Six Steps for a Healthier Massachusetts.

During summer, much of our school community spent time away from our campus—vacationing with family, working abroad, or simply adventuring. With the new academic year now underway, we have returned to SPH, to once more call Massachusetts home for the coming semester. With our deep roots in the state, it is worth taking a moment, as we renew our connection to the Commonwealth, to pause and consider health here.

Massachusetts is a state that is, in many ways, ahead of the national curve when it comes to health. It also has its own unique health challenges. What, then, are some policy efforts that can indeed achieve better population health in Massachusetts? I solicited answers to the question from the School’s Governing Council members, and added to the list a few of my own thoughts. Here I summarize six such ideas that rise to the top, in no particular order. The intent is to highlight ideas that are indeed doable, and that can yield benefits to the health of populations in both the short- and long-term.

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2. Increase alcohol taxation in the state. There is no question that alcohol taxation is linked to less alcohol consumption and that said taxation will, in turn, reduce substantial morbidity and mortality in the state. The health consequence of unhealthy alcohol use are abundantly clear, including cardiovascular disease, injury, liver damage, mortality, violence, and other health outcomes. Just to cite one example, Ziming Xuan from our community health sciences department recently led a study that found a 1 percent increase in alcohol prices was associated with a 1.4 percent decrease in the prevalence of adults who binge drink. Several economic studies have found that increasing alcohol prices can lower drinking and driving, alcohol-related injury and death, and alcohol-related violence and crime. Forward-looking alcohol taxation can both decrease alcohol consumption and channel tax revenue into health promoting opportunities such as those discussed here.
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5. Change the restrictions on definitions of homelessness. Although overall homelessness has decreased in the US, the rate in Massachusetts has increased faster than in any other state. Homelessness in and of itself is an adverse condition that traps many in a cycle of poverty. It is also associated with increased risk of a range of health problems, including drug use, poor nutrition, asthma, HIV transmission, and mental health problems, especially among youth. Many factors contribute to homelessness, many of them multifactorial and complex. However, at a simple level, restrictive definitions of homelessness reduce the number of individuals eligible for affordable housing and increase the number of people who are homeless. Restrictive definitions of homelessness that do not count people as homeless if they are living doubled up with relatives or friends or in motels, for example, mean that only 1 in 10 homeless children in the US are eligible for federal housing assistance.
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In closing, a note of optimism. A previous version of this note, from 2015, contained some additional suggestions, including raising the minimum tobacco sales age to 21, banning tanning beds, and clearing criminal records for individuals charged with nonviolent drug offenses.

Happily, we have since made progress in each of these areas, which is why they are not included here. The state has indeed raised the minimum tobacco sales age to 21. It has also banned minors from using tannings beds, and opened the door to expunging juvenile criminal records and records arising from marijuana use.   

This is all to the good, and will do much to improve health. Raising the tobacco sales age is a potent tool for lowering smoking rates, banning tanning beds will help prevent cancer, and clearing criminal records for nonviolent drug offenses will help reduce the mass incarceration that has done so much to undermine health (see my prior writing on this). Each of these areas represents progress, a step towards making this state as healthy as it can be, setting an example for how the rest of the country might do the same. We are not fully there—but we are headed in the right direction.

I hope everyone has a terrific week. Until next week.

Warm regards,

Sandro

Sandro Galea, MD, DrPH
Dean and Robert A. Knox Professor
Boston University School of Public Health
Twitter: @sandrogalea

Acknowledgement. This Dean’s Note was informed by conversations with the School’s Governing Council, with thanks to Laura Sampson and Catherine Ettman for contributing data to this Dean’s Note.

Previous Dean’s Notes are archived at: /sph/tag/deans-note/