HomeMy WebLinkAbout2001-12-12 Community Health Assessment Report Lexington Community Health Assessment: Health
Priorities for the Town
Submitted by the Health Assessment Advisory Committee for the Lexington
Board of Health
Health Assessment Advisory Committee
Burt Perlmutter, M.D., Chair
Wendy Heigger Bernays, PhD
Martha Sheridan, M.D.
James Fearnside
Nancy Earsy
Margaret Kennedy, M.S.
Frederick Mazer, M.D.
December 12, 2001
Health Assessment for the Town of Lexington: Health Priorities for the
Town of Lexington
Submitted by the Health Assessment Advisory Committee for the Lexington Board of
Health
Table of Contents
EXECUTIVE SUMMARY
I. INTRODUCTION
II. HEALTH ASSESSMENT
A. Process and Data Review
B. Definition and Scope of Public Health
C. Board of Health Role in Community
D. Lexington's Health Programs
III. PRIORITIZATION OF KEY HEALTH CONCERNS
A. Data Evaluated
1. Demographics
2. Environmental Factors
3. Disease Incidence
B. Information from Community Members
IV. KEY HEALTH PRIORITIES FOR LEXINGTON
A. Mental Health
B. Physical Exercise, Obesity, and Chronic Diseases
C. Traffic and Pedestrian Safety
D. Substance Abuse
E. Bioterrorism and Infectious Diseases
F. Senior Health
G. Pesticide Usage
V. RECOMMENDATIONS
VI. CONCLUSION
VII. REFERENCES
VIII. APPENDICES
1. Data Reviewed
2. Results of Community Discussion Groups
3. Community Health Resources and Municipal Programs
4. Health Assessment Advisory Committee Information
Lexington Community Health Assessment
Health Priorities for the Town
EXECUTIVE SUMMARY
The Health Assessment Advisory Committee, appointed by the Lexington Board of Health, carried
out a comprehensive analysis and evaluation of health issues and programs in the Lexington
community. The goal of the assessment was to gather public health data and community concerns
that could form the foundation for future planning of municipal health programs. Following the
assessment, the Committee developed a set of priority health issues that the Board of Health, or
other municipal agencies, may use to address now or in the future years. The assessment also gave
the committee the opportunity to gather information on the many health-related programs the Town
currently offers through different agencies. The assessment did not evaluate the nature or efficacy
of existing health programs.
The following report on the health assessment illustrates important new perspectives on municipal
health programming that will be integral to planning carried out by the Board of Health and
associated town agencies.
• The definition of"public health" extends far beyond the infectious disease and sanitation
focus typically associated with the mission of a Board of Health. While traditional disease
surveillance and prevention remain core public health programs for the town, our
prioritization process suggests that other health concerns and influences, including
behavioral and environmental factors, should be given more attention in future municipal
health programming. These conclusions are supported by similar findings in other
communities across the state. Mental health, substance abuse, lifestyle factors and traffic
safety emerged as just a few of the priority health areas that Board of Health do not
typically address, but will require support.
• Health programs often develop in a variety of municipal agencies, and are not necessarily
connected to Board of Health efforts. In many cases, health programs develop under other
agencies where they can directly serve a target audience or evolve as an integral part of a
different but related program. Examples of public health services run by other departments
include the Senior Health Monitor Program operated by the Council on Aging, substance
abuse prevention programs run by the Lexington Public Schools, and Burn Prevention
classes run by the Fire Department. The separate development and operation of such
programs allows them to flourish within the optimal context and environment in terms of
service delivery, planning and budgeting. However, this progression does not obviate the
need for ongoing support for and engagement by the Board of Health.
• Collaboration between agencies administering health-related programs emerged as an
important component of a comprehensive municipal public health program. Most health
programs require extensive interagency work to provide communications, service delivery
and financial support necessary to program success. The yearly influenza vaccination
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clinic, for example, involves both the Health Department Staff and the Council on Aging.
An environmental management program proposed for the public schools will require the
involvement of the Health Department Staff, School facilities staff, and outside consultants.
Emergency planning for disasters, both natural and man-made, requires input from Health,
Police and Fire Departments. The Interagency Health Program Committee (IHPC), initiated
by the Town Manager in 2000, and a Health& Safety Committee to address emergency
planning, offers mechanisms for such needed collaboration between agencies.
• Public health programs form a core function of local government responsibilities that need
to be evaluated continuously as the private healthcare and public health spheres evolve. The
degree to which public programs support or even take the place of private healthcare
services will be a major challenge for municipalities. While the public and private system
interact, the distinctions between their goals and processes need to be reestablished for the
public. The private healthcare system, which serves individuals, does not replace the need
for solid public health initiatives that protect community health.
• Many residents remain unaware of the varied health programs the town currently offers, or
how to navigate through the system. Other community members are not aware of the future
health issues facing the town. Thus, the Board of Health and associated agencies will need
to improve communications with residents and stakeholders to ensure ongoing support and
development of current and future health interventions.
After completing the health assessment, the committee proposes a set of priority areas on which it
recommends the Board of Health and associated agencies focus over the next five to ten years.
These priority areas include:
• Mental Health
• Physical Exercise, Obesity and Chronic Diseases
• Traffic and Pedestrian Safety
• Substance Abuse
• Senior Health
• Pesticide Usage
The committee also suggested that the Board of Health examine several other issues for action
including cancer prevention, lead paint exposure and prevention, and indoor air quality.
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Lexington Community Health Assessment
I. INTRODUCTION
The following report attempts to define the key public health concerns of the people of the Town of
Lexington. These priorities were assigned after an extensive information gathering and evaluation
process involving committee members, state and municipal staff members, healthcare providers
and other professionals, and residents of the Town. This comprehensive health assessment and
evaluation process, carried out for the past 12 months (since September 2000), was designed to
provide the basis for program planning and for the identification of community health concerns that
the municipality should address now, and in the years to come.
II. HEALTH ASSESSMENT
A. Process and Data Review
The Health Assessment process was carried out over the course of one year. The committee
reviewed statistical data on morbidity and mortality, and behavioral and environmental factors at
the state, national and local levels, as such information was available. Community discussion
groups were also held to acquire information and concerns directly from residents and other
members of the Lexington community. The committee used these data to evaluate the health status
of the Town of Lexington from multiple perspectives. The committee reviewed the following
sources of information before prioritizing the health issues that emerged.
Disease and Health Status Statistics: Information was gathered from National, State and local
agencies regarding specific health indicators. These data included the incidence of many cancers in
Lexington and across Massachusetts, data on primary reasons for resident hospitalization,
communicable disease statistics, student health information from the Lexington Schools, mortality
data from State Vital Records, and other sources. The Massachusetts Community Health
Information Profile (MASS CHIP) provided information on injury statistics, prenatal care and
pregnancy outcomes, and other community health data.
Environmental Factors: Environmental conditions that could affect health, such as the age of the
housing stock, hazardous waste sites, weather patterns, water supplies, and other factors were
considered.
Demographic Data: Information on community socioeconomic breakdown, cultural makeup,
education levels and other factors that may impact the health of the town were drawn from the
Massachusetts Area Planning Council and other state sources.
Resident and Community Member Concerns: Community discussion groups, held in conjunction
with representatives of Mount Auburn Hospital and the Massachusetts Prevention Center in
Cambridge, sought to obtain information on health concerns directly from people who live, work or
participate in other ways in the Lexington community. Four community discussion groups were
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held, drawing in representatives from the faith community, local healthcare providers, local
business people, and interested citizens.
Municipal Program Review: Meetings were also held with individual staff members of municipal
agencies, including the Council on Aging and the Lexington Schools, to learn about existing
municipal health programs and how they currently meet the needs of the community.
B. Definition and Scope of Public Health
In the context of the assessment process, the committee defined the term "public health" in its
broadest sense to mean the wellness of the community quality of life, access to exercise,
emotional and mental health, and a safe, clean environment. The definition grew partly out of
discussions with community representatives describing their concept of a"healthy community".
This broad description of public health and its mission in Lexington in turn affected the
development of priorities for the town. The definition of public health as interpreted by the
committee also included the core functions of the Board of Health already in place.
