Place Matters is a Community Newspaper brought to you by the Boston Public Health Commission. Where we live, work and play are important factors in shaping our health. While bad health care and unhealthy habits like not eating healthy foods or not exercising contribute to poor health, the differences in health outcomes between people of color and White people cannot be explained simply by how well our doctors and nurses take care of us, what we eat, and whether or not we exercise. In this publication we explore what contributes to these racial health inequities in Boston and what we can do together to make sure everyone has a fair chance to be healthy.
Page 04 Word on the Street Teeny is one name for the beverage in the picture. Some youth know it by other names, but what is universally accepted about this beverage is that it has no nutritional benefits. Page 06 Welcome to Mattapan Vivien Morris is one of the city’s health champions. A long-time Mattapan resident and parent of two, this registered dietitian has been committed to the health and wellness of the place she calls home for many years. Page 09 Greening Boston’s Auto Body Shops The Boston Public Health Commission’s Safe Shops Project has partnered with auto shops to address health inequities in communities of color overburdened by toxic chemical exposure. PlaceMatters Spring 2013 A Publication of the Boston Public Health Commission Insid e Boston by the Numbers Boston is the largest city in Massachusetts. The city’s population has changed over time, with the 2010 US Census reporting 617,594 residents. Understanding the health of Boston begins with a deeper understanding of this place we call home. See page 2 Why Place Matters for Health Where we live, work and play are important factors in shaping our health. While bad health care and unhealthy habits like not eating healthy foods or not exercising contribute to poor health, the differences in health outcomes between people of color and White people cannot be explained simply by how well our doctors and nurses take care of us, what we eat, and whether or not we exercise. In this publication we explore what contributes to these racial health inequities in Boston and what we can do together to make sure everyone has a fair chance to be healthy. Differences in health status are often called health disparities or health inequities. The term “disparities” refers to differences, but we use the term “inequities” when we are talking about differences that are unfair or unjust. Lead Poisoning Rates Are Down in Boston Almost 90% of Boston’s housing was built before 1978 and often contains lead-based paint. However, Boston has made great strides in reducing rates of lead poisoning. See page 7 Often called social determinants of health, social, physical, and economic factors differ across neighborhoods and racial lines and deeply influence health outcomes. These factors, shaped by racism, are beyond individual control and can trump individual efforts to be healthy. Making healthy choices is harder when healthy conditions we live in help to determine what our health experience looks options are limited. For The and feels like throughout our lives. example, it’s harder to eat a healthy diet if you live in a neighborhood without supermarkets tes.1 Research provides clear evidence that or where few stores offer fresh affordable residents of neighborhoods where many produce. Living in such a neighborhood people are poor, where schools don’t have can contribute to unhealthy eating, being enough money to hire qualified teachers overweight, and having type 2 diabeContinued on page 10 Food Matters Understanding that place and race matter for health, we must explore the root causes of why communities of color experience higher rates of diabetes, overweight, and obesity than White communities. This article explores some of the social, economic, and physical factors that shape our food environments. See page 11 “Good” neighborhood/ “Bad” neighborhood? Categorizing things as “good” and “bad” is part of our cultural norm. However, when we stop and think about the history of calling some neighborhoods “good” and others “bad,” it reveals a lot about this nation’s history of racism. In 1944, the US Federal Housing Administration adopted color-coded maps that marked neighborhoods where people of color lived with red lines and sanctioned them as “hazardous investments.” This racist practice was adopted as a way to keep people of color out of the home-owning market.1 According to the Joint Center for Political and Economic Studies, “People of color are more likely to live in high-poverty neighborhoods because of a host of historical and contemporary factors that facilitate segregation, such as the ripple effects of Jim Crow segregation, ‘redlining’— the now-banned but persistent practice of disinvestment and economic discrimination against communities of color—and contemporary discrimination such as steering of minority home-buyers or renters away from majority White communities.”2 Racism and Stress Racism acts as a chronic stressor, causing the same effects on the body as losing a job or divorce: higher blood pressure, elevated heart rate, increases in stress hormone levels, and less ability to fight off illness. See page 8 Race Matters Race has no biological basis. Research shows that there is not one characteristic, trait, or even one gene that distinguishes all members of one race from all members of another race. Most genetic variation is within races, not between races. For example, a Korean and an African-American may have more genetic similarities than two Koreans or two African-Americans. However, race is a powerful social idea created to divide people by skin color and physical characteristics to justify unequal treatment. Throughout our history, social and economic policies giving advantages to White people have enabled them to build wealth and power, while placing barriers in the paths of people of color as they try to achieve success. Such policies do not always rely on individual racist acts. They are built into institutions in ways that create unfair results. Examples of such policies include discriminatory Breathe Easy The Boston Public Health Commission’s Healthy Homes Division has been working for several years with the Boston Housing Authority on smoke-free housing, managing pests, and other efforts focused on reducing the risk and triggers for asthma. See page 9 lending practices by banks that make it more difficult for people of color to purchase homes or live in healthy neighborhoods, inequitable funding of schools, and racial profiling. Our nation’s history of racial oppression has left us with a clear connection between place, race, and health inequities. Because of unequal access to education and job opportunities, people of color, on average, have lower incomes and less wealth than White people. Less money, coupled with discriminatory housing policies, leaves many more people of color living in poorer neighborhoods. In such neighborhoods it is more difficult to find healthy foods and safe places to exercise and often the quality of education is less than in wealthier neighborhoods. In addition, job opportunities are fewer and air pollution and other environmental hazards are worse. These factors lead to poorer Continued on page 6 Continued on page 12 2 Boston by the Numbers Boston is the largest city in Massachusetts. The city’s population has changed over time, with the 2010 US Census reporting 617,594 residents. Understanding the health of Boston begins with a deeper understanding of this place we call home. Boston is a city of neighborhoods, each with its own unique physical and social characteristics. Data Corner Several points are important to note about the data presented in this paper: • Data is drawn from a number of sources including the Massachusetts Department of Public Health, the U.S. Census Bureau, and the Boston Behavioral Risk Factor Survey. • The time between collecting data and making data publicly available varies by type of data. Some data might be available immediately after it is collected, while other data may not be available for two years. For example, 2010 birth data was not available until 2012. Survey data is generally collected every other year. • Public health data are essential to understanding and tracking changes in health inequities. Because data may vary year-to-year, it is important to look at trends. For example, outcomes for a specific health condition may be unusually positive for people of color in a specific year. However, it would be important to review the years after to determine if this is a temporary or permanent improvement. Sometimes a peak or drop in the data in one year reflects a change in the way data was reported or analyzed. • Data points represent people and the quality of their health. Seeing this data about our own city and communities can be difficult, especially when it shows inequity and injustice. • The Boston Public Health Commission publishes an annual report on the health of Boston residents. The report is published online and in hard copy. Individuals interested in examining additional types of health data or in learning more about how public health data are analyzed and presented are encouraged to review the report at www.bphc.org. Health of Boston: A Neighborhood Fo cus In 2010: 1 in 4 Boston residents lived below the poverty level.* In 2010: 24% of Boston residents had a high school diploma/GED 18% had some college/ Associates degree. 44% had a Bachelor’s degree or higher. 