Life expectancy in Massachusetts is still higher than in almost all other states, according to a new report from the U.S. Centers for Disease Control and Prevention. In Massachusetts, residents live to nearly 80 years of age, with only Hawaii surpassing that number.
Local experts attribute this consistently high ranking to the state’s excellent hospital system and near-universal health insurance, among other things. And while the latest statistics for 2021 have much to be commended for, they say there are still some troubling disparities behind this performance – even in the city of Boston alone.
“If you look at downtown Roxbury and downtown Back Bay, it’s about three or four miles,” said Dr. Asaf Bitton, a family medicine physician at Brigham and Women’s Hospital and executive director of Ariadne Labs at Harvard TH Chan School of Public Health. “And it depends on the census tract, but (the difference in life expectancy is) between about five and 15 years. Three miles!”
“I’ve been doing this for a long time,” Bitton continued. “I still find it just unbelievable and horrifying at the same time.”
A recent report from the Boston Public Health Commission found that black Boston residents died prematurely at higher rates in 2021 than in 2017, a rate that had increased by more than a third. There were no significant changes for Asian, Latino or white residents during those years.
National Center for Health Statistics
One of the main problems, in Bitton’s view, is preventable deaths.
“My clinic is in a part of Jamaica Plain that is very close to some of the largest housing projects in Boston,” Bitton said. “And we serve a wide range of people who live nearby and face enormous daily challenges related to health care, finances and structural racism.”
Many of these problems are also related to lifestyle choices, added Dr. Richard Dupee, chief of geriatrics at Tufts Medical Center, including physical activity, proper diet, smoking and drug use.
He said he asked his team one morning this week how many of the patients they treated were there because of their lifestyle.
“So we looked at every single one,” Dupee said, “and of the 18, 12 were here because of lifestyle choices. Well over half. And that’s consistent.”
“Every time I’m on duty, it’s the same thing,” he continued. “It’s about the question: What are your eating habits? Smoking, definitely. Lack of exercise. Whatever. And of course, because we’re an inner-city hospital, a lot of medication use.”
Massachusetts has struggled to prevent overdose deaths for nearly a decade; at about 2,000 deaths per year, the rate is one of the highest in the country.
Still, Dupee said, Massachusetts’ performance compared to other states speaks to the benefits residents have of living in “a kind of medical mecca of the universe,” giving residents the opportunity to receive excellent preventive health care.
“In Massachusetts, for example, heart disease is no longer the leading cause of death. And the reason for that is because everyone is taking a statin,” he said. “Patients come to us and we tell them when they’re 40, ‘Your LDL is too high, you need to take a statin.’ And so cancer is now the leading cause of death.”
But Bitton warned that Steward Health Care’s recent bankruptcy threat for several Massachusetts hospitals is a clear sign of how quickly residents can lose access to health care. He wants hospitals and clinics to remain open and financially viable.
“It’s not like you say, ‘Oh, just drive to Boston, go to the next big health system.’ We’re talking about people who might take two or three buses, who have mobility issues, who might have had a relationship with this doctor, this health system, these teams for 20, 30 years that you can’t just build overnight.”
Two hospitals – Carney Hospital in Dorchester and Nashoba Valley Medical Center in Ayer – are scheduled to close at the end of the month. Bitton urged state regulators to proceed with caution.
“It’s critical that the state regulators and policymakers who are approving and reviewing this deal do everything they can to ensure the viability of these health systems in the communities they serve, because closing health systems that serve as safety nets for vulnerable populations is associated with worse outcomes in one, two, three years,” he said. “That’s been proven throughout the health literature. So again, a call not to be complacent, even though we may say, ‘Oh, we have wonderful health systems in general.’ The details matter.”