Public health programs generally address two key influences on health status; environmental
factors and lifestyle or behavioral influences. Environmental considerations typically include food,
water, air and soil, and also socioeconomic status. From another perspective, environmental
concerns include the many influences on health over which an individual has little or no direct
control (excluding genetic make up). Lifestyle factors include the many behaviors over which an
individual does have direct control, such as diet, exercise and smoking, to name a few. But
environmental and behavioral influences often interconnect; for example, smoking affects indoor
air quality through environmentally transmitted smoke (ETS); inappropriate disposal of household
hazardous waste can affect drinking water supplies. Public health programs must target one or more
facets of a health problem. In order to correct environmental conditions that affect disease status,
behavioral and attitude changes may be necessary to correct the problem involved.
C. Board of Health Role in the Community
In the course of examining health concerns, the committee also analyzed the current role of the
Board of Health in the community and its capacity to affect a broad range of health issues. Boards
of Health form the governing municipal body on health issues in a community in accordance with
M.G.L. Chapter 111. Typically, a Board of Health has a legal responsibility to create environmental
health regulations (e.g., food safety, wastewater management), develops health promotion
programs, monitors communicable diseases, and provides health screening and other individual
clinical services where these programs serve the good of the public health. Programs implemented
by Boards of Health aim to serve populations, rather than individual needs, and change from one
municipality to the next to meet the specific needs of a given community.
The concept of public health, particularly from the municipal perspective, has changed dramatically
over the past 50 years. Subjects such as domestic violence and mental health were not part of the
focus of a Board of Health or their staff even ten years ago. Now, new health concerns have
enlarged the number of issues that affect public health, requiring additional support and action from
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the Board of Health. In addition, the growing requirement for funding of health-related programs in
agencies outside the local Board demands more involvement from the Board and other agencies in
order to determine the value, reach and impact of municipal efforts on public well being.
D. Overview of Lexington's Health Programs and Resources
Municipal health programs may include many different agencies in the town. The Health
Department staff working for the Board of Health provides essential inspectional services and
education for food establishments, pools, camps, and other organizations, develops environmental
health protection programs, offers health screening and vaccinations, and creates health promotion
programs. Lexington Public Schools support a strong health curriculum in the high school grades,
work with Lexington Police on substance abuse programs, employ Wayside Services for crisis
intervention with troubled youths, and provide guidance and counseling to students. Public school
nurses offer extensive health support and protection programs to school-age children including
vision, hearing and scoliosis screening, immunization information, allergy control support and
other services. Lexington Police also provide domestic violence counseling and support services
through the Domestic Violence Response Team. The Council on Aging provides a range of health
information services specifically for the senior audience, hypertension screening, a home visiting
program for frail seniors called the Senior Health Monitor Program, "meals on wheels" and others.
These programs and other health resources are outlined in Appendix 3.
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Lexington Community Health Assessment
III. PRIORITIZATION OF KEY HEALTH CONCERNS
The priorities described in this report reflect a lengthy and complex balancing of factors
contributing to health outcomes. No single piece of datum, e.g., morbidity or mortality alone,
provided the key to prioritization. Rather, a variety of factors including disease incidence,
environmental concerns specific to Lexington, demographic influences, and the public's perception
of an issue were considered in terms of the way they affected the impact of a health issue on the
community.
Many health concerns have multiple causes, some of which may not be easily addressed through
standard public health or individual intervention methods. In such cases, health concerns might not
be within the purview of the Board and its associated agencies (e.g., certain inherited conditions).
In other instances, a given public health problem, while clearly a priority issue, might already be
addressed, or even solved, through the program of a particular agency in the town(e.g., Hepatitis B
and vaccinations to prevent the disease). Finally, while a specific disease or behavior may be a
health concern, its underlying cause may form the real source of the problem for the community
(e.g., lung cancer is a health priority, but smoking cessation is the best way to address the problem).
Or a particular pattern of behavior or environmental factor may contribute to a variety of different
health issues, and may actually be the target for prioritization and intervention, rather than a
specific disease. For example, high blood pressure and heart disease are associated with obesity,
and all three may in and of themselves be health priorities. However, poor school lunch programs,
or lack of access to exercise are also factors that contribute to these problems and offer
opportunities for public health interventions. Based on the complexity of public health issues, all
health concerns were prioritized within a framework from which the specific health issue could be
best identified and addressed.
Health concerns were evaluated and prioritized with the following equally-weighted questions:
1) Do the statistical data(if available) support this concern?
2) Is this a matter of local, statewide, or national concern?
3) Are mechanisms currently in place to address the problem?
4) Is the problem better suited to intervention on an individual, rather than public level?
5) Is the problem one that is ongoing (e.g., food safety), emerging issues (violence among
schoolchildren), or a seasonal matter (e.g., West Nile encephalitis and pesticide usage).
6) Is this issue a direct, or indirect cause of disease or ill health?
7) How many persons would be affected by the particular concern?
8) Have representatives of the community expressed concern about this subject or problem,
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regardless of its documented health impact?
A. Data Evaluated
Numerous data were evaluated and considered before prioritizing the key health issues for
Lexington (Appendix 1, Data Reviewed). The following information formed the basis for the
prioritization process.
1. Demographics
In addition to specific statistics on diseases, injuries, or mortality, other broader factors influenced
the prioritization process based on the long-term effects of certain factors on health outcomes. For
example, the demographic profile of the town suggests potential health issues that may occur in the
community based on age distribution, socioeconomic factors, cultural influences and other
indicators. In Lexington, the following key demographic factors were considered in the
prioritization process:
Senior Population: While the aging of the population will affect the entire country, Lexington has a
high proportion of persons over 65 (18%-25% by the year 2010 according to forecasts), with an
estimated 30-32% over age 55 as of the year 20001' 2. Since health issues rise dramatically between
the ages of 50 and 60, and health spending continues to grow as people age, this sector of the
population will exert pressure on both private healthcare providers and many municipal services.
Falls and emergency needs may increase usage of 911 emergency services and the demand for
homecare visits. Housing problems, including hoarding of materials or animals in the home, and
poor sanitation, can occur when elders are isolated from families and their communities, or when
they are not given adequate daily care and support for daily living. The need for in-home visits for
frail elders will also grow. Connection of individuals to the community, both physically and
emotionally, and access to safe exercise, are key factors in maintaining wellness in older people.
These emerging health issues will need to be supported through public transportation and
maintenance of public roads and walkways. The incidence of chronic diseases, such as diabetes,
grows rapidly within this population. Finally, seniors will increasingly need assistance in gaining
access to healthcare whether it is from a private or public source.
Children under 18: The fine school system in Lexington draws many young families into the town.
The number of children age 19 or under according to 2000 estimates stood at 27% of the total
population3 The influx of children in turn requires a variety of health support services to ensure
their well being, including school nursing services, camp safety inspections, and health protection
and education within and outside the schools. As children grow, substance abuse, violence and
psychological support needs become prime health matters that both the schools and the community
must address. This sector of the population may also be affected by growing rates of diabetes,
asthma, and other chronic conditions.
Socioeconomic factors: Lexington remains an economically stable and well-off community where
most residents can obtain health insurance independently or through their employer. The median
household income is $67, 389 and the median family income at $76, 410 according to the 1990
Census information4,5. Most residents have private healthcare insurance; however, such coverage
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does not replace a strong public health program that works to prevent disease and injury, and seeks
to promote wellness. While a high socioeconomic status usually points to better health status, it
does not guarantee it, nor does it obviate the need for solid prevention measures such as
vaccinations, disease surveillance, environmental management and many others. Finally, economic
status does not guarantee access to some types of healthcare (e.g., mental health benefits),
particularly among the senior population.
Education: The residents as a whole have a very high education level, another factor contributing to
positive health outcomes. 93% of the population holds a high school degree or higher, while 56%
holds a Bachelor's degree or higher according to the 1990 Census.6 High education levels tend to
have a positive effect on health outcomes within a population.
Major Ethnic Populations: The Asian population in Lexington stands at approximately 8% of the
total residential audience. Asian people may have specific health concerns, such as osteoporosis in
women, higher rates of liver cancer, and cultural barriers that may interfere with access to both the
public and private healthcare systems. Health programs must take into account any specific needs
of this or other populations and design outreach efforts accordingly.
