Have you ever wondered why people from across the US, even from other countries, like Panama, where I'm from, come all the way to Boston to get treatment? They come here to get the best care they can get; but why Black Bostonians don't receive the same care people from so far away come to get? According to the Boston Globe's article on Health in Boston, only 11% of people admitted into Mass General, in which the best doctors are found, are Black ("Color Line Persists). The purpose of my Story Map is to deeply analyze the Health Care segregation problem in Boston and how it strictly related to other aspects in Boston's landscape such as housing and transportation.
The transect starts in Franklin Park, which is characterized by the abundance of green areas that act as a curtain to the city. The Lemuel Shattuck Hospital is right by the park. Its proximity allows patients and visitors to access the park and interact with nature. This is a huge benefit for mental and physical health, as the natural aesthetic of Franklin Park calms the mind and dissipates the stress of the outside world. Frederick Olmsted believed that green space and interaction with neighbors was a huge benefit to humans and was integral to public health. If we solely focus on this we could forget about the invisible story of health segregation behind it. This is why my Emerald Necklace transect's goal is to shed light on the health inequity that most times is hidden and unspoken.
Before digging into the health segregation problem it is important to define health inequity, which is different from health inequality or health disparity. Health disparities are simply differences in the presence of illness, access to medical health, and health outcomes between different groups of the population. Health equity is when those differences could be avoidable and are unjust. Most of the times the difference between health inequality and inequity is that health inequality is determined by natural unchangeable reasons as genetics. On the other hand, health inequity is most of the times driven by poverty, stress, and other aspects that are avoidable and unfair and generally determined by race (Boston Public Health Commission).
Now that we defined the situation in Boston as a health inequity we can begin to analyze what are the main determinants of the issue. In Boston, racism plays an important role in creating health inequities. First of all, the city itself is racially segregated, meaning black people live in separate communities than whites. Black communities are denser in population than white ones and have poorer lifestyle conditions, as well as earn less income, therefore, don’t accumulate wealth. This is a consequence of the history of segregated laws discussed in "The color of Law" by Richard Rothstein. Additionally, health resources in Boston are inequitably distributed throughout the city, following the patterns of segregation. As a result of all these factors, that are all driven by race, Black people in Boston don't enjoy the same health care system as White people do. These statements are all acknowledged by the Boston Public Health Commission, which has the intention to make health equitable in Boston (Boston Public Health Commission).
Two main stops of the Story map are the Massachusetts General Hospital, or Mass Gen and the Boston Medical Center. In Mass. Gen whites are "four times as likely to be admitted than whites" while "black Bostonians are more than three times as likely to get care at Boston Medical Center" according to the Boston Globe's series article. Even though BMC is still considered a good hospital, it is still worse than the Harvard Institutions, let alone the Mass General. As to the Harvard affiliated Institutions which are the Brigham and Women's Hospital, the Beth Israel Deaconess Medical Center and the Boston's Children Hospital, also part of the transect, don’t show the same racial imbalance as the Mass Gen and the BMC with 30% of black patients ("Color Line Persists).
This is when the location of these hospitals becomes relevant. The Mass Gen, surrounded by white communities has mostly white patients, while the BMC, which is nearer to Roxbury and Dorchester, which are black communities, treats mostly black patients. The Harvard Institutions since are also near the black communities has more diversity among their patients. In these examples, the Mass Gen and the BMC are racially segregated because they follow the housing segregation patterns, however, as the Harvard Institution's location breaks the patterns, more diversity comes in. Furthermore, public transportation is also an important factor for health inequity, which is why bus stops and T stops near each hospital are included in the story map. It is important to note how Mass General and the Harvard institutions have T stops, while the BMC and the Lemuel Shattuck Hospitals have only less reliable bus stops. Additionally, if a person that lives on a black community wants to access one of the hospitals that have a T stop they would still have to do so using a bus, which are less reliable, because of the routing of the lines. Most of the times missed appointments are related to lousy transportation ("In Focus: Reducing Racial Disparities).
To conclude, pre existing patterns of housing segregation have shaped the health care system with the same segregated patterns. Location of hospitals and public transportation are key to the access of patients to these institutions to get the care they need. The Boston Public Health Commission has been doing efforts for the past years to work towards health equity. However, even if the system radically changed, black people would not necessarily leave the institutions that welcomed them in the past. This is because, besides the previously mentioned factors, there is still a racist environment that is not socially welcoming. According to the city's health care survey in 2013, 11% of blacks reported being mistreated by the hospital staff because of their race, compared to 2.5% of white patients ("Color Line Persists). Also, a "consistent body of research demonstrates significant variation in the rates of medical procedures by race, even when insurance status, income, age, and severity of conditions are comparable" (Nationalacademies.org). This means that not only the system has to change but also individuals’ perspective and attitude towards black people should be more welcoming. When we see a landscape from the outside it is difficult to notice what is happening inside, that is why through my Story Map I hope to uncover part of the sometimes invisible patterns and inequities that are present in Boston's Health system. In an ideal Boston, there would be health equity and Black people's health would be of easier reach than of foreigners who come from other countries to get treatment.
Boston Public Health Commission. (2015). Health Disparities Vs. Health Inequities.
[online] Available at: https://www.bphc.org/whatwedo/health-equity-
Inequities.aspx [Accessed 25 Nov. 2019].
Boston Public Health Commission. (2015). Why Racism Matters. [online] Available
health-equity/Pages/Why-Racism-Matters.aspx [Accessed 25 Nov. 2019].
"Color Line Persists, in Sickness as in Health Boston. Racism. Image. Hospitals.:
Boston is Home to some of the World's most Famous Hospitals, but its Black
Residents, to a Striking Degree, Take their Health Needs Elsewhere. ." Boston
Globe, Dec 12 2017, ProQuest. Web. 25 Nov. 2019 .
"In Focus: Reducing Racial Disparities In Health Care By Confronting Racism |
Commonwealth Fund." Commonwealthfund.org. N. p., 2019. Web. 25 Nov.
Nationalacademies.org. (2002). Unequal Treatment: Confronting Racial and Ethnic
Disparities in Health Care : Health and Medicine Division. [online] Available
[Accessed 25 Nov. 2019].