2012-2013 yor, City of Boston Thomas M. Menino, Ma H, Chair Paula Johnson, MD, MP lic Health Commission Board of the Boston Pub tor H, MEd, Executive Direc Barbara Ferrer, PhD, MP ommission Boston Public Health C on Building a Healthy Bost *DATA SOURCE: U.S. Census Bureau, 2010 American Community Survey Average life expectancy at birth for Boston residents was 77.9 years for the combined years of 2000-2009. Back Bay, Allston/Brighton, and North End residents had the highest average life expectancy while residents of Roxbury, South Boston, and North Dorchester had the lowest average life expectancy. The average life expectancy for Back Bay residents (the highest of all Boston neighborhoods) was almost 6 years more than Boston residents overall. The average life expectancy for Roxbury residents (the lowest of all Boston neighborhoods) was about 4 years less than for Boston overall and for South Boston residents about 3 years less. CHARLESTOWN 76.8 NORTH END 80.0 ALLSTON/BRIGHTON 81.8 BACK BAY SOUTH 83.7 END FENWAY 78.3 SOUTH 78.8 BOSTON 74.6 ROXBURY 74.0 JAMAICA PLAIN 79.3 ROSLINDALE 77.4 MATTAPAN 76.5 HYDE PARK 77.5 EAST BOSTON 78.2 Life Expectancy in Years 74.0 - 76.4 76.5 - 78.8 78.9 - 81.3 81.4 - 83.7 NORTH DORCHESTER 76.2 WEST ROXBURY 79.7 SOUTH DORCHESTER 77 .0 Life Expectancy, Boston, 2000-2009 Combined. Note: 2000 U.S. Census Population used for life expectancy. Data Sources: Boston resident deaths, Massachusetts Department of Public Health; Census 2000, US Department of Commerce, Bureau of the Census. Data Analysis: Boston Public Health Commission Research and Evaluation Office. 3 The city has become more racially and ethnically diverse over the past several decades. In 2010, 27% of Boston residents were foreign-born, originating from a wide array of countries such as the Dominican Republic, China, and Haiti.1 These diverse populations represent a variety of languages including Spanish, French, Chinese, and Vietnamese. The percentage of Latino residents in Boston has continued to increase from 6% in 1980 to 18% in 2010. Understanding the city’s diversity is essential to developing policies and strategies that address health inequity in Boston. In recent years, Boston’s racial make-up has shifted, with people of color making up the majority of the city’s population as of 2010. However, this shift has not happened consistently across neighborhoods. People of color is a term used to unify racial and ethnic groups in solidarity with one another and describes people who would generally not be categorized as White. The term is meant to be inclusive among people usually categorized as “racial minorities,” emphasizing common experiences of racism.2 Minority, which means “less than,” is becoming less and less statistically true in many places, like Boston, where the numbers of people of color make up a larger portion of the population than White people.3 2% 2% 17% 47% 22% 9% In 2010: 1 in 8 Boston residents were unemployed.* ›› White Asian Black Latino (of any race) Other Race* Two or More Races residents were unemployed. ›› 1 in 4 Black residents and 1 in 5 Latino *Includes American Indians/Alaskan Natives, Native Hawaiian/Other Pacific Islanders, and Some Other Races Population by Race/Ethnicity, Boston, 2010. Data source: Census 2010, US Department of Commerce, Bureau of the Census. Data analysis: Boston Public Health Commission Research and Evaluation Office. 1 in 8 Asian By percentage, Mattapan has the most Black residents, the North End the most White residents, East Boston the most Latino residents, and the South End the most Asian residents.4 The map below also shows that many parts of Boston are racially segregated with a concentration of Black and Latino residents living in the same neighborhoods while a concentration of White residents live in other neighborhoods with few people of color. Each dot on the map represents 100 residents. residents and 1 in 13 White residents were unemployed. In 2010: Among Boston Racial/Ethnic Groups, 2010 (1 dot = 100 residents) Asian Black Latino White residents, 36% owned homes while 64% rented.** ›› ›› residents and 4.5 in 10 White 3 in 10 Black residents were homeowners. ›› Distribution of Racial/Ethnic Groups, Boston, 2010. Data Source: Census 2010, US Department of Commerce, Bureau of the Census. Data Analysis: Boston Public Health Commission Research and Evaluation Office. residents and ›› 3 in 10 Asian 2 in 10 Latino According to the Joint Center for Political and Economic Studies, “segregation is associated with poorer health because it concentrates poverty, thereby excluding and isolating people of color from mainstream resources necessary for economic mobility, such as good schools, good jobs, and access to banks and capital for business development.”5 There are many reasons for (and consequences of) residential segregation, some of which are covered in this paper. It is important to note that racial segregation does not occur simply because people choose to live near people of the same racial group as themselves. It is the result of deliberate housing policies of the federal, state, and local governments.6 1 2 3 4 5 6 residents were also homeowners. *DATA SOURCE: U.S. Census Bureau, 2010 American Community Survey **DATA SOURCE: Census 2010, US Department of Commerce, Bureau of the Census American Communities Survey, 2010 Sen, R. (2012, May 12). Opinion: Minorities: Try People of Color. CNN: In America http://inamerica.blogs.cnn.com/2012/05/18/ opinion-minorities-try-people-of-color/ Adapted from the Boston Public Health Commission, Racial Justice and Health Equity Initiative: Core Workshop Facilitator’s Guide, Nov 2011. Health of Boston 2011, Boston Public Health Commission Research and Evaluation Office, Boston, Massachusetts. Wenger, M. Place Matters: Ensuring Opportunities for Good Health for All. Joint Center for Political and Economic Studies, September 2012. Massey, D.S. (2004). SEGREGATION AND STRATIFICATION: A Biosocial Perspective. Du Bois Review, 1 , pp 7-25 doi:10.1017/S1742058X04040032 4 Word on the Street A Teeny Story in Jamaica Plain by Youth of the Jamaica Plain Equity Collaborative T eeny is one name for the beverage in the picture to the right. Some youth know it by other names, but what is universally accepted about this beverage is that it offers nothing good to you. You don’t find teenies in every store in Jamaica Plain. In fact; these drinks are mostly found in stores that cater to Jamaica Plain’s AfricanAmerican & Latino communities. Other stores in Jamaica Plain have fresh juice for sale and encourage healthy eating. How can stores, divided by a few blocks, impact the value of resources available to people? Life’s basic needs such as housing, education, and jobs are distributed unequally just like the Teeny. As anyone from Jamaica Plain will tell you, there are two Jamaica Plains. In one part of Jamaica Plain, people are wealthier, homes are in good condition, and the youth are doing well. In the other part of Jamaica Plain, people have less money, and many young people are struggling in school and dealing with issues of community violence. These inequities create worse short term and long term health problems for African American and Latino youth and their families. The block you live on indicates your access to a healthy and safe life. We might share a zip code, but communities in Jamaica Plain don’t share the same health outcomes.1 Go Ahead, Have a Feeling by Emmani Nzingha Rawlins W hy is the public school in my district miserable? Why do I feel prettier when my hair is straightened? Why do I feel the need to save or help people of color? Why am I uncomfortable asking any of the aforementioned questions? Two years ago, as an app roach to improving community health, the Southern Jamaica Plain Health Center brought together 16 youth, half of whom identify as White and half of whom identify as people of color, to participate in a year-long racial healing and reconciliation process. I joined the Youth Racial Healing and Reconciliation process last year because I heard about it from a friend who had been a part of the group since its inception. This community opened my eyes to the different levels of privilege and oppression I saw and felt every day, but had no words to express. As a society, we can never address the immense setbacks and psychological effects of racism, for people of all races, until we first learn that it is okay to have a feeling. In fact, one must have a feeling in order to start the healing process. We coined the phrase “you have to feel to heal to deal.” This is our motto because we believe that much of the denial of racism’s existence comes from unresolved and repressed emotions, which, when left ignored, only yield superficial exploration of racial politics. Through readings, racial affinity groups, workshops, healing circles and speak outs, we were challenged to move beyond intellectual conversations about race and racism and to support each other, to experience the feelings that come up when we talk about racism, and to understand the ways it shapes our existence. Through the process of racial healing, I learned a lot about the history of racism and the history of America, which go hand-in-hand. Above all, I have come to understand myself better as a person. I now understand that before joining the team, I wasn’t really living with my entire self, which isn’t really living at all. I was usually stuck in my head or my heart, and except for a few moments of insight, I could never be one-hundred percent truthful with myself or anyone else because my thoughts and feelings were not connected. Our team absolutely believes in the power of the unity between head and heart. When I experience the unity of my thoughts and feelings, I see my life with greater clarity, and it enables me to communicate with others more effectively. Moving through life hiding inside my head by virtue of defense mechanisms and rationalization, or hiding behind my emotions—never finding harmony between the two— is an easy escape, but the real work comes when I can take stock of my life and be held accountable for my own actions, thoughts, prejudices, and struggles. I learned that it is okay to “have a feeling,” because those feelings are what keep me grounded in reality. I cannot take care of myself or my pain until I first admit that I am feeling some sort of pain. I cannot address a problem with someone else until we both make it known that there is a problem. It was a powerful moment in my