HealthHealth StatusStatus ofof DorchesterDorchester ResidentsResidents

PresentedPresented byby NancyNancy Norman,Norman, MD,MD, MPHMPH thethe BostonBoston PublicPublic HealthHealth CommissionCommission

OctoberOctober 17,17, 20062006 Boston Neighborhoods

Charlestown

East Allston- Boston Brighton Back Bay North South End End Fenway South Boston Roxbury

North Jamaica Plain Dorchester

Roslindale South West Dorchester Roxbury Mattapan

Hyde Park MAP PREPARATION: Boston Public Health Commission Research Office Dorchester Communities

The following six areas contain all Dorchester census tracts (previously defined as North and South Dorchester). Each area is distinct (census tracts appear in only one area). The boundary definitions start on the west side of the area and proceed north, east and south, and then return to the starting street.

The six communities described below by census tracts and street boundaries are defined for statistical purposes only and should not be confused with neighborhood boundaries defined by the Boston Public Health Commission, the City of Boston, or by neighborhoods themselves.

Codman Square/Southern Franklin Field Area Census Tracts: 919, 923, 1001-1005 Boundaries: Blue Hill Avenue, Talbot Street, RR, Geneva Avenue, Bowdoin Street, Washington Street, Centre Street, Dorchester Avenue, Gallivan Blvd, Morton Street, Blue Hill Avenue

Although Grove Hall extends into Roxbury, the Roxbury section has not been included in the geographical definition used in this presentation.

Dorchester Grove Hall Area Census Tracts: 901-906, 924 Boundaries: Blue Hill Avenue, West Cottage Street, Dudley Street, Magnolia Street, Robin Hood Street, Hartford Street, Wayland Street, Magnolia Street, Quincy Street, Columbia Road, Railroad Tracts, Talbot Avenue, Blue Hill Avenue, Harvard Street, Austin Street, American Legion Hwy, Blue Hill Avenue

Fields Corner Census Tracts: 916-918, 920-922 Boundaries: Columbia Road, Quincy Street, Bowdoin Street, Church Street, Freeport Avenue, Morrissey Blvd, Ocean, Victory Road, Morrissey Blvd, Neponset Avenue, King Street, Dorchester Avenue, Centre Street, Washington Street, Westville Street, Bowdoin, Geneva Street, Columbia Road Uphams Corner Area Census Tracts: 907-908, 912-915 Boundaries: Hartford Street, Robin Hood Street, Magnolia Street, Dudley Street, E. Cottage Street, RR, Norfolk Avenue, E. Cottage Street, Pleasant Street, High Street, Church Street, Quincy Street, Magnolia Street, Wayland Street, Hartford Street

Savin Hill/Harbor Point Census Tracts: 909-911 Boundaries: Pleasant Street, E. Cottage Street, Crescent Avenue, around Columbia Point, city boundary to harbor, Morrissey Blvd, Freeport Street, High Street, Pleasant Street

Lower Mills/Neponset Census Tracts: 1006-1009 Boundaries: Dorchester Avenue, King Street, Neponset Avenue, Pope’s Hill, Freeport Street, City Boundary, River Street, Standard Street, Manchester Street, Maryknoll Street, Morton Street, Gallivan Blvd, Dorchester Avenue TheThe ChallengesChallenges inin UnderstandingUnderstanding HealthHealth inin DorchesterDorchester--NumberNumber 11

„ DorchesterDorchester isis notnot oneone oror twotwo neighborhoodsneighborhoods--butbut severalseveral distinctdistinct onesones „ SomeSome havehave namesnames andand distinctdistinct “corners”“corners” oror “squares’“squares’ „ OthersOthers areare moremore vaguevague “areas”“areas” „ NoneNone havehave clearclear boundariesboundaries TheThe ChallengesChallenges inin UnderstandingUnderstanding HealthHealth inin DorchesterDorchester ––NumberNumber 22

„ HealthHealth datadata isis collectedcollected andand analyzedanalyzed inin differentdifferent waysways thatthat maymay notnot matchmatch thethe notionsnotions ofof aa neighborhoodneighborhood „ MeaningfulMeaningful analysisanalysis requiresrequires thatthat thethe numbernumber ofof casescases isis largelarge enoughenough-- requiringrequiring enlargingenlarging thethe neighborhoodneighborhood boundariesboundaries RacialRacial andand EthnicEthnic Makeup,Makeup, DorchesterDorchester andand Boston,Boston, 20002000

