2006
2004
67%
20%
54%
10%
White 55%
57%
0%
< High School High School College (1-3 yrs) College (4+ yrs)
0% 20% 40% 60% 80%
Source: Massachusetts Department of Public Health, Source: Massachusetts Department of Public Health,
Behavioral Risk Factor Surveillance System – Trends Data Behavioral Risk Factor Surveillance System – Trends Data
Percentage of MA Adults Who are Overweight* Percentages of 109,674 MA Public School Students
or Obese, 2001–2009 Who Are Overweight* or Obese,
Percentage of MA adults Who are Overweight or Obese, Percentages of 109,674 MA Public School Students Who Are
2001-2009 Overweight orLevel
by Grade Obese,and Gender,
by Grade 2008-2009
Level and Gender, 2008-2009
���
40% Males
���
Females
��� 35%
��� 30%
���
25%
���
20%
���
15%
���
��� 10%
���
5%
���
���� ���� ���� ���� ���� ���� ���� ���� ���� 0%
Grade 1 Grade 4 Grade 7 Grade 10
Source: Massachusetts Department of Public Health
Source: Massachusetts Department of Public Health,
Behavioral Risk Factor Surveillance System – Trends Data
Essential School Health Services Program
O ral Health has been treated separately from the rest dental needs.
of the body and often not included in programs and • 35% of seniors at meal sites had untreated decay with 17%
policies that seek to improve health. Current research shows having major to urgent dental needs.
that oral infection is associated with serious systemic disease
• Nearly 20% of seniors at meal sites had not had a dental visit
such as cardiovascular disease, diabetes, pulmonary disease
in more than 5 years.
and perinatal complications. Oral conditions can often give
important clues about one’s state of physical health. Access Cost of dental care, lack of insurance and shortage of
to oral health care and prevention can have a significant dental providers were the three major barriers to seniors
impact on overall health and well-being but there are barriers receiving care in long term care facilities.
to receiving oral health care in Massachusetts. Disparities for Although community water fluoridation has been
vulnerable populations or groups at-risk have been extensive shown to be the most effective way to prevent dental disease,
and continue to exist due to the lack of access to prevention the Commonwealth has made little progress in increas-
programs, dental treatment, and dental providers. ing the number of communities that provide fluoridation.
Massachusetts continues to rank 36th among states in per-
Trends cent of residents with access to fluoridated water.
Unlike medical insurance where Massachusetts health Between 1995 and 2005, more than 8,000 new cases
reform has led to coverage for approximately 97% of resi- of oral and pharyngeal cancer were diagnosed in the
dents, only about 76% of the residents of the Commonwealth Commonwealth with approximately 2,000 cases result-
have access to dental benefits, 17% with MassHealth and 59% ing in death. Although oral and pharyngeal cancer can be
with commercial insurance. 1.3 million residents live in diagnosed in early stages by relatively non-invasive visual
53 cities and towns federally designated as Dental Health exams by dental and medical providers, many continue to
Professional Shortage Areas (DHPSAs). The percent of adults be diagnosed at later stages with spread to other tissues and
who did not visit the dentist over the past year has improved a poor prognosis.
slightly from 23.4% in 2006 to 22.2% in 2008. Disparities con-
tinue with 42% of White adult residents having tooth loss Groups at Risk
compared to 52% of Blacks and 49% of Hispanics. Blacks and
Disparities in receiving oral health care for vulnerable
Hispanics experienced a significant increase in reports of
populations have always been extensive and continue to
access to dental care in 2009 from 61% to 72% for Blacks and
exist. These groups at-risk include children, the elderly, low
from 65% to 72% for Hispanics.
income, developmentally disabled, medically compromised,
In a 2008 survey among third graders in Massachusetts, homebound or homeless, persons with HIV, MassHealth
48% had experienced dental disease in the past which, members, the uninsured and institutionalized, as well as
although unacceptable, is lower than the national aver- racial, cultural, and linguistic minorities.
age of 50% and one of the lowest rates in the nation. 17%
After having been eliminated in 2002 and reinstated in
were noted to have untreated dental decay, lower than the
2006, the MassHealth Adult Dental Program was dramati-
national average of 26% and lower than the Healthy People
cally reduced in July 2010, eliminating restorative care effect-
2010 goal of 21%. Disparities among children continue to
ing over 680,000 MassHealth adults.
exist, however (Graph 3).