life when I finally understood this important process as my truth, but just understanding isn’t enough; in those painfully cliché words, “You have to walk your talk.” I agreed with everything I was learning through the process, but I did not see any change in myself or my relationships until I actually held myself to being as “real” as possible, inside and out. Being so truthful with myself and others can be uncomfortable because most people aren’t used to that level of honesty, but it is necessary if we want to fortify the relationships we already have and to create more meaningful, sincere connections with each other in the future. We invited a camera to follow us in some of our activities, community teachings, and an emotional speak out activity. I am thrilled to share with you this video documenting part of our process and our charge to the adults in our communities. http:// youtu.be/QtDfajOTayM 1 02130 Health + Youth, Jamaica Plain Youth Health Equity Collaborative Report, 2011 5 Word on the Street is a collection of opinion pieces written by people involved in the movement for health equity in Boston. These articles represent personal opinions of the authors, and except for the article by Dr. Ferrer, they are not endorsed by the Boston Public Health Commission. Extending my REACH ’ll never forget the first time I went to a community meeting about the health of Boston. It was the first place I heard details about how the health status of Boston residents differs by race and ethnicity. Being a Jamaican woman, I paid close attention to the stats about Black residents. What I saw made me so angry. Learning this information left me with many questions about why the health of Boston residents differs by skin color. At the time I came to my first meeting in 2005, the Boston REACH Coalition had established itself as a space for learning about health and well-being, organizing around policies to promote equity, and sharing information about what was going on in the community. By the end of the meeting I felt a combination of anger about the state of the health of Black Boston and resolve I By Shauntell Foster-Dunbar to get involved. What I didn’t know at the time, was that getting involved would include a deeply personal process of fully understanding how the past has shaped my experience as a Black woman in Boston. In reflecting back on my upbringing in Jamaica, I realized the subtle messages I had internalized about race. When a White person came to our house, I saw my family react differently than when other people came over. They jumped up and offered their seats, and spoke in hushed envious tones about our guest’s hair, their skin, and the way they talked. I learned from a young age that everything they were was better than I was. Better than we were. I acted out my feelings of inferiority by asking my grandmother to hot comb my hair so it could look like our guest. When I first came to Boston, I was excited to be enrolled in a predominantly White school, and I wanted to date only White boys, not realizing that they were not as excited as I was to be around them. As I got older and went to a more racially diverse school, my racial identity changed in another way. I now had more Black friends, but I still felt confused about my own racial identity. I didn’t identify with African Americans. “I am nothing like them,” I said. I was exposed to messages, some subtle and others not, about African Americans being lazy, thieving people who did not work. I began to cling tightly to my Jamaican identity as a way to protect myself from those stereotypes of other Black people in this country. Participating in the REACH Co alition meetings really has changed who I am. Prior to joining, I didn’t understand the impact of structural rac- ism. I didn’t understand my own internalized racism. I saw acts of interpersonal prejudice between people, but unless it happened to me or my family, I used to say that racism didn’t exist or at least didn’t impact me. When I learned about the history, of colonization and about movement building, I began to see my experience reflected in those of African Americans and other people of color at the Coalition. It was at that first REACH meeting I attended where I heard about Black women’s health that I began to really see myself in the data. Not just that the numbers spoke to the health of my family, but that my lived experience has been shaped by racism, and our collective health continues to be shaped by it. Since that first REACH Coalition meeting, I’ve met a lot of people committed to working in solidarity. We have an action plan to work on educating more residents about health inequity, taking action on policies related to the social, economic, and physical environments that impact our health, and building a strong network of people to work towards racial equity. The more I learn, the more I see. I’m still mad about the data. But I keep coming back to REACH because I need a place to plug into social change, and I am able to turn my anger about racial inequity into something productive. Shauntell Foster-Dunbar is Co-chair of the Boston REACH Coalition which meets the first Monday of every month. For more information, call 617-534-2291. Building a Healthy Boston I By Barbara Ferrer, Executive Director, Boston Public Health Commission n Boston, we have made significant progress improving the health status for many of our residents. Mortality rates have dropped steadily for the past 10 years. There are significantly fewer teen pregnancies, a near disappearance of lead-poisoned children, and fewer people are smoking tobacco. Our success is a result of improved monitoring, advances in medical research, increased access to prevention, screening, diagnosis, and treatment, and policy changes that reduced exposure to harmful substances. As Commissioner of Public Health in Boston, I know all too well that there are groups of residents in Boston that have not benefited equally from our progress and who bear a severe and unequal burden of diseases. To tackle this imbalance, we must understand and address the many issues that influence our health, paying particular attention to finding approaches that allow all residents to have equal access to the conditions that promote the best possible health. In the recent past, many of our programs have focused on individuals. These programs intended to influence knowledge, attitudes, and behaviors. Moving forward, we will need to prioritize strategies that focus on the interpersonal, community, and societal influences of disease and health. We will need to understand how racism and poverty limit the opportunity for many Boston residents to make healthy choices and have led, in particular, to significantly worse health outcomes for many Black residents in the city. As the articles in this paper describe, health is influenced by where we live, the jobs we hold, our knowledge of risk, our access to resources, and our support systems. It is critically important that our public health programs recognize and address these broader realities. With this in mind, the Boston Public Health Commission has developed overarching public health goals. While we will continue to make progress in many areas to improve the health of the City of Boston, we have chosen to focus the efforts of the entire health department on three problems that unequally affect people of color. We are committed to reducing the rates of chlamydia infection, low birth weight, and overweight/obesity over the next five years. Chlamydia, the most frequently reported sexually transmitted infection, if left untreated can cause infertility in women. In Boston, Blacks and Latinos had chlamydia rates seven to eleven times higher than Whites. Low birth weight is a serious cause of infant death and a risk factor for developmental difficulties during childhood and chronic diseases later in life. In Boston and across the nation, Black babies are born at a low birth weight more frequently than babies of any other racial or ethnic group. Overweight and obesity are linked to nearly thirty preventable diseases, such as Type 2 diabetes, certain cancers, heart attacks and strokes. In Boston, Black and Latina women and girls have the highest rates of both overweight and obesity. The good news is that research has shown promis- ing ways to tackle these three health problems. Over the next five years, the Boston Public Health Commission will build upon our existing work and continue to develop new approaches with partners throughout the city to reduce the rates of chlamydia, low birth weight, and overweight/ obesity. We will also reduce the unequal burden of these diseases—the health inequity gap— for people of color by twenty to thirty percent. As we move forward together, I welcome the support of all Bostonians in helping to achieve these goals to ensure that our progress towards a healthier city can be equally shared by all. 6 Neighborhood Spotlight Welcome to Mattapan Vivien Morris is one of the city’s health champions. A long-time Mattapan resident and parent of two, this registered dietitian has been committed to the health and wellness of the place she calls home for many years. In 2005, Vivien helped to start the Mattapan Food and Fitness Coalition (MFFC), a group of residents and community organizations working to increase access to physical activity and healthy food for Mattapan residents. They knew the messages from the medical community and media about eating healthy could only serve people who had access to healthy options. Since 2006, the Mattapan Food and Fitness Coalition has organized a farmers market in the heart of Mattapan. The MFFC youth expanded that project this year to include a mobile farm stand. MFFC also supports community gardening. The Grow Your Own initiative, led by The Food Project, has increased access to affordable fresh produce in Mattapan, Dorchester, and Roxbury, through the creation of 400 backyard gardens throughout the three neighborhoods. By bridging differences in