2 or More 2 or More Races Other Races Other 5% Asian Asian Race 3% Race 8% 8% 2% 4%

Black 23%

White 24%

White Black 49% 45% Latino Latino 14% 14% Dorchester Boston

DATA SOURCE: U.S. Department of Commerce, Bureau of the Census, American FactFinder, Census 2000 DATA ANALYSIS: Boston Public Health Commission Research Office PopulationPopulation byby Race/Ethnicity,Race/Ethnicity, DorchesterDorchester Communities,Communities, 20002000

Race/ Dorchester Codman Fields Grove Lower Savin Uphams Ethnicity Overall Square/ Corner Hall* Mills/ Hill/ Corner Franklin Neponset Harbor Field Point

Total Population 128,503 30,301 26,219 21,562 21,753 11,048 17,620

White 24% 7% 19% 2% 60% 49% 26% Black 45% 72% 41% 65% 23% 15% 30% Latino 14% 13% 14% 23% 4% 10% 18% Asian 8% 3% 13% 0.4% 8% 22% 7% Other Race** 4% 2% 7% 5% 1% 2% 11% Two or More Races 5% 4% 6% 5% 3% 3% 8%

*Dorchester section of the Grove Hall area **”Other race” includes Native Hawaiians/Other Pacific Islanders, Alaskan Indians, and Other Races DATA SOURCE: Census 2000, U.S. Department of Commerce, Bureau of the Census, American FactFinder DATA ANALYSIS: Boston Public Health, Commission Research Office PopulationPopulation byby AgeAge Group,Group, DorchesterDorchester andand Boston,Boston, 20002000

65+ years 65+ years 8% 0-17 10% years 20% 45-64 0-17 years years 30% 45-64 19% years 18%

18-24 years 16% 18-24 years 25-44 11% Dorchester years Boston 25-44 36% years 32%

DATA SOURCE: U.S. Department of Commerce, Bureau of the Census, American FactFinder, Census 2000 DATA ANALYSIS: Boston Public Health Commission Research Office PopulationPopulation byby AgeAge Group,Group, DorchesterDorchester Communities,Communities, 20002000

Dorchester Codman Fields Grove Lower Savin Uphams Overall Square/ Corner Hall* Mills/ Hill/ Corner Franklin Neponset Harbor Field Point Total Population 128,503 30,301 26,219 21,562 21,753 11,048 17,620

Ages 0-17 30% 33% 31% 37% 22% 23% 29% Ages 18-24 11% 10% 11% 10% 9% 15% 11% Ages 25-44 32% 31% 32% 30% 35% 37% 33% Ages 45-64 19% 20% 19% 16% 20% 17% 18% Ages 65+ 8% 7% 7% 7% 14% 9% 9%

*Dorchester section of the Grove Hall area DATA SOURCE: Census 2000, U.S. Department of Commerce, Bureau of the Census, American FactFinder DATA ANALYSIS: Boston Public Health, Commission Research Office ForeignForeign--BornBorn ResidentsResidents byby CountryCountry ofof Origin,Origin, Dorchester,Dorchester, 20002000

Caribbean: 41.9% Haiti 13.2% Jamaica 8.4% Dominican Republic 7.8% Trinidad & Tobago 5.5% Other Caribbean countries 7.0% Asia: 20.9% Vietnam 17.2% Other Asian countries 3.7% Europe: 8.4% Northern Europe 4.1% Other European countries 4.3%

DATA SOURCE: U.S. Department of Commerce, Bureau of the Census, American FactFinder, Census 2000 DATA ANALYSIS: Boston Public Health Commission Research Office PrimaryPrimary LanguageLanguage SpokenSpoken atat Home,Home, DorchesterDorchester Adults*,Adults*, 20002000

English 64%

Spanish 12%

French Creole 6%

Vietnamese 6%

Portuguese 5%

* Ages 18 and over DATA SOURCE: U.S. Department of Commerce, Bureau of the Census, American FactFinder, Census 2000 DATA ANALYSIS: Boston Public Health Commission Research Office Selected Socioeconomic Indicators Boston Overall North Dorchester and South Dorchester, 2000 Indicator Boston North South Dorchester Dorchester % Population with Less than 21% 31% 23% High School Diploma or GED (Adults Ages 25 and Over) % Population Below Poverty 20% 23% 18% Level* % Children (Under 18) Below 26% 31% 24% Poverty Level* % Adults 65 and Older Below 18% 20% 15% Poverty Level* Median Household income** $39,629 $34,132 $38,987

