When Dr. Bisola Ojikutu, MD, MPH, executive director of the Boston Public Health Commission, called for an updated report about life expectancy in Boston, she found not much had changed in a decade. Today, the difference in life expectancy between a small census tract in Roxbury and an equivalent one in Back Bay — a distance of a mere 2.5 miles — is an alarming 23 years. Twelve years ago, that number was 33. 

On Sept. 26, 2024, Ojikutu brought up the illustrative finding as a panelist at “Lengthening the Lead on Health Equity: Closing Life Expectancy Gaps,” a discussion that was part of Globe Summit 2024. Pharmaceutical company Sanofi hosted the session, which Tanisha Sullivan, head, External Engagement & Health Equity Strategy, Corporate Affairs at Sanofi, moderated. Other panelists included Dr. Robbie Goldstein, MD, PhD, commissioner at the Massachusetts Department of Public Health, and Dr. Joseph R. Betancourt, MD, MPH, president of The Commonwealth Fund. The discussion focused on health equity and solutions that might begin to close gaps in life expectancy in the Boston area and beyond. 

What the data says

While the example of Roxbury highlights the problem of disparities in life expectancy, it is by no means the only neighborhood seeing a challenge. Pockets of relative disadvantage pop up all over the city including in Dorchester, Mattapan, East Boston, and areas of Allston, Ojikutu says. The disparity in these neighborhoods stands in stark contrast against the life expectancy of the city overall, which was 82 in 2023, she points out.

Zooming out of Boston, the state sees two key factors contributing to decreased life expectancy: cardiometabolic diseases and maternal morbidity and health, Goldstein says. The news is not all dire, he adds. The Commonwealth Fund, which advances policy, practice, and leadership development in the service of affordable, quality health care for all, ranked Massachusetts first in the nation for maternal health. Last year, it ranked the state number one for health care access.

A primary care crisis in the United States also compounds health inequities and disproportionately impacts communities of color, Betancourt says. He adds that in considering investments to address challenges in primary care, we also want to be thinking about how to make sure that communities of color are not left behind.

Potential solutions

With the stark discrepancies in life expectancy clearly in sight, Sullivan asked the panelists for strategies to translate discussions into solutions. “How do we get to the actionable solutions faster?” she asks.

First, we need context. In addressing disparities in life expectancy, we need to be aware that these problems have been centuries in the making, Ojikutu says. “It has been an issue of structural racism and systemic inequities and deeply embedded issues [such as] systematic disinvestment from communities that takes time, effort, and concerted energy to overcome.”

Goldstein agrees. “These are centuries-old problems, so to think that we could solve them in five or 10 years is not realistic. They’re hard problems and we have to accept that they’re hard problems.”

Goldstein points out one problem as especially hard to ignore: racism. Over a 10-year period, maternal morbidity increased for all birthing people in the state, but the rate of increase was 2.5 times for Black birthing people, and adds that they were showing up in a birthing center or a hospital and not being listened to.

“Explicit acknowledgement of racism as the underlying cause of these disparities is what I think we have to do as a state right now. We have to be explicit, not exclusive. There’s a lot that goes into health equity,” Goldstein says. “We have to think about race and ethnicity and geography, and we certainly have to think about economic diversity across the state. But if we don’t explicitly start with race, we are going to continue to see these increases and these gaps that are just unacceptable.”

Betancourt echoes that the evidence is clear when it comes to structural racism, and that it has more of an effect on health equity than class does. “This isn’t just about, to be clear, poor Black individuals. It crosses socioeconomic status.” 

Reflecting on the studies, he says the positive is that “good data gives us a springboard for taking action.”

We also need to study the drivers that shape health disparities, and “zoom in to understand what’s happening at the community level,” Ojikutu says. Studies have found that the drivers shaping disparities in life expectancy are predominantly “social determinants of health, the conditions in which we live, work, play, and eventually die,” she says. 

Because of these findings, the city has intentionally focused on addressing these social determinants, which can include housing, employment, and wealth, Ojikutu says. The city’s Live Long and Well agenda focuses particularly on the issue of economic mobility and wealth creation, she points out. The Atrius Health Equity Foundation has invested $10 million toward the agenda and requests for proposals will be going out soon. “We want to look for community coalitions that address how we get wealth built in these communities where we see lower life expectancy,” Ojikutu says. Goldstein agrees that community outreach is critical. “Part of advancing health equity in Massachusetts is about going out into the communities flipping the script. It’s not about ‘here’s the money we’re going to give you’ but [asking] the community ‘what is the best way to spend this money?’ We’ve got to let them drive our policies and practices,” he says. 

At the statewide level, the “Advancing Health Equity in Massachusetts” plan led by the Executive Office of Health and Human Services, focuses on 10 geographies which show marked health inequities. “We’re going to use all of our collective energy and funding to try to advance the programs that we think are going to have an impact and really make a difference in life expectancy,” Goldstein says. 

Even something that seems tangentially related, like broadband access for everyone in the Commonwealth of Massachusetts, addresses health inequities, Sullivan says. Goldstein pointed out that a telehealth call from one’s own home can make folks feel comfortable and engaged with providers. As founder and medical director of the MGH Transgender Health Program, he has seen a different aspect of health equity surface as transgender folks have been denied care in many medical settings. 

Hope for the future

While solutions to address discrepancies in life expectancy are getting off the ground, there’s plenty of hope and steady steps toward progress, the panelists agree. 

For one thing, the state is using mobile vans and mobile integrated health care. “We go out now and vaccinate people, get them signed up for health care, do virtual visits when we need specialists to come in,” Goldstein says. “It’s all in a way that I don’t think we could have thought of 10 years ago.”

Ojikutu sees hope in the investments being made to address systemic problems like discrepancies in life expectancy. “When I hear, ‘let’s just not make this a Black problem or a Latino problem. Let’s make this our problem as a society,’ that gives me hope,” she says. 

Sullivan embraces the inequities that affect all underserved people, including communities of color, LGBTQ+, and rural and urban folks. “There are even gender dynamics here,” she says. “While race is clearly an issue that we’ve got to wrestle with when we’re talking about health equity and life expectancy gaps, what we’re really talking about is underserved communities writ large … We’re really talking about ensuring that regardless of who you are, your life expectancy cannot be, hopefully, at some point, determined by your demographic label,” Sullivan adds.

As Betancourt points out, the momentum to address discrepancies in life expectancy is firmly in place and we need to keep registering measurable progress. “We’re a national leader and should continue to be a national leader in health equity. It’s a journey, but continuing to build on [our achievements] and making it sustainable is critical,” he says.