City aims to tackle life expectancy gap, health disparities with new Live Long and Well Agenda

A new report released by the Boston Public Health Commission this month marks the next step in its first population health equity agenda, which is aimed at reducing life expectancy gaps in the city.

Under the campaign, called the Live Long and Well agenda, the city is looking to target overdose deaths, cardiometabolic diseases and preventable cancers — conditions that disproportionately affect communities of color and that the commission has identified as the leading causes of premature death in those communities of color.

In that work, said Dr. Bisola Ojikutu, the city’s health commissioner, the key to addressing those gaps lies beyond actions to treat individual cases of heart disease or cancer but, instead, looks to the broader societal factors that impact health — things at a community level.

“We really do need to think what is the community change?” Ojikutu said. “What is the structural change? What are the systems that need to be changed to improve health and well-being for people.”

When the Boston Public Health Commission first announced the agenda in July, it was tied to a data point rreleased by the commission in 2023 that found a nearly 23-year gap in life expectancy between one census tract in Back Bay and another in Roxbury.

In Roxbury, residents were expected to live just shy of 69 years. About two miles away, in the Back Bay tract, residents were expected to live more than 91 years.

“It has never made sense, never acceptable, that you could get on a train from Ruggles and take just four or five stops to downtown Boston and live 23 years longer,” said Michael Curry, president and CEO of the Massachusetts League of Community Health Centers.

The two tracts were those with the lowest and highest life expectancies, respectively, but Ojikutu said similar gaps exist across the city.

The key to addressing it, according to the new agenda, lies outside hospitals in what public health experts call social determinants of health. These determinants are things like access to housing, or to healthy food, or economic mobility — factors that impact on how healthy a life someone can live and how much attention they can devote to things like the health conditions that the agenda is hoping to target.

“We know that if people have the resources to eat healthy, we can get them to eat healthy,” Curry said. “We know that if people have stable housing, then they don’t have to make some of the difficult choices that people are having to make when they don’t have stable housing that makes your health, not your priority.”

The agenda builds on work that the city’s health commission has been doing previously. Even the focus on upstream factors — those so-called social determinants — are not new for the department, but the new push is intended to strengthen previous efforts and put social determinants front and center, Ojikutu said.

“We have done that in the past … but what we’re trying to do is really embed the sense that we have to focus upstream,” Ojikutu said. “We have to focus on the bigger, community-level issues if we want to address things like life expectancy and like decreasing early death.”

The agenda is taking a relatively longer vantage point — the deadline it set to fully address the discrepancy isn’t for another decade — but the city is starting out with large sums of money to try to start making a dent.

Last month, the Public Health Commission — in collaboration with Atrius Health, which provided the funds — issued a request for proposals to make use of $5 million in Roxbury, Dorchester and Mattapan to address economic mobility, a prominent social determinant of health it has said drives cardiometabolic disease.

That RFP is calling on coalitions, led by community organizations, to develop solutions that could include efforts like workforce development or small-business development, but Ojikutu said the commission is looking for innovation, so the request was left open-ended.

And when that money is distributed, it will be in large installments. Ojikutu said that the grants will offer up to $2.5 million to the coalitions.

“We’re really looking to invest deeply and not with small amounts of money,” Ojikutu said.

Responses to the RFP are due by March 12 and the Public Health Commission expects to announce the recipients of the funding in June.

A key focus of the agenda is collaboration. At the agenda’s summertime launch, it was presented jointly by the Public Health Commission alongside the Atrius Health Foundation, which is providing the initial $10 million in funding, and the Boston Community Health Collaborative, a group of organizations in Boston that works to increase understanding of the city’s community health needs and priorities.

Ojikutu said bringing in other supporters will be key to meeting the city’s goals around reducing life expectancy gaps.

“To get to the big structural change, you really do need to partner and collaborate in order to get there,” she said.

Curry said that, in that work, the state’s community health centers, which his organization represents, are “locked in” with the commission and the Atrius Foundation in their agenda.

“This report centers the conversation, provides us with the data and the analysis around where those inequities are — particularly within certain diseases — and really becomes the rallying cry for us to collectively work together to address the disparities,” he said.

And in a time where federal funding — especially for efforts around equity — has been thrown into question by President Donald Trump and his administration, collaboration with private funders like the Atrius Foundation is more important than ever, Ojikutu said.

“This is the time for us to bring private and less traditional partners to the table because there’s this uncertainty around federal funding for this type of work,” Ojikutu said. “We really don’t know where that will go in the future.”

Previously, the city relied on several federal funding sources to address public health efforts. For example, a $21 million grant program announced last year aimed to address youth and family behavioral health in Boston Public Schools. Other federal funding to the Boston Public Health Commission has targeted HIV, as well as racism in public health.

A BPHC spokesperson confirmed no programs have currently been impacted by any executive orders issued by the Trump administration.

Trump’s early actions to limit federal funding also took aim at things like environmental justice. Across the country, officials have reported not being able to access federal funds allocated to them for things like replacing diesel school buses with electric ones, weatherizing homes, removing lead paint, and launching conservation projects to protect residents from natural disasters — even after a federal judge ordered the funds to be unfrozen.

How much his executive actions will target health equity remains to be seen. Early orders took aim at some Biden-era policies around lowering drug costs and expanding coverage under public insurance programs, but largely his health orders have had limited heft.

For now, the city’s health commission is operating under business as usual, but if the field does see major rollbacks Ojikutu said she hopes private partners will step up to help close the gaps.

“Funders who have a long-standing interest in this, they are essential,” she said. “We want to galvanize them, mobilize them, maybe have them working together to invest collaboratively towards efforts like this in the public sector. This would be the time to do it.”

Curry said he saw the release of the report as a moment to bring in new support from novel sources. He said the report is a “call to action.”

“They’ve done the altar call. Now they just need all parties to invest, to commit, to be equally as resolved so we can address these issues,” Curry said.

For the work, the city has set a 10-year deadline to address the gaps, with a goal to close the divide in life expectancy by 2035.

Curry said he sees that goal as achievable, but it “depends on all of us.”

“In order for this to be addressed, we need everyone at the table and, quite frankly, we need every resource available,” he said.