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From YouTube: Health of Boston "Year in Review"
Description
Boston Public Heath Commission briefing hosted by Councilor Ayanna Pressley, Chairwoman of the Healthy Women, Families & Communities Committee to discuss the status of health in Boston.
A
I
strongly
believe
it
is
our
duty
to
engage
and
educate
our
community
around
issues
of
Public
Health.
This
briefing
today
will
provide
some
much-needed
insight
on
public
health.
Trends
in
our
city
will
hopefully
allow
for
a
better
understanding
of
the
social
and
economic
determinants
that
shape
the
health
of
our
communities
and
the
residents
of
our
city.
First
I
want
to
say
thank
you
to
chief
Martinez
and
director
loopy
for
coming
today.
A
Today,
we've
been
soliciting
questions
and
things
and
so
appreciate
the
opportunity,
even
if
folks
can't
be
here
physically
to
have
that
interactive
dialogue.
So
I,
thank
you
all
for
being
here
to
brief
the
council
and
the
public
on
the
health
of
Boston
report,
which
was
released
in
February
I
commend
the
Health
Commission
for
producing
this
report
annually
and
for
being
here
today.
So
we
can
understand
the
implications
of
these
determinants
on
citywide
health,
health
outcomes
from
fatal
overdoses
due
to
substance
use
disorders,
to
the
trauma
of
rampant
community
violence.
A
It
seems
our
ability
to
create
a
healthcare
system
that
works
for
all
of
us
and
not
just
a
select.
Few
is
an
ongoing
challenge.
Nonetheless,
we
are
making
real
and
good
progress.
Insurance
coverage
in
Boston
across
the
state
is
near-universal
making
access
to
health
care
services
much
more
attainable
to
all
of
our
residents.
Despite
these
achievements
that
are
highlighted
within
the
report,
many
inequities
remain
across
many
racial
and
socio-economic
groups.
A
I
look
forward
to
engaging
in
conversation
like
these
more
throughout
the
year
to
partnering,
with
you
to
work
to
eliminate
the
inequities
and
barriers
that
impact
our
ability
to
achieve
optimal
health
status
for
all,
regardless
of
race
or
zip
code.
This
report
gives
us
an
important
foundation
to
tailoring
our
work
in
public
health
to
address
the
most
urgent
issues
of
our
city
and
to
continue
our
efforts
to
address
the
needs
of
boston
residents,
especially
the
most
vulnerable
amongst
us.
A
Thank
you,
and
so,
if
you
would
like
to
extrapolate
and
highlight
whatever
you'd
like
from
this
comprehensive
report,
if
you
would
also
share
with
the
public
if
they
are
interested
in
physically
accessing
this
report,
how
that
might
be
possible
online
or
if
they
can
get
physical
access
to
one
and
then
just
before
you
speak
in
your
presentation,
if
you'll
just
provide
your
name
and
your
title
for
the
public.
Thank
you
great.
B
Thank
You
councillor,
thank
you
for
having
us
chief,
Marty,
Martinez,
Health
and
Human
Services
chief
for
the
city.
Just
thank
you
so
much
to
the
counselors
are
here
and
and
for
everyone.
That's
joining
us
to
sort
of
learn
more
about
the
health
of
Boston
and
the
report
that
you're
going
to
hear
Commissioner,
Valdes,
Lupi
and
Dan
Dooley
who's,
our
director
of
research,
the
research
and
evaluation
office,
we're
gonna
sort
of
walk
us
through
some
of
the
highlights.
In
the
overview
of
what
the
report
has
shown
and
sort
of
look
at
some
of
the
data.
B
That's
there
I
think.
One
of
the
things
that's
important
to
remember
is
that,
in
order
to
do
is
take
two
key
words
to
create
optimal
health
for
all
Bostonians.
Regardless
of
what
zip
code
you
live
in,
we
have
to
understand
that
what
the
data
says.
We
have
to
understand
what
the
numbers
say,
not
just
our
instincts,
but
what
data
tells
us
not
only
about
our
progress,
because
I
think
you'll
you'll
see
in
this
report
there's
been
some
great
progress
in
different
areas.
B
Some
gains
we've
made
and
some
headway
we've
made
of
building
a
healthier
community,
but
also
to
own
the
disparities
that
continue
to
exist
and
what
those
persistent
challenges
are
to
close
those
disparities
and
to
better
understand
them.
So
that's
kind
of
what
we're
gonna
cover.
You're
gonna,
see
some
of
the
highlights
and
we're
gonna
recognize
some
of
the
challenges.
A
Did
just
went
to
them,
I
was
remiss
to
acknowledge,
and
so
for
all
of
the
the
progress
that
has
been
made
and
the
progress
to
come
that
that
certainly
does
require
a
collaboration
and
not
just
partners
within
City
Hall,
but
certainly
in
community
and
so
I
do
want
to
acknowledge.
Abcd
intervene,
Goldson
for
her
advocacy
and
what
she
does
on
the
front
lines
every
day.
We
thank
you
for
your
partnership.
Okay,
absolutely.
B
C
You,
chief
and
good
afternoon,
councilor
thank
you
for
hosting
us
this
afternoon
and
councillor
Flynn.
My
name
is
Monica
Valdes,
Lupi
and
I'm.
The
executive
director
of
the
Boston
Public
Health
Commission,
the
local
health
department
for
the
city
of
Boston,
dan
and
I,
will,
as
chief
said,
walked
through
the
report
for
you,
but
I
also
want
to
acknowledge
our
staff
from
our
research
and
evaluation
office
who
are
sitting
in
the
audience.
Really.
C
I
won't
read
through
it
other
than
to
say
that,
in
addition
to
important
health
data
that
we
have
gathered
and
analyzed,
there
are
also
some
chapters
that
really
focus
and
really
zero
in
on
the
persistent
health
inequities
that
we're
seeing
trends
in
those
and
then
also
the
social
determinants
of
health.
So
the
report
really
does
a
nice
job
of
weaving
in
what
are
those
root
causes
that
contribute
to
the
persistent
health
equity
inequities
that
we
see
in
certain
racial
and
ethnic
groups?
C
Oh
thanks
in
this
next
slide.
You
know
where
do
we
get
the
data
that
forms
the
basis
and
some
of
the
data,
such
as
the
adult
health
and
risk
factors,
is
actually
data
that
we
have
in-house
and
the
staff
do
the
analysis
analyses
in-house,
but
we
also
rely
on
data
from
our
partners
at
the
Boston
Public
Schools.