*Based on Income in 1999 **Estimated Median Household income in 1999 DATA SOURCE: U.S. Department of Commerce, Bureau of the Census, American FactFinder, Census 2000 DATA ANALYSIS: Boston Public Health Commission Research Office 88 KeyKey HealthHealth IssuesIssues inin YourYour NeighborhoodNeighborhood andand WhatWhat YouYou CanCan DoDo AboutAbout ThemThem

ƒ OverweightOverweight && ObesityObesity ƒ CancerCancer (Breast,(Breast, Prostate)Prostate) ƒ AsthmaAsthma ƒ EnvironmentalEnvironmental LeadLead ƒ PrematurityPrematurity andand LowLow BirthweightBirthweight ƒ InfectiousInfectious DiseaseDisease ƒ SubstanceSubstance AbuseAbuse ƒ ViolenceViolence andand TraumaTrauma Overweight & Obesity WhatWhat HealthHealth ProblemsProblems DoesDoes ExcessExcess WeightWeight IncreaseIncrease thethe RiskRisk ofof GettingGetting oror Worsen?Worsen?

ƒ DiabetesDiabetes ƒ HighHigh bloodblood pressurepressure ƒ HighHigh cholesterolcholesterol ƒ HeartHeart disease/strokedisease/stroke ƒ AsthmaAsthma ƒ ArthritisArthritis ƒ CertainCertain cancerscancers (especially(especially breast,breast, uterus,uterus, colon,colon, esophagus)esophagus) BostonBoston AdultsAdults WhoWho AreAre OverweightOverweight oror ObeseObese byby Race/Ethnicity,Race/Ethnicity, Boston,Boston, 2001,2001, 2003,2003, andand 2005*2005*

100% .

80%

64% 60% 55% 50% 46%

40% 28%

to be Overweight or Obese 20% Percentage of Respondents Determined 0% Boston Asian Black Latino White *Boston samples only NOTE: The term “obesity” refers to all levels of excess weight combined. DATA SOURCE: Behavioral Risk Factor Survey, Behavioral Risk Factor Surveillance System (BRFSS), Boston Public Health Commission DATA ANALYSIS: Boston Public Health Commission Research Office AdultsAdults WhoWho AreAre OverweightOverweight oror ObeseObese byby Neighborhood,Neighborhood, 20032003 andand 2005*2005*

100% s

80% 70% 64% 64% 60% 58% 57% 60% 55% 50% 50% ______48%______44% 38% 36% 37% 40% 32%

20% Percentage of Respondent of Percentage

0%

* N * n r n y rk n n le ry n * y O ton y* w te to a ai a a u o d ur T h a to s s P l p d b n b ig B s e o nwa P ta in x ost E x S r e h B e e a t l o B O B k rl rc F d c a s R h B / c st M h ut Ro n a a o Hy ai Ro ut o t to B h D a m s s C E a o S e ll J S W A * Boston samples only **Back Bay includes the North End DATA SOURCE: Behavioral Risk Factor Survey, Behavioral Risk Factor Surveillance System (BRFSS), Boston Public Health Commission DATA ANALYSIS: Boston Public Health Commission Research Office DiabetesDiabetes Mortality:Mortality: AgeAge--AdjustedAdjusted RatesRates byby DorchesterDorchester andand DorchesterDorchester Communities,Communities, 20022002--20042004

60 53 n

40 37 32 29 30

24 26

______22 ______20

Deaths per 100,000 Populatio 100,000 per Deaths 0 Boston Corner Point Savin eponset Field Uphams Codman Hill/Harbor Lower Dorchester Sq/Franklin Grove Hall* Grove

*Dorchester section of the Grove Hall area Corner Fields DATA SOURCE: Boston resident deaths, Massachusetts Department of Public Health Mills/N DATA ANALYSIS: Boston Public Health Commission Research Office Heart Disease Mortality: Age-Adjusted Rates by Dorchester and Dorchester Communities, 2002-2004

270 250 238 216 n 225 210 206 213 188 ______180 160

135

90

45

0 Deaths per 100,000 Populatio 100,000 per Deaths Boston Corner Point Savin eponset Field Uphams Codman Hill/Harbor Lower Dorchester Sq/Franklin Grove Hall* Grove Fields Corner Fields

*Dorchester section of the Grove Hall area Mills/N DATA SOURCE: Boston resident deaths, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office WhatWhat CanCan YouYou DoDo toto ReduceReduce thethe RiskRisk ofof BecomingBecoming OverweightOverweight oror Obese?Obese?

