What runs through your mind as you sit in your doctor’s office, waiting to be called? You’re likely wondering about the long wait or hoping to get to the bottom of the aches and pains you’ve been having all week. Or maybe you’re worried about your last visit’s test results. Either way, your zip code is probably the last thing on your mind. When it comes to health, most people don’t think about how it can be attributed to the environment in which they live.
Health is impacted at both the individual and community levels. While biology and personal behaviors can greatly affect health, community-level factors such as housing, education, environmental exposure, public safety, employment, and income are strong predictors as well. In fact, these social determinants of health—the social and physical environments of where one lives, works, and plays—drastically shape the quality of life for all individuals. As a Global Health Corps fellow working with the Boston Public Health Commission (BPHC) this year, I’ve had the opportunity to delve into these issues on a deeper level and to mobilize greater awareness in the communities we serve.
In a recent report, Health of Boston 2012-2013: A Neighborhood Focus, the Commission used demographic and socioeconomic profiles to connect race and household earnings with health outcomes. White residents of Boston with higher earning power, on average, enjoy better health than their Black and Latino counterparts—demonstrating that lower-income communities of color disproportionately shoulder the burden of poor health and are therefore more likely to have higher rates of infant death, asthma-related emergency department visits, heart disease and diabetes hospitalizations, adulthood obesity, and depression. Despite living in one of the healthiest cities in America, Boston residents do not all share the same level of health.
One of my fellowship year goals is to support the Commission as it works toward health equity for all of its residents—a vision that comes to fruition through the Boston Health Equity Goals (BHEG). The initiative was created to bring attention to health outcomes disparities—specifically in the areas of obesity, Chlamydia, and low birth weight (LBW). These goals were chosen because they are longstanding health problems, good indicators of overall health, caused by unjust practices, and compliant with existing models for social change. In alignment with the BPHC’s mission to protect, promote, and preserve the health and wellbeing of all Boston residents, particularly the most vulnerable, bureaus across the Commission have created programs targeting low-income and resource-limited communities. In doing so, we hope to significantly reduce the gap in health outcomes between White residents and residents of color, as well as obesity, Chlamydia, and low birth weight rates overall. In addition, we aim to find tangible solutions that can be used as models for other communities and health systems across the country and the globe.
Since starting my placement at the Boston Public Health Commission, I’ve developed a broader understanding of the factors important for wellbeing as well as an ability to think critically about health matters affecting the city and its residents. As the year goes on, I hope to further examine these social determinants of health—particularly through the lens of racial justice—as a way to reconcile differences in health outcomes and support resource development needed to ensure equity across the board.