age, class, ethnicity, educational and economic background, community gardens have become valued parts of neighborhoods and places of individual and collective pride. Vivien speaks fervently about the good things happening in Mattapan. She credits the youth of Mattapan for inspiring and leading much of the efforts. “The youth of the Mattapan Food and Fitness Coalition see the challenges in their neighborhood and are less blinded by fear that change is not possible. They are sure that it is. When we allow the youth to lead they pull us all out of our limited vision and challenge us to see and make manifest the possibilities,” she said. Mattapan United, a collective of organizations and coalitions, is working to improve quality of life by improving access to jobs and education and ensuring their neighborhood is maintained with clean streets and parks. This group was born out of the community’s response to violence, channeling their energy into sustainof color is not all in the past. For 20 years, there has been an effort to create the Neponset River Greenway, a walking and biking park to stretch from the Boston harbor to Hyde Park along the Neponset River. To the south, east, and west of Mattapan, the development and construction of Pope John Paul Park happened early on and quickly. This area is state land that borders Boston and Milton, so the three jurisdictions have a stake in what happens. However, there is a glaring break in the greenway, and it is at the part of the greenway that abuts Mattapan and divides Mattapan from neighboring Milton. Construction delays have been blamed on a lack of state funding to complete the project. Progress has also been challenged by resistance from residents in Milton and the stereotype of Mattapan as a “bad” neighborhood. There are supporters on both sides of the undeveloped land who have been working for years to redraw the plans in a way that is favored by residents on both sides of the river. This has led to new agreements between the neighborhoods to complete the greenway. Unfortunately, the resources still are not available. Achieving equity in health requires prioritizing resources and investment in communities that have historically seen disinvestment. “Mattapan is not a community looking for handouts. Just imagine what could be in this community if we were allowed the resources invested in other communities,” Vivien said. Mattapan has a long road ahead of it to improve the environment that promotes the health of its residents. The history of disinvestment in communities of color is a result of racism that still affects Mattapan today. 1 Vivien Morris Mattapan Food and Fitness Coalition (MFFC) “The youth of the MFFC see the challenges of their neighborhood and are less blinded by the fear that change is not possible. They are sure that it is. When we allow the youth to lead, they pull us all out of our limited vision and challenge us to see and make manifest the possibilities.” able social change. In August 2012, Mattapan celebrated the opening of a brand new community health center. The Mattapan Community Health Center has always been an anchor in the neighborhood and now, sharing physical space with other local businesses, this new facility is an economic anchor. Mattapan Community Health Center is a true community partner, having been part of many efforts to invest in and invigorate the community from its very beginning. Residents of Mattapan have long been organizing to ensure high quality education for residents of Mattapan, recognizing the power of schools as a gateway to the future for our youth. “It’s not just about having a fancy new building or about saving money on bussing to other schools. We are a community of young people, but it’s not about the numbers. It’s about investment in the community and about what education can do to transform a community” said Vivien. In 2009, doors opened to a new public library in Mattapan that has since become a cultural institution promoting literacy. That investment is paying off, as it has become one of the most highly utilized libraries in the city of Boston. Mattapan is a young neighborhood, with over one fifth of the population under age 18.1 It is a working class community and is home to Boston’s second largest percentage of residents born outside of the U.S.2 Over the last two decades, Mattapan has become home to many Haitian immigrants. The neighborhood now has the largest Haitian community in Massachusetts.3 Many Mattapan residents work multiple low wage jobs because of their immigration status, despite having come to this country with substantial education and experience. Today Mattapan is more than 80% Black,4 but until the late 1960s Mattapan was a largely White community.5 This population shift was not by accident; it was the result of racebased banking and real estate practices. These practices resulted in flourishing suburbs and disinvestment in inner city communities such as Mattapan, which faced the additional loss of businesses and a reputation that discouraged future investment. While the new construction and coalitions in Mattapan are promising, disinvestment in communities 2 3 4 5 Health of Boston 2011, Boston Public Health Commission Research and Evaluation Office, Boston, Massachusetts. Data source: U.S. Census Bureau, American Community Survey 2006-2010 estimates. Boston Redevelopment Authority Research Division Analysis Data source: U.S. Census Bureau, 2010 American FactFinder Data source: U.S. Census Bureau, 2010 American FactFinder Gamm, G. (2001) Urban Exodus: Why the Jews Left Boston and the Catholics Stayed. First Harvard University Press. Race Matters Continued from the cover health outcomes. People of color, on average have higher rates of many illnesses.1 Understanding the multiple ways racism shapes health is necessary to address inequities in health. Racial justice is the creation and proactive support of policies, practices, attitudes, and actions that turn out fair power, access, opportunities, treatment, and outcomes for all people, regardless of race.2 The Mattapan Food and Fitness Coalition draws on the wonderful ethnic and cultural diversity of the Mattapan community to promote a healthy living environment, with a focus on access to healthy foods and the promotion of physical fitness for all ages. 1 Health of Boston 2012-2013, Boston Public Health Commission Research and Evaluation Office, Boston, Massachusetts. 2 Adapted from the Boston Public Health Commission, Racial Justice and Health Equity Initiative: Core Workshop Facilitator’s Guide, Nov 2011. 7 The Greening of Boston’s Auto Shops There are over 500 auto body and repair shops in Boston, many disproportionately clustered in low income communities of color such as Roxbury, Dorchester, and the South End. Although they are an important source of wellpaying skilled jobs, the chemicals and processes involved can also make them sources of air, soil, and water pollution in the neighborhood and put their workers at risk of occupational asthma and other health problems. Through the Boston Public Health Commission’s Safe Shops Project, many of these businesses are working to address these risks and reduce their pollution impact on the neighborhoods in which they are located. The owners and workers of these shops have chosen to invest their time and money in learning about better work practices and switching to safer alternative products. These choices protect the health of workers and the neighborhood environment. The United States Environmental Protection Agency and the Toxic Use Reduction Institute at UMass Lowell recently provided the Safe Shops Project with funds to help 22 auto body and repair shops take part in a trial use of water-based brake cleaner and paint spray gun washer in place of the toxic solvent-based products they had been using. Seventeen auto shops, mostly in the neighborhoods of Roxbury, Dorchester, and Jamaica Plain, were able to switch their harmful spray brake cleaner with a waterbased cleaner. Spray brake cleaners release into the environment and expose workers to harmful solvents. Not only does the water-based cleaner reduce worker exposure to these chemicals, but it also reduces exposure to asbestos, which can still be found in some brake pads and clutch linings. Most people mistakenly believe asbestos use has been completely eliminated and therefore do not wear the right mask to protect themselves while performing a brake job. A graduate of the Safe Shops Program, 912 Auto Center and owner Larry Dos Santos have made a number of changes to prevent pollution and green the shop. Most significantly, 912 Auto Center switched from solvent-based paints to waterbased car paints. The waterbased paint reduces worker exposure to solvents that can cause breathing problems and brain damage, as well as increase risks of cancer. This switch also means neighbors are protected from these Rafael Soto from J & C Auto Repair demonstrates how to use a hydrophobic mop. Photo courtesy Safe Shops News Letter 2008 Johnny’s Auto Center, 120 Blue Hill Ave, Roxbury. Photo courtesy Safe Shops News Letter 2011 chemicals. For his efforts, his shop was one of the winners of the 6th Annual Mayor’s Green Awards in April 2012. Dos Santos also installed an indoor ventilation system that reduces indoor air pollution and makes the heating and cooling system more efficient. He has provided training to his workers on safety and personal protective equipment to reduce pollution and protect themselves from toxic exposures. The Safe Shops Project applauds Alfredo Bautista at Alfredo Auto Repair, Mario Mejia at DR Auto Repair, Rafael Soto at J&C Auto Repair, and Xavier Mejia at Xavier Auto Repair for using a hydrophobic mop technology to clean up spills and recycle oil. This mop can absorb oil in a cleaner and safer way than the traditional mop and does not collect water or antifreeze, allowing the oil to be collected and recycled. It is common practice to use kitty litter to soak up spills, but that generates hazardous waste. The use of this new