Boston's approach to maximizing health equity in policy, systems, and environmental change

Black and Latino residents of Boston experience obesity and its health consequences at significantly higher rates than do White residents. In order to reduce health inequities, policy, systems, and environmental change strategies must specifically address social determinants of health, including the inequitable distribution of health-promoting resources and opportunities. Boston's Communities Putting Prevention to Work obesity initiatives integrate health equity approaches at every level, with the dual goals of narrowing disparities and improving overall health outcomes. This presentation will include a discussion of Boston's CPPW planning process, an overview of select implementation efforts, and a description of evaluation efforts. Boston designed its portfolio of strategies to include both city-wide and targeted "place-based" initiatives in low-income neighborhoods of color. Collaboration with existing coalitions in these neighborhoods was initiated at early design stages. Key initiatives include a media campaign to raise awareness of risks associated with sugar-sweetened beverages to build broad-based support for policy change; Boston Bike Share, which includes subsidized memberships, bicycle stations in target neighborhoods, and community mobilization workshops to increase familiarity with bicycling as leisure and active transport options; expansion of urban gardening programs; and a physical activity referral system at “safety net” community health centers through which subsidized memberships to fitness facilities are available. The evaluation strategy includes data collection on both process and outcome indicators to measure behavior and attitude changes among Boston residents. Multi-level community approaches should include thoughtful, data-driven strategies that promote health equity. Evaluation of these strategies is essential for building the evidence base.