2. Environmental Factors
Environmental health, taken in the broadest sense of the term, includes issues ranging from food
safety and water quality to hazardous waste, pesticide usage, and housing. The Environmental
Protection Agency (EPA) offers a broad definition of environmental health as "those aspects of
human health, including the quality of life, that are determined by interaction with physical,
chemical, biological and social factors in the environment. It also refers to the theory and practices
of assessing, correcting, controlling and preventing those factors in the environment that may
adversely affect the health of present and future generations."8 Specific geological characteristics of
the town and weather patterns may also affect health within the community. Some of the key
environmental factors considered in the Health Assessment included the following:
Radon: Due to the geological characteristics of Middlesex County, surveys from the EPA show
Lexington and other neighboring towns to be at a higher than average risk for elevated radon levels
in homes.9 Radon measurements are considered elevated above 4 picoCuries (pCi)per liter of air.
The presence of radon has been correlated with increased risk for lung cancer. Building
construction also has a major effect on radon levels; homes that allow little air turnover may have
high radon levels due to build up within the home air space. Testing for the gas, however, is simple
and inexpensive, and the problem may be remedied frequently for $1,500 or less according to the
EPA.
Water Quality: Water quality has a major impact on health depending on the levels of
microorganisms, lead, arsenic, copper, sodium, fluoride or other trace contaminants in the water
supply. Most homes in Lexington receive their water from the Quabbin Reservoir of the
Massachusetts Water Resource Authority (MRWA). The water from this source is generally
considered safe, but lead contaminants inside the residential piping system may contribute to higher
lead levels at individual taps. The Lexington Water& Sewer Department and the Health
Department provide ongoing communications to residents on this subject.
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Other residents, however, may draw drinking water from an on-site private well due in part to
rising water costs. This practice, however, may draw contaminants in the form of minerals,
pesticides, herbicides, or other materials from local soils and groundwater. Private wells are
protected by local regulations, but they are not tested as frequently as the public water supply, nor
is the area immediately around the private well subject to the same protective regulations as public
wells and other water supplies. Thus, private wells may be at risk for contamination from
environmental sources.
Ambient Air Quality: The prevailing winds in Lexington are northerly and westerly10. Thus, in
order to determine possible airborne sources of contamination, it would be necessary to look for air
releases from these directions not just sources within the town." In addition to these sources,
vehicle exhaust from local roads and major highways (Routes 2 and 128) may contribute to air
pollution in the community. Levels of air pollutants in the Middlesex County area for carbon
monoxide, sulfur dioxide, and particulate matter (PM-10) were considered good, while ozone levels
were considered moderate, having exceeded the 8 hour exceedance level for 4 days at the Sudbury
monitoring station in 1998.12
Soil Quality: Soil quality is an important factor in an examination of health concerns. While few if
any residents derive the bulk of their food supply locally, vegetable gardens may be affected by the
presence of elevated levels of lead. Lead may be a soil contaminant in gardens close to older
homes, where lead paint may have contaminated the soil from painted siding on homes. High iron
levels in the soil may also infiltrate home well water supplies. Schoolyards, playing fields and
residential yards may contain elevated levels of contaminants such as pesticides either from direct
application or from runoff from other areas.
Hazardous Waste Sites: Hazardous waste sites or places where toxic materials have been disposed
of illegally or accidentally spilled may contaminate the soil or the water supply. The Massachusetts
Department of Environmental Protection, Bureau of Waste Site Clean Up cites 97 sites in
Lexington: 23 with hazardous materials; 4 with hazardous materials and oil, and 70 with oil. The
majority of the sites are of low risk under the Massachusetts Contingency plan(M.G.L. 21E).
However, 3 sites are rated as Tier 1B, 2 as Tier 1 C, and 15 as Tier 2 sites,13 with those of greatest
concern rated as Tier 1A. A more serious area of contamination at Hanscom Air Force Base is
currently under remediation. The US EPA lists 60 facilities that handle hazardous wastes in
Lexington. The Toxics Release Inventory of the United State Environmental Protection Agency
lists 3 facilities with toxic releases to the environment.14 In two cases toxic materials were released
to a publicly owned water treatment works (POTW) or to a licensed hazardous materials handler at
an off-site location.
Lexington also participates in a regional household hazardous waste facility located on Hartwell
Avenue, at the site of the former landfill. Eight collections are held each year to facilitate removal
of hazardous materials found in the home from the waste stream, and to prevent contamination of
the environment. No hazardous materials are deposited or stored at the site.
Pesticide Usage: Pesticide usage remains a major concern of residents and should be examined
given the potential effect on water resources and local ecology. Besides small truck farms in the
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area where crops and plants are grown, and golf courses, pesticide usage is probably highest on
individual home lawns and gardens, or on public recreational spaces. Pesticide usage in public
buildings should also be examined. Pesticide regulation is outside the scope of authority of local
Boards of Health, and may be controlled only on by Bureau of Pesticides under the Massachusetts
Department of Food and Agriculture according to state law. However, municipalities may limit
usage of pesticides in public places, and may carry out communications programs to spread
awareness about pesticide risks. Lexington's public school system was one of the first in
Massachusetts to implement an Integrated Pest Management (IPM) program to minimize the use of
pesticide agents in schools buildings. School buildings and fields, and daycare centers in the
community and across the state will be required to implement this pest control approach under the
Children and Families Protection Act, signed into law in 2000.
Roadways, Public ways: The condition of roadways and public transportation contributes to the
capacity of residents to have safe physical exercise and access to Town services and spaces.
Although the safety of sidewalks and roads often vary with the seasons and traffic conditions, many
of the sidewalks are continually in poor condition and in need of repair. Given the primary
importance of sidewalks and public way maintenance on basic physical mobility and health, it is an
issue health and related agencies in Town need to address.
Recreational Facilities/Open space: Recreational facilities also contribute to physical fitness with
its attendant health benefits. Fortunately, Lexington has a strong Conservation Commission
dedicated to preserving open space, and public recreation facilities, which are overseen by the
Town Recreation Committee and staff and maintained by the Town. The Conservation
Commission owns and manages over 1,300 acres of open space, including public lands. Including
parks, cemeteries and conservation land, the Town holds more than 10,000 acres of open space.
Indoor Air Quality: Indoor air quality issues have been an issue in the public schools, although
steps have been taken by the school system to address the problems. Indoor air quality problems
can exacerbate chronic diseases like asthma and allergies, and may interfere with the learning
environment for children.'5'16 Indoor air quality needs to be monitored and maintained to ensure the
optimal learning environment for children in schools, and a safe working environment for public
workers. For example, fumes from heavy equipment at the DPW facility at 201 Bedford St.
infiltrate the space where administrative offices are located, possibly posing a hazard to workers
there. Radon gas, a known carcinogen mentioned above, also contributes to poor indoor air quality.
According to the US EPA, all buildings should be tested every five years and remedial action taken
if levels exceed 4 pCi/L. A strong tobacco control program and local health regulations minimize
levels of environmentally-transmitted smoke (ETS) in public places.
Natural Disasters: Lexington is at low risk for most natural disasters. However, some parts of the
town are at risk for flooding, revealed during last year's flooding rains, and the region is at risk for
an earthquake. In such instances, emergency preparedness on the part of both residents and public
safety agencies, including the Board of Health, is essential to protecting the public health.
Climactic variations also exacerbate weather-related disaster situations.
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Man-Made Disasters: The events of September 11, 2001 and the subsequent threat of anthrax
infection renewed concerns about bioterrorism and local preparedness for such an event.
Emergency planning for biological, chemical and other disasters that may affect the population is
essential to future public health planning. Coordination among town agencies including Police,
Fire, Health, Schools and between State and local entities will be essential to the success of any
emergency preparedness plan.
Emergency Disease Epidemics: Emerging pathogens such as variant E. coli strains, vector—borne
diseases such as West Nile encephalitis, and the threat of an imminent influenza pandemic have
renewed concerns about infectious diseases. The threat of a potential bioterrorist attack with an
agent such as the smallpox virus also reinforces the need for local preparedness to deal with a
widespread disease outbreak. Enhanced surveillance of infectious diseases will be an essential part
of an effective plan. However, environmental controls to contain outbreaks such as mosquito
control, food safety programs and water protection will be essential to preventing outbreaks.
3. Disease Incidence
Information was collected on a number of diseases or conditions, including diabetes, cancer,
asthma, allergies, AIDS, sexually transmitted diseases, tuberculosis and others. Hospitalization
data, including the primary ten preventable reasons for hospitalizations from Massachusetts
Division of Health Care Finance and Policy, Uniform Hospital Discharge Data Set(UHDDS), and
information from the Massachusetts Community Health Information Profiles (MassCHIP) were
also used.