So
the
youth
risk
behavior
'el
survey
of
our
colleagues
at
the
State
Health
Department
in
terms
of
birth
and
death
certificate
data
and
also
national
data
sets.
C
So
there
are
two
if
I
were
to
summarize
the
two
primary
reasons
that
remain
important
for
the
Public
Health
Commission
to
develop
the
report.
It
would
be
twofold
and
first
it's
really,
as
you
said,
and
you
set
it
up
very
well
in
terms
of
assessing
the
health
of
our
residents
and
really
providing
a
very
comprehensive,
detailed
view
of
what
the
health
of
Bostonians
looks
like
across
our
different
neighborhoods
to
lift
up
where
we
see
trends
not
only
focused
on
the
deficiencies.
C
In
terms
of
health
inequities,
but
where
we
see
improvements
and
Dan
will
be
able
to
highlight
the
improvements
that
we've
seen
over
time
when
he
digs
a
little
bit
deeper
in
terms
of
that
data,
because
it
doesn't
happen
in
terms
of
some
of
the
data
that
you'll
hear
more
about
in
terms
of
infant
mortality.
For
example,
the
improvements
that
we
see
didn't
happen
the
two
years
or
the
five
years
that
we
are
able
to
look
at
that
data.
C
That
is
actually
improvements
based
on
investments
by
the
city
and
the
state
in
the
Commission
to
really
address
some
of
the
deficiencies
and
health
inequities
that
we've
seen
so
really
first
is
to
provide
an
assessment
of
the
health
of
our
residents.
The
second
is
to
take
that
information
and
promote
it
to
share
the
information
with
different
constituencies.
Policymakers
elected
officials
like
yourselves,
to
use
the
data
to
help
drive
program
program
and
policy
design
and
to
ensure
that,
as
you
said,
that
we're
investing
our
resources
appropriately
in
the
right
neighborhoods
to
tackle
the
right
issues.
C
So
there
are
a
number
of
different
constituencies
that
rely
on
the
health
of
Boston
and
on
this
slide
just
a
sample.
You
know
clearly
our
health
care
providers,
our
community
health
centers
and
our
teaching
hospitals
in
the
city
leaned
on
the
data
and
the
analysis
that
we
provide
through
health
of
Boston
as
they're
developing
their
different
community
health
needs
assessment
reports
that
we
are
required
by
the
state
and
the
federal
funders
that
they
are
accountable
to
again.
I
already
mentioned
the
policymakers,
but
also
community
coalition's.
C
A
little
less
than
half
really
of
those
requests
are
from
our
internal
partners,
so
across
are
over
40
programs
at
the
Commission,
but
over
half
are
really
external
partners
who
reach
out
to
Dan
and
our
colleagues
at
the
research
and
evaluation
office
to
run
different
analyses,
and
so
those
external
partners,
I've
already
mentioned,
include
individuals.
Other
city
agencies.
In
fact,
a
third
of
our
external
requests
came
from
our
sister
partners.
C
Other
agencies
who
actually
work
with
Public
Health
in
terms
of
really
looking
creatively
across
the
administration
at
different
policies
and
and
interventions
that
can
be
developed,
address
health
inequities.
So
those
partners
include
the
Boston
Planning
and
Development
Association
Boston
Housing
Authority
in
Boston,
Public
Schools
27%
of
our
requests
actually
came
from
the
community
health,
centers
hospitals
and
healthcare
related
nonprofit
agencies
and
then
about
a
quarter
came
from
universities
and
students
who
might
be
working
on
different
capstone
projects
or
different
research
initiatives.
C
So
you
know
there
really
is
a
range
of
different
constituents
who
tap
into
and
use
the
health
of
Boston
I'm
I'm.
Actually
now
gonna
shift
over
to
Dan
who's.
Gonna
walk
us
through
some
of
the
data
and
how
to
access
it
and
that's
a
way.
So
you
asked
how:
how
can
individuals
get
the
report
so
Dan's
gonna
walk
through
it.
Thank.
D
You
I'm
Dan
Dooley
research
director
at
the
Commission.
The
the
slide
you're
looking
at
here
shows
we've
got
the
report
located
on
the
web
at
two
different
locations,
so
one
at
the
Boston
Public
Health
Commission,
where
you
can
actually
access
individual
chapters
as
well
as
a
pendous
ease
that
give
all
the
rate
data
behind
the
charts
that
are
in
the
report
itself.
It's
also
the
full
report
is
also
access.
D
You
can
reach
at
Boston
gov,
and
then
we
wanted
to
mention
that
we're
actually
in
the
process
of
developing
a
an
online
data
visually
visualization
tool
that
will
allow
for
interactive
access
to
the
data
itself,
and
this
will
be
more
in
line
with
data
dashboards
that
you
may
have
accessed
already
and
it'll
allow
for
different
types
of
stratifications.
Look
at
the
data
that
way
and
cut
it
different
ways
that
should
be
available
sometime
this
summer.
D
I'd
also
wanted
to
mention
that
the
report
itself
is
about
six
hundred
and
sixty
plus
pages
of
information,
which
is
extensive
and
I
could
not.
It
would
take
me
days
to
get
through
it
all.
So
this
is
basically
highlights
and
just
a
brief
summary
of
some
of
what's
in
there,
but
it's
also
meant
to
give
you
an
idea
of
how
to
access
the
data
and
what
you'd
be
seeing.
D
D
Another
example
of
improvements
in
this
year's
report,
our
arrow
summary
tables
that
we've
generated
for
quick,
summary
comparisons.
In
this
example,
here
we've
got
health
indicators
going
down
the
left
side
and
then
the
arrows
underneath
the
the
various
racial
ethnic
groups
that
we
present
and
then
the
sexes
indicate
whether
or
not
those
rates
have
increased
or
decreased
or
have
stayed
approximately
similar
when
compared
to
the
reference
group.
Our
racial
ethnic
groups,
comparisons
throughout
the
report
are
comparing
to
the
white
residents
of
Boston
and
our
sex
comparison
throughout
the
report
compared
to
the
male
residents
female-to-male.
D
Then
another
inclusion
in
this
year's
report
is
inclusion
of
unique
perspectives.
At
the
conclusion
of
each
chapter.
We
have
unique
perspectives
from
community
residents
and
from
public
health
professionals
where
they're
giving
a
perspective
on
essentially
the
content
of
the
chapter
itself,
so
making
I
think
it
helps
to
personalize
some
of
the
data
and
the
experience
that's
being
that
Boston
is
experiencing.
