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A growing body of research indicates that there are many community-level factors that affect individuals' physical, mental, social, and financial well-being, which in turn affects their health. Protective factors-such as social supports, connections to jobs that pay living wages, and good quality housing and schools-all help to make a community "healthy." People who live in healthy communities tend to live healthier lives and have better health outcomes, but without protective factors, people are more likely to suffer from obesity, asthma, heart disease, cancer, diabetes, and high blood pressure.

Massachusetts ranks among the best-performing states in the nation for many health indicators. Yet, when we examine the diverse groups that make up the state's population, we find that some groups, including racial and ethnic minorities and individuals with mental illness, experience far worse health than the overall Commonwealth average. The Executive Office of Health and Human Services (EOHHS) is committed to eliminating these disparities by creating policies and regulations that support healthy communities and by partnering with local communities to create healthier and safer environments for residents.

What Are We Measuring?

Through EHSResults, EOHHS evaluates its progress in this critical area by internally monitoring a number of measures. Examples include:

Managing Asthma Effectively

Age-adjusted rate of asthma hospitalizations per 10,000 residents (by race/ethnicity) (Click to view larger chart and data details.) Why Is This Important?

Asthma control can be negatively affected by inadequate medical management and environmental factors, including indoor and outdoor air pollutants and allergens, such as mold, radon, particulate matter, and ozone, which are found in homes, schools, child care settings, workplaces, and the air in surrounding communities. When an asthma attack is severe, it can require increased levels of monitoring and care in a hospital setting. Trends in hospitalization over time can show if intervention and management strategies are having an impact on the burden of asthma. [1] Asthma can be controlled and asthma hospitalizations prevented through proper assessment and monitoring, patient education, pharmacologic treatment, and control of the environmental and other factors contributing to asthma severity.

How Are We Doing?

From 2004 through 2007, the Commonwealth-wide age-adjusted rate of hospitalization due to asthma remained stable. During the same period, Blacks and Hispanics consistently had the highest rates-in 2006, Blacks and Hispanics had rates of 33.7 and 32.1 per 10,000 residents, respectively, in comparison with the statewide rate of 14.5 per 10,000 residents.

Asthma hospitalizations are largely preventable. EOHHS has several efforts aimed at reducing the burden of asthma among Massachusetts residents. These efforts include the Asthma Prevention and Control Program (APCP) that helps improve asthma outcomes by expanding asthma surveillance, broadening Commonwealth-wide and regional asthma partnerships, and improving asthma management and control through evidence-based interventions. This program also improves the hospitalization rate of Blacks and Hispanics in targeted geographic regions. EOHHS also has multiple evidence-based efforts focused on addressing the clinical and environmental triggers that affect asthma-such as air quality, occupational hazards, and smoking-and on helping prevent asthma hospitalizations in Massachusetts.

Preventing and Controlling Diabetes

Percentage of adults who have diabetes (by race/ethnicity) (Click to view larger chart and data details.) Why Is This Important?

An estimated 24 million children and adults in the U.S. have type 2 diabetes. Complications associated with diabetes include heart disease, stroke, kidney disease, vision loss, and nerve damage. Diabetes and its associated complications not only impact the lives of many individuals but also drive significant cost increases in the health care system. In 2007 alone, diabetes-related medical expenditures in the United States added up to an estimated $116 billion, which included $27 billion for diabetes care, $58 billion for chronic diabetes-related complications, and $31 billion for excess general medical costs.

Overall, diabetes prevalence based on self-reporting has increased from 5.6 percent in 2004 to 7.2 percent in 2008. This increase could be due to several factors: more people are at risk for type 2 diabetes because of the increased prevalence of obesity and physical inactivity; more people are getting screened and diagnosed with diabetes earlier; and people are receiving better care for their diabetes and are, therefore, living longer with the disease. As reflected in the graph, Blacks and Hispanics are at higher risk for developing diabetes.

There also are 57 million people in the United States with pre-diabetes, a condition in which blood sugar levels are higher than normal but not high enough to be considered diabetes. Weight loss and regular moderate physical activity can prevent or delay the onset of type 2 diabetes for individuals with pre-diabetes. The Massachusetts Diabetes Prevention and Control Program (DPCP) tracks the prevalence of type 2 and pre-diabetes and how often people with diabetes receive the recommended care to prevent or treat diabetes-related complications. The DPCP works with health systems to implement changes to provide optimal care, has piloted several worksite-based initiatives for people with pre-diabetes, and provides free educational materials to Massachusetts residents and health care providers.

Managing Depression in the Commonwealth

Percentage of adults who reported 15+ days sad, blue, or depressed during the past month (Click to view larger chart and data details.) Why Is This Important?

There is a strong relationship between depression and obesity, diabetes, smoking, and unemployment. Massachusetts tracks the percentage of individuals who report having had more than 15 days where they felt sad, blue, or depressed as a proxy for depression. These data on depression assist the Department of Mental Health (DMH) and other EOHHS agencies in monitoring the mental health status of residents and in identifying population-specific interventions.

How Are We Doing?

In 2008, 6.7 percent of survey respondents indicated they had more than 15 days in the past month where they felt sad, blue, or depressed, indicating that depression continues to be a significant public health concern. To address this issue, DMH collaborates with EOHHS and community partners on activities to identify and prevent depression in Massachusetts. Examples include efforts to reduce the stigma associated with mental illness in young adults, education about depression, and suicide prevention activities.

Examining Violent Crime in our Communities

Homicide age-adjusted rate per 100,000 (by race/ethnicity) (Click to view larger chart and data details.) Why Is This Important?

Individual and public safety is another component of a healthy community. When communities face high rates of crime, residents tend to avoid venturing outside to exercise or play. The stress of worrying about safety is also shown to lead to adverse health outcomes, such as heart disease and poor birth outcomes, [2] and the experience of violence has been shown to lead to negative health outcomes ranging from arthritis to heart disease and cancer. [3] EOHHS monitors the homicide rate in the Commonwealth, because it is an important indicator of violent crime and is a risk factor for community health.

How Are We Doing?

While the homicide rate for Massachusetts has stabilized in recent years, it has increased 45 percent since 2000. However, the Commonwealth still fares better than most of the United States-the Massachusetts homicide rate of 2.9 deaths per 100,000 people is 52 percent lower than the national homicide rate of 6.0 deaths per 100,000 people.

The Department of Public Health (DPH) youth violence prevention work is focused in high-risk communities across the Commonwealth, intentionally reaching adolescent boys and young men of color. DPH uses best practice approaches in promoting positive youth development and has developed a shared agenda for prioritization of this work with public safety, education, and labor and workforce development agencies.

Additionally, DPH is focusing its violence prevention efforts on targeted areas such as domestic violence and child abuse.

Learn More

[1] Akinbami L., The State of childhood asthma, United States, 1980 - 2005.

[2] Bell and V. Rubin, Why Place Matters: Building a Movement for Healthy Communities,

[3] See, for example, "Adverse Health Conditions and Health Risk Behaviors Associated with Intimate Partner Violence-United States, 2005." Mortality and Morbidity Weekly Review, February 2008; and Felitti et al., "Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study." American Journal of Preventive Medicine 1998 May; 14(4):245-58


This information is provided by EHSResults.