Some of the key diseases or conditions noted in discussions within the committee and with the
community included the following:
Chronic Diseases
Chronic diseases, such as asthma, arthritis, chronic obstructive pulmonary disease, and diabetes
among others often have multiple environmentally-related components that may be controlled
through public health measures. Air quality factors often exacerbate asthma, while chronic
obstructive pulmonary disease (COPD) and smoking are linked. Such diseases are increasing
within the entire population, but the incidence of many chronic diseases also will increase simply
with the aging of the population. Chronic illnesses affect quality of life, and may have high
emotional, physical and economic costs both for individuals and the public.'?
Asthma: The incidence of this disease has been increasing for many years; however, the causes of
asthma remain largely unknown. The incidence of the disease continues to grow across the nation,
with an estimated 14.9 million persons suffering from the disease, 500,000 hospitalizations
stemming from the illness, and 5,000 deaths each year.18 Certain factors may serve as "triggers" for
the disease, including dust mites, allergens, pollution, and animal dander. Reports from the
Lexington Public School Nurses indicate that in 1999-2000, 426 Lexington students had asthma
(prevalence=7%); the number increased to 501 during the 2000-2001 school year (prevalence
=8%), and 523 for the 2001-2002 year out of a total of 5981 students (prevalence=9%). The
cumulative incidence (number of new cases in a given period) for the disease is 17% for the three
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year period. Many cases in the teen years have been attributed to exercise-induced asthma, but the
disease may be underreported.19 Asthma prevalence nationwide among children 5-17 years of age
was reported as 130 and 135 per 1,000 children, or roughly 13%, for 1997 and 1998 respectively. 20
Chronic Obstructive Pulmonary Disease (COPD) and Heart Disease: Data from the Massachusetts
Division of Health Care Finance and Policy,21 indicate that COPD and heart disease are two of the
leading preventable hospitalizations for the Lexington area(Number 1 and Number 5 respectively).
Heart failure is the 5th among the top 30 diagnostic related groups (DRGs) for Lexington, and
COPD the 13th.22 Both diseases have a high association with smoking so that tobacco control
efforts and smoking cessation offer effective prevention measures for these outcomes. Lexington
currently collaborates with three neighboring towns on a tobacco control program that targets retail
sales of tobacco, education programs, and cessation.
Diabetes: Diabetes mellitus is a chronic condition involving elevated blood sugar levels. More than
800,000 cases are diagnosed each year; the disease is most common among those over age 60,23 but
rates are rising among youth. The disease contributes significantly to morbidity and mortality levels
in the U.S., causing blindness, renal failure, lower extremity amputations and cardiovascular
disease. It is the seventh leading cause of death in Massachusetts; approximately 244,500 adults in
the State have the disease24 and it is the seventh leading preventable hospitalization in the state.25
Local data, from a Behavioral Risk Factor Survey carried out in Lexington and other nearby towns
do not show significant differences from that of the State. 26 Risk factors for the disease include age
(over 45 years), obesity, diet, and family history.
Cancer
Cancer rates are often a source of concern to residents. Surveillance on cancer rates by community
is carried out by the Massachusetts Department of Public Health, Health Statistics Bureau. Each
year, hospitals, laboratories and physicians report to the state Tumor Registry the different types of
cancer diagnosed in communities across the State. The information collected is then compared to
expected rates of each type of cancer for each community based on basic demographic information,
including population age distribution(cancer occurs more frequently in older populations
irrespective of lifestyle or environmental factors).
From this information and the known risk factors for different types of cancer, local Boards of
Health can identify rising incidence of cancer within a given town or city. However the information
is not sufficient to facilitate easy identification of the various behavioral, lifestyle and
environmental risk factors that might contribute to rates of different types of cancer without
additional studies. The statistics generated by the Massachusetts Cancer Registry offer incidence
rates by town or city at the time of diagnosis, but not according to street address. Thus it is difficult
to determine the effect of the many environmental factors that contribute to cancer without
identification of the residence and a health history. Tracking the possible source of cancer also
becomes difficult for several other reasons: 1) A lengthy latent period of 20 years or more
following exposure to a carcinogen may precede disease onset; 2) "Cancer" includes many
different diagnoses characterized by uncontrolled cell proliferation, with each type of cancer
initiated and promoted through different mechanisms and, 3) cancer development often involves
multiple contributing factors, rather than a single source of the disease. In addition, the geographic
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Lexington Community Health Assessment
borders of the town do not confine any disease to the town; a full analysis of the problem
necessarily may involve cases from one or more different neighboring municipalities.
Reports of cancer incidence in Lexington point to statistically significant higher than expected rates
of prostate cancer (19% above levels expected for the local population.27 The Massachusetts
Department of Public Health has indicated that the apparent elevation in figures for prostate cancer
in towns like Lexington are due to increased screening, especially after age 40. At this time neither
the Lexington Board of Health nor the State have identified a regional or local factor to account for
this significant difference in disease incidence.
For most other types of cancer, Lexington rates were at or below(8% for total cancers)predicted
rates for Massachusetts. Many residents have voiced concern about breast cancer rates in the town
However, the Standard Incidence Ratio (SIR), which measures the increase in specific types of
cancers over baseline or expected levels for a given community, showed breast cancer rates in
Lexington for the 1994-1998 period to exceed levels predicted for the community by 15%
(observed/expected= 174/151 cases). According to the Massachusetts Department of Public
Health, this number was not considered to be statistically significant, i.e., the increased number of
cases might be due to chance or other factors such as residential turnover.
Mental and Emotional Diseases
While no local data could be obtained on mental health information for the general population, data
for the adolescent high school population were obtained from the Centers for Disease Control
Behavioral Risk Factor Survey (BRFS) carried out in Lexington High School in 1995 and 1999.28
These reports illustrated the emotional status and behaviors of the high school age population.
Information from the community discussion groups revealed that concerns about mental health and
support services are emerging as a major concern for residents. Residents and other community
members voiced concerns about access to care and the limitations of existing programs to support
mental health. Nationally, mental health disorders affect nearly 40 million persons between the
ages of 15 and 54 years, and include conditions such as anxiety, post-traumatic stress, mood
disorders, depression, and schizophrenia. Preventive interventions may require a mix of programs
to address the many factors contributing to such diseases.29
B. Information from Community Members
In order to ascertain the real concerns of residents and others in the Lexington community outside
of the disease data and priorities set by the State and Board of Health the committee sponsored
four community discussion groups in the Town Office Building. Marcia Lazar, Director of
Community Health for Mount Auburn Hospital, facilitated the four sessions. Representatives from
many sectors of the town, including all residents, parents, the faith community, business people,
civic organizations, support groups and other organizations were invited to attend the meetings.
The goal of the meetings was to determine how the public viewed health matters in Lexington, and
their expectations of the municipality and its role in addressing these problems.
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Lexington Community Health Assessment
A variety of issues were raised during the discussion groups, including mental health issues
(particularly in the schools), substance abuse in the community, obesity and lack of physical
fitness, and roadway safety. A synopsis of the results of the community discussion groups may be
found in Appendix 2. The first question offered to each group, "What is a Healthy Community?",
served to define the basis on which to evaluate the health status of the community as perceived by a
community member.
The profile of health concerns generated from the community discussion groups reveals the value
of the sessions. While many of the concerns fell within the traditional scope of Boards of Health,
many did not, suggesting the need to expand the focus of municipal activities and support for health
programs. In addition, the information from the community discussion group sessions reinforced
the preliminary findings of the Health Assessment Committee after the initial data review. Many
social, lifestyle and behavioral concerns emerged from the session, while infectious disease and
environmental concerns were of lower priority for the different groups.
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Lexington Community Health Assessment
IV. KEY HEALTH PRIORITIES FOR LEXINGTON
The following list of priority health concerns includes a discussion of the key affected populations,
and the main issues that make them key concerns for the town. The resulting priorities reflect the
combined input of the many information sources used. Included is a discussion of possible
interventions that may contribute to the prevention or mitigation of specific health issues
Historically, the Lexington Board of Health has not been involved directly in many issues that in
years past were considered social or psychological problems, rather than health concerns. However,
the prioritization process revealed such health matters to be among the most important ones facing
the town. Communities often associate Board of Health efforts strictly with inspectional and
infectious disease services. However, merging the broad-based environmental focus of the Board of
Health with more targeted behavioral and mental health concerns will provide a new level of public
health service to the community.