ƒ FocusFocus onon eatingeating healthyhealthy foodsfoods ƒ AvoidAvoid sugarysugary sodas,sodas, snacksnack foodsfoods ƒ ReduceReduce portionportion sizessizes andand eateat smaller,smaller, moremore frequentfrequent mealsmeals ƒ TryTry toto exerciseexercise dailydaily ƒ TalkTalk toto youryour primaryprimary carecare doctordoctor ƒ ParticipateParticipate inin thethe BostonBoston StepsSteps ProgramProgram BREAST CANCER WhatWhat IncreasesIncreases thethe ChancesChances ofof GettingGetting BreastBreast Cancer?Cancer?

ƒ AgeAge (chance(chance increasesincreases withwith age)age) ƒ ExcessiveExcessive alcoholalcohol intakeintake ƒ FamilyFamily historyhistory ƒ PostmenopausalPostmenopausal hormonehormone useuse ƒ PhysicalPhysical inactivityinactivity ƒ ObesityObesity ƒ EnvironmentalEnvironmental factorsfactors EverEver HadHad aa Mammogram*Mammogram* byby Race/EthnicityRace/Ethnicity Boston,Boston, 2001,2001, 2003,2003, andand 2005**2005**

100% 93% 93% 94% 94%

s 80%

60%

40%

20% Percentage of Respondent of Percentage

0%

Boston Black Latina White

*Women Ages 40 and over **Boston samples only DATA SOURCE: Behavioral Risk Factor Survey, Behavioral Risk Factor Surveillance System (BRFSS), Boston Public Health Commission DATA ANALYSIS: Boston Public Health Commission Research Office NOTE 11/06: Rates on this slide have been revised. Breast Cancer Mortality: Age-Adjusted Rates by Dorchester and Dorchester Communities, 2002-2004 80 on i t a 60 opul

40 000 P 34 31 33 ______26 ______

100, 23 21 18 20 hs per at e n<5 D 0 r n i ll* e er on t er a bor t n n s n nkl d n i H ar a el e he r H Bost / v c Cor Po l F Savi Fi l r Uphams o r Neponset Codman ds Cor Hi Lower Do Sq/ G s/ el l l Fi *Dorchester section of the Grove Hall area Mi DATA SOURCE: Boston resident deaths, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office PinkPink andand BlackBlack CampaignCampaign PROSTATE CANCER WhatWhat IncreasesIncreases thethe ChancesChances ofof GettingGetting ProstateProstate Cancer?Cancer?

ƒ AgeAge (chance(chance increasesincreases withwith age,age, especiallyespecially afterafter ageage 50)50) ƒ RaceRace ƒ FamilyFamily historyhistory ƒ DietDiet richrich inin animalanimal fat,fat, meat,meat, andand highhigh--fatfat dairydairy productsproducts ƒ PhysicalPhysical inactivityinactivity EverEver HadHad PSAPSA TestTest forfor ProstateProstate Cancer*Cancer* byby Race/Ethnicity,Race/Ethnicity, Boston,Boston, 2001,2001, 2003,2003, andand 2005**2005**

100% 84% 82%

s 77% 80%

60%

40%

Percentage of Respondent of Percentage 20%

0% Boston Black White

*Ages 40 and over for Black men and ages 50 and over for White men **Boston samples only DATA SOURCE: Behavioral Risk Factor Survey, Behavioral Risk Factor Surveillance System (BRFSS), Boston Public Health Commission DATA ANALYSIS: Boston Public Health Commission Research Office Prostate Cancer Mortality: Age-Adjusted Rates by Dorchester, and Dorchester Communities, 2002-2004

120

n 107

100

80 66

60 47 48

40 30 ______28 ______20

n<5 n<5

Deaths per 100,000 Populatio 100,000 per Deaths 0 Boston Corner Point Savin Field Uphams Codman Hill/Harbor Lower Dorchester Sq/Franklin Grove Hall* Grove Fields Corner Mills/Neponset *Dorchester section of the Grove Hall area NOTE: Savin Hill/Harbor Point had no prostate cancer deaths during 2002-2004. DATA SOURCE: Boston resident deaths, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office WhatWhat CanCan YouYou DoDo toto ReduceReduce thethe RiskRisk ofof ProstateProstate Cancer?Cancer?

