SUMMARY

Greater Boston is an international leader in the “life sciences” field, which has grown in each of the last five years. A driver of the regional economy, the health sector is also a driver of dramatically increasing costs for individuals, businesses, municipalities and the Commonwealth. Yet high expenditures do not guarantee superior health outcomes. As reported by the New England Healthcare Institute, 50% of health status is determined by lifestyle behaviors and options and 20% by environmental exposure to toxins, yet 88% of health care dollars are spent on access to care and only 4% on improving behaviors and options. As a result, Boston is experiencing rising rates of chronic preventable diseases such as asthma and diabetes. Change is underway, however. Massachusetts’ first-in-the-nation law, entitled An Act Providing Access to Affordable, Quality, Accountable Health Care, is designed to ensure virtually universal access to health insurance and public health initiatives at the city and state level, including recent budget increases for the state Department of Public Health, contribute to declining rates of teen births, childhood lead poisoning, AIDS and asthma hospitalizations. The Boston Public Health Commission, community health centers and community agencies are implementing new programs to address chronic health problems such as asthma, diabetes and obesity. Similarly, while racial and ethnic disparities in health status persist, the City of Boston and its partners in the community and health care organizations have launched a nationally-recognized effort to understand, reduce and ultimately eliminate such disparities. Boston and the region are widely considered healthy places to live: since 1990, Massachusetts has been among the top 10 states in all but one of the United Health Foundation's Annual State Health Rankings  and was ranked 7^th best in the nation in 2006. However, Massachusetts is also one of the most expensive states when ranked for health care expenditures.

CONTEXT

The health sector in Boston consists of three inter-related components: public health infrastructure; the health care delivery and medical education system; and the life sciences industries. The Boston Public Health Commission, descendant of the nation’s first public health department, provides leadership for the city’s public health sector, which includes three schools of public health and a variety of exemplary prevention and community-based initiatives. The health care delivery segment includes world-class medical institutions and neighborhood-based health centers, with 22 inpatient hospitals of which 14 are teaching hospitals, 3 medical schools, and 25 community health centers. Many key institutions are clustered in the Longwood Medical and Academic Area, where each day more than 37,000 employees and 15,000 students provide medical care, conduct research, teach, and attend school. According to the Greater Boston Chamber of Commerce, the combined health care and life sciences industry is one of the metropolitan area’s five leading industries and the only one in which employment levels increased each year from 2001 to 2004, with total employment rising to an all-time high of 252,400 jobs in 2004. The “life sciences” sector, as defined by the Milken Institute, includes the pharmaceutical industry, medical devices industry, biotechnology industry and R&D. As ranked by Milken, Boston is home to the nation’s largest life sciences “super cluster,” anchored in teaching hospitals, independent institutions and private sector companies.

Key Trends

	Spending on health care by individuals, businesses, the City of Boston and the Commonwealth continues to rise dramatically while spending on public heath remains well below the 2001 high point. Health expenditures continue to disproportionately focus on access to care and treatment, at the expense of improving healthy behaviors and reducing adverse environmental exposures. Boston’s youth are at risk from an increase in unhealthy behaviors after nearly a decade of decline, as well as a resurgence in violence and homicides. More »

Accomplishments & Developments

	The Massachusetts Legislature adopted An Act Providing Access to Affordable, Quality, Accountable Health Care, the first of its kind in the nation designed to ensure that virtually every person in the state has health insurance.  The Mayor's Task Force to Eliminate Health Disparities released a comprehensive data report and Blueprint of recommended actions. The Massachusetts Department of Public Health’s budget increased substantially for Fiscal Year 2007 after years of devastating cuts. More »

Challenges

	Rising health care costs are straining the budgets of Greater Boston’s families, businesses and city and state government.  Both the public health and health care delivery systems are experiencing shortages of qualified workers, particularly in primary care. The Commonwealth faces many challenges as it implements key provisions of the Universal Health Care legislation and works to eliminate the problem of the uninsured in Massachusetts. More »