D
So
at
this
point,
I'm
going
to
move
now
and
start
to
discuss
the
some
of
the
progress
and
some
of
the
improvements
that
we've
seen
I'm,
also
in
the
process
going
to
try
to
mention
a
some
of
what
the
Public
Health
Commission
has
done
in
hopefully
contributing
to
the
progress
that
we're
seeing
I'm,
not
able
to
mention
everything.
There's
there's
many
many
different
programs
but
I'm
going
to
point
out
at
least
a
few
as
we
go
along.
B
A
I
was
just
curious
and
I.
Don't
know
if
this
was
gonna
be
part
of
the
presentation,
but
on
infant
mortality
specifically-
and
you
cited
some
some
programs
that
were
certainly
very
grateful
for
so,
which
is
the
cause
for
infant
mortality
related
to
prenatal
care
and
access
to
nutrition
and
the
decrease
of
other
social
determinants.
Stressors
like
poverty,
racism.
That
sort
of
thing
is
that
what
we
would
credit
as
the
contributor
to
black
infant
mortality?
Well,.
D
There
are
many
many
contributors,
but
those
all
are
playing
a
part.
The
you
know,
there's
many
risk
factors
for
infant
mortality,
perhaps
chief
among
them
is
low
birth
weight
births
and
and
the
factors
that
you're
discussing
and
describing
actually
contribute
to
low
birth
weight
births
so
and
we'll
talk
a
little
bit
further
in
the
presentation
around
the
role
of
the
social
determinants,
but
those
those
are
more.
D
The
upstream
contributors,
then,
okay
to
the
factors
that
actually
lead
to
the
poor
health
outcomes
and
and
certainly
then,
our
programs,
a
healthy
baby,
healthy
child
and
the
Healthy
Start
initiative
are
invested
in
trying
to
improve
those
rates,
access
to
prenatal
care,
lowering
low
birth
weight,
and
then
you
know,
access
to
nutritious
foods
and
lowering
stressors
etc.
Thank.
A
D
Well,
so
this
just
to
wrap
up
on
this.
This
is
a
the
female
reduction
in
the
female
birth
rate
among
females
ages,
15
to
17,
which
has
happened
over
from
2011
to
2015,
we've
seen,
reductions
among
Latinas
and
among
black
infant
and
mothers,
and
those
reductions
have
been
then
part
of
the
overall
reduction
for
Boston.
D
D
This
next
slide
shows
reductions
in
elevated
blood
lead
levels
by
year.
This
is
these
blood
blood
levels
have
been
coming
down
among
children.
These
are
for
children
under
age,
six
that
are
tested
for
blood
lead.
We
understand,
know
that
blood
blood
levels,
elevated
blood
level,
lead
levels,
create
trouble
with
learning
cognitive
disorders
and
and
could
create
brain
damage.
Eventually,
so
there's
been,
there's
been
a
lot
of
effort
in
regulation,
laws
to
bring
down
blood
blood
levels
and
we
have
in
the
Commission.
D
A
My
point
is,
since
we
know
we,
what
contributes
to
disparities
is
that
even
with
having
insurance,
culturally
many
families
still
don't
prioritize
preventative
health,
and
so,
unless
there
is
a
you
know,
a
crisis
or
some
really
obvious.
You
know.
Maybe
a
child
is,
is
coughing
or
wheezing
or
seems
fatigued
or
delayed.
They
might
not
be
prompted
so
I'm
simply
just
saying
that
you
know
I
trust
the
data,
but
there's
probably
many
children
that
have
suffered
or
been
exposed
and
who
simply
haven't
been
tested.
So
we
couldn't
account
for
them
in
these
improved
outcomes.
Right.
D
D
C
Think,
as
a
city,
we've
done
a
tremendous
job
in
terms
of
the
housing
stock
to
work
with
landlords
and
industry,
around
lead
paint,
and
so
I
know
our
home
visitors
and
our
environmental
health
program.
That's
where
this
work
falls
under
is
dance
at
in
terms
of
lead,
poisoning
prevention
team.
We
can
confirm
with
you
the
process.
Thank
you.
Welcome.
D
D
You
can
see
that
the
the
rates
have
decreased
for
both
and
at
that
in
2015
data
Boston
had
a
rate
of
5%
for
cigarette
smoking
among
high
school
students,
public
high
school
students
compared
to
9%
in
the
US
and
youth
binge
drinking
Boston
has
11%
of
students
reported
binge
drinking
compared
to
18%
in
the
u.s.
and
on
the
smoking.
I
think
we're
just
now
getting
the
2017
data,
and
it
looks
as
though
cigarette
smoking
is
continually
is
continuing
to
decrease
among
high
school
students.
Oh.
D
D
Wanted
to
mention
that,
in
terms
of
asthma
reductions,
we
do
again
the
Public
Health
Commission
has
an
asthma
prevention
and
control
program.
It's
been
very
active
in
conducting
home
visits
that
these
home
visits
community
health
workers
work
to
reduce
than
the
asthma
triggers
that
that
caused
hospitalizations.
We
need
to
ask
my
a
survey
shion's
also
with
the
heart
disease.
Hospitalizations
were
very
active
in
in
working
to
provide
access
to
healthy
foods,
to
reduce
consumption
of
unhealthy
foods
as
well.
D
D
So
we've
also
experienced
decreases
in
cancer
mortality
from
2011
2015
reduction
in
cancer
mortality
overall,
the
at
in
2015,
then
the
the
rape
cancer
mortality
rate
for
Boston.
It
was
equivalent
to
what
we
see
for
for
healthy
people,
target's
healthy
people
2020
and
a
little
bit
higher
than
what
we
see
overall
in
the
US
and
in
Massachusetts,
the
cancer
mortality
rate
in
Boston
has
decreased
12%.
D
That
includes
reduction
among
black
residents
of
18
percent
reduction.
The
rates
for
Latino
and
Asian
residents
are
lower
than
the
rate
for
white
residents.
I
want
to
take
this
moment
to
mention
to
we're
also
in
about
to
release
a
cancer
report
that
looks
more
closely
at
cancer
incidence
and
mortality
overall
in
among
five
cancer
sites.
With
this
report
will
cover
an
1999
to
2013.
D
A
D
D
C
D
So
those
are
some
of
the
successes
that
we've
experienced
so
far
that
we
see
in
the
data
now
I'm
going
to
switch
focus
to
discuss
something
of
more
about
what
are
considered
new
and
continued
challenges
within
the
data.