A. Mental Health
Mental health and related behavioral issues were reported repeatedly in the surveillance data,
through community discussion groups, and through meetings with healthcare providers. The
reasons for the repeated mention and high priority given to mental health issues include:
• Mental illness can have a profound effect not only on the patient but also on the mental
status of the people with whom they live, and failure to address the problem can have a
long-lasting effect on numerous people. But access to services to help mental health
problems remain very restricted. Mental health intervention services, if at all available, are
limited in most health insurance programs, often to ten or fewer office visits, and are
inaccessible for those with no private health insurance. Even after a clear diagnosis of a
mental condition, persons with mental illness including depression, bipolar disease, suicidal
tendencies, and other related behaviors may not have access to or may not take advantage of
mental health programs. While school programs do attempt to intervene with children at
risk, there are limited public systems or services that can adequately address these matters
in adults. Interviews with the staff of Lahey Lexington by members of the Health
Department in 2001 indicate that many individuals, particularly the elderly, do not receive
complete care for mental and emotional problems due to gaps within the healthcare system.
• A Behavioral Risk Factor Survey in 1999 illustrated the existence of mental illness,
particularly depression and suicidal tendencies, among high school age students.30 The 1999
survey of Lexington High School students indicated that 24% of students surveyed had
seriously considered suicide, while 12% reported that they had actually attempted suicide.
Of the students queried, 26% had either been threatened or injured with a weapon at school,
or had been in a fight, suggesting that problems with violence should be addressed.
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• Demographic factors including the growing number of elders in the population, suggest that
many individuals in the community may eventually be at risk for depression, isolation from
the community, and mental disorders associated with aging.
• According to hospital discharge data collected by the Massachusetts Department of Public
Health, Division of Health Care Finance and Policy, psychoses (DRG 430) is the 6th of the
top thirty diagnostic related groups (DRGs) for Lexington, with 76 cases for FY 99.
(Rate=304/1 00,000).31
• People affected by mental illness frequently have problems with activities of daily living
(ADLs); conditions in their homes may become unsafe and unsanitary, posing a hazard to
themselves and their families. Such conditions place increasing pressure on Health
Department resources, and frequently cause workplace hazards for public safety staff.
• Messages from the community discussion groups suggested that there is need for counseling
parents on child development, especially from birth to age five that may have a major
impact on future development. Overworked and frequently absent parents often cannot or
do not provide the necessary interaction with their child to ensure their future emotional
health. "The Report of the Surgeon General's Conference on Children's Mental Health: A
National Action Agenda"notes that "The burden of suffering experienced by children with
mental health needs and their families has created a health crisis in this country. Growing
numbers of children are suffering needlessly because their emotional, behavioral, and
developmental needs are not being met by those very institutions which were explicitly
created to take care of them."32 The report also notes that, in the U.S., "one in ten children
and adolescents suffer from mental illness severe enough to cause some level of
impairment... but only"one in five such children receive specialty mental health services."
Recent information from the Lexington Domestic Violence Response Team indicates that
many of the domestic violence calls to the Police Department are for child-against-parent
violence.
33
These data, and the views expressed by citizens in community discussion groups, state that mental
health issues should be studied and addressed by the municipal health programs in the future.
B. Physical Exercise, Obesity and Chronic Disease
Recent reports confirm that physical activity can protect against many health concerns, including
being overweight34. Activity has been shown to have a protective effect for coronary heart disease,
hypertension, non-insulin-dependent diabetes mellitus, osteoporosis, and colon cancer. Exercise
may also reduce feelings of depression and anxiety35 . To combat obesity, the 1996 National Heart,
Lung, and Blood Institute's clinical guidelines and the federal dietary guidelines for Americans
recommend at least 30 minutes of physical activity per day for all adults.
Maintaining a healthy body weight or body mass index (BMI), engaging in physical exercise
regularly, and following a healthy diet are some of the major means of preventing a range of both
physical and mental health problems. However, most adults and children do not engage in physical
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activity sufficient to show benefits in terms of overall health and disease prevention.36 Promotion of
the behaviors contributing to a healthy lifestyle may prevent the disability and financial costs
stemming from a wide range of serious illnesses and chronic diseases. Physical exercise, and
related health issues such as obesity and chronic illnesses should be a focus of the town public
health program for the following reasons:
• Due to time and safety constraints, students and adults tend to use vehicles to travel to
school and work even when their destinations are less than one mile away.
• School diets are high in fat and sugar; snacks available through vending machines are often
poor in nutritional value
• Busy schedules prevent people from maintaining lifestyles that facilitate weight control
• At least one half of adults are considered overweight
• Diabetes is on the rise among increasingly younger people, while diseases that may be
prevented by exercise and weight control-- heart disease, stroke, chronic diseases such as
arthritis and circulatory problems--remain among the top causes of death and disability in
the nation and locally. Data from the Health Care Finance Administration illustrates that
diabetes was the 7th (1998), 8th (1997) and 10th, (1999) cause of preventable hospitalization
among Lexington residents37. This disease may rise dramatically in Lexington as the
population ages, since people over the age of 45, irrespective of health status, are at
increased risk for the disease. Inactivity and weight gain contribute significantly to Type 2
or adult onset diabetes. The disease is predicted to rise 76% among persons in their 30s
according to researchers; much of this increase will be attributed to obesity. The longer a
person has the disease, the greater the chance for debilitating complications.38
• Heart disease, another major preventable condition, and some chronic diseases may be
delayed or prevented by simple lifestyle changes.
• Obesity, stemming from poor diet and lack of exercise, plagues the nation as a whole. The
long-term effects of being overweight contribute to considerable costs to the individual and
the community in the form of disability, higher insurance rates, and lost work time.
Obesity, lack of exercise and poor diet can contribute to diabetes, hypertension, heart
disease, circulatory issues, and many other poor health outcomes. Obesity among the U.S.
population has reached epidemic proportions. State and national averages point to a
growing level of obesity in the population overall. About one half of adults in the US and
in Massachusetts are now considered overweight.39
Data from the local Community Health Network Association (CRNA), which includes the
Lexington area"shows 82% of people participated in leisure time activity in the past month this
percentage is significantly higher than the state average of 75.3% in BRFSS studies."40 However,
lifestyle and behavioral factors, including busy schedules, often prevent adequate exercise for many
sectors of the population. Poor sidewalks and pedestrian hazards also prevent children and the
elderly from engaging in activities that contribute to good health. While the town has many
resources in favor of promoting exercise open space, many recreational facilities, and a public
bike path other environmental factors may help augment existing exercise levels.
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Enhancing physical exercise may be one of the top means of preventing a range of poor health
outcomes in the population. Additional complementary programs that make dietary changes for the
young easy and healthy food accessible, enhance public ways and conservation areas in terms of
accessibility, and help persons with physical challenges to incorporate physical activity into their
lifestyle will all contribute to the health of the community.
C. Traffic/Pedestrian Safety
Reduction of pollution levels and increased resident physical activity levels depend on more
pedestrian traffic and greater usage of public transportation. However, the condition of the roads
and sidewalks may create hazards for both drivers and pedestrians. Again, this problem will
continue to grow as an older population dependent on a limited public transportation system must
negotiate the local road and walkways. Concerns about traffic safety include the following:
• Poor conditions in roadways
• Limited sidewalks, many in need of repair or obstructed, and often not cleared in winter
• Increased traffic on roadways
• Limited mobility of older persons
• Use of bikes, skates and scooters, particularly by children, in high traffic areas
• Limited public transportation system, difficult to access for some persons, especially seniors
• Need for greater crosswalk availability and visibility
• Road rage
While not usually considered a health issue in the past, the physical condition of the local
environment may have a direct effect on injury rates from both traffic and pedestrian causes, and
affects health indirectly by facilitating physical exercise for all sectors of the population. By
addressing these safety issues, we will also directly address the obesity and exercise dilemma in the
community.
D. Substance Abuse
Substance abuse remains a major issue in the town across all age groups, and especially among
adolescents as they experiment with using alcohol, "Ecstasy,"marijuana and other drugs. Despite
many efforts to reduce substance abuse of all forms, it remains a problem among all age groups.
Middle aged persons and the elderly may suffer from mild to high levels of alcoholism that make
them prone to traffic accidents, unintentional injuries, and increased complications from diabetes.
Even moderate alcohol use may have an effect on emotional health and may contribute to violence
in the home.
