Pulse of the region's health

Substantial health disparities exist among the region's suburbs and two of its largest cities, Lowell and Lawrence, where teenagers are more than twice as likely to become pregnant and fewer expectant mothers of all ages receive adequate prenatal care, according to a new state health survey.

The report also shows gaps among racial and ethnic groups in a range of categories, including the rates of HIV infection and AIDS, asthma, diabetes mortality, and opioid overdoses. Meanwhile, the region's predominantly white suburbs are healthier than the state as a whole on a host of indicators, including rates of homicide, sexually transmitted diseases, and accident-related injuries.

The 173-page Regional Health Status Indicators report represents a departure from past documents generated by the Massachusetts Department of Public Health, which usually releases statewide numbers or city-by-city data for certain health categories, such as births. But new Health Commissioner John Auerbach asked the department to produce region-by-region omnibus reports, dividing the state into six areas, including a northeast band that sweeps north and west of Boston through much of this area and includes the communities on the North Shore and beyond, up to the state border.

"We're providing communities with the most comprehensive health report that the department has ever released on the health of a region," Auerbach said. The compilations do not include analysis to explain the numbers, but nonetheless should help state and local public health officials and healthcare providers better understand regional health issues. Auerbach said the reports -- and a series of public forums across the state -- will help the department set policy and funding priorities to target local health concerns.

"This is part of a developing relationship with the residents of the regions," said Auerbach, who held a northeast forum in Andover this month.

Local health officials and healthcare providers welcomed the commissioner's approach and called the report a useful illustration of the region's health. But the report contains few surprises for those who work in the field treating patients or trying to address socioeconomic, linguistic, and other demographic obstacles to good health.

Many of the statistics in the report are related, local officials and providers said. For example, areas with high teen pregnancy rates tend to have a lower percentage of expectant mothers who receive adequate prenatal care -- measured by an index that takes into account the timing of the initial visit and the number of total visits -- because of fear or lack of education.

"A lot of times teenagers are hoping they're not pregnant and don't think they can tell their parents about it," said Dr. Glennon O'Grady, medical director of the Greater Lawrence Family Health Center, which provides medical care, outreach, and other services to 43,000 patients of all ages, focusing especially on the low-income Latino population.

Mothers who don't receive adequate prenatal care are also likely to be at higher risk of having babies with low birth weights or pregnancies that end in infant mortality, providers said.

Cultural and language barriers can keep pregnant women from seeking prenatal care. "People coming from countries where there's not very accessible healthcare, their tradition is to wait until you're very close to delivery before seeking any care and relying more on family members," said Dorcas Grigg-Saito, CEO of Lowell Community Health Center, which, like the Greater Lawrence center, is a nonprofit community health center designed to provide care, education, and other services to an underserved community.

Many new Americans also can be confused by the complex US healthcare system, Grigg-Saito said. And many uninsured pregnant women do not know they are eligible to receive prenatal care at a health center through MassHealth or Healthy Start, she said.

Agencies in both cities are engaged in various multilingual, multicultural efforts to educate residents about health issues and to extend services. A decade ago, the teen birth rate in Lawrence exceeded 110 and in Lowell it surpassed 75 per 1,000 females ages 15 to 19. The rate was 71.7 in Lawrence and 51.4 in Lowell in 2005.

"We have so many success stories: young people that have gone on to college, that have not become pregnant as a teenager, that have delayed fatherhood, that have avoided HIV infection, that have not become addicts in their teens. And that's because when prevention is done the right way, it works," said Erica McNamara, program director for the Lowell Community Health Center's Teen Coalition, which operates teen and preteen programs that combine health and lifestyle education with peer mentoring, community-building activities, arts, and other empowerment methods.

But the Lowell coalition and similar agencies have been hampered by state cuts that forced them to scale back programs, McNamara said. Success "takes energy and time and a sustained commitment," she said.

The Department of Public Health report showed that causes of death in this region largely mirror those for the state, with cancer and heart disease each accounting for about one in four deaths. But although the adult smoking rate was similar for the state and region in 2005 (about 18 percent ), this area had a higher rate of invasive lung cancer: 76.7 cases per 100,000 residents from 1999 to 2003, compared with 72 for the state.

The reasons are unknown, but environment could be a contributing factor, O'Grady said. Urban congestion, city traffic, and the presence of local incinerators contribute to poorer air quality in Lawrence, for example, he said. Grigg-Saito said urban air quality and deteriorating housing stock can also exacerbate asthma.

Black and Hispanic residents here and across the state had higher diabetes mortality rates than white and Asian residents, according to the study. O'Grady said diabetes and heart disease are functions of genetics, diet, and exercise. In addition, low-income residents of Lawrence are less likely to have access to recreation facilities and are more likely to eat cheap processed foods sweetened with high-fructose corn syrup. O'Grady said people don't feel full when they eat those foods, so many eat more than they should. "You can just keep eating high-fructose corn syrup indefinitely."

The Greater Lawrence center has obtained grants to perform outreach education on diabetes and asthma prevention and maintenance, O'Grady said.

From 2003 to 2005, the region experienced 223 opioid-related emergency room visits per 100,000 residents, compared with 181 per 100,000 for the state. ER rates for abuse of opioids, including heroin and prescription painkillers, varied locally by race and ethnicity. In Lawrence, white residents were more than twice as likely as Hispanic residents to end up in the ER for opioids, while in Lowell, Hispanic residents were slightly more likely than white residents to land in the ER.

The report also identified regional concerns for refugees who have been resettled in the last five years, including the need for bilingual, bicultural services. The federal government resettled more than 1,300 refugees in the area from fiscal 2002 through 2006. While many refugees in the past came from war-torn regions in Southeast Asia and Europe, an increasing number in recent years have come from African countries. During the five-year period covered in the study, 45 percent of resettled refugees were 19 or younger when they arrived in this area.

The report identified tuberculosis monitoring as a regional health concern. Of 1,237 refugees tested in the area during the period, 44 percent tested positive for latent TB infection, meaning a person carries TB but has not developed symptoms. Partnerships among the state, local health officials, and area clinics help to ensure testing, evaluation, and treatment to manage TB and prevent its spread, according to the report.

Frank Singleton, director of the Lowell Health Department, said two of the four public health nurses on his staff "do nothing but TB," working with the city's roughly 15 annual active TB cases to monitor the patients' conditions and ensure they take their antibiotics.

Singleton said he appreciated the report and regional outreach, calling it a credit to Auerbach.

At the same time, though, he questioned the effectiveness of creating a northeast region for study purposes, given urban-suburban health differences. "There's a lot of white people out there in Andover that dilute this thing," he said.

Singleton said the report would prove more useful to hospitals, community health centers, and nonprofit groups than it would to cash-strapped city and town health departments, which have to first deal with sanitary inspections and the prevention of communicable diseases.

"You can run all these statistics up a flagpole, but we're not going to do much with them," he said. "Because, to be honest with you, we don't have many resources" for outreach and prevention.

To view the Northeast Regional Health Status Indicators report, go to mass.gov/dph/resep and click on the Population Health Statistics link.

Eric Moskowitz can be reached at emoskowitz@globe.com.