Study links health, economic fitness

Report underlines burden of poverty


By Stephen Smith, Globe Staff, 5/28/2003


Residents of Lynn and Lowell are the most likely to die prematurely among the
state's 30 largest cities, while Newton and Brookline are the healthiest
communities in Massachusetts, according to a report that for the first time
ranks where Bay Staters are most likely to live longest.


The study released yesterday by the Department of Public Health provides a stark
snapshot of the health care haves and have-nots in the state and reflects the
profound interplay between economic fitness and physical health. Newton had the
33d highest median income as reported in the 2000 Census, while Lynn stood
324th, near the bottom of the state's 351 cities and towns. Similarly, Lowell
was number 321.


''We have a lot of people settling here who are the working poor, and you end up
with a lot of stress in their families because people are literally on top of
each other,'' Lowell health director Frank Singleton said. ''It leads to a lot
of people having drug and alcohol abuse and domestic violence. It's having
people living under conditions that the average middle-class community couldn't
even dream of. It's something you don't see in the Newtons and Wellesleys.''


In Newton, where the rate of premature deaths was half that of Lynn, the health
commissioner attributes citizens' longevity in part to the access and knowledge
that affluence can buy.


''It sounds as if socioeconomic status is playing a role in our statistic,''
Newton health commissioner David Naparstek said. ''People here are very
health-conscious. If the number of people walking up and down Commonwealth
Avenue speaks to the health of the community, then that speaks loudly in
Newton.''


The state annually chronicles what kills people in Massachusetts, but the study
of 2001 deaths marked the first attempt to provide a community-by-community
report card that demonstrates how poverty affects health.


Researchers examined deaths among people under the age of 75, a population most
likely to be helped by health interventions such as healthier diets or a
reduction in smoking, unprotected sex, or other risky behaviors. To make
comparisons among communities fair, the state analysts adjusted their figures to
account for differences in age distribution in the cities and towns.


The resulting statistic, known as a premature mortality rate, is intended to
provide a view of deaths that could be postponed. Much of the attention
yesterday focused on the state's 30 largest municipalities, mainly because the
statistical significance of findings was greatest in the bigger cities and
towns.


That analysis showed that while statewide, 347 of every 100,000 people die
prematurely each year, that figure is nearly 468 per 100,000 in Lynn and 466 in
Lowell. By comparison, Newton's rate was 218 per 100,000, while Brookline stood
at about 233.


Brookline health director Alan Balsam said that the widely varying premature
death rates can't be explained only in terms of wealth. Socioeconomic status, he
explained, ''is a proxy for so many other things, including education and access
to quality care.''


In the communities faring poorly in the review, a brew of social, economic, and
health forces conspire to end lives early, with health specialists pointing to
violence, lack of health insurance, and the stress that comes from battling
poverty. A significant segment of deaths in cities such as Lynn and Lowell could
be blamed on injuries, a category that includes drug overdoses. Statewide, in
2001, the number of deaths due to overdoses and other poisonings soared by 22
percent compared with the year before.


''We have a heroin epidemic going on in the state right now,'' said Deborah
Klein Walker, an associate commissioner in the Department of Public Health.
''It's cheap, it's easy to get.''


In Worcester, which ranks among the leaders for both premature deaths and
poverty, authorities said yesterday's study comes at a particularly difficult
time as state money to battle AIDS and other diseases is evaporating.


''This study on deaths is concerning because we do have a significant
impoverished population, and we have a significant homeless population,'' said
Dr. Leonard Morse. ''They don't live three score and 10. That's just another
indicator of a real need for everyone to address and be attentive to that
segment of the population that have less.'' State officials decided to examine
the data by community to better direct scarce prevention dollars where they're
most needed.


''If we're going to look at prevention,'' said Malena Orejuela, a state
epidemiologist, ''it's not only changes in health behavior. There's a lot more
to it, and we need to look at all of it.''


Stephen Smith can be reached at [log in to unmask]


This story ran on page B1 of the Boston Globe on 5/28/2003.






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