• A 1999 Behavioral Risk Factor Survey41 report supports concerns about adolescent
substance usage. The survey indicates that 36% of high school students surveyed had used
alcohol in the past thirty days, 23% had used marijuana in the past thirty days, with 15%
smoking the drug 1-9 times, while 7% had tried controlled substances such as cocaine,
crack or steroids at least once.
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• Contributors to the community discussion groups cited concerns about tacit parental support
of alcohol use in minors and their ignorance of children abusing various drugs.
• Seniors may also be affected by polypharmacy taking multiple drugs that may have
dangerous synergistic or antagonistic effects.
• The Community Health Information Profile for Lexington noted that 119 people were
admitted to DPH funded treatment programs in 1998, while 69 alcohol and drug-related
hospital discharges occurred in 1997.42 While the counts were well below the State crude
rate for these indicators, they suggest that substance abuse remains a significant problem in
the town.
• Tobacco use continues as a problem among young people in Lexington, where usage
continues despite a strong tobacco control program. In 1999, 50% of high school students
reported trying cigarettes, while 9% continued to smoke regularly.
Substance abuse problems are not new in any community, and programs are in place particularly in
the school system to combat some of these problems. However, efforts against substance abuse
must be continued and continually evaluated to protect vulnerable populations and other
residents from misuse of drugs, alcohol, and tobacco, and their attendant emotional, physical and
financial cost to the community.
E. Bioterrorism and Infectious Diseases
Recent bioterrorist attacks with the spore-forming anthrax bacteria point to the need for local
emergency preparedness and community awareness regarding infectious disease outbreaks. In
addition to the possibility of a bioterrorist event, other infectious diseases have emerged and
continue to threaten the public health, including E. coli infections, West Nile encephalitis, and
food-borne illnesses to name a few. State and federal health officials also indicate that a worldwide
outbreak of influenza may occur soon, and may cause widespread illness and fatalities. Rising
antibiotic resistance among various bacterial strains and the lack of a vaccine for many diseases
increases the need for local preparation and service.
Outbreaks of infectious disease, whether from E. coli in hamburger or anthrax from a bioterrorist
attack, emerged as another key priority for the Town. Surveillance of infectious diseases must be
improved to identify and address an outbreak or attack quickly effectively.
F. Senior Health
Seniors have a significant number of health issues that emerge solely from advancing age, but are
also due to decreased exercise, poor diet, substance abuse, and isolation from society and support.
These illnesses and contributing factors that may contribute to poor health outcomes include:
• Untreated depression and mental illness
• Polypharmacy, or taking multiple drugs that may interact with negative side effects
• Isolation from support, families and community, such that health prevention and protection
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Lexington Community Health Assessment
measures are not taken, injuries become more common, mental status deteriorates
• Susceptibility to influenza and related complications such as pneumonia
• Poor access to transportation and community services
• Lack of understanding of or access to the healthcare system
This growing sector of the community will be faced with decreased support in the form of home
health visits (limited under the 1996 Omnibus Act that decreased Medicare B payments), less
support from immediate family members who may live far away or be unable to offer help, and
increased isolation in their homes. The changes in the social and healthcare systems harm many
individuals, and the increasing needs of this population for municipal programs will probably strain
town resources. The growing demand for emergency services, including intervention by the Health
Department regarding living conditions, and growing reliance on existing services (e.g., the Senior
Health Monitor program run by the Council on Aging, "Meals on Wheels"), and the use of 911
services illustrate the extent of this rapidly emerging problem.
G. Pesticide Usage
Boards of Health cannot regulate pesticide usage under Federal and State law; however, other
actions may be taken to reduce pesticides in the environment including user awareness and reduced
application on public lands. Pesticides are used in three key areas:
• Municipal usage for mosquito control, public building maintenance, pool disinfection and
parks and fields control (herbicides and pesticides).
• Home/residential usage for lawn and garden maintenance and home pest control (termites,
ants).
• Farm usage for fields and crop growing
The use of pesticides, herbicides, and fertilizers contributes to the overall toxic load of the
environment and deposits breakdown products and nitrates into the ground and surface waters.
Given Lexington's hydrological placement at the top of three watersheds (Charles River basin,
Shawsheen and Boston Harbor), where ground water and runoff here fill municipal wells
elsewhere, the town has an obligation to protect groundwater. Locally, pesticide, herbicide and
fertilizer usage may affect private wells, used increasingly for domestic purposes. In addition,
extensive pesticide and herbicide usage may affect the environment and human health in other
ways, depending on their composition and fate in the environment. Regardless of toxicity,
pesticides should be used judiciously to prevent long-term threats to the environment and human
health.
For many years, the Lexington Public Schools have used the Integrated Pest Management(IPM)
approach to pesticide usage in school buildings. This model should be examined for application
elsewhere in other public buildings and public spaces such as the Battle Green.
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Lexington Community Health Assessment
V. ADDITIONAL HEALTH PRIORITIES
The priorities listed above do not replace existing ones for the Board of Health or other municipal
agencies. Rather, the prioritization process aimed to determine which health issues, if any, required
additional support or focus both from the Board and the entire community. Many other health
issues continue to be of concern for the community, and will require ongoing efforts by local
government. Such health issues of concern include the following:
Cancer Prevention
• Prostate Cancer: The higher than predicted incidence of prostate cancer will require ongoing
surveillance by the Board of Health and the State to identify potential environmental or lifestyle
factors that might contribute to the incidence of this disease in Lexington.
• Breast Cancer: The growing concerns about breast cancer in the community warrant ongoing
efforts to inform residents about the disease, risk factors and new findings about the disease.
Regardless of statistics from the cancer registry, this disease should be treated as a key area of
concern based on residential concerns about its incidence.
• Other types of Cancer: The public often views cancer as a single disease, when the term
actually designates multiple diseases with different etiologies. Since many cancers result from
lifestyle issues, rather than chemical exposure, efforts should be made to emphasize the link
between individual habits and cancer. The effect of diet and personal behaviors on certain types
of cancer (e.g., lung and bladder) has been well documented.43 It is estimated that 25% of all
cancers might be prevented by diet alone, and another 30%prevented through elimination of
tobacco usage. In addition, the Board should improve communications to the community
about environmental factors (e.g., radon in homes) that may contribute to cancer risk. The
aging of the population will also be a factor contributing to increased incidence of may types of
cancer; thus, communications and support mechanisms should be analyzed to address this
health concern.
Finally, cancer remains a particularly frightening disease in the public's mind, and is often
attributed to environmental factors not in control of the average citizen. Communication and
information programs may help dispel many of the myths and fears surrounding the disease, and
encourage risk-decreasing behaviors and increased screening for different types of cancer.
Lead paint: While Lexington has very few cases of lead paint poisoning among children, the age of
many buildings in the town increases the potential risk of lead ingestion and contamination of the
environment. The removal of exterior lead paint can cause significant production and dispersion of
lead-containing dust when outdoor surfaces are sanded, or when paint chips fall to the ground.
While painting contractors are required to contain such contamination under State law, local
regulations passed by the Board of Health permit local control of situations in which paint removal
may harm the community. To prevent long term contamination of the environment, and to protect
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Lexington Community Health Assessment
children and adults who may be harmed by lead, effort should be made to spread awareness about
this issue throughout the community.
Indoor Air Quality: Poor indoor air quality may contribute to a range of health problems. In
particular, air quality issues may be contributing to the high prevalence of asthma rates in
Lexington and across the country. In our local schools, where such problems have been identified,
such conditions may interfere with learning as well. Despite attempts to rectify such problems in
the town, the issue remains of great concern to residents, parents and employees in town alike. Air
testing, renovations, and other corrective measures may result in considerable costs to the town. As
a result, the Town or Board of Health should develop a clear policy as to how such problems
should be handled so that indoor air quality problems are addressed effectively.
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Lexington Community Health Assessment
Lexington Community Health Assessment
VI. RECOMMENDATIONS
The committee recommends that the Board and its associated agencies consider the following
measures to address the priority health issues identified above.
Mental Health
Public health programs seldom address mental health issues, with the exception of substance abuse
interventions. The private, rather than public health system typically addresses depression,
suicidality and other psychoses where individual care may be taken. Public agencies, such as
schools, usually take on the role of identifying potential cases and referring them to the appropriate
agencies in State government or a private provider. Lexington public schools, for example, offer
crisis management for youths at risk through a contract provider.
