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Healthy People/Healthy Economy: A Five-Year Review and Five Priorities for the Future

January 1, 2015

The first Report Card (2011) identified a dozen priorities for decisive action to improve health in Massachusetts. The need to act was summed up in the title of our first report, The Boston Paradox, published in 2007. As we saw it, Massachusetts had "plenty of health care, but not enough health." The Commonwealth ranked high on many measures of health status and health care compared to the rest of the United States. But it was not immune to risks such as rising rates of overweight, obesity and diabetes that threatened to increase the burden of illness on many families, to drive up health-care costs that were already too high, and to sap the economic vitality of the state.So how have we done? Clear signs have emerged that rates of growth in overweight and obesity in the Massachusetts population at large have stayed flat over the last two to three years. Similarly, overweight and obesity have leveled off among youth in several high-risk communities aided by the Commonwealth's Mass in Motion program. We have seen a widespread effort to promote a "culture of health."A real culture of health requires investment of real dollars in priorities that shape our lifelong health. Here there have been encouraging signs as well.In 2011 we documented a "mismatch": increased health care spending by the Commonwealth came at the expense of investment in crucial long-term determinants of health such as education and public health programs. Since then, the Commonwealth's spending on health care and other health-related priorities has come closer into balance.But it is far too early to give ourselves good grades. First, it remains to be seen whether the unhealthy weight gain in Massachusetts has stopped for good. After all, America's obesity crisis has been more than 30 years in the making. In Massachusetts, rates of overweight, obesity and related conditions such as diabetes remain at historically high levels. Disparities in rates and resulting health risks among African-American and Latino residents remain stubbornly high. There is an especially urgent need for addressing what can be termed "ZIP-code disparities," or huge differences in health between affluent communities and low-income, high-risk urban neighborhoods throughout the state.And while Massachusetts adults are among the nation's healthiest, the state's youth consistently fall in the middle of the pack for risks such as overweight and obesity, with especially troubling numbers for the youngest children. These facts do not bode well for our economic future.It likewise remains to be seen whether the Commonwealth's tentative steps toward a better balance can be sustained in state expenditures on both health care and the determinants of health. The growth in health-care spending in Massachusetts has slowed in the last two to three years, but experts are divided on whether this trend will continue. Meanwhile, recent budget increases for public health and other health-related programs have not come close to making up for cuts in real inflation-adjusted spending suffered over the last 15 years.And so as Governor Baker, the Legislature and community leaders reset the state's agenda, we offer one overarching goal and five specific recommendations for further action. The Commonwealth's overarching goal should be to make steady progress toward a culture of health. To make this a reality, Massachusetts officials need to fully embrace the "health in all policies" approach that many experts and health-care leaders see as essential if we are to improve health, avoid unnecessary spending, and sustain our economic vitality. Nearly every government action, from capital planning and construction to the design or reform of programs, represents an opportunity to contribute to better health for all residents.

Healthy People/Healthy Economy: Annual Report Card 2014

June 1, 2014

This fourth annual Healthy People/Healthy Economy Report Card makes the case once again that health and wellness are essential to the future of the Commonwealth. This Report Card outlines more than a dozen complementary policies and practices to improve health and prevent disease, and it is critical that we adopt them.This year, the Report Card intensifies its focus on health at both ends of the lifespan— young children and seniors. Equally important, it stresses the urgent need for action to improve health at the neighborhood and community level in order to enhance lives and meet the Commonwealth's new goals for controlling health care costs.Massachusetts is now focused squarely on the difficult task of controlling its health care spending. With the enactment of Chapter 224 in 2012, the Commonwealth became the third U.S. state, following Maryland and Vermont, to assert control over all public and private health care spending. Under Chapter 224, the Commonwealth aims to keep the rate of increase in total health care spending equal to or less than the state's economic growth rate. This ambitious goal builds upon the state's achievement of the highest rate of health insurance in the country, with about 96 percent of residents covered. While people who live in Massachusetts are already among the healthiest in the United States, there are many areas for improvement, and making those improvements is key to controlling future costs.Let's look at the record.Massachusetts ranks high among the states on most health indicators. One well-regarded national report, America's Health Rankings, rates Massachusetts as the 4th-healthiest state in the country. Yet measures like these mask important and costly problems.For example, even though the Commonwealth is among the states with the lowest levels of overweight, obesity and illnesses related to unhealthy weight, including Type 2 diabetes, the overall national trend has been consistently negative. In Massachusetts: - The percentage of obese people has doubled since 1990, from approximately 10 percent to more than 20 percent.- The number of cases of diabetes skyrocketed 80 percent between 1995 and 2010.- The cost impact of diabetes, which is estimated to be more than $6 billion per year, will escalate unless the current trend is reversed.- Equity issues remain, as African Americans are more likely to report that they are in fair or poor health compared to whites (about 18 percent vs. 12.5 percent), and Hispanics are much more likely to report poor health status (27 percent).- Low-income residents are much more likely to characterize their health as fair or poor (29 percent of residents earning less than $25,000, compared to 4.7 percent of residents earning more than $75,000 per year).- People who have completed high school or college are much more likely to report their health as good compared to those who have not finished school (Only 6 percent of college graduates characterized their health as fair or poor, compared to nearly 35 percent among those who did not finish high school).