hydrophobic mop has improved the way employees collect oil from the floor without worrying about it getting into the environment. Boston’s Success in Reducing Lead Poisoning in Children Boston has made great progress in reducing the number of children with high blood lead levels as well as maintaining high lead screening rates. Children under age six are most at risk for lead poisoning. Lead poisoning is a serious but preventable disease that affects the development of a child, and can cause serious speech, hearing, learning, and behavior problems. If left untreated, lead poisoning can permanently damage a child’s brain, 20 18 16 14 12 10 8 6 4 2 0 18.4 14.7 13.5 11.2 10.9 8.1 6.3 5.3 4.6 kidney, blood, and nervous system. Major sources of lead exposure are lead-based paint and lead contaminated dust found in deteriorating buildings. Almost 90% of Boston’s housing was built before 1978 and often contains lead-based paint. Lead poisoning is concentrated in Boston neighborhoods that are predominantly communities of color: Dorchester, Mattapan and Roxbury. In November of 2010, officials from 4.0 3.2 2.7 2.2 2.0 1.6 1.2 1.2 0.9 0.7 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Children Less Than Six Years of Age With Elevated Blood Lead Levels (≥ 10 µg/dL), Boston, 1993-2011. Data Source and Analysis: Boston Public Health Commission Office of Environmental Health. the federal government visited Boston to celebrate Boston’s success in reducing the incidence of childhood lead poisoning – the number of Boston children diagnosed with high blood lead levels (greater than or equal to 10 μg/dL) has dropped by 96% since 1993. The number of children with high blood lead levels dropped from 5,590 in 1993 to 151 in 2011.1 This achievement is due to collaborative efforts between federal, state and local partners, parents, and others to offer lead education and de-leading training to landlords, homeowners and parents over the last two decades. There is still work to do to completely eliminate lead poisoning in Boston, particularly in low-income neighborhoods of color. In May 2012, the Centers for Disease Control and Prevention recommended the old 1 clinical lead poisoning level of greater than or equal to 10 μg/dL be dropped to greater than 5 μg/dL, and that surveillance and monitoring of children be implemented. As of 2011, there are approximately 900 children under the age of six with elevated lead levels between 5 μg/dL and 10 μg/ dL in Boston. The Lead Poisoning Prevention program at the Boston Public Health Commission implemented new lead poisoning guidelines in September 2012 with medical, health education, outreach, and environmental interventions. Boston Public Health Commission Environmental Health Office. 8 “The Canary in the Mine” Life-course theory Canaries were once used in coal mining as an early warning system.1 Before advances in ventilation and air quality monitoring, miners would release a canary into a mine before entering to see if toxic gases were present. The presence of toxic gases would kill the bird, and if the miners didn’t hear the bird singing they knew that conditions were unsafe. If the canary kept singing, it was a sign that the miners could enter. The phrase “canary in the coal mine” is used to refer to an early warning sign of a disaster. Just like coal miners used canaries, public health officials know that certain health outcomes are an indication of what’s to come. Birth outcomes are one health outcome that tells us a lot about the health of the rest of the population. The Boston Public Health Commission is committed to reducing the gap in low birth weight rates (babies weighing less than 5 pounds, 8 ounces, at birth) between Black and White babies by 25% by 2016. Being born at a low birth weight deeply affects an individual’s health and life-chances in several ways. Low 16% Percent of Low Birth Weight Births within Race/Ethnicity birth weight is a common factor in infant death during the ﬁrst year of life. More than 74% of infant deaths in the U.S. are due to babies being born at a low birth weight.2 Between 2000 and 2010, the rate of Black infant deaths was consistently higher than the Boston average and the rates of White, Asian, and Latino infant deaths. The graph below shows the percentage of low birth weight births within race and ethnicity between 2000 and 2010. A greater percentage of Black babies were born low birth weight than White, Latino, and Asian babies. A number of studies have shown chronic stress on women over time may play a major role in the negative outcomes for mothers and their infants.3 These stressors include, but are not limited to, racism, domestic violence, and inadequate access to health resources and housing. Nationally, housing is a major challenge for low-income families. Homelessness, which increased 20% for families between 2007 and 2010, is one form of housing stress.4 Other common causes of housing stress expe- 12% 8% 4% 0% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 BOSTON Asian Black Latino White Low Birth Weight Births Within Race/Ethnicity, Boston, 2000-2010. Data Source: Boston resident live births, Massachusetts Department of Public Health. Data Analysis: Boston Public Health Commission Research and Evaluation Office. rienced by low-income families include trouble paying rent, spending the majority of income on rent, living with other families in one housing unit, and bouncing among friends and relatives.5 The relationship between housing stress, pregnancy, and birth outcomes is complex. Pregnancy increases the risk of homelessness, and having a child clearly increases the need for space. Almost half of US women are not entitled to paid sick or maternity leave.6 There has been a lot of research about the relationship between homelessness and health. For pregnant women, homelessness is often associated with poor physical health, depression, unmet need for health care,7,8,9 lower birth weight, premature birth, and developmental delays for their babies.10,11,12 In November 2011, the Healthy Start in Housing program was announced as a collaborative effort between the city’s public health department and the city’s housing authority. The Healthy Start in Housing program is an initiative aimed at lessening the stress on pregnant women who are at risk of having a poor birth outcome by providing them with housing, counseling, and other needed support. This is the first coordinated initiative of its kind in the country that addresses the multiple stressors that pregnant women of color in Boston face. 1 Man And His Machines: Resuscitation Cage For Mine Canaries”. The World’s Work: A History of Our Time XLIV (2): 474. August 1914. 2 BPHC Briefing on Infant Mortality Reduction 3 Health of Boston 2011, Boston Public Health Commission Research and Evaluation Office, Boston, Massachusetts. 4 United States Department of Housing and Urban Development (2010) 2010 Annual Homeless Assessment Report to Congress. 5 Joint Center for Housing Studies of Harvard University (2011) State of Nation’s Housing. 6 Institute for Women’s Policy Research, Family Leave & Paid Sick Days. 2010. 7 Lewis, J., R. Andersen, and L. Gelberg, Health care for homeless women. Journal of General Internal Medicine, 2003. 18(11): p. 921-928. 8 Institute for Children, P.H. (2012) Profiles of Risk: Maternal Health and Well-being. 9 Richards, R., R.M. Merrill, and L. Baksh, Health Behaviors and Infant Health Outcomes in Homeless Pregnant Women in the United States. Pediatrics, 2011. 128(3): p. 438-446. 10 Merrill, R.M., R. Richards, and A. Sloan, Prenatal Maternal Stress and Physical Abuse among Homeless Women and Infant Health Outcomes in the United States. Epidemiology Research International, 2011. 2011(Journal Article). 11 Stein, J.A., M.C. Lu, and L. Gelberg, Severity of Homelessness and Adverse Birth Outcomes. Health Psychology, 2000. 19(6): p. 524-534. 12 Park, J.M., A.R. Fertig, and P.D. Allison, Physical and mental health, cognitive development, and health care use by housing status of low-income young children in 20 American cities: a prospective cohort study. American Journal of Public Health, 2011. 101 Suppl 1: p. S255-61. Racism and Stress Racism acts as a chronic stressor, causing the same effects on the body as losing a job or divorce: higher blood pressure, elevated heart rate, increases in stress hormone levels, and less ability to fight off illness.1 Even if a person of color doesn’t feel that he or she has experienced overt racism, experiences where racism may be subtle could set off a stress reaction. Did I not get a call back for that job because of my name? Did she move to another seat because of my skin color? The answers do not have to be “yes” to cause stress. Simply thinking about your race regularly and asking yourself these questions can cause stress. We must start by acknowledging that racism impacts health by adding stress and reducing life expectancy. “In our society today, everybody experiences stress. However, in many disadvantaged communities what we have is the accumulation of multiple, negative stressors and it’s so many of them it’s as if someone is being hit from every single side. And it’s not only that they’re dealing with a lot of stress, they have few resources to cope.” —Dr. David Williams2 1 Wyatt, S.B., Williams, D.R., Calvin, R., Henderson, F., Walker, E., and Winters, K. (2003) Racism and Cardiovascular Disease in African Americans: Evidence and Implications for the Jackson Heart Study. American Journal of Medical Sciences 325(6):315-331. 