THE BOSTON PARADOX Lots of Health Care, Not Enough Health

The objective of this report is to focus on broad trends in Greater Boston’s health, its health care, and its overall economic competitiveness in a way that will suggest new strategies Greater Boston can use to meet three often conflicting goals: ■ The best health for all Greater Boston residents ■ Effective and sustainable health care ■ Sustained economic growth that benefits all Greater Boston residents As a result the full version of this report examines trends in many different fields, organized into two sections: The Health of Greater Boston ■ Population and Demography: The report looks at broad, ongoing trends at work in Greater Boston’s changing population that will affect health and health care demand. ■ Determinants of Health: Scientific research in epidemiology has identified several factors that have a decisive influence on the health and life expectancy of an entire population such as Greater Boston’s. The most critical “determinants” include socio-economic factors such as educational attainment level and the distribution of income among residents. Socioeconomic factors decisively influence the interaction of four other types of determining factors: genetics; environmental factors; health-related personal behaviors; and the degree of access to health care (such as the level of insurance coverage in the population). Greater Boston’s Economy and Its Health Care ■ Health Status: In the interest of brevity this report examines six conditions prevalent throughout the population: heart disease and cancer (the two leading causes of mortality); hypertension; low birth weight (LBW) births; and diabetes and asthma (both chronic diseases of increasing prevalence in Greater Boston). Equally important conditions (such as mental health) may be incorporated in future revisions or as pertinent data is developed. * Sources of Health care funding: the report examines trends in three sectors that provide the majority of health care financing: employer-sponsered health insurance, state government and the federal government. * Uses of Health care funding: The report examines the five largest categories of health care as enumerated in the National Health Expenditure Accounts, the federal government's annual measure of all health care-related expenditures in the US and the 50 states. Trends in public health and the health insurance industry are also examined. * Related Industries: The report examines three fields tightly linked to health care in Greater Boston: Medical and Nursing education; Biomedical research and technology transfer; and the life science sector