As
we
mentioned
earlier
about
low
birth
weight
that
low
birth
weight
births,
birth,
low
birth
weight
is
a
risk
factor
for
infant
mortality
and
though
we've
seen
reductions
over
a
longer
term
in
infant
mortality,
we
in
the
last
five
eight
years
we
do
not
see
reduction
in
the
rate
of
low
birth
weight
births.
D
D
The
healthy
people,
2020
goal
is
around
27%.
Boston
has
achieved
that
goal
at
close
to
25%,
but
Boston's
achieve
that
goal,
because
the
white
residents
about
20%
report
hypertension,
and
we
have
higher
rates
among
Latino
and
black
residents
in
the
city
of
Boston,
the
rate
for
Asian
isn't
here.
We
need
two
years
day,
two
years
for
agents,
but
it's
similar
to
the
rate
for
a
white
residence.
D
D
D
B
So
conce
are
just
one
of
the
things
I
think
to
add.
That's
important
is
that
you
know
we
see
these
benchmarks
to
the
you
know
healthy
to
the
national
standards
and,
although
in
many
of
these
scenarios
and
we're
better
than
that
national
average,
well,
what's
difficult
to
sort
of
make
sure
that
I
want
to
make
sure
our
viewers
understand.
B
We
have
to
continue
to
think
about
where
that
gap
is
and
that
inequity
and
and
how
we
focusing
on
the
disparity.
Some
of
the
programs
do
great
work,
but
clearly
the
disparities
still
exist
and
a
lot
of
these
indicators
that
were
reviewing
so
for
me
I
just
want
us
to
recognize
that,
as
it
still
presents
more
work
to
be
done
absolutely.
A
So
is
that
about
us
needing
to
be
more
deliberate
in
the
surveying.
It's
my
recollection
from
the
last
report
that
the
asian-american
community
actually
has
the
the
highest
life
expectancy
in
the
city
of
Boston
I
think
their
average
was
like
80,
but
they
were
disproportionately
bearing
things:
lung
cancer,
more
smoking
of
cigarettes
and
that's
my
recollection.
But
so
what
would
need
to
happen
for
us
to
be
able
to
get
a
full
composite
in
including
the
Asian
community
I.
D
Believe
we've
actually
addressed
that
in
the
in
the
new
data
that
we're
getting
2017,
we've
actually
changed
the
sampling
structure
so
that
we
over
sampled
in
in
areas
to
bring
to
boost
the
Asian
sample
size.
That
will
then
permit
us
to
put
that
statistic
out,
and
that
was
largely
the
result
of
recognizing
this.
You
know
limitation
that
we
were
experiencing
on
occasion.
D
C
The
challenges
in
getting
the
large
enough
sample
size
on
the
Asian.
What
happens
is
there
is
data
at
the
state
and
national
level
to
show
that,
when
you
put
out
when
we
display
data
this
way,
it
makes
it
seem
as
if
there
are
no
health
inequities
or
disparities
in
the
Asian
population,
when,
in
fact,
when
you
look
at
certain
chronic
diseases
like
diabetes
or
cervical
cancer
and
are
able
to
stratify
by
particular
agen
ethnic
groups,
that
those
rates
actually
mirror
are
more
comparable
to
their
black
and
Latino.
A
Counterparts
so
no
absolutely,
and
we
find
that
in
our
schools
when
it
comes
to
academic
outcomes
and
the
achievement
gap
as
well,
because
we're
not
saying
Asian
data,
you
know
in
the
aggregate,
including
Laotian,
Cambodian,
Filipino
right,
and
so
it
can
hide.
Those
disparities
and
I
was
going
to
ask
that
question.
That
was
a
very
good
segue,
because
I'm
not
sure
within
that
surveying
for
black
residents,
knowing
we
have
a
huge
black
immigrant
community
and
and
a
black
Latino
community.
C
Jen
could
probably
speak
to
this
I
can't
recall
if
it's
in
the
health
of
Boston,
but
there's
also
evidence
that
shows
that
immigration
status,
particularly
if
you're
a
recent
immigrant,
often
has
a
protective
factor
initially
and
then
over
time.
Health
conditions
worsen,
because
some
of
those
social
determinants
in
terms
of
racism,
poverty,
economic
opportunities,
so
I
mean
I,
think
you're,
spot-on
in
terms
of
the
nuances
and
limitations
that
we
have
with
some
of
the
data
yeah.
D
And
I
can
share
that.
That
is,
in
fact,
at
least
years
in
the
u.s.
is
in
the
data
itself.
We
don't
have
it
further
stratified
by
race
or
ethnicity,
but
what
we
could
investigate
that
to
see
if
we
could
look,
you
know
what,
how
many
years
we
could
put
together
to
try
to
find
out.
You
know,
if
that's
possible,
with
the
data
that
we've
received,
but
we
do
know,
as
Monica
said
that
often
times
it's
the
case.
A
Then
my
last
question
is
you
know
how
many
of
these
disparities
social
determinants
aside,
is
some
of
this
genetically
passed
on.
So
you
know,
and
so
the
disparities
just
persist
and
perpetuate
without
personal
disruption
and
intervention.
If
your
family
has
historically
had
people
that
have
diabetes
or
hypertension
or
our
beefs
or
are
obese,
what
are
the
odds
that
you're
predisposed
so
I'm
wondering
you
know
how
many
of
these
disparities
are
generational
and
are
about
literally
DNA
and
that's
exacerbated
by
social
determinants?
That's
something
you
could
speak
to
or
do
you
think
there's
much.
D
D
Can
speak
to
that?
It's
a
great
question
and
there's
I
think
there's
a
lot
of
research
trying
to
pull
that
apart
and
try
to
understand
the
relative
contributions
to
the
disparities
that
we're
seeing.
That's
a
it's,
a
very
difficult
area
to
try
to
understand
what
portion
is
presenting.
You
know,
you
know,
was
a
contributor
to
the
outcome
and
so
the
it
that's
the
type
of
information
that
would
result
from
very
well-designed
in
robust
research.
D
D
A
The
health
of
our
communities
in
the
city
determines
everything
we
don't
just
only
care
from
a
place
of
benevolence
and
and
general
care
and
concern,
but
it
is
about
our
workforce
and
our
economy
and
the
productivity
of
the
cities.
So
you
know
from
my
vantage
point:
it
is
the
best
investment
that
will
yield
the
greatest
ROI.
So.
