Spending on health care by individuals, businesses, the City of Boston and the Commonwealth continues to rise dramatically while spending on public heath remains below the 2001 high point.

• Massachusetts per-employee health insurance premiums are among the highest in the nation and continue to rise.  A 2006 survey conducted by Mercer Health Benefits found that per-employee health care costs amounted to $9,428—the 4^th highest in the US and the 9^th fastest growth rate.  This is an increase from the 2005 per-employee premium of $8,000, which the human resources consulting firm Hewitt Associates found to be nearly double the $4,144 spent in 1999. 
• The 2005 Employer Health Insurance Survey, conducted by the Division of Health Care Finance and Policy, found that from 2001 to 2005, median employee contributions doubled for individual health plans, from $40 to $80 per month and contributions for family plans increased from $172 to $239.
• A Municipal Research Bureau analysis of the City of Boston’s Fiscal Year 2007 budget found that the City’s health insurance costs have risen by 92.2% since 2001 to $234.8 million, absorbing almost half of the City’s total budget over that 6 year period.
• The Commonwealth’s health care costs are also rising, both for providing health insurance to state employees and for state health care subsidy programs.  An analysis by the Massachusetts Taxpayers Foundation found that health care costs rose from 26% of the state budget in FY01 to 32% in FY06. 

Budget cuts continue to limit spending on public health.  Beginning in 2001, the state Department of Public Health (DPH) underwent three years of devastating budget cuts, declining from $408 million in Fiscal Year 2001 to $262 million in Fiscal Year 2003.  Although public health advocates have fought successfully to reverse the cuts, DPH’s FY07 budget of $370 million remains 15% lower than in FY01 (when adjusted for inflation).  

• Program cuts have eliminated mental health services for thousands of mentally ill adults and children, closed clinics treating people with sexually transmitted diseases and eliminated vaccinations for people at risk of hepatitis and influenza. 
• The Massachusetts Tobacco Control Program—considered highly successful in decreasing youth and adult smoking—faced dramatic budget cuts, from $50.1 million in FY01 to $4.25 in FY07.  Coincidentally, the percentage of students reporting cigarette use “within the past 30 days” rose from 13.1% in 2003 to 15.3% in 2005, reversing a steady decline from 1993 to 2003 (See Indicator 7.5.4). 

Health expenditures continue to disproportionately focus on access to care and treatment, at the expense of improving healthy behaviors and reducing adverse environmental exposures.  In Massachusetts, health costs exceed $50 billion a year, so one-third equals about $17 billion annually.  Recouping even a fraction would free up resources for education, housing, recreation, nutrition, and other health determinants that now compete with health care. 

• A new study by the New England Healthcare Institute, The Boston Paradox: Lots of Health Care, Not Enough Health, shows that 50% of health outcomes are determined by healthy behaviors and options and an additional 20% by environment, while only 10% is based on access to health care (and the remaining 20% by genetics), yet spending priorities are almost opposite these figures:  of the $1.9 trillion spent on health nationally, 88% is spent on access to care and only 4% on improving healthy behaviors.  This is generally true in Massachusetts as well.
• The Massachusetts Health Council's 2006 Common Health for the Commonwealth report concluded that Massachusetts “must support an investment in prevention which will ultimately reduce the utilization and costs of the health care system and save lives.”
• Based on data indicating that one-third of American health care expenditures are unnecessary, it has been calculated that Massachusetts is wasting $17 billion annually on unnecessary and potentially harmful health care. 

Racial/ethnic health disparities persist. 

• The data issued by the Mayor's Task Force to Eliminate Health Disparities in June 2005 found that Black Bostonians suffer worse health status than all other residents, including higher rates of preterm birth, overweight, diabetes, hypertension, heart disease, cancer mortality and premature death.  Latino Bostonians also suffer worse health than white residents on many key health indicators including asthma hospitalization and mortality, HIV, overweight, diabetes and mental health.
• The Task Force analysis concluded that these disparities could not adequately be explained by lower income, lower educational levels or personal behavior such as smoking.

Boston mirrors the nationwide trend in a dramatic increase in obesity, as well as the related disease of Type 2 diabetes, despite having lower rates than the national average. 

