Boston — home of the first public health department in the US — has a long and illustrious history as a center for innovative public health strategies. From the introduction of smallpox inoculations in the 18th century to NeighborWalk, a community walking program, in the 21st, Boston’s groundbreaking initiatives have become models for public health practices nationally and internationally.

OVERVIEW

Boston contains an unusually dense and accomplished network of organizations and institutions that work collaboratively to provide high quality care, disease prevention, health education and health promotion.

This network includes the nearly 30 Boston community health centers that provide primary care in neighborhoods throughout the city, traditional fee-for-service and managed-care direct-service providers, three schools of medicine, three schools of public health, and scores of community-based and social service agencies. Boston is also home to 22 hospitals, of which 16 are teaching hospitals — preparing the next generation of physicians, nurses, and technicians from around the nation and around the world. 

In the last decade especially, Boston has led the nation in investments in public health directed toward research, screening, and education that prevent minor health problems from becoming major, chronic and costly.  The city is an acknowledged leader in building initiatives to address risky behaviors, with measurable outcomes in smoking cessation, youth violence prevention and teen pregnancy prevention. These are considered to be among the most high-impact of all preventive health programs, saving millions of dollars in future public expenditures.

In addition, Boston’s hospital and medical school community contribute significantly to regional economic growth and jobs. Boston’s community health centers alone account for a total of payroll of $300 million — one of the largest industry sectors in the city.  Twenty-two inpatient hospitals are located within the city of which 16 are teaching hospitals, including Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel/Deaconess Hospital, Children’s Hospital, The New England Medical Center and Boston Medical Center. Drawing from the region and beyond, these hospitals saw a combined total of 217,000 patients, had over 3.8 million outpatient visits, and witnessed over 22,000 births in 2000.

Between 1984 and 1999, the city’s hospital and medical school community invested close to $1.1 billion in new facilities. In 2000, health services accounted for one out of every seven jobs in Boston. Growth in the health services sector in Boston has been stable in varying economic conditions, in part because of Boston’s role as a world-class provider of medical care and research expertise.

Several mergers consolidated health care providers, resulting in the creation of new health systems in Boston. Partners HealthCare system is the outcome of a merger of Massachusetts General Hospital and Brigham and Women’s Hospital. CareGroup Healthcare System is the outcome of a merger of Beth Israel/Deaconess Medical Center, New England Baptist Hospital and Mount Auburn Hospital. Boston Medical Center is the result of a merger of Boston City Hospital and Boston University Hospital. New England Medical Center is the result of a merger of Tufts Medical School and the Floating Hospital. And Caritas Christi Health Care System is the result of a merger of St. Elizabeth Hospital in Brighton and Carney Hospital in Dorchester.

Health care costs are rising again in the state and the nation after a brief hiatus in the mid-1990s — led by increases in prescription drug costs and by increased use of expensive new technologies.

But declining state tax revenues in 2001, 2002 and 2003, coming on the heels of a series of reductions in state tax rates, are now leading to deep cuts in health programs.  These cuts are imposing disproportionate burdens on the city’s most vulnerable populations:

WHAT HAS CHANGED SINCE 2000?

As a result of the terrorist attacks of 9/11, attention is being paid to community disaster preparedness locally and at the state level.  Major initiatives to enhance Boston’s ability to respond to terrorism have been implemented in the wake of these attacks and the continuing threats they represent. This new focus is also redirecting scarce resources away from conventional public health services.

Boston’s EMS responded to more than 100,000 incidents in 2001 — a record for one year. Even before the events of 9/11 and the subsequent feared anthrax attacks, Boston’s EMT Dept was one of the first five in the nation to recognize and respond to incidents involving weapons of mass destruction.

The Boston Public Health Commissioners voted in December 2002 to ban smoking in all places of work, including bars, nightclubs and restaurants beginning May 5, 2003. Boston will then become the largest city outside of California to prohibit smoking in restaurants and bars.

CHALLENGES

An estimated 8% percent of Boston residents are uninsured, with a higher percentage of non-insured people of color. And increasing costs are driving these numbers up. There is a growing reliance on higher premiums, co-pays, and deductibles in the system with coverage stripped as a result of changes in benefit structure. Experts agree that fewer preventive and primary care resources will result in sicker people and higher costs down the line. Similarly, reductions in insurance coverage are associated with increases in the use of expensive emergency room services for non-acute care. Many in Massachusetts argue for a single-payer health care system — setting an example for the rest of the country to follow. Lawmakers are not convinced.

Declining federal and state revenues and rising health costs threaten to di