A new report ranked Massachusetts second among the 50 states when evaluating the overall health of its women and children.
The United Health Foundation’s annual Health of Women and Children report showcased many positive health trends among Bay Staters, which experts largely attribute to the state being among the wealthiest and most educated in the country, as well as the state government’s proactive approach to improving residents’ health.
Even so, the report also identified several women’s and children’s health metrics on which Massachusetts could improve.
Socioeconomic factors play a role in health
It’s no coincidence that the report ranked Massachusetts number one in social and economic health factors for children and number seven for women, experts say.
The state did especially well on education metrics, including having the highest percentage of women ages 25 to 44 who graduated from a college or technical school — something experts say is likely due to Boston being an education hub.
Typically, high income and education levels correlate with good health outcomes, experts say. This was reflected in the report, which found that Massachusetts had the lowest child mortality rate in the country and was among the best when it came to women’s and infant mortality.
“We often look at health metrics and think they measure the quality of a health care system, but often, it’s really about wealth and social structure,” Boston University community health sciences professor Eugene Declercq recently told Boston.com.
According to Williams College economics professor Tara Watson, you are also less likely to smoke, be obese, or get pregnant as a teen if you are highly educated and/or wealthy, though it’s not clear why.
This was reflected in the report, which found that the Bay State had the second-lowest teen birth rate in the country — a rate which was half that of the country as a whole. It also had low smoking rates among pregnant people and women ages 18 to 44, and at 22.7%, the state had the lowest obesity rate among women in this age range.
Watson said that children of wealthy, educated people are also less likely to experience “adverse childhood experiences,” such as dealing with a parent struggling with addiction or witnessing violence in their neighborhood. This was evident in the report as well, as Massachusetts had the second-lowest percentage of children ages 0 to 17 who have dealt with these experiences.
How state government promotes health
Boston University community health sciences professor Sophie Godley, who used to work for the state Department of Public Health, said the state has a long history of implementing programs that promote health. The programs often work to educate health care providers and affected communities on health issues, or help people find treatment for health problems, she said.
For decades, Godley said, the state has had outreach and support programs targeting issues such as teen pregnancy and smoking, for instance..
Another example is the efforts the state has taken to get families enrolled in WIC programs, Godley said. This is reflected in the report, which found that Massachusetts had the second-highest percentage of eligible children enrolled in the program.
Massachusetts legislators have also contributed to the state’s good health by passing laws that promote health, experts said. For example, Godley said, state law requires insurers to offer robust coverage in their health insurance plans.
“This is a state that has always been at the forefront of health care reform,” she said, adding that this has been true regardless of what political party was in power.
While the causal relationship between strict gun laws and firearms-related deaths is often debated, data has shown that such laws correlate with fewer gun deaths. As Massachusetts has some of the most restrictive gun laws in the country, it’s not surprising then that the report found that it had the lowest rate of gun-related deaths for both women and children.
Similarly, Massachusetts has some of the highest water quality standards and regulations in the country. Experts say this may be why the state tied with several others for having the best water quality in the report.
Why the Massachusetts Health Connector is so important
Experts agreed that the biggest way the Massachusetts state government promotes health is through the Massachusetts Health Connector, which makes it possible for nearly every Bay Stater to have health insurance.
This is likely why the report found that Massachusetts had the lowest rate of uninsured women and children in the country, at about 3% and 1%, respectively. In the country overall, nearly 12% of women and a little over 5% of children were uninsured.
When people have health insurance, they are more likely to seek out preventative care and treatment for issues that may seem minor but can turn more serious later, Watson said. In that way, Declecq said, they stop health problems before they start.
This was reflected in the report, which found that a greater share of women and children received preventative care and regularly visited the doctor in Massachusetts than in the country as a whole.
The saturation of doctors in a small state, which experts say is tied to Boston being a medical school hub, also helps Bay State residents’ access health care easily.
“You only have to travel — even if you’re in a pretty rural location – maybe an hour to get to a doctor, whereas if you’re in rural Texas, you might be driving two or three hours,” Boston College nursing professor Brittany van de Water said.
Health problems tied to known issues
The report highlighted that Massachusetts struggles with housing-related issues. For one, the rate of households with children that spend more than 30% of their income on housing was higher than the national average. Experts cited the state’s ongoing housing crisis as being responsible for this problem.
“There’s a well-known high cost of living in Massachusetts, especially in the eastern part of the state,” Watson said. “ … That’s been true for a long time, but housing prices in Boston and other similar coastal cities have gone up even more in the past few years, and so it just becomes that much less affordable for the average person.”
Additionally, the Bay State’s relatively old housing stock, which goes back to the age of the state itself, seems to be causing problems. Experts said this is why the report recorded the state having some of the highest rates of asthma in women and children.
The report also found that nearly 30% of Massachusetts’s housing stock carries an elevated lead risk — a rate far higher than that of the nation as a whole.
Another area where Massachusetts seemed to perform poorly was in regards to children’s mental health. The report found that the state had some of the highest rates of anxiety and depression among children ages 3 to 17. The state’s childhood victimization rate was also the third-highest in the country, and more than double the national rate.
But several experts said they thought this might not actually be bad news. Since Massachusetts has such good health care access, they said it’s possible that the state doesn’t actually experience these health issues at higher rates, but that its health care providers are simply catching these issues more often than in other states.
This may be why the report found that the Bay State had the lowest teen suicide rate in the country — a rate which was half that of the country as a whole.
“We’re doing a better job of intervening,” Watson said.
Health problems without a clear explanation
Experts said there wasn’t a clear explanation behind every health metric on which Massachusetts did poorly in the report.
One example is the Bay State’s higher-than-average rates of excessive drinking, illicit drug use, and drug-related deaths among women. The report also found that the state had high rates of children ages 12 to 17 using drugs or alcohol.
Both Declercq and Watson agreed that, while it’s not clear why, it’s well-known that the opioid crisis has hit Massachusetts harder than many other states. Godley added that the state has had high alcohol abuse rates for a long time, though the cause of this issue is also unknown.
Why state leaders shouldn’t get too confident
Declercq said he is skeptical of the argument that Massachusetts’s poor performance on some health metrics is simply due to doctors catching these issues more often. He cautioned state leaders from taking too much solace in the state’s good overall health metrics for women and children, as the report identified many potential improvement areas.
For instance, despite the Bay State’s positive performance on preventative care metrics generally, the state had one of the lowest annual pap smear rates. The report also found that the state could stand to improve when it comes to women’s fruit and vegetable consumption.
Experts also warned that while Bay State women and children are, on average, healthier than those in other states, the state’s most vulnerable populations are still struggling.
“When states do well, the people who get behind get left further behind,” Godley said.
For instance, the report found that while the state had a lower child poverty rate than the nation as a whole, it had one of the worst racial disparities among impoverished children.
Health disparities in Massachusetts are also geographic, experts said. Watson gave the example of pollution, which she said disproportionately affects certain neighborhoods, while Godley said many of the state’s small cities have a high teen pregnancy rate.
“You risk a dangerous arrogance if you become too confident that things are going well,” Declerq said.
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