2 David Williams, Unnatural Causes: Place Matters, Executive Producer Larry Adelman (2008; San Francisco, CA: California Newsreel) DVD. 9 Breathe Easy What is Asthma? Asthma is a chronic respiratory disease that results in episodes of coughing, wheezing, difficulty breathing, and chest tightness. People with asthma have airways that are very sensitive to triggers in the environment. An asthma attack can be triggered by many factors including mold, pet dander, dust mites, cockroaches, and other allergens, as well as certain chemicals, exposure to tobacco smoke, and infections, including the common cold. Stress can also lead to mold and dust in the home may increase risk of hospitalization, as can having a smoker in the home. Other environmental conditions like the presence of auto shops and bus depots around the neighborhood can increase environmental exposure to things that can make asthma worse, as compared to a neighborhood with more parks and green spaces that minimize air pollution. To ensure that people with asthma can be healthy and active, it is important to address these physical and be able to sleep through the night, go to work or school, be physically active, and climb the stairs instead of taking an elevator. Creating healthy environments in homes and neighborhoods by reducing exposure to known triggers is essential to reducing asthma hospitalization.1 What is the Boston Public Health Commission doing to address these issues? The Boston Public Health Commission’s Asthma Pre vention and Control Program provides home visits to Boston children and adults with asthma who are referred by a doctor or nurse. The program works closely with other city agencies, including the Boston Housing Authority and Boston Inspectional Services Department, to ensure that Boston housing is healthy for all Boston residents. During the asthma home visits, a trained community health worker provides education about the causes and triggers of asthma, information on asthma medications and how to use them, referrals for other resources like smoking cessation, pest control, and housing assistance. Breathe Easy at Home is a program that allows doctors, nurses, or other health professionals to make on-line referrals for their Boston patients with asthma for a home inspection conducted by the Boston Inspectional Services Department. The inspectors identify asthma triggers and enforce the state sanitary code. The state sanitary code is designed to ensure a minDorchester: Codman Square is one of three Boston Housing Authority developments where youth were employed during February school vacation to paint billboards as part of a competition. imum standard of housing, without pests, mold, or other poor housing conditions. Dorchester resident Robenia Chambers and her two children all suffer from asthma. Because of their asthma, her children have had trouble sleeping through the night and making it to school. Robenia has always avoided enroll- for harmful chemicals. Smoke-free homes The Boston Housing Authority has adopted a smoke-free policy, in response to resident complaints and relocation requests due to smoking in some buildings. This effort started when residents of the Washington- Play Lots Community Development Corporation Properties Boston Housing Authority (public housing developments) Boston Hospital Properties Other Smoke-free Housing Boston Public Schools Boston Neighborhoods Smoke-free Areas, Boston, 2012. Map source: Boston Public Health Commission Information and Technology Services, 2012. Roslindale: Washington-Beech resident Meena Carr is seeing the benefits of the smoking ban on her grandson Malik’s health. (Photo credit: Michele McDonald for The Boston Globe / July 27, 2010) trigger asthma. Asthma can be well controlled by avoiding triggers, recognizing and treating attacks early, developing an asthma action plan with a health care provider, and taking the right medicines at the right time. Some things that can increase the risk for having asthma are obesity, a family history of asthma, allergies, and exposure to triggers. How are different people affected by asthma differently? As shown on the map to the right, the highest rates of young children being hospitalized for asthma are concentrated in a few neighborhoods. According to recent data, a child from Roxbury is much more likely to be hospitalized due to asthma than a child from West Roxbury, although the two neighborhoods are only a few miles apart (see map).While in most cases, we can’t prevent asthma, physical and social environments play a big part in how well asthma can be controlled. Poor housing conditions that social conditions. People whose asthma is under control should be able to do what everyone else does. People with asthma should CHARLESTOWN 6.4 EAST BOSTON 6.8 ALLSTON/BRIGHTON 5.2 FENWAY 3.7 BACK BAY 6.8 SOUTH SOUTH END BOSTON ROXBURY 8.8 6.6 Asthma Hospitalizations per 1,000 Population 5.5 or less 5.6 - 11.0 11.1 - 16.5 16.6 - 22.0 22.0 NORTH DORCHESTER JAMAICA PLAIN 17.1 9 .4 WEST ROXBURY ROSLINDALE SOUTH DORCHESTER 4.0 11.0 14.8 14.2 HYDE PARK MATTAPAN 9.7 Asthma Hospitalizations for Children Under Age 5, Boston, 2008-2010 Combined. Data Source: Inpatient Hospital Discharge Database, Massachusetts Center for Health Information and Analysis. Data Analysis: Boston Public Health Commission Research and Evaluation Office. Map Created By: Boston Public Health Commission Research and Evaluation Office. ing her children in activities, including summer camp, that she thought would make their asthma worse. Robenia had an opportunity to work with an asthma home visitor from the BPHC’s asthma program. She learned how to reduce environmental triggers in her home and how to correctly administer the many asthma medicines the family takes. Robenia was referred to the Commission’s Breathe Easy at Home program to address housing conditions like pests and mold. By reducing things in the environment that trigger asthma, Robenia was better able to manage her family’s symptoms. She and her children are having far fewer asthma symptoms, and the children attended camp for the first time this past summer The Commission has also worked in partnership with the Boston Housing Authority, tenants, and resident organizations to transition to smokefree housing and to implement pest management that is effective and limits the need Beech Housing Development asked the Boston Housing Authority to recognize their housing development as smoke-free. As of October 2012, all Boston Housing Authority developments are smoke-free, meaning that smoking is not allowed in any apartments or common spaces. Public housing residents have higher than average prevalence of diabetes, asthma, and many other diseases made worse by secondhand smoke. The Boston Housing Authority is the first large housing authority in the nation to implement a universal smoke-free policy. Public housing is not the only Boston property to go smoke-free. Since 2010, 6,500 units of subsidized and market-rate multi-family housing has also gone smoke-free. 1 Centers for Disease Control and Prevention. Asthma. Centers for Disease Control and Prevention. [Online] September 5, 2006. [Cited: January 20, 2009.] http:// www.cdc.gov/asthma/faqs.htm. 10 Education School segregation is a result of neighborhood segregation, which has shaped access to quality education in Boston. Boston has a complicated history of court-ordered school desegregation that disproportionately affected poor Black and White children. The era of busing and forced desegregation in Boston was an important moment in the city’s history. The violence that met desegregation was a shock to the nation as it clashed with Boston’s image and identity as a “liberal” city.1 However, there is a long and complex history that includes systemic racism, class struggle, divided ethnic communities and many battles for quality education.2 diploma had less than half the annual earnings and were three times more likely to die before the age of 65 compared to adults with at least a bachelor’s degree.3 The percentage of the population with less than a high school diploma is higher in Boston than in the entire state (14.2% and 10.9%, respectively), but is comparable to the rate for the nation as a whole (14.4%).4 Education is a pathway to higher income and wealth, and it also has strong influences on health status and access to health care.5 This map shows that the neighborhoods of East Boston, the South End, Roxbury, Dorchester, and Mattapan had higher percentages of the population with less than a high school diploma than Boston overall. Of these neighborhoods, Roxbury, Dorchester, and Mattapan have higher Allston/Brighton Fenway Roxbury Jamaica Plain Charlestown East Boston Back Bay South End South Boston North Dorchester 14.2% of Boston residents age 25 or older have less than a high school diploma (95% con dence interval: 12.9%-15.5%). West Roxbury Roslindale Mattapan South Dorchester Compared to Boston Overall Signi cantly lower than Boston overall Not signi cantly di erent from Boston overall Signi cantly higher than Boston overall Insu cient sample size Hyde Park Adults with less than a high school diploma In the United States, adults with less than a high school 80% Percent of Population Ages 25+ within Race/Ethnicity Percent of Population With Less Than a High School Diploma, Boston, 2006-2010 Combined. Note: The neighborhood definitions are based on census tracts. Data Source: U.S. Census Bureau, 2006, 2007, 2008, 2009, and 2010 American Community Surveys. rates of poor birth outcomes and chronic disease hospitalization than Boston overall.6 60% 59 44 47 Educational attainment by race/ethnicity The chart on the left shows 1 that in 2010 there were racial differences in the educational attainment of Boston residents. The percentage of Boston residents with less than a high school diploma was highest among Latino adults (32%) and lowest among White adults (7%). The percentage of adults who had completed a bachelor’s degree or higher was highest among White adults and lowest among Black and Latino adults. 40% 32 24 14 20 7 24 20 34 33 19 18 9 27 18 15 19 20% 17 0% 2 Less than HS Diploma HS Diploma/GED Some College/ Associate Degree Bachelor's Degree or Higher 3 4 5 BOSTON Asian Black Latino White Educational Attainment by Race/Ethnicity, Boston, 2010. Data Source: U.S. Census Bureau, 2010, American Community Survey. 