While much of the legacy of Rev. Martin Luther King Jr. is focused on things like workers’ rights, access to quality education, discrimination, transportation and other efforts trying to dismantle systemic racism, health equity leaders today point to another aspect of King’s work.
Michael Curry, president and CEO of the Massachusetts League of Community Health Centers, said King’s work around health equity is sometimes forgotten.
“He knew and understood that ‘I can integrate a lunch counter, or desegregate a school, but one of the most immediate things in this fight for justice is health justice, because it’s really literally life or death,’” Curry said.
At the time, a strong focus of that work was targeted around where and how Black communities accessed care, including 1966 remarks at the Second National Convention of Medical Committee for Civil Rights — an event attended or organized by pioneers of the early community health center movement — where King is often quoted as saying “of all forms of discrimination and inequalities, injustice in health is the most shocking and inhuman.”
“When Dr. King was advocating, he was trying to remind society that one of the critical aspects of his work was to desegregate hospital systems in the 1960s,” Curry said.
At the time, in the South many hospitals were segregated and across the country Black patients faced challenges around access to equitable care that properly acknowledged their personal pain and experience.
Those gaps in care had prominent implications for the health of Black patients. According to the reporting at the time, in his 1966 speech, King noted the mortality rate among Black infants in a nearby Chicago neighborhood was as bad as in Mississippi.
Despite the gap of almost sixty years between King’s remarks at the meeting of the Medical Committee for Human Rights and the present day, gaps in the health of residents based on the color of their skin persist.
“We know disparities exist,” Curry said. “You can be partisan, you can debate all kind of things, but what you can’t debate is the numbers.”
Locally, officials have tracked prominent gaps in health outcomes. A series of reports from the Boston Public Health Commission released between 2023 and 2024 found that diseases like diabetes and asthma were more prevalent among Black adults in the city. The same population was more likely to die of heart disease, invasive cancers and drug- and opioid-related deaths.
And those disparities have significant outcomes in life expectancy in the city of Boston. A 2023 report from the city’s Public Health Commission found that at 77.6 years, Black residents on average had a life expectancy just over two-and-a-half years less than the city’s average overall life expectancy of 80.2.
By neighborhood, Mattapan, Roxbury and Dorchester had the lowest life expectancy, none of which rose much above 78 years old. Parts of Dorchester reached 78.2 years of life expectancy. According to that report, neighborhoods that are generally whiter had a generally longer life expectancy while those that are home to more residents of color, especially Black residents, tend to have shorter life expectancy.
One of the most dramatic instances of those gaps, perhaps, was the two-decade gap in life expectancy that was identified in the same 2023 report on mortality from the BPHC. That report found that between a census tract in Roxbury — the area with the lowest life expectancy in the whole city — and a census tract in Back Bay about two miles away, there was a gap of nearly 23 years.
It was a stark enough disparity to prompt extensive news coverage when it was first published, and led to the launch of a new campaign from the Boston Public Health Commission aimed at tackling the worse rates of cardiometabolic diseases, preventable cancers and opioid overdoes — what they identified as the main drivers of the gaps in life expectancy.
That kind of gap, Curry said, is not unique to Boston.
“You could see that whether you’re talking about Lowell, Lynn, Lawrence, Worcester, Springfield, Chelsea, right?” he said. “Those disparities exist.”
Much of the work of health equity in the present day is an understanding that the work closing gaps in health extend beyond just hospitals to all the other day-to-day factors that impact health, like access to housing or food or economic mobility — what public health experts call social determinants of health.
Curry said he often sees the sentiment that people try to blame negative health impacts on an individual’s choices but, in reality, variations in access to other things beyond a hospital’s walls can have big impacts, things like cancer outcomes or maternal health and morbidity.
“We like to blame people that it’s their circumstances, their behavior, that leads to adverse outcomes, but we know that’s not fully truth,” he said. “It’s also about trauma; it’s also about racism writ large; it’s about poverty; it’s about food insecurity that make you having a healthy baby less likely.”
For Thea James, co-executive director of the Boston Medical Center Health Equity Accelerator, one of the most prominent social determinants of health when it comes to disparities in outcomes is economic mobility.
In addition to her work helping to lead BMC’s Health Equity Accelerator, James, who has a background in emergency medicine, still works in the hospital’s emergency department once a month.
“I’m still always asking people [in the ER], ‘What would it take for this not to happen again?’” James said. “I don’t care what story they tell me, the root of it is always economics.”
In that, she said, health equity gaps tie back to the early roots of slavery in the United States, as well as the 1960s fights of King. In his “I Have a Dream” speech, he described Black communities living “on a lonely island of poverty in the midst of a vast ocean of material prosperity.”
“The lack of ability for people to have financial security, to be able to build generational wealth always leaves people having to prioritize other things or to settle for less,” she said.
Curry, too, said those economic gaps leave people struggling to balance their access to care and health.
“If you don’t have health insurance, and you have to go get medication and pay the actual cost of the medication, you don’t take your medication,” Curry said. “If you have a pain in your side, and you know that going to a doctor or emergency room is going to cost you several hundred dollars, you ignore the pain in your side until now it’s stage four instead of a stage one cancer.”
That focus on economic elements has also been identified by city leadership. The life-expectancy campaign, called the Live Long and Well Agenda, prioritizes efforts to address economic drivers and mobility.
Both James and Curry said that in those present efforts to close gaps, both in care and the other social determinants that impact health, Boston and Massachusetts is the place to be.
“Boston is very, very unique in this space, in terms of its progressiveness, and its intentionality and delivering on those things in a way that I can personally see how it’s manifested,” James said.
Curry pointed to recently signed legislation aimed at increasing oversight in for-profit health care and at decreasing the cost residents pay for prescription medications.
“We’re doing that in Massachusetts,” Curry said. “Other states are not focused on that because states are not bold enough to advance legislation that provides those protections.”
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