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By Andrea Tobias
We all know what makes an individual healthy: Nutritious food. Restorative sleep. Exercise. Fulfilling relationships. An adequate income.
But what makes a community healthy? How can you evaluate the place where you live and help foster a culture of wellness for your community, your family, and yourself?
Massachusetts has clear advantages. A recent report by U.S. News ranked it the second healthiest state in the nation. The factors researchers considered were infant mortality rates, obesity, smoking, suicide and overall mortality, as well as the number of adults who described themselves as having poor mental health.
The Bay State’s percentage of residents with no insurance was just 2.4 percent in 2021, compared to the national rate of 9.2 percent, according to the Center for Health Information and Analysis. Plus, Massachusetts residents experience the added benefit of receiving some of the best hospital care in the nation. Eleven of Massachusetts’ hospitals meet U.S. News’ competitive standards: a set of evaluations which take the quality of common procedures as well as that of specialty treatments for rare and life-threatening conditions into account. Those assets aside, the qualities that make thriving communities are “very similar to what makes healthy families,” says Greg Wilmot, president and chief executive officer of the East Boston Neighborhood Health Center. Wilmot, whose health center sees more than 100,000 patients annually, cites access to health care, quality education, opportunities for employment, and safe, affordable housing as fundamental.
Environmental factors can also affect a community’s health. This summer, many people from different areas in the state experienced episodes of extreme heat due to climate change. Air quality in Massachusetts was a concern following the wildfires in Canada. A neighborhood is healthy when “members of the community can interact in the environment in safe ways. That’s air quality, that’s open spaces, that’s buildings that have central air,” Wilmot says.
Tangible benefits of green space and clean air
Amenities like ample green space have a quantifiable role in enhancing health, according to Peter James. The Harvard Medical School associate professor at the Harvard Pilgrim Health Care Institute’s Department of Population Medicine studies how the places where people live, work, and play influence their health.
Through his research, James found that more green space around residents’ homes is associated with lower rates of depression and anxiety, better cognition, higher levels of physical activity, lower breast cancer risk, and lower mortality rates. Additionally, people who live in denser and more walkable neighborhoods have higher levels of physical activity, while higher levels of air pollution are linked to increased cardiovascular disease and higher mortality rates.
Some early implications derived from James’ studies are surprising. For example, living in noisier areas is associated with increased cardiovascular disease risk, according to analyses in development. His team has also observed that increased levels of light pollution are related to higher rates of breast cancer risk.
Neighborhoods with greater percentages of low-income and non-white residents across the United States “consistently have lower access to green space, worse food environments, higher air pollution, and higher exposure to noise,” James says. “These exposures combined could contribute to health disparities that we see by income and race across the country.”
For several decades, racial equity and social justice have been the mission of the Boston Public Health Commission (BPHC), the city’s health department, according to Executive Director Dr. Bisola Ojikutu. The city of Boston labeled racism a public health crisis in June 2020.
Yet health equity in the region remains a challenge. The Health of Boston report, issued by the BPHC in May, identified a 23-year difference in life expectancy between a census tract in Roxbury (68.8 years) and one in the Back Bay (91.6 years).
Addressing health disparities
A second sign of inequity is the prevalence of heat islands — areas of more intense heat, fewer trees, and frequently, more concrete — in certain neighborhoods, including Chinatown, Dorchester, Mattapan, and Roxbury. Extreme heat leads to more people needing emergency care for heat-related incidents.
While Massachusetts state law sets minimum heating requirements for landlords during winter, there’s no law which explicitly states a landlord must provide cooling in summer, according to M. Patricia Fabian, associate professor in the department of environmental health at Boston University.
The city’s fixes for extreme heat have included adding canopies to reduce surface temperatures, creating more access to drinking fountains, and planting more trees to expand green space. Still, some residents say there’s much more to do. In a 2022 research project called Photovoice/Fotovoz, Fabian and colleagues invited residents from Chelsea and East Boston to document their experiences of urban heat and climate change. One theme that emerged was tree equity. “There were stark differences around not just park access but green space in general” among neighborhoods, Fabian says.
BPHC regularly talks with and hears from residents about the health of their communities at community meetings. The agency also conducts surveys and other outreach to learn about health-related problems that communities are facing, including a community health needs assessment every couple of years. The responses, Ojikutu says, help guide BPHC’s improvement plans.
Priority areas from the 2022 assessment and improvement plan focused on housing; economic mobility and inclusion; accessibility of services; as well as mental and behavioral health, including substance use.
How to build a healthy community
Just as individuals can take steps to strengthen their own physical and mental health, they can enhance the health of their community. Here’s how:
Get informed. James, who works with communities to encourage environmental policy change, recommends Massachusetts Environmental Public Health Tracking community profiles for insight into communities across the Commonwealth. The Metropolitan Area Planning Council, Boston’s regional planning agency, has a robust resource for environmental and health data. James also likes Google Earth Engine, where “people can download research-grade data and get more information about the environments they live in.”
Get active and involve others. It could be a simple step, like attending or hosting a neighborhood block party “to celebrate the achievements happening in the community,” Wilmot says. The city’s Civic Power Pledge suggests other activities, such as planning a neighborhood cleanup. Or attend a BPHC community meeting. “We want people to become civic leaders within their communities,” Ojikutu says, “and be the change agents themselves.”
Stay engaged and vote to support the policies you favor. Learn about candidates for local and statewide offices. Governmental policies shape many social determinants of health, including education, economic stability, and health care access.
In the future, it may be easier to gain understanding about the health of your community. BPHC plans to develop a health equity dashboard where people can type in their neighborhood and see how it fares on a variety of health measures.
Change starts with knowledge, but it doesn’t end there. “A healthy community,” Fabian believes, “is one where citizens have a voice, [the] city has a way to communicate and incorporate the citizen voice, and citizens are empowered to be part of the conversation and solutions.”
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