D
A
D
Move
on
this
is
a
presentation
of
pretty
much
the
three
indicators
that
we
just
saw,
but
now
it's
diabetes
among
adults,
hypertension
among
adults
and
obesity
among
adults,
but
this
is
an
example
of
our
Maps,
our
neighborhood
maps,
and
what
we
find
basically
the
way
we
present
these
data
are,
the
darker
colors
represent
the
higher
rates
and
the
lighter
colors
represent
the
lower
rates
of
these
chronic
disease,
in
particular
when
the
higher
rates
are
when,
when
you
compare
to
the
rest
of
Boston.
So
in
this
case,
all
three
maps
are
showing
the
same.
D
D
I'm
gonna
now
turn
in
next
few
slides
are
going
to
discuss
a
little
bit
about
what
we
have
in
our
substance
misuse.
Mortality
data
this
slide
here
shows
that
we've
had
increases
in
overall
substance
misuse:
mortality
from
2011
and
2015
a
54%
increase
this.
We
also
have
a
49%
increase
in
alcohol-related
mortality
and
a
71%
increase
in
drug
related
mortality.
So
it's
the
alcohol
and
the
drug
that
are
combined
for
the
overall,
so
we're
seeing
increasing
rates
across
the
board.
D
D
D
This
next
slide,
then,
with
fentanyl
back
in
the
mix.
This
next
slide
looks
at
the
increases
in
substance
misuse:
mortality
than
by
race,
ethnicity,
for
black
Latino
or
white.
We've
got
significant
increases.
We
didn't
have
enough
cases
among
Asian
residents
to
rate
their
experience
over
those
years.
D
D
In
this
next
slide
then
presents
leading
causes
of
premature
mortality
by
year
and
pretty
much
premature
mortality
is
mortality
among
residents
under
age
65
this
by
year
presents
a
ranking
of
the
leading
causes
of
mortality
and
for
residents
under
65
cancer
is
the
leading
cause
of
mortality
across
the
board.
Ranked
number
one
ranked
number
two
for
the
first
three
years:
2011
through
2013,
it's
heart
disease
mortality,
but
that
was
then
we
moved
to
the
third
in
14
and
15
and
was
replaced
by
accidents.
Now.
D
D
D
We
we
calculate
that
71
percent
of
accidents
were
unintentional,
opioid
overdose
and
if
we
were
to
rank
that
explicitly,
it
would
rank
3rd
among
premature
mortality
by
year.
So,
if
you
just
isolate
opioid
overdose
mortality,
it
would
rank
third
in
2015,
and
this
next
slide
presents
leading
causes
of
injury
mortality
by
race,
ethnicity,
and
so
this
is
all
ages.
D
And
what
we
see
here
are
differences
in
in
ranking,
whereas
for
Asian
residents
the
leading
call
the
cause
of
injury
mortality
is
Falls
and
injury
mortality
is
considered
preventable,
so
Falls
for
Asian,
but
leading
among
black
residents.
How
is
homicide
and
then
among
Latino
and
white
roses
unintentional
poisoning
again
the
influence
of
the
opioid
overdose,
their.
B
We
don't
necessarily
yet
have
that
specificity
for
the
current
years
or
the
closer
years
were
at,
but
thinking
about
the
face
of
the
opioid
disorder
and
what
it
looks
like
I
think
is
also
part
of
thinking
about.
How
do
we
make
sure
all
communities
are
reached
within
programming
and
services?
So
I
just
wanted
to
point
that
out.
A
A
I
also
worry
that,
with
such
a
focus
on
the
crisis
of
the
opioid
epidemic
and
overdoses
that
we
are
not
focused
on
other
substance,
abuse
disorders,
because
I
do
see
on
the
ground
an
increase
in
meth
use,
and
you
know
sort
of
so
much
attention
in
programming
and
advocacy
directed
there
when
we
still
in
general,
have
a
substance,
abuse
disorder,
an
addiction
problem
that
you
know,
opioids
don't
have
the
monopoly
on
so
I'm.
Something
bigger
conversation.
D
This
next
slide
then
presents
our
framework
for
social
determinants
of
health.
A
social
determinants
could
be
thought
of
as
the
conditions
in
which
people
live,
work
play
or
go
to
school
they're.
Basically,
these
are
upstream
upstream
factors
that
contribute
to
poor
or
contribute
to
health
outcomes
to
be
poor
or
not
not.
D
So
our
framework
then
recognizes
in
social
determinants
we're
talking
about
social
capital,
education,
transportation,
employment,
food
access,
social,
economic
status,
housing,
and
then
we
in
our
framework
also
acknowledged
the
role
of
racism
on
all
forms
of
racism
that,
if
that
play
a
role
in
in
the
relationship
with
social
determinants
of
health,
so
we
consider
racism
to
be
a
social
determinant
in
itself,
but
then
also
a
factor
that
contributes
to
other
social
determinants
that
we
have
identified
so
again.
These
social
determinants
are
the
upstream
factors
that
are
that
contribute
additionally
to
health
outcomes.
D
D
D
So
one
of
the
ways
we
have
recognized
that
we
address
social
determinants
is
by
acknowledging
enhancing
our
community
assets.
This
slide
here
lists
what
we
believe
are
some
of
the
community
assets
that
exist
and
my
community
assets
were
we're
talking
about
engaged
communities
and
partners,
community-based
organizations,
community
health,
centers
and
hospitals
engaged
state
and
city
agencies.
We're
also
talking
about
physical
and
built
environment,
assets
and
economic
assets,
as
well
as
strong
leadership.
D
One
I
thought
one
way
to
sort
of
illustrate
a
relationship
between
its
is
the
outcomes
that
we
see
and
some
of
the
determinants.
It
would
be
to
consider
a
map
here.
This
map
shows
I,
believe
higher
rates
of
I
can't
see
exactly
which
one
but
I
believe
that's
the
emergency
department
visits
and
it
shows
the
crescent
shape.
Neighbor.
The
neighborhood's
within
the
question,
shape
they're
Roxbury,
our
to
Dorchester
region's
Matapan,
with
higher
rates
of
emergency
department,
visits
for
assaults.
D
So
these
are
emergency
department
visits
and
the
there.
The
case
definition
is
based
on
icd-9-cm
diagnosis,
and
so
when,
when
a
patient
is
seen
they
get
diagnosed
and
then
the
determination
is
made
whether
you
know
whether
or
not
their
injury
resulted
from
someone
else
intentionally,
and
that
would.
A
A
D
Welcome
so
we
we
consider
them
this
next
map
and
I
believe
when
I
flip
the
order.
This
I
can't
this.
This
next
map
shows
a
vote.
