In a multicultural town, trying to zero in on disease

Ayano Strickland, a mentor in a program encouraging good health habits, demonstrates how to use a Nautilus machine. (Jim Davis/Globe Staff)

In a city that celebrates its unique demographic makeup, diversity poses a challenge in one important area.

Understanding the health of Cambridge residents is complicated by the multicultural population, with large blocks of young and old residents. But the recent release of two reports by the Cambridge Public Health Department, in conjunction with various local organizations and community groups, sheds light on the dimensions of the issue.

The reports, one on men's health disparities and the other on the status of women and girls, are both "part of a project we started last year to look at the needs of the community," said Claude-Alix Jacob, the city's chief public health officer. "We want to make sure that people are aware of relative gaps in health across genders, race, and ethnicity."

"The data helps us as we design programs and think about policy," said Kimberly Sansoucy, who directs the city commission that was involved with the creation of the report on the status of women.

Among the more eye-catching findings in the women's report was that 47 percent of women in Cambridge diagnosed with HIV develop AIDS within three months, a rate "significantly higher than the statewide average and also higher than men," Sansoucy said.

Such findings act as a starting point for discussion about how to deliver effective healthcare programs in a city with a disproportionately high student population (almost one in three residents is between the ages of 20 and 29); a racial composition that has diversified dramatically in the past four decades (in 1970, 91 percent of the city's residents were white; in 2000, this had dropped to 68 percent); and a high immigrant population (one out of every four Cantabrigians is foreign-born).

"Are there immigrant women who come into the country with HIV who are not then treated once they arrive here?" said Sansoucy , enumerating a list of hypothetical explanations for the anomaly. "Is it because women with HIV are isolated within their communities, because they don't have access to healthcare, because of cultural differences where women do not have as much independence or are not allowed to seek treatment? Those are the questions we hope to spur with public health officials."

"Part of this is figuring out how we tailor our outreach to not only the lower socioeconomic status, but also to some of the other immigrants that are here," Jacob said. The city's newcomers include a high number of students, and Cambridge residents overall, he said, "have a higher educational status" compared to the rest of the state "because we've got the titans of the academic community here."

This high student population affects how data can be interpreted, said Andy Ellingson, who contributed to epidemiological research for the men's health report. "For all the comparisons, we have to adjust for age because we have so many students between Harvard and MIT . . . If you compare a city of 30-year-olds to a city of 80-year-olds, you're naturally going to have a higher death rate among the 80-year-olds. Age-adjusting helps compare apples to apples."

Such adjustments are also needed because the elderly population in Cambridge remains predominantly white.

"Fifty years ago, Cambridge was a very white city and the people who are oldest in the community still tend to reflect that," said Ellington. It tends to be younger families in general who move into the city, [but] it takes a while to have that reflected in the mortality data as well."

Jacob emphasized that his department is especially concerned with how to tackle "the burden of disease for men of color in Cambridge."

The men's health report, for example, found that black men are hospitalized for diabetes at a rate 48 percent higher than the rate of hospitalization for white men. This is similar to rates of diabetes hospitalization statewide, but also points to the need for local initiatives to reach men effectively in their home communities, he said.

In late 2007, the health department, along with the Cambridge Health Alliance, the Cambridge Family YMCA, and the Margaret Fuller Neighborhood House - a community organization located in the city's densely and diversely populated Area IV neighborhood near the Massachusetts Institute of Technology - received grants totaling $844,000 to support a local initiative designed to improve health in men of color.

Called the Men's Health League, the project pairs health and fitness mentors with men at risk for diabetes, stroke, and heart disease, and also connects them with doctors and health insurance.

The league is wrapping up the first cycle of a 12-week exercise and health-awareness program called Fit for Life.

Ayano Strickland, 34, serves as one of the program's 10 mentors. Twice a week, he guides a young man (who preferred to remain anonymous) through a workout at the YMCA in Central Square, swimming laps, jogging on treadmills, and going through a Nautilus weight circuit routine.

Strickland, a holistic health counselor, also doles out advice on diet and nutrition that translates into general encouragement.

"He's a young man and he's short on cash so he's really interested in fast food," said Strickland. "I've been encouraging him to stop eating McDonald's, Wendy's, and Taco Bell and . . . checking in with him to make sure his lifestyle is in tune with what he wants for his health goals."