6 Logan, J., Oakley, D., Stowell, J. (2003). Segregation in Neighborhoods and Schools: Impacts on Minority Children in the Boston Region. Lewis Mumford Center for Comparative Urban and Regional Research University at Albany. Retrieved from: http://www.s4.brown.edu/ usschools2/reports/report3.pdf Union of Minority Neighborhoods. “Boston Busing/Desegregation Project: For Truth, Learning, and Change. Key Findings to Date.”April, 2011. 20 July 2012. >http://www.unionofminorityneighborhoods.org/images/stories/BBTP-Key_Findings.pdf< Heron M, Hoyert DL, Murphy SL, Xu J, Kochanek KD, Tejada-Vera B. Deaths: Final data for 2006. Natl Vital Stat Rep. 2009;57:1-134. US Census Bureau, 2010 American Community Survey. Joint Center for Political and Economic Studies (November 2012) Place Matters for Health in Boston: Ensuring Opportunities for Good Health for All. Health of Boston 2012-2013, Boston Public Health Commission Research and Evaluation Office, Boston, Massachusetts. Place Matters Continued from the cover or provide adequate equipment and supplies, where there are not enough safe places to exercise, where the air is polluted, where housing is substandard, or where transportation is limited, are likely to have worse health outcomes than residents in neighborhoods where few people are poor and these other problems don’t exist. Because discrimination and racial segregation historically limited the job and housing choices for people of color, they are more likely to live in neighborhoods with these unhealthy conditions. Other factors that shape health include feeling safe, having friends, trusting neighbors, education, and financial stability. Research has shown that supportive friends and family can serve to protect against stress and depression, which in turn, protect against physical and mental illness.2 Racism also causes stress. Sometimes you know it, and sometimes you don’t. (See Four Levels of Racism at right.) Unfair differences in health experiences of racial groups have been a reality throughout our history. To tackle this injustice, we must understand and address the many factors shaping our individual and collective health and provide all residents with fair access to the conditions that promote the best possible health. When no one is unhealthy because of their social situation, including their race, and everyone is able to reach their full health potential, we will have achieved health equity. Treuhaft, Sarah, Hamm, Michael J. and Litjens, Charlotte. Healthy Food for All: Building Equitable and Sustainable Food Systems in Detroit and Oakland. [Online] 2009. http://www.policylink.org/atf/cf/%7B97C6D565BB43-406DA6D5-ECA3BBF35AF0%7D/Healthy%20Food%20For%20All-819-09-FINAL.pdf. 2 Achat, H, et al. Social networks, stress, and health-related quality of life. 1998, Vol. 7, 8, pp. 735-750. 1 Four Levels of Racism Racism operates on multiple levels: internalized, interpersonal, institutional, and structural. Internalized Racism is what happens inside of people. These are personal beliefs of racism that exist inside our minds. Examples include prejudice, internalized inferiority and superiority, and beliefs about race influenced by the United States, dominant culture. Examples: Internalized inferiority — a child of color does not have any teachers of his/her racial group and because of this believes his/her group isn’t as smart as the teacher’s racial group, White. Internalized superiority — a White student has all White teachers, which leads the student to believe White people are smarter than people of color. Interpersonal Racism occurs between people. Interpersonal racism exists when we bring our private beliefs into our communications with others. This includes public expressions of racial prejudice, hate, bias, and bigotry between people. This also includes what we witness but don’t speak up about. Example: Not speaking up when witnessing someone using a racial slur or racial stereotype. Institutional Racism occurs within organizations. Institutional racism is discriminatory treatment, unfair policies and practices, and /or the absence of equitable opportunities, based on race that an organization perpetuates (this could be internal or public-facing.) Example: Banks that provide loans at inflated interest rates in communities of color. Structural Racism is racial bias across institutions and society. It is the system of structures, institutions, and policies that that work together to advantage White people and disadvantage people of color. These factors work together to continue racial inequities in society over time. Example: The racial wealth divide exists and persists over generations because of housing, educational, employment, criminal justice, and other policies that collectively have a negative impact on the ability of families of color to accumulate wealth while creating opportunities for White people to develop and maintain wealth. 1 1 Adapted from the Applied Research Center, 2011 11 Food Matters Understanding that place and race matter to health, we must explore the root causes of why communities of color experience higher rates of diabetes, overweight, and obesity than White communities. Listed here are some of the social, economic, and physical factors that shape our food environments. likely to have children who are overweight or obese. Bigger portion sizes for food and beverages have become the norm at home and in restaurants and stores. Even our plates are growing. In the 1940’s a dinner plate averaged approximately 9 inches in diameter, but now plates can average 12 or 13 inches across. The bigger the plate, the more likely we are to fill it. Inactivity. Children and adults spend more time passively sitting with television sets, computers and video games, while at the same time consuming more calories. Increased reliance on cars. Federal, state and local transportation policies have been focused on moving traffic faster as opposed to encouraging safe walking and biking routes. Financial and educational pressures on schools have resulted in the elimination of physical education (gym) classes and opportunities for physical activity. Many schools also supported activities by selling unhealthy foods in vending machines and bake sales. Unhealthy school meals result from inadequate funding from the federal government. U.S. food and farm policies. Unhealthy processed and packaged foods high in sugars, salt, and fat are generally cheaper to buy than fresh locally grown fruits, vegetables and whole grains. The explosion in the availability of these types of food is due partially to federal food and agriculture policies that have supported the growing of certain crops – including corn and wheat that are processed into unhealthy sugars and starches – over healthier alternatives such as fruits and vegetables. One corn product, high-fructose corn syrup, is a sweetener used as a key ingredient in many junk foods. Billions of dollars are spent advertising and promoting unhealthy food and beverages to make people want to eat these products. There are some strategic marketing efforts aimed at communities of color and at children. Financial pressures on working families result in less time or money available to prepare healthy foods or to engage in physical activity. Research shows that parents who are not active are more Promising Strategies? Racial health inequities are not unique to Boston. Cities around the country, and the nation as a whole, have simi- lar stories when it comes to how place matters and how communities of color tend to bear an unfair burden of disease and premature death. Across the country, cities and counties are developing cross cutting solutions that expose the root causes of these unfair differences in health status and focus on racial equity. In order to make lasting change in the physical environment to improve opportunities for optimal health, we need to band together and advocate for policies and laws at the local, state and federal level that support people’s ability to live healthier lives. From improving school food to advocating for changes in the federal transportation and farming policy, the Boston Public Health Commission has partnered with residents and coalitions to address the barriers to healthy weight in Boston and around the country. Like other cities across the country, Boston is tackling policies around sugar-sweetened beverages. In 2011, Mayor Thomas M. Menino issued an executive order to ban sugarsweetened drinks and to adopt healthy beverage standards for vending machines and other points of sale in buildings. In an effort to make Boston a more bike-friendly city, more than 60 miles of bike lanes have been created; thousands of bike racks have been installed; and the new Hubway bike share had a successful first two seasons. The Transportation Department’s Boston Bikes program has offered bike riding classes and given away over 1000 free bikes to children, youth, and adults in low income neighborhoods. Efforts are ongoing to improve safety for bicyclists and to make sure that all bicyclists wear helmets. Boston, like many cities, is developing guidelines for street re-design that will make walking and biking easier. These guidelines, based on urban planning principles known as “Complete Streets,” are almost finished and already being used in street re-design. These recommendations are becoming part of the redesign of Central Square in East Boston and the Melnea Cass Boulevard in Roxbury. Boston Public Schools has been working hard to increase physical education teachers and classes; to add more physical activity in the school day; to get junk foods and beverages out of vending machines, school stores and school events; and to make school meals healthier and more appealing to students. There is more work to do! We must continue to build awareness of the negative impact of sugar-sweetened beverages on health and the benefits and safety of drinking tap water. As a community, we can demand that tap water is widely available in school, workplace, and other community locations. There are plans to expand the Hubway bike rental program into other neighborhoods, specifically reaching out to communities of color. For