Voter
turnout
rates,
and
here
this
would
be
a
measure
of
community
assets
and
we
actually
have
largely
through
the
same
area
the
lower
voter
turnout
rates
for
general
elections
in
the
city
of
Boston.
So
that
would
imply
that
that
the
residents
are
less
engaged
in
the
voting
process.
D
A
A
Maybe
there
are
many
bodegas
or
you
know
things
like
that
in
most
of
our
bodegas
do
actually
offer
fresh
produce
and
things
like
that,
but
I
just
wonder
if
that's
something
that
could
be
accounted
for
something
to
be.
You
know,
mindful
of
even
our
food
pantries
and
what
is
the
quality
of
food
that
is
being
provided
there
or
senior
meal
sites.
You
know,
are
the
offerings
things
that
are
improving.
Outcomes
are
contributing
to
these
disparities,
so
the
food
is
accessible,
but
but
is
it
quality
and.
D
And
I
think
that's
a
great
point.
The
data
as
we
receive,
doesn't
allow
us
to
make
that
type
of
differentiation
we
are
able.
You
know
we
do
include
when
we,
when
we
have
access
to
the
data
in
this
case,
say
the
farmers
market,
where,
where
it's,
you
know
much
more
reasonable
to
conclude
that
you're
going
to
get
access.
You
know
farmers
markets
to
vegetables,
fruits
to
healthy
foods,
but
we're
you
know.
We
basically
have
limitations
in
the
data
that
we
can
access
so.
C
I
would
say
good
question
in
terms
of
food
deserts.
On
the
flip
side,
there
are
food
swamps,
and
so
we
might
not
have
that
available
in
the
health
of
Boston
report.
But
in
terms
of
that
piece
we,
it
could
be
something
I
suspect
it's
something
that
at
the
program
level,
so
an
on
our
chronic
disease
team,
they
had
a
multi-year
grant
that
they
received
from
the
CDC
we
branded
it.
Let's
get
healthy,
Boston
and
I
do
think
some
of
the
neighborhood
champions
and
community
groups
that
receive
these
grants
actually
looked
at
that
very
issue.
A
B
B
It
would
suggest
that
the
office
of
food
access
less
holistically,
but
has
a
variety
of
different
efforts
through
the
city.
That's
trying
to
partner
with
farmers
markets
pantries,
trying
to
think
about
what
food
is
available
at
community
health
centers,
which
exist
in
all
of
our
neighborhoods
right.
So
I
do
think.
There's
some
of
that
in
terms
of
the
programmatic
piece.
But
the
data
piece
I
think
is
the
larger
question
that
I
think
would
be
interesting
to
sort
of
map
that
out,
because
food
insecurity
really
doesn't
consider
sort
of
that.
A
B
A
B
So
we
so
that's
that's
sort
of
the
presentation
of
the
information
in
the
data
and
I
think,
as
you
can
see,
there's
lots
of
both
assets
and
progress
and
also
there's
obviously,
challenges
that
persist
and
I.
Think
without
it
out.
There
continues
to
be
tremendous
effort
on
the
part
of
the
Commission,
as
well
as
other
city
departments
that
are
working
to
sort
of
close
some
of
these
challenges,
but
also
the
CBO's
and
the
community
that
are
kind
of
taking
these
these
head-on
so
wanted
to
give
you
the
presentation
of
information,
but
also
didn't.
A
For
you
won't
keep
you
here
too
long
because
I,
you
know
I
do
want
more
time
to
pour
over
this
and
we'll
make
sure
my
colleagues
who
all
wanted
to
be
here,
but
given
the
close
proximity
to
our
council
meeting
I'm
sure
they're
all
somewhere
eating,
but
we
will
make
sure
that
they
that
they
get
the
annual
report
and
I
know
some
of
them
have
been
in
their
offices.
You
know
watching
from
there
so
I
appreciate
the
presentation,
appreciate
your
work
and
just
a
couple
of
questions.
A
A
You
know
crimes
and
mental
health
illnesses
and
things
like
that
I
think
because
of
stigma,
I'm,
so
it's
it's
either
we
can't
get
the
the
universe
or
you
don't
have
the
the
researchers
dedicated
so
I
just
wanted
to
I,
guess
just
ask
and
if
you
want
to
revisit
the
suicide
part
itself,
because
antidote
lis
I've
heard
that
we're
those
numbers
continue
to
increase
by
firearm
or
non
firearm.
I,
don't
know
if
if
most
of
your
suicide
accounting
is
is
based
on
drug
use
or
how
we
are
how
we
are
counting
that
so.
C
A
A
B
C
In
terms
of
the
what
you've
just
highlighted,
it
is
actually
something
when
we
look
at.
There
was
just
a
recent
convening
that
Northeastern
University
School
of
Law,
pulled
together
around
what
you
know
is
called
the
diseases
of
despair.
So
drug
you
know
drug
addiction
and
then
also
suicide,
and
so
we
did
engage
a
consultant
to
help
us
look
into
the
data
more
closely
around
suicide
and
have
been
reviewing
that
because
nationally
are
are
at
the
state
and
the
local
levels.
Our
suicide
rates
are
actually
lower
than
national.
Okay,.
C
However,
when
you
look
a
little
bit
deeper
and
stratified
by
race
and
ethnicity,
we
have
some
preliminary
information
that
suggests
that
there
is
a
disparity
and
an
increasing
trend
among
a
certain
age
group
and
also
racial
groups.
So
that
is
actually
something
that
we
that
was
brought
to
our
attention
and
that
we're
reviewing.
Okay.
A
You
know
you
know:
oftentimes
I
find
that
there
are
trends
and
advocacy
as
well.
You
know
that
are
mirrored
by
where
we
see
spikes
and
increases
and
then,
when
those
numbers
begin
to
dissipate,
you
know
usually
the
advocacy
around
those
those
issues
dissipates
as
well,
and
that
is
certainly
true
for
HIV
and
AIDS,
which
we
speak
about.
You
know
with
with
less
frequency
and
intentionality
as
we
once
did,
but
but
meanwhile,
because
many
folks
are
engaging
continue
to
engage
in
high-risk
behavior
and
those
high-risk
behaviors
are
not
usually
in
a
silo.
A
So
I
was
asking
the
question
about
suicide
because
it's
my
understanding
that
we're
seeing
an
increase
in
suicide
of
men
of
color
and
I,
also
just
based
on
the
calls
that
I
get
I.
You
know,
I,
don't
know.
If
you
can
substantiate
this.