The primary dental safety net in our state has increased
Seniors continue to face difficulty in accessing dental
since 2008 to consist of 48 community health center dental
care. For MassHealth seniors (over 60 yrs.) 73% did not have
programs and satellites, which have over 377,000 patient
a dental visit over the last year vs 28% of all seniors over
visits per year. The Massachusetts Dental Society continues
65 years. In a 2010 survey of Massachusetts seniors it was
to encourage more of its members to become MassHealth
found:
providers. There has been an increase in dental providers
• 74% of seniors in long term care facilities had gingivitis and for MassHealth patients. In 2008, 20% of dentists accept-
59% had untreated decay with 34% having major to urgent ed MassHealth but in fiscal year 2010, 27% of dentists in
24.5
24
23.5
23
22.5
22
21.5
21
20.5
20
2000 2001 2002 2004 2006 2008
Source: “A Profile of Health Among Adults 2008”. BFFSS. February 2009
������������������������
���������
Source: MDPH BRFSS, 2008
������������������������
Disparities in the Prevalence of Untreated Tooth Decay Among Massachusetts' Third Grade Children
���������
Source: Catalyst Institute "The Oral Health of Massachusetts' Children" January 2008
1Economists have found that direct assistance to low income families is among the most effective means of stimulating the economy and creating jobs. This is the case
because such families spend the assistance immediately to meet their needs and the resulting increase in demand for goods and services stimulates economic activity,
including hiring. See, e.g. http://www.cbpp.org/files/12-19-02ui.pdf, page 7.
2 See Census website, PRESENTATIONS>DAVID JOHNSTON>REMARKS>PG 7: http://www.census.gov/newsroom/releases/archives/news_conferences/20-09-16_
news_conference.html
The Center on Budget and Policy Priorities estimates that a total of 3.3 million non-seniors were moved out of poverty in 2009 as a result of UI benefits, including 1 million
children residing in families that received UI benefits: http://www.offthechartsblog.org/looking-at-today%E2%80%99s-poverty-numbers/
3Economic Policy Institute, A Lost Decade, September 16, 2010: http://www.epi.org/publications/entry/a_lost_decade_poverty_and_income_trends
4Congressional Budget Office, Estimated Impact of ARRA, August 2010 (Table 1, pg 3) : http://www.cbo.gov/ftpdocs/117xx/doc11706/08-24-ARRA.pdf
5 Economic Policy Institute, Reasons for Skepticism About Structural Unemployment (Page 9) available at: http://www.epi.org/publications/entry/bp279/
14%
10% 10.3%
9.9% 9.9% 10.0%
8%
6%
4%
US MA
2%
0%
2005 2006 2007 2008
High-School Graduatee
(includes equivalency)
10.0%
25%
23.5%
20%
15%
10%
7.1%
5%
4.2%
2.8%
0%
Female householder All families People ages 65 and Married-couple families
families older
27.4%
20% 25%
24.7%
20% 21.1%
15% 19.5%
15%
15.0%
10%
10% 10.7%
MA US 9.5%
7.4%
5% 5%
0%
Statewide 18-24 Years Less than Under $25K Disability College 4+ $75K+ MetroWest
0% Old High School Household Years Household
2000 2002 2004 2006 2007 2008 2009
More Likely to Smoke
Education Income
Less LikelyIncome
to Smoke
Source: Behavioral Risk Factor Surveillance System – Trends Data; CDC
Source: Massachusetts Behavioral Risk Factor Surveillance System, 2009
Current andFrequent
Current and Frequent Cigarette
Cigarette Use Among Use Among
High School High
Students in Current* Cigarette Use by Grade Level
School Students in Massachusetts, 1993-2009
Massachusetts, 1993 - 2009 Massachusetts, 2009
40.00%
12th 21%
35.00% 35.7%
34.4%
11th 18%
30.00% 30.3%
30.2%
Current*
Frequent*
10th 15%
25.00% 26.0%
9th 11%
20.00% 20.9% 20.5%
18.2% 18.4%
17.7% 8th 7%
15.00% 15.5% 15.9% 16.0%
13.2%
7th 4%
10.00%
9.5%
8.9%
8.1%
6.9%
6th 2%
5.00%
Source: Massachusetts Youth Risk Behavior Survey Source: MA Department of Education, MA Department of Public Health.
• Current cigarette smoking = past 30 day use * Current cigarette use is reported use in the last 30 days.
• Frequent cigarette smoking = more than 20 of last 30 day use
$16,000,000.00
Estimated Cost
$14,000,000.00 Medical Savings*
$10,000,000.00
* Based on cost-benefit model at the Business Case ROI
$8,000,000.00 website. Incremental ROI is per participant. Calculations
run by the Massachusetts Department of Public Health,
$6,000,000.00 Tobacco Cessation and Prevention Program (MTCP) on
4/5/2010. Accessed at www.businesscaseroi.org
$4,000,000.00
$2,000,000.00
$-
Year 1 Year 2 Year 3 Year 4 Year 5 Total
$(2,000,000.00)
$(4,000,000.00)
Carlene Pavlos
Director, Violence and Injury Prevention
MA Department of Public Health
Hate Crimes and Number of Incidents and Sexual Violence Experienced by Age Group — MA
Bias Motivation, 2006-2008 Sexual Violence Experienced
Adults, by Age Group — MA Adults, 2009
2009
Hate Crimes and Number of Incidents and Bias Motivation,
2006-2008
0.2
TOTAL 0.18
0.16
Disability
Women
0.14
Men
Ethnicity 0.12
2006 2007 2008
0.1
Sexual Orientation
0.08
Religion 0.06
0.04
Race
0.02
2010
2010