• According to the most recent data available from the Massachusetts Health Council, the number of obese adults in Massachusetts increased 80%, accompanied by a 50% increase in Type 2 diabetes, between 1990 and 2004.  The Council estimates that obesity-related illnesses cost Massachusetts more than $1.8 billion annually.
• According to the Boston Public Health Commission, in 2005 52% of all Bostonians were overweight or obese, with even higher rates for blacks (66%) and Latinos (54%).  A survey of Boston public high school students by the Harvard School of Public Health found that 43% described themselves as overweight and an additional 19% classified themselves as at-risk for becoming overweight.
• The rising rate of obesity is driving a growing epidemic of Type 2 diabetes.  The Boston Public Health Commission reports that 3.6% of Boston residents have diabetes, with rates varying strongly by age (12.5% aged 65 and older) and race (with Blacks having the highest percentage at 8.3%).

Asthma incidence continues to increase despite public health efforts to reduce trigger events, improve medical management and reduce hospitalizations related to asthma.

• In Massachusetts, lifetime asthma rates have risen to 14.9% of adults and 14.6% of children. 
• A study by the Massachusetts Department of Public Health found that some Boston school children suffer from asthma at rates far higher than the 9.5% of kindergarten through eighth graders with asthma statewide.  The study found that at five Boston schools, more than 30% of students have asthma.  Children in Roxbury have the highest asthma rates.
• However, after rising from 2000 through 2004, asthma hospitalization rates for children under age 5 dropped from 11% in 2003 to 6.8% in 2005 (See Indicator7.4.2).
• The Boston Public Health Commission is targeting asthma management and prevention efforts to five Boston neighborhoods with the highest rates of childhood asthma.

Hunger and homelessness are rising in Boston and Massachusetts. 

• Project Bread's 2006 Status Report on Hunger in Massachusetts found that 2.7% of Massachusetts households experienced hunger from 2002-2004 (up from 2% from 1999 to 2001) and 7.1% were at risk from hunger (up from 6.7% in 1999-2001).  Among low-income households, 18% experience hunger and 56% of families with incomes below $20,000 were unable to meet their basic nutritional needs.
• The City of Boston’s annual count of homeless persons in 2006 found 6,413 women, men, and children, the highest number since 1992.

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.

• Youth Risk Behavior Surveillance System (YRBSS),a national survey conducted in public high schools, indicates that the decrease in youth suicide attempts in Boston, from roughly 14% of high school youth in 1993 to 8.9% in 2003, showed an uptick to 9.4% in 2005.  (See Indicator 7.5.3)
• Marijuana use “within the past 30 days” rose from 19.6% in 2003 to 21.2% in 2005 and the percentage of survey participants reporting having offered, sold or given an illegal drug on school premises rose from roughly 27% in 2003 to roughly 29% in 2005. 
• The percentage of students reporting cigarette use “within the past 30 days” rose from 13.1% in 2003 to 15.3% in 2005, reaching a 15-year high.
• Sexual activity among Massachusetts teens declined from 47% in 1995 to 41% in 2003 but rose to 45% in 2005, with only 6% reporting using condoms (See Indicator 7.5.4).
• A resurgence of youth homicide, particularly in Mattapan, Roxbury and Dorchester, resulted in 75 homicides in Boston in 2006, double the number in 2000 (See Public Safety).

The link between environmental toxins and health continues to drive many of Boston’s public health strategies. 

• Environmental exposures to toxins found in or near residential areas are linked to certain cancers, respiratory irritation, inflammation, and hindered brain development. 
• The City of Boston has established a goal of eliminating childhood lead poisoning by 2010.  Only 2% of children tested in 2006 were found to have elevated blood lead levels and many high risk neighborhoods such as Mattapan, South Dorchester and North Dorchester have seen rates decline by 50% or more over the past five years due to targeted prevention efforts (See Indicator 7.7.1). 

Greater Boston’s life sciences industry is strong and growing but not as rapidly as life sciences clusters in competitor cities and states.

• The Milken Institute, an independent economic think tank, ranked metropolitan Boston number one in the US for the strength of its life sciences cluster, based in part on receiving the top ranking for what Milken calls the “innovation pipeline.” 
• The ability of Greater Boston’s health care institutions to attract research funds from the National Institutes of Health (NIH) is unmatched, with all of the top five hospitals ranked by amount of Federal research funding in fiscal year 2005 located in the City of Boston.  However, NIH funding has been stagnant in recent years, resulting in a 12% cut adjusted for inflation.
• In 2004, the most recent year for which data is available, Battelle found that life sciences industries employed more than 42,000 workers in metropolitan Boston, ranking Metro Boston 5^th among US regions in life sciences employment. 
• Life sciences employment is growing, but more slowly than in competitor regions and states.  The University of Massachusetts’ Donahue Institute found that while bio-pharmaceutical employment statewide grew by 44 percent from 1998 to 2004, Massachusetts fell from 5^th to 7^th in the nation in total bio-pharma employment.