There
were
seeing
an
increase
in
drug
use
usage
specifically
of
meth
crystal
meth,
with
an
overlay
of
LGBT,
youth
and
men
of
color,
and
consequently
an
increase
in
HIV
and
AIDS
infections
and
those
new
infections.
The
lion's
share
of
that
being
bore
by
young
men
of
color,
so
I
just
wanted
to
know.
A
If
that's
something
that
you
know
you
believe
to
be
academically
supported,
is
it
something
you're
hearing
just
wanted
to
make
sure
we're
not?
You
know
thank
God
for
modern
medicine
and
there
have
been
tons
of
advances,
but
I
don't
want
us
to
lose
sight
of
HIV
and
AIDS
any
other
issues
that
I
decided.
So
is
this
something
that
you're
familiar
with
or
seeing
or
hearing
so.
D
Yeah
and
I
don't
mean
to
diminish
the
impact
of
crystal
meth
and
it's
out
there,
but
and
on
a
relative
scale.
You
know
the
Boston
indicators
have
always
had
very
low
low
numbers
of
the
crystal
meth,
and
that
said,
it's
it's.
It's
been
a
part
of
the
LGBT
community,
wouldn't
what
you
know
across
the
country?
It's
it's.
So
it's
been
a
part
of
that.
D
A
A
A
D
Know
in
other
parts
of
the
country-
that's
not
the
case,
but
but
but
the
kind
of
information
you're
giving
is
the
kind
of
flag
that
we
would
then
you
know
take
very
seriously
to
look
to
see
what's
happening
in
the
data
moving
forward.
You
know
as
we're
getting
more
I'm
the
data
we're
presenting
here
is
a
few
years
old
already
so
and-
and
you
know
just
from
experience
around
drugs
epidemiology-
that
the
trends
can
you
know,
change
very
quickly
and-
and
we
can
have
you
know
problem.
So
it's
very.
C
D
C
Do
have
both
at
the
city
appropriation
level
and
with
our
federal
funds
that
we
receive
from
her,
so
the
Ryan
White
Care
Act's.
We
actually
do
do
a
out
of
education
and
outreach
to
vulnerable
populations,
and
so
this
is
certainly
something
that
we
can
go
back
to
them
and
check
on
the
different
performance
indicators
that
they
gather
through
the
program,
if
they're
seeing
an
increasing
trend
in
terms
of
intersection
of
crystal
meth
and
high
risk
behavior
among
the
clients
that
are
being
served
through
our
different
community-based
organization.
A
So
when
you
talk
about
CBO's,
you
know
I,
think
about
our
organization
like
Fenway
health
right
and
so
your
urine
rate.
So
how
does
that
work?
How
are
you
conferring
with
them?
So
do
they
call
you?
Are
they
prompted
to
call
you,
because
you
have
a
monthly
or
quarterly
convening?
Do
they
just
send
you
an
email
and
say
this
is
what
we're
sending
do?
They
produce
their
own
report
that
they
turn
over
to
you.
So
how
might
an
organization
like
the
Fenway,
Health,
Center
or
any
other
community-based
organization?
C
A
couple
of
different
ways
so
because
we
provide
on
the
Ryan
White
funding,
that's
15
million
dollars
that
the
city
receives
to
serve
metro,
Boston
and
also
New
Hampshire.
So
it's
a
regional
grant,
so
in
that
instance,
and
also
in
our
education
outreach
grants
because
we
provide
community-based
organizations,
so
health,
centers
and
other
nonprofit
groups
funding
they're
required
to
provide
us
back
with
routine
reports,
and
we
have
program
staff
that
actually
meet
with
talk
with
them
routinely
to
look
at
the
different
indicators.
C
The
the
data
that
we
receive
varies
by
the
type
of
funder
funding
that
we
distribute
in
the
contracts
that
we
have.
So
that's
one
way.
The
other
way
that
I
can
share
with
you,
because
we're
going
out
to
reap
recur
our
federal
funds.
They
just
held
a
series
of
meetings
in
Boston
community
dialogues
in
Boston
and
also
outside
of
the
city
and
in
New
Hampshire,
to
make
sure
that
the
funding
and
the
RFP
that
we're
going
to
develop
are
actually
it's
going
to
actually
target
the
most
salient
issues.
C
A
A
That
in
general
or
you're,
saying
specific
to
this
is
Ryan
White
and
hiv/aids.
So
let
me
ask
about
so
with
that
15
million
and
I
know.
Marty
is
very
big
on
you
know
the
chief
rather
own
evaluative
tools
and
so
I
know.
There's
a
lot
of
work
happening
internally
to
get
us
to
that
point.
But
I
am
curious
about
funders
and
you
know
how
are
we
meeting
these
disparities
and
how
are
those
folks
being
evaluated?
It's
15
million
dollars
and
split
between
New,
Hampshire
and
Boston?
C
C
That
is
actually
something
that
we
also
track
as
well
and
there's
a
whole
new
Quality,
Management
Council,
that's
being
stood
up
to
look
more
closely
at
the
data
and
how
we're
meeting,
how
we're
meeting
different
goals
and
objectives
and
if
we're,
making
an
improvement
because
of
the
investments,
the
majority
of
the
funding
actually
is
in
Massachusetts,
so
it's
driven
by
prevalence
of
hiv/aids,
so
the
majority
and
I
can
get
you
the
breakout.
But
the
majority
is
in
Massachusetts.
B
But
in
Boston
by
the
council,
there's
no
question
that
the
Ryan
White
funding
has
dramatically
impacted.
Indeed
over
years,
decrease
the
HIV
rate,
a
new
infection
rate
and
then
also
the
complexity
of
the
disease
within
the
community.
Moving
forward
there
there
I
don't
have
the
specific
numbers,
but
there's
no
and
we
can
get
them
for
you.
B
B
Today
that
we
don't
forget
that
prevention,
primary
prevention
is
still
a
huge
piece
of
that
work
and
that
populations
today
may
have
forgot
the
struggle
that
came
before
so
I
just
I
want
to
note
that,
because
what
we're
seeing
in
the
data
may
be
one
thing
CBO's
are
concerned,
many
of
them
are
doing
public
awareness
campaigns
and
other
initiatives
to
ensure
that
communities
of
color,
especially
within
the
LGBTQ
community,
get
access
to
the
care
and
treatment
that
they
need.
So
the
data
may
be
in
one
place,
but
the
on-the-ground
CBO's
may
have
another
conversation
about.
A
It
thank
you.
We
spoke
about
low
birth
weights
and
infant
mortality.
