1. Understanding Health Inequities in Boston Barbara Ferrer, PH.D., MPH, M.ED Executive Director Boston Public Health Commission

2. Health Indicator Black White Asthma (< 5, hosp) 11.4 per 1000 3.4 Birth Weight (Less than 3.3lbs) 3.0% of births 1.6% Body Weight (Overweight or Obese) 68% 41% Breast Cancer (Morality) 29.7 per 100,000 25.9 Cervical Cancer (Mortality) 5.6 per 100,000 2.3 Death Rate (Mortality) 1116.8 per 100,000 919.6 Diabetes (Mortality) 41.8 per 100,000 16.6 Drug Related Mortality 15.7 per 100,000 19 Heart Disease (Mortality) 239.6 per 100,000 238.1 High Blood Pressure 30.4% 17.2% HIV / AIDS (Mortality) 28.1 per 100,000 6.8 Homicide 27.2 per 100,000 2.2 Hospitalization 163.8 per 1000 108.9 Infant Mortality (Mortality) 8.7 per 1000 4.1 Lung Cancer (Mortality) 61.6 per 100,000 66.2 Prostate Cancer (Mortality) 68.3 per 100,000 31.2 Smoking during pregnancy 6.3% 5.1% Suicide (Mortality) 3.6 6.2 Teen Birth Rate (15 - 17) 14.1 per 1,000 6 Uninsured 9.2% 6.5% Racial Disparities in Boston

3. Life Expectancy of Black and White Boston Residents, 2004-2006 DATA SOURCE: Boston resident deaths and live births, Massachusetts Department of Public Health Data ANALYSIS: Boston Public Health Commission Research Office

4. Infant Mortality Rates by Race/Ethnicity and Year, Boston, 1993-2005 NOTE: Rates for Asians and Others are not presented because each group had less than 5 deaths per year for most of the years shown. DATA SOURCE: Boston resident deaths, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office n<5

5. Cumulative Birthweight Distribution by Race/Ethnicity, Boston: 2000-2005 DATA SOURCE: Boston Resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office 90.85% 9.15% 4.06% 2.03% 1.17% 0.77% 0.23% Other 93.07% 6.93% 2.79% 1.26% 0.58% 0.28% 0.09% White 92.06% 7.94% 3.05% 1.54% 0.80% 0.51% 0.18% Latino 86.75% 13.25% 5.97% 3.46% 2.02% 1.41% 0.54% Black 93.31% 6.69% 2.04% 0.90% 0.49% 0.19% 0.08% Asian 2,500g+ <2,500g <2,000g <1,500g <1,000g <750g <500g

6. Birthweight-Specific Infant Mortality Rates by Race/Ethnicity, Boston, 2002-2004 * Count is 0; therefore rate not calculated. NOTE: ELBW is <500g, VLBW is <1,500g, LBW is <2,500g, NBW is 2,500g+. DATA SOURCE: Boston resident live births and infant deaths, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office n<5 *

7. IS IT ABOUT EDUCATION OR INCOME?

8. Racial & Ethnic Disparities Infant Mortality & Education NCHS 2002 10.2 6.8

9. Racial & Ethnic Disparities Infant Mortality & Household Income 16.6 11.2

10. IS IT ABOUT HEALTH BEHAVIOR?

11. Racial & Ethnic Disparities Infant Mortality & Cigarette Smoking NCHS 2002 13.2 9.2

12. Low Birthweight by Smoking Status and Race/Ethnicity, Boston, 2005 Percentage of Births Within Race/Ethnicity and Smoking Group NOTE: LBW for Asian smokers not shown because n<5 DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission

13. Racial & Ethnic Disparities Infant Mortality & Prenatal Care NCHS 2002 12.7 7.1

14. NOTE: LBW percentage are not shown where n<5. PNC adequacy was assessed by the Kotelchuck Index (APNCU Index). DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office Low Birthweight by Adequacy of Prenatal Care and Race/Ethnicity, Boston, 2005 n<5

16. Racial & Ethnic Disparities Infant Mortality & Nativity 9.2 14.2 Per 1,000 Live Births NCHS 2002

17. Low Birthweight by Maternal Birthplace, Boston, 2004 SOURCE: Boston resident live births, Massachusetts Department of Public Health ANALYSIS: Boston Public Health Commission Research Office

18. WHAT ABOUT RACISM ?

21. Model of Social Determinants of Health Disparities

24. Low Birthweight by Neighborhood Boston, 2005 NOTE: Back Bay includes the North End/ DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research Office

25. Asthma Hospitalizations of Children Under Age 5 by Neighborhood, Boston, 2004-2006 *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

27. Number of Youth Per Facility Across Boston Neighborhoods 1999-2000 * Combined Central Area includes Beacon Hill/Back Bay, Central, Fenway/Kenmore, and South End. DATA SOURCE: Play Across Boston: Summary Report, December 2002

30. Racial and Ethnic Disparities Stress & Preterm Birth Mother Placenta Fetus Stress Hypothalamus Pituitary Adrenal CRH CRH ACTH Cortisol Norepineprhine + + Hypothalamus Pituitary Adrenal Liver CRH ACTH Cortisol DS 16 alpha OH DS Estriol + + Adapted from Hobel 1998

31. Racial & Ethnic Disparities Low Birth Weight & Racism 12% 20% P < 0.01