Developing programs directed at mental health issues will require extensive analysis of the extent
of the problem in Lexington. The already strong program in place in the public schools, and recent
efforts by the Council on Aging to address depression in elders, will provide needed information on
mental health issues in the town. Mechanisms for addressing mental health concerns directly,
offering communications programs and other interventions may be created after such an evaluation.
We recommend that the Board of Health or the Town Manager charge a committee representing
stakeholders, municipal agencies and concerned citizens with the task of evaluating mental health
concerns in the town and making specific recommendations as to action the Board of Health and
other agencies may take.
Physical Exercise, Obesity and Chronic Diseases
General physical fitness leads to a variety of health benefits, while its converse generates a range of
detrimental health outcomes. Diabetes, obesity, stroke, accidental injuries, osteoporosis and a host
of other conditions may be prevented through basic lifestyle changes. Changing lifestyles, however,
requires more work than basic health promotion. Programs to change poor health behaviors must
attempt to integrate good habits into everyday schedules.
The Board of Health should examine and encourage opportunities among all age groups for
increased exercise. Promotional programs such as a"walk to school or work"program should be
planned and coordinated with the public schools, Parent Teacher Association, and Board of Health.
Substance Abuse
Substance abuse remains a highly complex issue that cannot be resolved through a single program
or approach. This health issue is often a symptom of larger health issues facing an individual,
family or the community itself. The Board of Health should work with agencies in Town that
currently work to address this issue in order to evaluate the problem, assist key agencies working
on substance abuse (i.e., the School system), and provide, where possible, possible interventions..
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Lexington Community Health Assessment
Senior Health
The Board of Health should work with the Council on Aging to evaluate the major health issues
facing the elderly today, and to design cooperative intervention programs to help seniors. This step
will help augment existing programs and may take advantage of State supportive services such as
the Minuteman Homecare Services currently provided to seniors. In addition, steps should be taken
to educate physicians and families about the problem of polypharmacy. Efforts on substance abuse
should also be coordinated with existing programs run by the Police Department and School
Department. The Board of Health should also research and implement where possible intervention
programs for other adults and children that are preventative in design rather than remedial.
Pesticide Usage
The Board of Health should examine programs carried out by other towns, such as Wellesley and
Marblehead, designed to minimize pesticide usage in the community. In addition, pesticide usage
by businesses, residents and public agencies should be examined to determine the extent of
pesticide and herbicide application. Finally, a communications program to help decrease such usage
should be developed. However, local Boards of Health cannot regulate residential use of pesticides
however.
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Lexington Community Health Assessment
Lexington Community Health Assessment
VII. CONCLUSION
The list of priorities above offers a broad plan of action for the Board of Health and its associated
municipal agencies to address. While these recommendations ask for a new focus in specific areas
of public health, they do not attempt to eliminate or convey a lack of concern for ongoing efforts of
the Board of Health in the many areas it currently targets. Rather, we have attempted to offer
priorities that engage the efforts of the entire public and private health community, and health
programs that may have a major preventative effect on some of the most critical conditions facing
communities like Lexington today.
While many strong health programs and resources serve the community today, the health
assessment offers an opportunity to identify new issues in the community and can provide valuable
information for those running health programs. The assessment process should be ongoing, rather
than a single study, and should provide the basis for more extensive analysis and program
development in the future.
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Lexington Community Health Assessment
VIII. REFERENCES
1 Lexington Community Profile.Metropolitan Area Planning Council.Population Age Group Forecasts. October, 1998.
2 Population Projections: Lexington Town.MISER,University of Massachusetts,Amherst. July 1999.
3 Population Projections: Lexington Town.MISER. University of Massachusetts,Amherst. July 1999.
4 Community Profiles Lexington,Middlesex County.Dept. of Housing and Community Development. July 2000.
www.communityhealth.hrsa.gov
5 1990 US Census Data.Database C9OSTF3A.Lexington CDP. July 26,2000.
6 Community Profiles-Lexington.Middlesex County.Department of Housing and Community Development.July
2000.http://www.communityhealth.hrsa.gov
7 Population Projections: Lexington Town.MISER.University of Massachusetts,Amherst. July 1999.
8 Goldman L,Apelberg B,Koduru S,Ward C, Sorian R.Healthy from the Start: Why America Needs a Better System
to Track and Understand Birth Defects and the Environment.Baltimore,MD: The Pew Environmental Health
Commission, 1999.
9 Indoor Air Quality(IAQ)-EPA Map of Radon Zones-Massachusetts.January 9,2002.
http://www.epa.goviaq/rdon/zonemap/zmapp21.html.
10 National Oceanic and Atmospheric Agency: http://www.noaa.gov
"Massachusetts Department of Environmental Protection,Air Assessment Branch,Aerometric Information Retrieval
System. 1998.
12 Massachusetts Department of Environmental Protection.
13 Massachusetts Department of Environmental Protection,Bureau of Waste Site Clean Up: Site/Reportable Release
Look Up. September 9,2000.
14 United States Environmental Protection Agency,Envirofacts Warehouse,Toxics Release Inventory Query for
Lexington, September 9,2000.
is US Environmental Protection Agency. "The Inside Story: A Guide to Indoor Air Quality". Office of Air and
Fadiation. September, 1993.
16 IAQ Tools for Schools.Managing Asthma in the School Environment.US Environmental Protection Agency. Indoor
Environments Division, Office of Air and Radiation.April 2000.
17 Centers for Disease Control,National Center for Health Statistics.Healthy People 2000.p.238.October,2001.
18 Centers for Disease Control,National Center for Health Statistics,Healthy People 2000.p.238.October 2001.
19 Lexington Public Schools.Jane Franks,R.N.Personal Communication.2000.
20 Trends in Asthma Morbidity and Mortality.American Lung Association.p.2. January 2001.
http://www.lunusa.org/data/asthma/asthmach1.html
21 Top Ten Preventable Hospitalizations for Lexington,Uniform Hospital Discharge Data set(UHDDS),Health
Systems Measurement and Improvement Group,Massachusetts Division of Health Care Finance and Policy. 1998.
22 Top 30 DRGs for Lexington Residents,FY 99,Division of Health Care Finance and Policy, Case Mix Data. October
16,2000.
23 Centers for Disease Control and Prevention,National Center for Health Statistics.Healthy People 2000.p.238.
October 2001.
24 The Burden of Diabetes in Massachusetts 1993-1995.Massachusetts Department of Public Health,Bureau of Family
and Community Health,Diabetes Control Program. p.1.July 1999.
25 Top 30 DRGs for Lexington Residents,FY 99,Division of Health Care Finance and Policy, Case Mix Data October
16,2000.
26 Behavioral Risk Factor Survey,Health Risks and Preventative Behaviors(1994-1999), Greater
Woburn/Concord/Littleton CHNA,March 2001.
27 Massachusetts Department of Public Health.Bureau of Health Statistics,Research and Evaluation. Cancer
Incidence in Massachusetts 1994-1998: City and Town Supplement.p. 167.October 2001.
28 Northeastern University's Center for Criminal Justice Policy Research. An Overview of the 1999 Lexington High
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Lexington Community Health Assessment
School Survey. Comparisons between the 1995& 1999 Youth Risks Behavior Survey Presented.March 1,2000.
29 Centers for Disease Control and Prevention,National Center for Health Statistics,Healthy People 2000.P. 127.
October 2001.
30 Northeastern University's Center for Criminal Justice Policy Research. An Overview of the 1999 Lexington High
School Survey. Comparisons between the 1995& 1999 Youth Risks Behavior Survey Presented.March 1,2000.
31 Top Thirty Diagnostic Related Groups(DRGs)for Lexington,Data from the Massachusetts Department of Public
Health,Division of Health Care Finance and Policy. 1999.
32 The Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda.
September 18,2000.http://www.surgeongeneral.gov/ch/childreport.htm.
33 Colleen Dunbar,Lexington Police and Stephanie Scogland,Domestic Violence Response Team,personal
communication. October 2001.
34 Prevalence of Leisure-Time Physical Activity Among Overweight Adults United States, 1998.Morbidity and
Mortality Weekly Report. 49(15): 326-330.April 21,2000.
35"Physical Activity and Health.A report of the Surgeon General."U.S.Department of Health and Human Services,
Centers for Disease Control and Prevention, 1996.
36 Centers for Disease Prevention and Control,National Center for Health Statistics.Healthy People 2000.p. 65.
October 2001.
37 Top Ten Preventable Hospitalizations in Lexington,Massachusetts Department of Public Health,Healthcare
Finance and Policy, 1999.