ƒ GetGet regularregular checkcheck--upsups withwith youryour doctor/providerdoctor/provider ƒ DiscussDiscuss whenwhen itit isis bestbest toto obtainobtain thethe PSAPSA screeningscreening testtest ƒ JoinJoin communitycommunity effortsefforts toto promotepromote healthhealth && combatcombat cancercancer ASTHMA Asthma Hospitalizations Among Children Under Age 5 by Year, Boston, and Dorchester, 1994-2005 20

16

12

8

4

Hospitalizations Population per 1,000 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Dorchester 17 14 11 10 10 12 12 12 13 14 10 8 BOSTON 12119878899987

DATA SOURCE: 1997-2000 Acute Case Mix files, Massachusetts Division of Health Care Finance and Policy; 1994-1996 discharge data, Massachusetts Health Data Consortium, Inc. Rates are calculated using resident population estimates from MISER for 1991-1998, and the US Census 2000 for resident population by zip code for remaining years. DATA ANALYSIS: Boston Public Health Commission Research Office. AsthmaAsthma HospitalizationsHospitalizations AmongAmong ChildrenChildren UnderUnder AgeAge 55 byby Neighborhood,Neighborhood, Boston,Boston, 20012001--20052005

20

15 13 11 11 11 10 10 9 9 ______8 7 6 5 5 4 4 3 3

Hospitalizations per 1,000Hospitalizations Population 0

* r N n y n n y rk in n le ry n d ry O to a w te to a a a a u to n u T h s s w la p d b s E b ig B sto e o n P P x o h x S r k h e e a tta lin o B t o O c le c F d c a s u B /B a r r t B y i o R o n B a o s H a M R th S t R to h D a m u s s C E a o e ll J S W A *Includes the North End DATA SOURCE: Acute Care Hospital Case Mix files, Massachusetts Division of Health Care Finance and Policy DATA ANALYSIS: Boston Public Health Commission Research Office WhatWhat CanCan BeBe DoneDone AboutAbout Asthma?Asthma?

ƒ Don’tDon’t smokesmoke andand avoidavoid exposureexposure toto smokesmoke ƒ EliminateEliminate pestspests ƒ RemoveRemove rugs,rugs, ifif possible.possible. IfIf not,not, useuse aa specialspecial dustdust--removingremoving vacuumvacuum ƒ CoverCover mattressesmattresses ƒ ConsiderConsider whetherwhether petspets mightmight bebe makingmaking asthmaasthma worseworse ƒ GetGet regularregular andand consistentconsistent medicalmedical carecare andand trytry notnot toto runrun outout ofof medicationsmedications ƒ BPHCBPHC AsthmaAsthma ProgramProgram -- HealthyHealthy HomesHomes InitiativeInitiative ENVIRONMENTALENVIRONMENTAL LEADLEAD ChildrenChildren withwith ElevatedElevated BloodBlood LeadLead LevelsLevels byby Neighborhood,Neighborhood, 20052005

3.5% 3.2% 3.0% 2.7% 2.7% 2.5% 2.2% 2.0% 2.0% ______2.0% 1.7% 1.8% 1.5% 1.5% 1.3% 1.2% 1.1% 1.0% 1.0% 1.0% 0.8%

0.5%

Percentages Screening Positive Screening Percentages 0.0% 0.0%

n d y ter on an n TON hton End dale E ig ost Plai tap h in B t OS t Fenway or Roxbury B Back Bayarlestownorches Mat N th Boston t Roxbur h D Hyde Park Rosl South C Eas ou llston/Br Jamaica S Wes A DATA SOURCE: Lead Screening Data, Boston Public Health Commission, Environmental Health DATA ANALYSIS: Boston Public Health Commission Research Office PREMATURITYPREMATURITY andand LOWLOW BIRTHWEIGHTBIRTHWEIGHT WhatWhat IncreasesIncreases thethe ChancesChances ofof Prematurity?Prematurity?

