In Boston, your zip code can determine how long you live. This is not hyperbole – it is a documented fact.
The Boston Public Health Commission recently released a Health Equity Report that reveals a sobering reality: there exists a 23-year difference in life expectancy between Roxbury and Back Bay, two Boston neighborhoods separated by just over two miles.
Twenty-three years is nearly a quarter century – enough time for some to raise children, build a career, travel the world, or simply enjoy life’s everyday moments. For some Bostonians, this may represent the difference between seeing their grandchildren graduate school versus dying prematurely from preventable causes.
While this gap has narrowed from 33 years since 2007, the continued disparity represents one of the most profound inequities in Boston. And it is not just unique to Roxbury. Similar patterns of lower life expectancy affect other neighborhoods throughout Boston like Dorchester, Mattapan, East Boston, and Jamaica Plain.
Though, the causes behind these disparities are not a mystery.
Decades of structural racism have resulted in residential segregation and chronic disinvestment in Black and brown communities. These patterns have created neighborhoods with vastly different opportunities for health, influencing factors like access to nutritious food, safe housing, quality healthcare and economic opportunity.
The three leading causes of premature mortality in Boston – unintentional drug overdose, cancer, and cardiometabolic disease – as identified in the report shed light on these disparities. Each disproportionately impacts communities of color. Black Bostonians have a significantly higher heart disease mortality rate compared to all other racial and ethnic groups. Black men in Boston are 50% more likely to die from colon cancer than white men. And in 2023, the opioid overdose mortality rate for Black and Latinx residents was 131% and 48% higher than the rate for white residents, respectively.
These statistics are not just numbers. They represent lives that are cut short by preventable conditions.
So, what’s some good news? The city has committed to eliminating this life expectancy gap entirely by 2035. Mayor Michelle Wu and Commissioner of Public Health, Dr. Bisola Ojikutu, have outlined a comprehensive approach that addresses not just healthcare access but the fundamental drivers of health: housing, economic mobility, neighborhood conditions, and community empowerment.
However, the government alone cannot solve this crisis. Health equity is everyone’s responsibility.
For healthcare institutions, this means examining biases in the delivery of care and investing in community-based programs. Boston’s medical institutions have a responsibility to ensure a continuum of care beyond hospital walls into the communities most affected by health disparities.
For businesses, it means creating economic opportunities and investing in underserved neighborhoods. The report highlights how wealth and health are inextricably linked, with economic mobility serving as a key pathway to better health outcomes.
For community organizations, it means continuing to advocate for and implement neighborhood-level solutions. The Boston Community Health Collaborative demonstrates how coordinated efforts can address complex health needs at the local level.
For individual Bostonians, it means supporting these efforts through civic engagement, volunteering, and recognizing how our collective choices shape the health of our entire city. It also means checking our own biases and assumptions about health disparities.
The BPHC report offers a roadmap for action, from expanding naloxone distribution to prevent opioid overdose deaths to increasing cancer screenings and management in underserved communities. It emphasizes the importance of culturally relevant food access programs and creating safe spaces for physical activity.
Boston has always prided itself on being a city of innovation and progress, but this work belongs to all of us. A 23-year gap in life expectancy between neighborhoods isn’t just a public health crisis – it’s reflective of the unjust reality Bostonian neighbors are experiencing each day.
The question isn’t whether we can eliminate this gap – it’s whether we have the collective will to do so. The time for action is now.
Kevan Shah, MSc, MSM is founder and executive director of End Overdose Together. He is a MD candidate at Cooper Medical School of Rowan University.
