Study scopes out health gaps by village

Researchers have developed a new methodology that they hope will be used by state and local health departments to track health disparities by neighborhood village - as in Savin Hill, Uphams Corner or Franklin Field - with the hope of encouraging more effective public policy.

While the Boston Public Health Commission routinely collects data at the wider neighborhood level, Dr. Jarvis Chen, a research scientist at Harvard's School of Public Health (HSPH), and his colleagues took a closer look to pinpoint the specific areas suffering the most extreme inequalities. They used census tracts - each made up of 3,000 to 4,000 people - o map premature mortality (death before age 65) in relation to poverty levels and found a great deal of variation within each neighborhood in terms of both socioeconomic levels and public health.

"Until this study, no one looked at the phenomenon of social class gradient in mortality," said Chen, who found that in the most deprived census tracts - where at least 20 percent of residents live in poverty - the premature mortality rate is 40 percent higher than in Boston's most affluent census tracts - where less than 5 percent of residents are below the poverty line.

The discourse has traditionally focused on racial and ethnic disparities in health, which are related to socioeconomic variations in particular areas, said Dr. Nancy Krieger of HSPH, but the aim of this study was to "bring together concerns about racism and health, and classism and health."

According to the 2000 census, the percentage of people in northern parts of Dorchester that are living in poverty ranges from 10 percent to more than 20 percent. Chen found that in 12 of the 22 census tracts (CTs) making up Dorchester's "north" section, 20 to 30 percent of premature deaths were associated with CT poverty. They would not have occurred if those people "had the same mortality experience as residents in the least impoverished CTs in Boston."

"There is an excess of deaths occurring among the poorest populations," Chen said. "Deaths that really shouldn't be occurring at such a young age," considering the medical advances the U.S. has made. But they are occurring, in high numbers, in particular areas.

"We all have a sense living in our society that those who experience more poverty or less access to resources are going to have poor health," Chen said. But it's "really important to report that data… Surveillance tells us what's going on and it holds policy makers and the public health infrastructure accountable."

Behaviors and lifestyles don't take place in a vacuum, Chen said. They happen within the context of communities where there is unequal access to resources necessary to maintain health.

The prior lack of community-based data measuring health disparities in most surveillance systems limits the effectiveness of public policies addressing these issues, Chen said. He hopes that state and local health departments will adopt his study's methodology in collecting and analyzing their public health data. Taking the social geography into account would, in his opinion, improve their capacity for monitoring socioeconomic inequalities in health.

Dan Driscoll, president and CEO of Harbor Health Services, said the issue of health disparities is a main concern at Dorchester's Neponset and Geiger Gibson health centers. The process of eliminating these inequalities, he said, begins by collecting patient data that will allow them to move beyond anecdotal evidence of disparities and quantify the issue.

Driscoll said Dorchester's health centers are transitioning to an electronic medical records system, which health care providers could search by a number of factors including race, ethnicity, or income, to determine "more scientifically, with more certainty, what the disparities are," in each neighborhood.

"It's important to think about how resources are distributed within neighborhoods," echoed Chen. "How some of the most important risk factors for diseases like diet, smoking, physical activity and access to good food are unequally distributed at the neighborhood level and within neighborhoods."

Chen believes that higher levels of public health are "achievable, if we put the social will behind it," and the first step is to use more sophisticated, in-depth data collection methods to provide an understanding of what is really going on in Boston's neighborhoods.

At the March 27 premiere of the documentary series at the JFK Library and Museum, Mayor Tom Menino called on Boston's community leaders from all sectors of industry to step up and eliminate inequalities.

"Long ago I pledged to make addressing health disparities a top priority of my administration and I encourage all of you to make it a top priority as well," Menino said. His remarks were followed by the screening and a panel discussion between the city's public health leaders.

In an effort to prompt discussion about the city's health disparities, the Boston Public Health Commission will be hosting screenings of "Unnatural Causes: Is Inequality Making Us Sick?" in neighborhoods around Boston over the next few weeks. The first screening will be held Monday, April 7, 6 p.m. at Lilla G. Frederick Middle School, 270 Columbia Road, with a panel discussion to follow. Other screenings will be announced in Jamaica Plain and Mattapan. Call 617-534-2291 for information. The first of the four-part series aired March 27 on WGBH, and the remaining three installments will air April 3, 10, and 17, all at 10 p.m.