ƒ LateLate oror nono prenatalprenatal carecare ƒ MultipleMultiple birthsbirths (having(having twins,twins, tripletstriplets oror more)more) duringduring oneone pregnancypregnancy ƒ SubstanceSubstance use:use: tobacco,tobacco, alcoholalcohol andand otherother drugsdrugs ƒ PreviousPrevious prematurep birthbirth ƒ HealthHealth ofof thethe mothermother priorprior toto pregnancypregnancy ƒ DomesticDomestic violenceviolence ƒ AgeAge ofof MotherMother LowLow BirthweightBirthweight Births,Births, Boston,Boston, DorchesterDorchester andand DorchesterDorchester Communities,Communities, 20042004

20% y

13% 13% 13% 11% 11% 9% 10% ______6% 5%

0% Percentage of Births within Communit within Births of Percentage Boston Corner Point Savin Field Uphams Codman Hill/Harbor Lower Dorchester Sq/Franklin Grove Hall* Grove Fields Corner Fields

*Dorchester section of the Grove Hall area Mills/Neponset DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office Low Birthweight by Race/Ethnicity: Percentages of Births, Boston, 2004

16%

13% 12% 9% 8% 8% 7% 6%

4%

0%

Percentage of Births within Race/Ethnicity Percentage of Boston Asian Black Latino White

DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office PrematurePremature Births,Births, Boston,Boston, DorchesterDorchester andand DorchesterDorchester Communities,Communities, 20042004

20% 17%

14% 12% 13% 10% 10% ______9% 10%

4%

0% Percentage of Births within Community Percentage of Births Boston Corner Point Field Savin Uphams Codman Hill/Harbor Lower Dorchester Sq/Franklin Grove Hall* Grove Fields Corner Fields

*Dorchester section of the Grove Hall area Mills/Neponset DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office Premature Births by Race/Ethnicity: Percentages of Births, Boston, 2004 y 16% 14%

12% 10% 9% 9% 8% 7%

4%

0% Percentage of Births within Race/Ethnicit within Births of Percentage Boston Asian Black Latino White

DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office InfantInfant MortalityMortality Rate:Rate: BostonBoston andand Dorchester,Dorchester, byby Year,Year, 19941994--20042004

12

10

8

6

4

2

Deaths per 1,000 Live Births Deaths per 1,000 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Boston 97786777766 Dorchester 11891098810996

DATA SOURCE: Boston resident live births and deaths, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office InfantInfant MortalityMortality Rate:Rate: Boston,Boston, DorchesterDorchester andand DorchesterDorchester CommunitiesCommunities 20002000--20042004

12 11 10 10 9 9 8 7 77 ______6 6

4

2 Deaths per 1,000 Births Live

0 Boston Corner Point Savin Field Uphams Codman Hill/Harbor Lower Sq/Franklin Dorchester Grove Hall* Grove Fields Corner

*Dorchester section of the Grove Hall area Mills/Neponset DATA SOURCE: Boston resident live births and deaths, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office WhatWhat CanCan BeBe DoneDone toto PreventPrevent PrematurityPrematurity andand LowLow Birthweight?Birthweight?

ƒ Improve the health of women before they get pregnant ƒ Discourage smoking/alcohol use during pregnancy ƒ Increase access to good prenatal care to detect medical problems ƒ Provide substance abuse treatment for women who have addictions ƒ Give support through pregnancy and infant’s first year for new mothers ƒ Encourage good nutrition before and during pregnancy ƒ Encourage teens to use contraception and wait until their 20’s to get pregnant BPHCBPHC ProgramsPrograms

ƒ HealthyHealthy Baby/HealthyBaby/Healthy ChildChild ƒ BostonBoston HealthyHealthy StartStart InitiativeInitiative ƒ Mayor’sMayor’s HealthHealth LineLine ƒ BAHEC/YouthBAHEC/Youth toto HealthHealth CareersCareers ƒ AdolescentAdolescent WellnessWellness ProgramProgram ƒ CentralCentral IntakeIntake Unit,Unit, (617)(617) 534534--55545554 INFECTIOUSINFECTIOUS DISEASEDISEASE SexuallySexually TransmittedTransmitted Disease:Disease: IncidenceIncidence Rates,Rates, BostonBoston andand Dorchester,Dorchester, 20042004

