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Common Health for the Commonwealth Booklet 2017 Common Health for the Commonwealth 9th Edition MASSACHUSETTS HEALTH COUNCIL Report on Preventable Conditions and Social Determinants of Health 2017 Common Health for the Commonwealth MASSACHUSETTS HEALTH COUNCIL Report on Preventable Conditions and Social Determinants of Health 2017 Supported by Massachusetts Health Council 200 Reservoir Street, Suite 101 Needham, MA 02494 617-965-3711 www.mahealthcouncil.org Copyright © 2017 Massachusetts Health Council, Inc. Contents Message from the Executive Director and President ................................................................ i Acknowledgments and Research Collaborators ........................................................................ ii Special Thanks .......................................................................................................................... iv A Note on the Data .................................................................................................................... v Executive Summary ....................................................................................................... vi Chapter 1. Social Determinants of Health ............................................................................. 1 Chapter 2. Health Risk Factors .............................................................................................. 3 Chapter 3. Preventable Health Conditions ............................................................................ 3 Introduction .................................................................................................................. 8 Chapter 1. Social Determinants of Health ..................................................................... 10 1.1 Income and Poverty ......................................................................................................... 11 1.2 Education ......................................................................................................................... 17 1.3 Housing and Homelessness ............................................................................................ 24 1.4 Nutrition and Food Security ............................................................................................ 30 Disease-Related Malnutrition*: An Effort to Better Understand Its Effects ......................... 38 and Strategies for Addressing It 1.5 Access to and Affordability of Care ................................................................................. 40 Chapter 2. Health Risk Factors ...................................................................................... 46 2.1 Tobacco Use ..................................................................................................................... 47 Chapter 3. Preventable Health Conditions .................................................................... 54 3.1 Asthma ............................................................................................................................. 55 3.2 Obesity ............................................................................................................................. 61 How Sweet is It? — The Amount of Sugar in Soda, Juice, Sports Drinks, .......................... 68 and Energy Drinks 3.3 HIV/AIDS ......................................................................................................................... 69 3.4 Hepatitis C ....................................................................................................................... 74 3.5 Injury Resulting from Violence ....................................................................................... 80 3.6 Substance Use — Opioids ............................................................................................... 87 3.7 Mental Illness ................................................................................................................... 96 3.8 Oral Disease ..................................................................................................................... 109 Message from the Executive Director and President We proudly release the ninth edition of the Massachusetts Health Council’s nationally recognized report, Common Health for the Commonwealth: Report on Preventable Conditions and Social Determinants of Health shines a light on the prevalence of health conditions and the social deter- minants of health and serves as a guide for council members to collaborate in building a culture of health in the Commonwealth. The council’s goal is to have good health and well-being flourish in all Massachusetts communities. This year’s report identifies many areas that demand the attention of government, civic, and busi- ness leaders. • The report identifies several troubling trends that impact the health of school-age children: 60 percent of students drank a sweetened beverage daily with middle school students slightly more likely to consume them than high school students. High school students, however, were less likely to consume multiple servings of vegetables and fruits than middle school students. • Massachusetts is a leader in access to health coverage but due to multiple factors, including high out-of-pocket costs, access to care is a persistent challenge for those with chronic health conditions or low incomes. • Smoking rates among high school students have fallen dramatically over the past decade, but electronic products have largely replaced cigarettes. When vaping is included, it appears there has not been a reduction in nicotine use among high school students. • Rates of major depressive episodes among adolescents have trended up recently in both Massa- chusetts and the United States, with 11 percent of Massachusetts adolescents reporting a major depressive episode in 2013–2014. Massachusetts must come together to address these and many other issues revealed in the Common Health Report. Fortunately, Health Council members are already working on solutions to some of these problems. For instance, the council is part of a coalition with the American Heart Association/American Stroke Association to enact policies that discourage the consumption of sugar-sweetened beverages and make access to drinking water a public health priority. And coun- cil members are committed to ensuring that Massachusetts remains a national leader in access to health coverage and resist efforts to roll back our commitment to universal coverage while simul- taneously addressing the cost of care that inhibits access for so many. Finally, on behalf of the Health Council, we thank the many organizations that make this report pos- sible with their generous support and thank all the individuals who authored policy perspectives for each topic. This edition of the Common Health Report will guide our work and collaboration over the next year to bring the conditions that enable real health to every community in Massachusetts. Sincerely, David Martin Michael Sroczynski Executive Director President i Acknowledgments and Research Collaborators Editors David R. Martin Jeffrey R. Stone Principal Investigators Abiola Animashaun, Carol Gyurina, and Robert Seifert Center for Health Law and Economics, University of Massachusetts Medical School The Center for Health Law and Economics (CHLE) is a unit of Commonwealth Medicine, the pub- lic service division of UMass Medical School. CHLE counsels public agencies and nonprofit health policy organizations in pursuit of an improved health care system. With collective expertise that integrates health law and health policy, CHLE helps health policy leaders transform ideas into re- ality by crafting inventive and sustainable solutions to systemic challenges. The investigators thank Carol Pryor for her research assistance. Research Collaborators Myron Allukian Jr. DDS, MPH President Massachusetts Coalition for Oral Health Caroline M. Apovian, MD, FACP, FACN Associate Professor of Medicine Boston University School of Medicine Director, Center for Nutrition and Weight Management Boston Medical Center Vicker V. DiGravio III President and CEO Association for Behavioral Healthcare Elizabeth K. Englander, PhD Professor of Psychology Director, Massachusetts Aggression Reduction Center Bridgewater State University Emmett Folgert Executive Director Dorchester Youth Collaborative Jessie M. Gaeta, MD, FASAM Chief Medical Officer, Boston Health Care for the Homeless Program Assistant Professor of Medicine, Boston University School of Medicine Rebekah Gewirtz Executive Director Massachusetts Public Health Association ii Camilla S. Graham, MD, MPH Co-Director, Viral Hepatitis Center Division of Infectious Disease Beth Israel Deaconess Medical Center Lisa Guisbond Policy Analyst, FairTest Executive Director, Citizens for Public Schools Polly Hoppin, ScD Chair, Primary Prevention Task Force, Massachusetts Asthma Action Partnership Research Professor and Program Director, College of Health Sciences/Lowell Center for Sustainable Production, University of Massachusetts, Lowell Marc Hymovitz Director of Government Relations American Cancer Society Cancer Action Network Joseph Kriesberg President and CEO Massachusetts Association of Community Development Corporations Carine Lenders, MD, MS, ScD Associate Professor of Pediatrics, Boston University School of Medicine Medical Director, Nutrition and Fitness for Life Program, Boston Medical Center Monica Valdes Lupi, JD, MPH Executive Director Boston Public Health Commission Aaron J. Manders, MS, RD, LDN Master Educator, Boston University School of
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