In a city where most residents are within a short distance of world class academic medical centers, and in a state that makes health insurance available to all, why is there such a such a disparity in life expectancy among the residents of three Boston neighborhoods?
That’s the compelling question recently asked by a team of researchers at Massachusetts General Hospital.
The project sought to see what role chronic stress played in the development of health-related disparities between residents of Roxbury, Jamaica Plain and Back Bay. Of the three neighborhoods, residents of Back Bay have the highest life expectancy at 89, residents of Jamaica Plain at 78 and Roxbury residents at 59.
The study team, which was led by Darshan H. Mehta, MD, MPH, of the Benson Henry Institute for Mind-Body Medicine at Massachusetts General Hospital, recently published their findings in Global Advances in Health and Medicine.
Details of the Survey
The team surveyed 326 residents from the three neighborhoods and asked them to rate the impact of 27 neighborhood stressors, 16 stress-related negative behaviors and 13 stress-related health problems.
Across all participants, the most commonly cited neighborhood stressors were related to finance (cost of living and housing), unequal treatment (including discrimination and intolerance), and unsafe bike and pedestrian access. The highest stress-related behaviors were eating poorly,intolerance and aggressive driving, and the highest stress-related health problems were substance abuse and obesity.
Among neighborhoods, however, there were significant differences in how residents responded.
Differences Among Neighborhoods
In Roxbury, the highest neighborhood stressors were cost of living, high substance abuse and discrimination. In Jamaica Plain, residents responded similarly, citing housing costs and alcohol and drug use along with unsafe bike and pedestrian access.
The three highest stressors identified by residents of the Back Bay were unsafe bike and pedestrian access, a lack of affordable fitness facilities and noise pollution.
When it came to the most significant stress-related health problems Roxbury residents cited substance abuse, obesity and gastrointestinal disorders. Jamaica Plain residents once again responded similarly, citing substance abuse, insomnia and obesity.
In the Back Bay, the top three stress-related health problems were chronic pain, anxiety and insomnia.
In the third and final part of the survey, participants were asked to identify which stress-related behaviors had the greatest impact on the overall health of their communities.
In Roxbury, residents identified physical violence, aggressive driving and child abuse/neglect. In Jamaica Plain,residents identified poor eating habits, intolerance and lack of exercise. In the Back Bay, poor eating habits, social isolation and intolerance were the top three.
Expected Outcomes and Notable Contrasts
The authors acknowledge that many of their findings predictably reflected economic disparities across the neighborhoods. According to the Boston Planning and Development Agency, the median household income in Back Bay as of 2015 was $88,500, compared to $76,000in Jamaica Plain and $26,000 in Roxbury.
But the study also identified some interesting contrasts.
For example, residents of Jamaica Plain and Roxbury identified stress-related health problems relating to sleep, diet and exercise has having the most significant impact on their community. However, they did not identify related characteristics, such as a lack of access to healthy foods and accessible exercise facilities as key contributors to stress.
This dissonance suggests that there is a blind spot when it comes to connecting neighborhood stressors to outcomes, the authors note.
Limitations, Strengths and Opportunities for Change
The team acknowledges that there were some limitations to their study. For one, the participants were not randomized—70% of participants came from community health centers in Roxbury and Jamaica Plain, or primary care practices in the Back Bay.
There were also likely differences in the patient populations between the community health and primary care settings. The team also asked residents to identify their health-related stress problems from a predetermined list of options, which may not have covered everything.
One strength of the study was that they were able to gather information about the effect of stress in each community directly from the residents that lived there. They could also compare the residents’ perception of how stress affects their community to the stress-related health problems they personally experience.
“It is essential to further illuminate the relationship between neighborhood stressors and the resultant stress-related health problems and behaviors if we hope to empower residents to make meaningful changes in their health,” the authors say.
“Our results suggest that the health of communities could benefit from tailored, neighborhood-level interventions that aim to reduce the unique stress burden that is present in neighborhoods.”
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