1,440 1,316

1,080

825

720

360 New Cases per Cases 100,000New Population 0 Boston Dorchester

DATA SOURCE: Massachusetts Department of Public Health, STD Division DATA ANALYSIS: Boston Public Health Commission Research Office SexuallySexually TransmittedTransmitted DiseasesDiseases byby Type,Type, IncidenceIncidence Rates,Rates, BostonBoston andand Dorchester,Dorchester, 20042004

1,200

1,023 Boston 1,000 Dorchester

800

627 600

400 252 164 New Cases per 100,000 Population 200 34 41 0 Chlamydia Gonorrhea Syphilis

DATA SOURCE: Massachusetts Department of Public Health, STD Division DATA ANALYSIS: Boston Public Health Commission Research Office HepatitisHepatitis C:C: IncidenceIncidence Rates,Rates, BostonBoston andand Dorchester,Dorchester, 20042004

300

250 219

200 187

150

100

50 New Cases per Cases 100,000New Population 0 Boston Dorchester DATA SOURCE: Massachusetts Department of Public Health, STD Division DATA ANALYSIS: Boston Public Health Commission Research Office HIV/AIDSHIV/AIDS Mortality:Mortality: AgeAge--AdjustedAdjusted RatesRates byby BostonBoston andand Dorchester,Dorchester, 20022002--20042004

15 13 n

12 12

9

6

3 Deaths per 100,000 Populatio 100,000 per Deaths

0 Boston Dorchester DATA SOURCE: Massachusetts Department of Public Health HIV/AIDS Surveillance Program DATA ANALYSIS: Boston Public Health Commission Research Office SUBSTANCE ABUSE SubstanceSubstance AbuseAbuse TreatmentTreatment AdmissionsAdmissions byby TypeType ofof DrugDrug Use,Use, DorchesterDorchester andand Boston,Boston, 20042004

Heroin, Other Opiates Alcohol 55% 32% Heroin,Other Opiates Alcohol 51% 36%

Cocaine, Crack 9% Cocaine, Crack 8% Marijuana Marijuana and and Other Other 6% 5% Dorchester Boston

NOTES: An individual client may be admitted to more than one program or treatment session. Data shown are for fiscal year July 2003 through June 30, 2004. DATA SOURCE: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Management Information System (SAMIS) DATA ANALYSIS: Boston Public Health Commission Research Office HeroinHeroin TreatmentTreatment AdmissionsAdmissions byby AgeAge Group,Group, DorchesterDorchester andand Boston,Boston, 20042004

Ages <25 Ages <25 14% 14%

Ages 25+ Ages 25+ 86% 86% Dorchester Boston

NOTES: An individual client may be admitted to more than one program or treatment session. Data shown are for fiscal year July 2003 through June 2004. DATA SOURCE: Massachusetts Department of Public Health, Bureau of Substance Abuse Services, Substance Abuse Management.Information System (SAMIS) DATA ANALYSIS: Boston Public Health Commission Research Office SubstanceSubstance AbuseAbuse Mortality:Mortality: AgeAge--AdjustedAdjusted Rates,Rates, DorchesterDorchester andand BostonBoston 20042004

30

n 26 25 22 20

15

10

5 Deaths per 100,000 Populatio 100,000 per Deaths 0 Boston Dorchester

DATA SOURCE: Boston resident deaths, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office GapsGaps inin accessaccess toto detoxdetox andand followfollow-- upup carecare

„ PeoplePeople beingbeing turnedturned awayaway fromfrom carecare – Only 140 community-based beds available – About 250 people a week unable to find a bed „ UninsuredUninsured individualsindividuals faceface extraextra challengeschallenges – 78% of failed attempts to access detox – Only 38 community-based beds available „ EmergencyEmergency roomroom visitsvisits risingrising – Unavailability of community detox results in more costly ER visits – ER $2,400 more expensive than 3-day inpatient stay WhatWhat CanCan BeBe DoneDone AboutAbout SubstanceSubstance Abuse?Abuse?

