population health

RECENT POSTS

50 Years Of American Health Choices: Smoking Gains Offset By Getting Fatter

(Lucia Sofo via Wikimedia Commons)

(Lucia Sofo via Wikimedia Commons)

Feeling optimistic? Then you may see the moral of this story as, “Yay, public health efforts! They can wield amazing power and save many lives.”

In more of a glass-half-empty mood? Then your takeaway may be, “If it’s not one thing, it’s another.” Or perhaps, that public health must play an eternal game of Whack-a-Mole.

The story itself: The National Bureau of Economic Research just sent over word of a new working paper that looks at American health behaviors and their effects over 50 years, from 1960 to 2010. It examined six behaviors: obesity, smoking, heavy drinking, unsafe driving, firearms, and poison or overdoses. What most struck me: Though we’re generally living longer, our health gains from shunning cigarettes and safer driving are all but erased by the rise in obesity and drug overdoses. Sigh. From the summary:

(Source: NBER working paper 20631, “The Contribution of Behavior Change and Public Health to Improved U.S. Population Health”)

(Source: NBER working paper 20631, “The Contribution of Behavior Change and Public Health to Improved U.S. Population Health”)

…The authors find that the gains associated with declines in smoking, motor vehicle fatalities, and heavy drinking are essentially offset by the losses arising from rising obesity and misuse of firearms and poisonous substances. Valued in dollar terms, there is a near zero net gain in health from public health and behavioral changes over the past fifty years. However, the analysis includes a mix of some risk factors that have been aggressively addressed through public health and behavioral changes over a long period (smoking, unsafe driving), and others that are in the earlier stages of being addressed and have proven challenging (obesity, prescription drug addiction).

The authors conclude “our study demonstrates the enormous benefits of public health and behavioral change in improving population health, underscoring the importance of continued advances in these areas of research and practice.”

I asked Harvard health economist David Cutler, who co-authored the report, what he’d want the public’s takeaway to be (and included a plea to help me beat down my own cynicism.) His e-mailed response:

There are some who see this as ‘glass mostly empty’ – i.e., if it’s not one thing, it’s another. But remember how hard these changes are. Quitting smoking is very difficult, and yet millions of people have done it. Reducing caloric intake is very difficult, though weights finally seem to be stabilizing. The difficulty of these interventions makes the successes particularly notable.

Readers, your own thoughts? Read the full paper here and the summary here.

Boston’s Health, By T Stop: Neighborhoods Near But ‘Health Worlds Apart’

BPHC data posted in Dr. Sandro Galea’s “Dean’s Note” on Boston health disparities.

BPHC data posted in Dr. Sandro Galea’s “Dean’s Note” on Boston health disparities.

If you went on a little T ride with Dr. Sandro Galea, the new dean of the Boston University School of Public Health, the urban landscape would never look quite the same to you, I bet. You wouldn’t just see neighborhoods, anymore; you would see health neighborhoods.

In his latest “Dean’s Note” post, Dr. Galea uses images like the one above to illustrate the yawning gaps in health statistics among Boston’s neighborhoods. (Get off at Dudley Square, the diabetes rate is 11 percent; get off at Arlington, it’s just 3 percent.) He also posts T-stop numbers on low birth weight, physical activity and homicide, among other health-related stats. And he writes:

Inured as we are to inequalities in health, we might well shrug off these health differences as ones between far-apart worlds. But are they? In fact, the geographic space we are talking about here is remarkably small. We are dealing with geographic differences of roughly four miles, or about an hour’s walk. In many respects, it is remarkable that areas so close to one another should have such dramatically different health indicators—“health worlds apart” that are simply down the street from one another.

Those health worlds may be far apart indeed. A new “Child Opportunity Index” suggests that Boston may be the worst city in the country for Hispanic kids in terms of healthy development.

Developed by researchers at Brandeis University’s Heller School for Social Policy and Management and Ohio State University’s Kirwan Institute for the Study of Race and Ethnicity, the index finds that 58 percent of Hispanic children in Boston live in neighborhoods with the lowest level of access to “healthy development resources,” from parks to high-quality child care.

The index also found Boston to be the sixth-worst metro area in the country for African-American children.

From the press release, headlined, “Boston has the Highest Concentration Nationally of Hispanic Children Living in the Worst Neighborhoods for Healthy Development:” Continue reading

New York Vs. Boston: Manhattan Wins On Life Expectancy

Comparing Boston, NYC, Mass. and national life expectancy

(Data from the Institute for Health Metrics and Evaluation, University of Washington. Chart by Jesse Costa for WBUR.)

The medical journal The Lancet recently published a fascinating piece on the dramatically rising life expectancy in New York City, giving major credit to Mayor Michael Bloomberg for his public health initiatives.

New York Health Commissioner Thomas Farley told The Lancet: ““We have really the nation’s first and maybe the world’s first public health mayor, who has made clear that he is willing to take controversial positions if they’re going to improve the health of his citizens.”

Well, naturally that raised my Boston hackles a bit. We, too, have a longstanding mayor who has made major efforts on the public health front, including the current “Boston Moves For Health” campaign, which aims to get Bostonians to lose 1 million pounds and walk 10 million miles. How, I wondered, do we compare to New York?

We’re not looking so great, according to the data kindly provided by the Institute for Health Metrics and Evaluation at the University of Washington. Their valuable data also served as the basis for The Lancet piece. As I read the graph above, we started out ahead and lost our lead. Looks just like far too many of our play-off seasons.

Now, needless to say, the influence of place on health is an exceedingly complex issue, and Lancet author Ted Alcorn notes that all kinds of factors are at play, from improving treatments for HIV to migrating populations. (New York County is Manhattan; Suffolk County roughly overlaps with Boston. It’s speculation, but I imagine people of more modest means have been priced out of Manhattan’s truly astronomical real estate more than out of Boston’s.)

But readers, I’d like to throw this question out to you: What does this graph say to you? How do you see history converging with health? And does this mean Boston Mayor Thomas Menino should emulate Mayor Bloomberg and ban Big-Gulp-sized drinks? Please stay tuned; I plan to gather opinions this week and wrap up on Friday.