Identifying vulnerable children: Boston's tale of two cities

Background:  A review of the social and economic experience of Boston’s children and families, including nearly universal health insurance coverage, may suggest that children in Boston enjoy equal access to health promoting opportunities.   However, one must examine geographic and sub-population-specific data to identify inequities in the distribution of social determinants that result in disparate health outcomes.

Methods:  Multiple data sources, including the Boston Survey of Children’s Health (BSCH), and the American Community Survey (ACS), were used to identify disparities in the distribution of social and economic factors that influence child health. 

Results: According to ACS data, approximately 30% of children in Boston live in neighborhoods with higher unemployment rates, higher prevalence of poverty among families, and lower educational attainment than Boston overall.    BSCH data indicate the plurality of White children (47.7%) live in high income households (>$100,000), while the plurality of Latino (48.2%) children live low income households (<$25,000). While 5% of Boston children were in fair/poor health, a higher prevalence of fair/poor health was reported among children in low income households (10.9%), households where parents had a high school diploma (11.5%), and households that received housing subsidies (15.0%).

Conclusion:  This analysis demonstrates how, for children, Boston is not one city with equal access to opportunities for optimal health but two cities: one where children experience few social risks that impact health and another where children experience a disproportionately higher burden of social risks.   These differences must be understood and addressed as part of comprehensive solutions to reduce health inequities.