more information, check out www.thehubway.com. Get involved with an organization or coalition in your neighborhood working to build peace, end violence, and ensure that residents feel safe being active in parks and other outdoor places across our city. Support neighborhood farmers markets, corner stores, and other venues that offer fresh, affordable, and healthy produce and whole grains. The Boston Public Health Commission launched a bicycle safety education campaign to increase helmet use among cyclists and increase community advocacy for street improvements that make it safer for biking and walking. A Healthier Boston, One Step and One Pound at a Time In April 2012 Mayor Thomas M. Menino launched Boston Moves for Health, a citywide initiative to improve the health and wellness of Boston residents. Through many community partnerships, the Boston Public Health Commission and other city agencies are increasing access to free and low-cost physical activities and healthy living resources across the city. Boston Moves for Health aims to reduce obesity in the city, with a focus on communities that have the highest rates. The initiative has four main goals: • • Increase opportunities for adults to be more physically active, eat healthy foods, and reduce their consumption of sugary drinks; Increase opportunities for children and youth in childcare settings, schools, and out-of-school-time programs to be physically active and to be offered water with meals and snacks; Increase the number of workplaces that provide healthy beverages and offer employees opportunities to get to a healthy weight; Increase the number of community health center patients and neighborhood residents participating in programs that promote healthy eating and active living. the launch. “We have added healthier beverages to vending machines and cafeterias in our schools and city buildings, launched the innovative Bounty Bucks program to improve purchasing power at farmers markets, built hundreds of backyard and community gardens, and changed the way we use our city streets through the Hubway bike share program. Now residents can bring even more healthy changes home to their communities by joining Boston Moves for Health.” In addition to providing a variety of resources for people who want to get active and be healthy, there is also an online community where residents can support each in reaching their health goals. The free www.BostonMovesForHealth.org website allows participants to set goals, record their progress and connect with friends and neighbors who can help keep them on track. Mayor Menino has challenged Boston to lose one million pounds and move 10 million miles by walking, running, biking, or getting moving in other ways. As of February 2013, residents are making great strides to make Boston healthier, with over 3 million miles moved across the city! • • “Together, we have come a long way toward making Boston a healthier city, and Boston Moves for Health is the next step forward,” said Mayor Menino at 12 Call to Action What can we do? While it is important to eat well, exercise, and see a doctor regularly, our health is tied to a number of other factors. It is essential to push for social changes that will improve the quality of everyday life and, in turn, the health of our families, friends, neighbors, and co-workers. One way to address inequities in systems and institutions influencing community health is to work on changing policies or practices that have unfair impacts and to implement policies and practices focused on equity. Policies are sets of rules that establish guidelines for behaviors, interactions, influence, and power. Policies exist and are enforced on multiple levels – families have policies (curfews, chores), public officials make and uphold policies (smoking regulations, traffic laws, etc.), and institutions and organizations have policies that govern the way they operate. Some policies can have positive or negative effects on our housing conditions, food environments, and the physical space in our neighborhoods, as well as our access to resources such as education and jobs. Policies can support turning vacant lots into community gardens and limit the advertising and availability of junk food while increasing access to healthy affordable foods. Policies can ensure street lights and cross walks are put up and maintained to support walking and biking. Policies can promote health equity by targeting what’s unfair and regulating improvements in things like air quality, transportation design, and job and educational opportunities. Take action! Raise awareness! Pass this paper on to a family member, friend, or stranger once you’ve read it. We need to be able to talk about racism and how it impacts all of us. Find out more about current local, state, and federal policy proposals and how they might impact the community. Contact your elected officials; testify at a legislative hearing; or write a letter to the editor for the local newspaper. Register and get out to vote! Vote in every election, not just the big ones! Our elected officials – from the President to state representatives and city councilors – make choices every day about how money is spent, what laws are passed and what problems are addressed. Voting is the best and easiest way to make sure you have a voice in these important decisions. To vote, you must be registered to vote at your current address. You can check to find out if you are registered by visiting the Boston Elections Department website, www.cityofboston.gov/ELECTIONS or by calling (617) 635-3767. Get to know your elected officials! Remember that elected officials make all these important decisions with limited time and information. To Tell us what is going on in your community to advance health equity and racial justice: visit www.whatsyourhealthcode.com and click on TAKE ACTION. Fill out a profile form, read about what other organizations in the area are doing, and learn how you can get involved. Organize a group of colleagues, friends, or neighbors to identify how you can advance health equity and racial justice, or join a community group or coalition working to address inequity in the social, economic, or physical environment. The Boston REACH Coalition is one such group that has been meeting monthly since 2000 to organize residents and organizations around action opportunities for health equity in Boston. Call 617534-2291 or check out www.bphc.org/healthequity for more information. There’s a lot of work to be done, but change is happening around us every day. Join the movement for health equity in Boston because everyone deserves the chance to reach their full health potential, regardless of their race or place! help make better informed decisions, our elected officials need to hear from us about the importance of supporting programs and policies that make a difference. It only takes a few minutes to call your legislator. Thank them when you are pleased with their actions or support, and constructively communicate to them when you are not. If you are concerned about an issue, let your elected officials know how it will affect you or your community. Remember that you have valuable information and expertise that elected officials may want or need. “Good” neighborhood/ “Bad” neighborhood? Continued from the cover Mortgage loans were regularly denied to people seeking to buy a home in redlined areas. Banks would offer inflated loans to Black home buyers in the redlined areas while White residents were told that the presence of Blacks would lessen their home values. This propaganda was intended to cause fear among White homeowners and was effective in getting many of them to sell their property and take out mortgage loans in the suburbs. Businesses and investors followed the housing market to the suburbs, while inner-city communities, that were now racially segregated, lacked investment.3 This practice of redlining was a form of structural racism, race based-practices across multiple institutions (banks, real estate, government), that resulted in residential segregation that can still be felt in Boston and other places across the country. The notion that when people of color moved into a “good” neighborhood and shortly thereafter the neighborhood became a “bad” neighborhood, had much more to do with the policy decisions and practices of banks, real estate industry, and the U.S. Government and little to do with the people of color who moved in. Squires, Gregory D., ed. Insurance Redlining: Disinvestment, Reinvestment, and the Evolving Role of Financial Institutions. 1997. 2 Wenger, M. Place Matters: Ensuring Opportunities for Good Health for All. Joint Center for Political and Economic Studies, September 2012. 3 Squires, Gregory D., ed. Insurance Redlining: Disinvestment, Reinvestment, and the Evolving Role of Financial Institutions. 1997. 1 Special thanks to the Boston Public Health Commission staff who contributed many hours to the concept, content, and design of the Commission’s first Place Matters publication. To view this publication online visit www.bphc.org/healthequity. Email firstname.lastname@example.org with questions or comments. Since 2006, Boston has participated in a nationwide effort called PLACE MATTERS through the Joint Center for Political and Economic Studies in Washington, DC (www.jointcenter.org). The Joint Center provides technical assistance to 16 teams in the form of facilitation, learning meetings, technical assistance grants, and access to data. Special thanks to Mike Wenger and Felicia Eaves of the Joint Center for Political and Economic Studies for their support of this work. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of the Joint Center or the Health Policy Institute. Some of the research cited in this brief was supported by award number 1RC2MD004795-01 from the National Institute on Minority Health and Health Disparities to the Joint Center. This report was made possible by the support of the Joint Center through a grant from the W.K. Kellogg Foundation.