Prepared by the Boston Public Health Commission Health of Boston 2014-2015 Martin J. Walsh, Mayor, City of Boston Paula Johnson, MD, MPH, Chair Board of the Boston Public Health Commission HuyHuy Nguyen,Nguyen, MD,MD, InterimInterim ExecutiveExecutive Director and Medical Director Building a Healthy Boston Boston Public Health Commission Health of Boston 2014-2015 Copyright Information All material contained in this report is in the public domain and may be used and reprinted without special permission; however, citation as to the source is appropriate. Suggested Citation Health of Boston 2014-2015: Boston Public Health Commission Research and Evaluation Office Boston, Massachusetts 2015 Acknowledgements This report was prepared by Snehal N. Shah, MD, MPH; H. Denise Dodds, PhD, MCRP, MEd; Dan Dooley, BA; Phyllis D. Sims, MS; S. Helen Ayanian, BA; Neelesh Batra, MSc; Alan Fossa, MPH; Shannon E. O’Malley, MS; Dinesh Pokhrel, MPH; Elizabeth Russo, MD, MPH; Rashida Taher, MPH; Sarah Thomsen- Ferreira, M.S.; Megan Young, MHS; Jun Zhao, PhD. The cover was designed by Lisa Costanzo, BFA. Health of Boston 2014-2015 Table of Contents Acknowledgements ........................................................................................................................................................................ 1 Introduction ...................................................................................................................................................................................... 5 Executive Summary ....................................................................................................................................................................... 7 Notes to Readers .......................................................................................................................................................................... 18 Health Equity ................................................................................................................................................................................. 22 Life Course Theory & Indicators............................................................................................................................................ 29 Healthy People 2020 .................................................................................................................................................................. 39 Chapter 1: Demographics ......................................................................................................................................................... 49 Chapter 2: Social Determinants of Health ......................................................................................................................... 63 Education ........................................................................................................................................................................ 67 Employment ................................................................................................................................................................... 76 Income & Poverty ........................................................................................................................................................ 88 Housing .......................................................................................................................................................................... 100 Racism ............................................................................................................................................................................ 111 Chapter 3: Health Related Behaviors ............................................................................................................................... 119 Smoking ......................................................................................................................................................................... 121 Alcohol ............................................................................................................................................................................ 125 Sugar-Sweetened Beverages ................................................................................................................................. 129 Physical Activity ......................................................................................................................................................... 133 Fruits and Vegetables ............................................................................................................................................... 137 Chapter 4: Access to Care ....................................................................................................................................................... 145 Chapter 5: Maternal and Child Health ............................................................................................................................... 157 Chapter 6: Chronic Disease .................................................................................................................................................... 177 Asthma............................................................................................................................................................................ 179 Diabetes ......................................................................................................................................................................... 189 Heart Disease ............................................................................................................................................................... 196 Hypertension ............................................................................................................................................................... 201 Overweight and Obesity .......................................................................................................................................... 204 Chapter 7: Sexual Health ........................................................................................................................................................ 213 Chlamydia ..................................................................................................................................................................... 217 3 2014-2015 Health of Boston Gonorrhea ..................................................................................................................................................................... 220 Syphilis ........................................................................................................................................................................... 223 HIV/AIDS ....................................................................................................................................................................... 226 Chapter 8: Infectious Disease ............................................................................................................................................... 233 Hepatitis B & C ............................................................................................................................................................ 235 Influenza ........................................................................................................................................................................ 240 Salmonella Infection ................................................................................................................................................. 243 Tuberculosis ................................................................................................................................................................ 246 Chapter 9: Mental Health ....................................................................................................................................................... 251 Chapter 10: Substance Abuse ............................................................................................................................................... 265 Chapter 11: Violence ................................................................................................................................................................ 279 Chapter 12: Cancer ................................................................................................................................................................... 287 Chapter 13: Death ..................................................................................................................................................................... 297 Technical Notes .......................................................................................................................................................................... 309 Data Sources ................................................................................................................................................................................ 323 4 Introduction 2014-2015 Introduction Welcome to Health of Boston 2014-2015! This report provides a broad picture of the overall health experience of our city, describes many of the contextual factors that influence the health of Boston residents, and identifies groups of individuals and communities at