Health and race fuel discussions in neighborhoods; 2009 City report setting the agenda

Health disparities along racial lines is a persistent theme in the Boston Public Health Commission’s Health of Boston 2009 report, which neighbors began discussing at community meetings this fall.

The findings in the report were the subject of a community meeting this week in Dorchester, organized in partnership with the Codman Square Health Council, part of the Codman Square Neighborhood Council.
Like other neighborhoods with large minority populations, Dorchester residents are experiencing higher rates of illness. The council focused the meeting’s discussion on three major items: gun violence, alcohol abuse, and diabetes/obesity.

“The report has so much information. We worked with the Health Council and the Neighborhood Council to survey the community to see what are the most important issues,” said Cynthia Loesch, president of the Neighborhood Council. “This meeting [hosted by the Codman Square Health Center] is a call to action. We’ve included information from community partners. We are focused on solutions, talking about what’s going on already in the neighborhood, and what we can do individually and together.”

Each presentation was made by a local youth and an adult. Loesch hopes that those who attended left with real priorities for next steps.
“We have set up follow-up meetings with the Boston Public Health Commission because we don’t want this to be just one presentation in Dorchester,” Loesch said.

While the report covers a range of health issues, one common theme is that minority populations are disproportionately affected by illness. The city’s African- American and Latino residents experienced higher levels of chronic disease, mortality, and poorer health outcomes than white residents, the report found.

Data gathered across a range of issues, from diabetes to heart disease, H.I.V., substance abuse, cancer, and rates of nonfatal violent crimes, supported that theme. The inequities are driven by several factors "including racism, poverty, and residential segregation," the report said.

"It’s not good news," said Pam Jones, director of policy and planning for the Boston Public Health Commission. "One big spike we saw was that the rate of mortality from substance abuse for Latinos rose 500 percent from 1999 to 2007."

African Americans across the city consistently had the highest hospitalization rate for diabetes and heart disease from 1998 through 2007. But hospitalization rates for Latinos is also on the rise, increasing 200 percent for diabetes from 1998 through 2006, and 87 percent for heart disease from 1998 to 2004, the report found.
Public safety and the environment also contribute to health.
The report found that 70 percent of residents in the Back Bay and West Roxbury reported that their neighborhoods were very safe, compared with 25 percent or less of residents in Mattapan, North Dorchester, and Roxbury.

Similarly, not all residents reported gunshots and shootings as being a big problem in their neighborhood. The report found that 36 percent of Mattapan residents, 37 percent of those who live in the northern sections of Dorchester, 29 percent of Roxbury citizens and 19 percent of residents in the southern area of Dorchester residents found shootings to be a problem. Overall, 13 percent of Boston residents reported the same.

Those neighborhoods also had the highest rates of nonfatal assault-related gunshot and stabbing injuries and homicides among all the neighborhoods, the report said.

"Where you live really does impact your health. Where you live in part is determined by your parenting, education, and housing availability. From a commission standpoint, all of those things are impacted by racism," Jones said.

This year, the Boston Public Health Commission’s report also included a section on community assets to help people become more aware of what resources are available in their community.

"We don’t want to just hit people with a bunch of data," Jones said. " We want to give people the tools and the information and allow them to have conversations with their neighbors to come up with solutions. We also want them to be aware that there are community assets that can be utilized."

Whether people are healthy is more than just a result of individual behavior.

"It’s up to us as a city and as a community to really look at how we together, through organizing and advocacy, come together to change policies and systems," Jones said "That has a lot to do with whether you are healthy. The health disparity is a very persistent problem. Most of the focus has been on the individual, trying to change people’s habits and educating them. These are all good things. But alone, they cannot change the disparities."

That won’t change until it becomes a more prevalent issue in the city and nationally, she said.

Codman Square has numerous projects and efforts that have resulted from community groups working together on solutions.
While many health issues seem different, they are linked and can be addressed with community effort, said Cynthia Loesch.
“Many of these issues are connected. We have to have ownership of all of these issues and of our environment,” she said.

The Codman Square Farmers Market is one example of a community effort that has made a difference in the quality of life in the neighborhood.
“The residents created this market and it has become a healthy resource,” Loesch said. “That effort was all grassroots.” The first year, the market brought in $30,000 worth of fresh fruits and vegetables to the neighborhood. This past season, that increased to $50,000, she reported.

While the Health of Boston report is conducted annually, the data can lag somewhat due to the time it takes to compile from various sources, Jones cautioned. Most of the data in the report is from 2006 and 2007, she said. "The data is at least a couple of years behind where we actually are."

The meetings are being held throughout the city by the Boston Public Health Commission in conjunction with the Boston Alliance for Community Health. In each neighborhood, the Commission and Boston Alliance for community health are partnering with a neighborhood coalition.

The next meeting will be held at the Harvard Street Neighborhood Health Center on Dec. 16 at 5:30 p.m. The meeting is held in partnership with the Franklin Field/Franklin Hill Healthy Boston Coalition.