„ Prevention:Prevention: NONO DRUGSDRUGS CoalitionCoalition „ Treatment:Treatment: accessibleaccessible throughthrough SubstanceSubstance AbuseAbuse ServicesServices CentralCentral IntakeIntake „ AdvocateAdvocate forfor increasedincreased statestate fundingfunding forfor substancesubstance abuseabuse treatmenttreatment programsprograms VIOLENCE and TRAUMA Non-Fatal Assault-Related Gunshot Wound and Stabbing Rates by Year, Boston and Dorchester, 1998-2005 20

16

12

Rate per 8

10,000 Population 10,000 4

0 1998 1999 2000 2001 2002 2003 2004 2005 Dorchester 13 16 15 14 12 11 13 13 BOSTON 88887678

DATA SOURCE: Weapons-related Injuries, Massachusetts Department of Public Health, Weapon-Related Injury Surveillance System DATA ANALYSIS: Boston Public Health Commission Research Office. Non-Fatal Assault-Related Gunshot and Stabbing Injuries by Neighborhood: Ages 15-44 Average Annual Age Specific Rates, 2000-2005 35 31 30 26 25 24

19 20 17

15 ______13 ______13 11 10 7 8 6 5 2 3 Rate per 10,000 Population 10,000 per Rate 2 2 0

* r y N n y n n y rk in n le r n d ry to a w te to a a a a a u to n u TO h to s s w P l p d b s E b ig B s e o n P ta in x o h x S r k e h e e a t l o B t o O B c rl c B F d c a s R u B / a r t y i M o th o R n B a o s H a R u S t to h D a m s s C E a o e ll J S W A *Includes the North End DATA SOURCE: Acute Care Hospital Case Mix files, Massachusetts Division of Health Care Finance and Policy DATA ANALYSIS: Boston Public Health Commission Research Office Non-Fatal Assault-Related Gunshot and Stabbing Injury Rates by Sex, 2005

25 22 Boston Dorchester

20

15 15

10 Rate per 10,000 Population 10,000 per Rate 5 4 2

0 Male Female

DATA SOURCE: Weapons-related Injuries, Massachusetts Department of Public Health, Weapon-Related Injury Surveillance System DATA ANALYSIS: Boston Public Health Commission Research Office. PercentagePercentage ofof NonNon--FatalFatal GunshotGunshot andand StabbingStabbing Injuries,Injuries, DorchesterDorchester andand BostonBoston Overall,Overall, 20052005

Gunshot Gunshot Injuries Injuries 51% 41%

Stabbing Injuries 49% Stabbing Injuries 59%

Dorchester Boston

DATA SOURCE: Weapons-related Injuries, Massachusetts Department of Public Health, Weapon-Related Injury Surveillance System DATA ANALYSIS: Boston Public Health Commission Research Office. Homicide:Homicide: AgeAge--AdjustedAdjusted RatesRates byby BostonBoston andand Dorchester,Dorchester, 20002000--20042004

21

n 19 18

15

12

9 8

6

3 Deaths per 100,000 Populatio 100,000 per Deaths

0 Boston Dorchester DATA SOURCE: Boston resident deaths, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office WhatWhat CanCan BeBe DoneDone AboutAbout ViolenceViolence andand TraumaTrauma

„ Improve community education and support – Comprehensive Community Safety Initiative Grove Hall, Intergenerational Crime Families – B-SMART – Bowdoin-Geneva, Leadership Team focused on reducing crime and improving the quality of life – Community Forum Meetings: Project Right – violence prevention and basketball for youth

„ Trauma Trainings – Expand partnership with the Children’s Trauma Recovery Foundation „ Provide specialized training for ministers „ Increase the numbers of trained lay people who can provide support & referral WhatWhat CanCan BeBe DoneDone AboutAbout ViolenceViolence andand Trauma,Trauma, continuedcontinued • Provide trauma information TheThe DisparitiesDisparities ProjectProject

6 hospitals and 2 CHCs have been funded to collect race, ethnicity, language and educational info on its patients using a framework developed by the BPHC’s Hospital Working Group

HOSPITALS: HEALTH CENTERS: „ BIDMC „ South Cove CHC „ BMC „ Uphams Corner Health „ BWH Center „ Caritas Carney „ Children’s Hospital „ MGH Questions?Questions? Comments?Comments?