There
was
recently
very
encouraged
by
a
national
movement
around
the
health
of
moms,
which
has
led
to
a
greater
awareness
around
maternal
mortality
rates
which
are
growing
because
of
a
post
birth
hemorrhaging.
We
also
see
sharp
disparities
along
race
lines.
There
I
think
black
women
are
dying
three
to
four
times
that
of
their
of
their
white
peers.
So
I
was
just
wondering
if
this
is
anything
that
the
Commission
is
seeing
here.
Thinking
about
addressing
the
issue
of
maternal
mortality,
if
we
have
any
data.
D
A
A
C
Can
start,
then,
and
and
chief
can
and
can
jump
in
so
I'm
actually
really
proud
of
what
we've
been
able
to
do
with
the
staff
that
we
have
obviously
given
some
of
the
analyses
that
you've
seen
and
movement
towards
using
data
in
a
more
and
getting
access
to
more
timely
data.
There
are
some
things
that
we've
begun
to
do
in
partnership
with
the
State
Department
of
Public
Health
in
terms
of
timeliness,
there's
also
the
fact
that
not
just
in
terms
of
sharing
of.
C
I'm
putting
it
in
real-time
right
in
a
more
timely
way,
so
some
data
that
there's
a
data
lag
and
there's
a
whole
process
at
the
state.
Having
worked
at
the
State
Department
of
Public
Health
I
know
that
there's
a
whole
process
in
terms
of
closing,
for
example,
different
files
like
the
death
records,
so
we've
been
making
some
good
progress
with
the
state
on
that
front,
I
think
in
terms
of
staff,
obviously
any
additional
resources
or
investment
in
terms
of
building
out
the
staff,
because
this
is
core
public
health.
C
D
A
D
D
D
You
know
just
just
reach
further
into
trying
to
develop
further,
develop
capacities
across
the
Commission
and
the
bureau's,
etc,
and
then
working
with
partners
outside
of
the
Commission
as
well.
I,
don't
feel
that,
were
you
know
that
we're
limited
it
in
terms
of
that
I
think
we've
got
a
very
strong
office
and
a
lot
of
support.
Oh.
A
D
A
C
Just
by
way
of
comparison,
so
we
probably
have
dense
at
9:00
on
his
team
across
the
Commission,
maybe
close
to
20
staff.
That
would
fall
under
like
a
title
of
epidemiology
research
right
by
way
of
comparison,
New,
York,
City,
Health,
Department
I,
think
has
close
to
300
people
who
they
would
define
as
research.
This
is
actually
something
that
we
talk
a
lot
about
in
our
big
cities:
health
coalition,
we're
actually
on
the
low
end.
C
When
you
compare
us
to
cities
that
were
more
comparable
to
so
Seattle
King
County
I
think
has
much
many
more
staff
than
we
do
in
this
space,
but
I
think
it's
a
it's
a
good
team
and
will
continue
to
on
the
federal
front
and
other
grants.
That's
actually
how
we've
been
able
to
grow
this
staff,
because
we
try
to
do
as
much
as
we
can
internally
for
programs
that
are
able
to
secure
those
federal
grant
awards
that
have
an
evaluation
component
keep
as
much
as
we
can
in-house
to
grow.
Well,.
A
It
seems
you
know
in
in
Washington
there's
you
know.
We
have
folks
that
don't
believe
in
in
science
or
public
or
public
education,
you
know
or
public
health
was
so
you
know
we're
having
to
observe
absorb.
You
know
more
of
the
the
financial
investment
to
ensure
that
it
will
be
sustainable
because
that's
been
my
frustration
with
grants.
Is
that
they're
often
a
one-time
investment
and
we're
able
to
make
great
strides
and
then
the
rug
is
sort
of
pulled
out
from
under
what
under
us
you
know.
B
B
That
right
so
doing
the
work
is
great
and
in
having
you
know
all
the
reasons
to
do.
It
is
important,
but
if
we're
not
telling
that
story
and
we're
not
lifting
it
up
and
we're
not
ensuring
that
this
health
conversation
is
happening
on
a
variety
of
topics
in
this
chamber
and
beyond,
then
then
it's
all
for
naught
so
the
pieces
of
giving
the
visibility
I
appreciate,
but
also
I,
think
the
more
that
the
consequent
do
to
help
us
raise
it
up
would
be
much
appreciated.
Okay,.
A
C
I'd
have
to
go
back,
I
mean
the
most
recent
thing
that
initiative
or
project
that
I
can
think
of
that.
Had
a
big
investment
in
terms
of
a
public
facing
campaign
was
let's
get
healthy
Boston,
which
is
a
partners
in
Community.
Health
was
what
the
CDC
program
was,
and
that
was
a
three-year
multi-year
program,
with
a
pair
Lea
large
percentage
of
the
funding
going
out
to
support
efforts
to
address
the
built
environment,
and
then
there
was
also
an
effort.
C
A
Accurate
because
you
know
certainly,
we
believe
and
that's
why
we
try
to
control
what
goes
on
billboards,
particularly
in
communities
that
have
disparities
along
all
outcomes,
that
we
are.
You
know
trying
to
control
that
because
we
do
believe
it
has
contributed.
So
if
we,
if
we
believe
you
know
alcohol
advertising
and
things
like
that,
have
contributed
to
poor
outcomes,
I'm
hoping
that
by
you're,
promoting
healthier
behaviors
that
it
isn't
contributed
to
improved
outcomes,
so
I
think.
C
It
was
I
think
it
was
and
I
think
when
I
went
with
them
to
their
end
of
grant
celebration
that
they
had,
unlike
some
of
the
other
grants
where
they
wind
down
and
people
release.
You
know
really
sad
because
the
the
funding
has
ended.
I
was
actually
really
impressed
that
one
I
guess
by-product
or
consequence
was
building
communities
to
be
better
engaged
in
advocates
and
at
that
end
of
the
year
kind
of
the
end
of
the
cycle
celebration,
each
of
them
were
bringing
in
all
of
the
proclamations
that
they
had
received
from
their
different
elected.
A
A
A
We
could
just
have
a
hearing
just
about
that,
so
we
will
not
get
to
unpack
that
today,
but
I
know
where
to
find
you
and
we'll
continue
to
enlist
you
in
that
conversation,
and
we
thank
you
for
your
partnership
in
that
work
and
as
the
founder
and
chair
of
the
Committee
on
healthy
women
families
on
communities.
You
know,
I
I,
just
firmly
believe
that
the
health
of
community
only
happens
if
we're
intentional
about
it
in
our
advocacy
and
our
policymaking
and
our
investments
and
our
resources
and
I.