#operationsmanual

kind words are always sweeter when they come from people you truly respect and admire!  thanks DJ Frederick!

if anyone wants a copy of this zine just hit me up!

By Dr. Barbara Ferrer, Executive Director, Boston Public Health Commission

Boston in many ways is a model of good health and a city that our peers across the country look to as an example for developing proven public health strategies that create stronger communities.  The data from this year’s Health of Boston report, an annual study produced by the Boston Public Health Commission (BPHC) that details the latest trends in our city health, is filled with encouraging signs.

Teen pregnancy is decreasing along with the percentage of preterm births in Boston.  The infant mortality rate for black infants is declining and inching closer to the overall city average.  Fewer people are dying from strokes.  Boston public high school students are smoking less.  And the hospitalization and mortality rates for heart disease have declined for a majority of our neighborhoods.

We could take comfort in this positive news, but the truth is we have an obligation to do more – much more.  The mission of the Boston Public Health Commission is to protect, promote, and preserve the health and well-being of all Boston residents, particularly the most vulnerable.  When we ask ourselves whether or not all residents are sharing in good health, the answer is they are not.

Certain populations in our city have a better shot at good health than others, and closing the gap on these inequities is our biggest challenge as we look to the future of public health in Boston.

You may have heard the terms health disparity and health inequity before.  Although they might sound interchangeable, we’re very intentional about using the word “inequities.”  While disparities refer to differences in health outcomes between groups, inequities refer to differences that are unnecessary, avoidable, unfair, and unjust. 

Here’s what we believe are the most significant inequities that we’re positioned to address, not only as a health department, but together as an entire city over the next several years.

Reduce the low-birth weight rate among Boston infants, and reduce the gap between white and black low birth-weight rates by 25%.

Reduce obesity and overweight rates among Boston residents, and reduce the gap in rates between white residents and black and Latino residents by 30% for school-aged children and 20% for adults.

Reduce Chlamydia rates among Boston residents aged 15 through 24, and reduce the gap in Chlamydia rates between black, Latino, and white residents in this age group by 25%.

Each and every one of the approximately 1,100 employees of the Boston Public Health Commission – not to mention the larger community of Boston – has a role to play in achieving these goals.  We refer to these three issues as our “Overarching Goals” for public health between now and 2016.

What are some strategies that we’re implementing to accomplish this work? 

Our Healthy Baby Healthy Child and Healthy Start in Housing initiatives work with expecting and new mothers to offer housing, free home visiting, case management, and support services to prepare parents for healthy deliveries, successful parenting, financial literacy, and school readiness in a culturally and linguistically appropriate manner.

A $4.6 million grant through the Centers for Disease Control and Prevention’s REACH (Racial and Ethnic Approaches to Community Health) initiative is helping us build on our obesity prevention work with partners from the YMCA of Greater Boston, the Harvard School of Public Health’s Prevention Research Center, community health centers,  and the Boston REACH  and VIP Coalitions which engage residents in the effort.  Together, our collaborative is working to increase opportunities for out-of-school physical activity for school-aged children; to ensure safe green space in the neighborhoods for exercise; and to promote healthy nutrition in partnership with community-based organizations.

With the help of students from the Boston Public Schools (BPS) and teens from BPHC’s youth programs, we worked with the school committee to successfully amend the BPS Wellness Policy to provide all high school students with access to sexual education and condoms.  We’re now working with youth to develop a social marketing campaign aimed at raising awareness about access to Chlamydia testing and treatment for young people.

In all three areas, our work is anchored by efforts to promote policies that create equitable opportunities for optimal health and well-being. Mayor Menino has issued an executive order banning the sale of sugary beverages in all municipal buildings.  Our Board of Health has passed regulations restricting youth access to tobacco and nicotine products in addition to prohibiting artificial trans fats in prepared foods at restaurants.  And we have worked tirelessly to ensure funding for youth development and job training programs.   

These are but a few examples of the strategies we’re utilizing to achieve health equity in Boston.  They’re the tip of the iceberg, but they hold a tremendous amount of promise for the future health of our city.

The City of Boston maintains a network of over 800 miles of streets.  Each year, an extensive maintenance and reconstruction program is undertaken to improve the condition of the city’s streets.  The construction season generally runs from April to mid-November. In a typical year, the City paves 25-35 miles of roadway. As we finish up this year’s “blockbuster” 60 miles of paving, we’re already planning for the next two years.

So how does the City decide what streets to repave? It starts with an annual assessment of pavement conditions.  Each year, PWD surveys about one-quarter of all City streets.  The results of these engineering studies form the basis of a recommended program for crack sealing (preventive maintenance), resurfacing (major maintenance), and reconstruction (complete rebuilding of a street).  This recommended program is then compared to the utility companies’ five-year maintenance and improvement plans, planned developments within the city, and available funding. The Mayor reviews the construction program each year to ensure that the investments further the strategic goals of the city and properly address constituents’ needs. 

Coordination with utility companies and property owners is critical because after a street has been paved, there is a five-year moratorium on cutting into the street. Streets that are recently paved are call “Guaranteed Streets,” and only in cases of legitimate hardship, determined on a case-by-case basis, are permits to cut into Guaranteed Streets granted.  In those cases the cost of restoring the street to new condition is charged to the entity requiring the work. This process is coordinated by the Public Works Department using a system called COBUCS (City of Boston Utility Coordination Software). As part of the application process for a construction permit, projects are cleared through the COBUCS system managed by the Construction Inspection and Coordination Unit in Public Works.