38 The Burden of Diabetes in Massachusetts 1993-1995.Diabetes Control Program,Massachusetts Department of
Public Health,Bureau of Family and Community Health. July 1999.
39 Massachusetts Public Health Association."The Health of Our Children: Who's Paying Attention?" p.2.2000.
40 Health Risks and Preventative Behaviors.Results from the Behavioral Risk Factor Surveillance System(1994-1999).
Greater Woburn/Concord/Littleton CHNA.March 2001.
41 Northeastern University Center for Criminal Justice."An Overview of the 1999 Lexington High School Survey.
Comparisons between 1995 and 1999 Youth Risks Behavior Survey Presented.March 1,2000.
42 Massachusetts Department of Public Health.Massachusetts Community Health Information Profile. CHNA(a)
Health Status Indicators Report for Lexington. September 28,2000.
43 Centers for Disease Control and Prevention,National Center for Health Statistics,Healthy People 2000.p.228.
October 2001.
27
Lexington Community Health Assessment
Appendix 1.
Results of Community Discussion Groups
Community discussion groups, facilitated by Marcia Lazar, Director of Community
Health, Mount Auburn Healthcare, were held in late April-early May of 2001.
Community representatives from many different civic and spiritual organizations, the
healthcare community, business representatives and residents themselves were invited to
the groups. Thirty people attended one of the four discussion groups held, representing
the health community (8), environmental concerns (2), mental/psychiatric (4), spiritual
leaders (2), and 14 residents who voiced their concerns as parents and as members of
civic organizations, and members of town government.
Representatives were asked to first define a healthy community, then to voice their
concerns about specific health issues. Lastly, they were asked to point out attributes of
the town that might contribute to a health community.
1. What are the Key Health Concerns for Lexington?
Key issues that arose at the community discussion groups, not in order of priority,
included:
• Disintegration of the family and pressure on the family unit, combined with
disconnection from the community and extended family was cited repeatedly
throughout the discussions. Lack of parental communication with children and
stress were noted as contributing factors to substance abuse, mental health
problems, risky behaviors among teens and other health issues. Violence among
youth was also cited as an issue.
• Senior concerns stood out repeatedly, especially concerns about isolated seniors
maintaining independence within their homes but losing contact with and access
to the community. Pedestrian safety and access to transportation were also
brought up several times.
• Mental heath in general, including depression, suicidal tendencies, stress and
other concerns were noted as problems in themselves, and also as contributing
factors to risky behaviors (piercing, tattooing, sex) and substance abuse.
Treatment of the mentally ill in the community was also of concern.
• Substance abuse itself was brought up at some, but not all of the meetings.
Drinking in particular was discussed as one of the key problems among
adolescents, along with use of"designer" drugs, and teen smoking.
• Obesity and related health issues, including diabetes, were discussed repeatedly as
major factors that affected children in the community. Lack of opportunity for
exercise, and poor nutritional options in the school menus were cited as
contributing factors.
• Pedestrian safety was cited repeatedly, along with traffic safety as a related
problem. Poor road conditions, lack of or poor sidewalks, and other unsafe
conditions make access and exercise difficult for many residents.
Other Health Concerns Voice at Discussion Groups:
• Pesticide Usage,especially in schools and on town land
• Indoor air quality, especially in schools
• School security
• Noise pollution
• Tree loss
• Violence, especially between parent and child
• Feral animals
• Academic stress among students
• No place for youth to congregate
• Lice among children
2. What is Your Definition of a Health Community ?
The first question each discussion group was asked was "What Constitutes a Health
Community". Each group gave a variety of answers, including the following definitions:
• Clean air, water, soil
• Safe traffic, pedestrian safety
• Low infant mortality
• Waste disposal
• Education for all
• Healthcare access
• Food safety
• Tobacco control
• Privacy
• No discrimination
3. What are Lexington's Health Assets?
• Health education in school program
• Full time nurses in schools
• Concerned, vocal population
• Open space
• Resources for recreation
• Educated population
• Strong responsive police department
• Adult daycare center
• Healthy religious communication
• Lexington Education Foundation
• Strong schools
• Health care institutions nearby
• High income and education levels among residents
• Excellent Fire Dept and Library
• Strong service organizations (Lions, Rotary)
• Limited industry/hazardous materials
• Skilled nursing facilities
• Reduced ETS (environmentally transmitted smoke) in schools
• Safe restaurants
Appendix 2.
Lexington Health Programs
Part of the health assessment process involved a review of current health resources and
services available to community members. The following outlines the current services
provided by different municipal agencies and the audience(s) for whom they are
provided.
Clinics and Hospitals
Lahey Clinic (Burlington)
Lahey Lexington
Mount Auburn Hospital (Cambridge)
Mount Auburn Healthcare (Lexington)
Emerson Hospital
Winchester Hospital
Beth Israel Deaconess (Pediatric)
Health Stop
Municipal and Public Health Services
Environmental Health Services
Environmental inspections
(food, housing, water, air, camps, pools) Lexington Health Department
Tobacco Control Minuteman Tobacco Control
Animal Control Lexington Health Department
Clinical Prevention Services
Vaccinations
(Hepatitis B for students, Influenza, Pneumococcal
disease) Lexington Health Department
Blood pressure screening for the general public Lexington Health Department
Blood pressure screening for seniors Council on Aging
Diabetes Screening Lexington Health Department
Nursing visits for homebound Lexington Health Department
Domestic Violence Response Team Lexington Police, Health,
Schools and Human Services
Senior Services
Medical monitoring for frail seniors Senior Health Monitor
Program through Council on
Aging
Senior support services Minuteman Homecare
Services
Student Health and Prevention Services
Student evaluations and health services Public School Nurses
Fire and burn safety Lexington Fire Department
Counseling support for students Lexington Human Services
Health Education Services Lexington Schools
Service Descriptions
Environmental Services
The Lexington Health Department offers many services to ensure a healthy and safe
environment for the community. The department carries out over 650 inspections each
year on food establishments, pools, camps, water sources, housing, hazardous waste
issues, nuisances and other concerns. The department works with the Massachusetts
Department of Public Health and the Massachusetts Department of Environmental
Protection to address these and other environmental issues including water and air
pollution issues, groundwater protection, control of communicable (e.g., influenza) and
vector-borne disease (e.g., West Nile encephalitis), and emergency planning for both
natural and man-made disasters.
Clinical Preventive Services
The Lexington Health Department also offers clinical screening and vaccine prevention
services through the Public Health Nurse's Office. Current services include vaccinations
for at risk groups (Influenza, Hepatitis B, and Pneumococcal Disease clinics), blood
pressure screening, tuberculosis screening for high risk groups, and diabetes screening.
The Department also collaborates with local private healthcare providers such as Mount
Auburn Healthcare to bring these and other services, such as osteoporosis screening, to
the community.
Nursing visits to the homebound are also offered on a limited basis.
Domestic Violence Support Services
Domestic violence persists as a major problem in many communities, not only as a
source of morbidity and mortality for women, but as a threat to the elderly, children and
even parents. The Police Department collaborates with other town agencies (including
the Schools, Council on Aging, and Health Dept.) to provide support services to victims
of domestic violence.
Senior Services
■ Health Promotion
The Council on Aging offers numerous lectures and support groups on the many health
issues affecting seniors, including cancer, osteoporosis, chronic diseases and healthcare
access.
■ Nursing Services
The Council on Aging provides basic medical monitoring services to frail, homebound
elders in Lexington. Approximately 80 seniors receive this service each year. The
program is funded through the municipal budget.
■ Minuteman Senior Services
A State-run agency, Minuteman Senior Services offers a range of support services
including "Meals on Wheels", Protective Services in accordance with the 1983 Elder
Abuse Law, memory disorder assessments, home health services, a dementia day
program, and other programs through a network of contracted providers. The Minuteman
Senior Services program is supported by the Massachusetts Office of Elder Affairs.
Youth Services
■ School Health Nurses Program
Basic screening and prevention services are provided to all students at the Public Schools
through one full-time nurse at each school. School nurses carry out a variety of services
including physicals, vision and hearing checks, scoliosis checks, dental protection
programs, and pediculosis (lice) checks.
■ Health Education Services
The Comprehensive Health Education Program teaches students to avoid problems such
as substance abuse and contagious diseases, and to understand and demonstrate the
responsibility they share as individuals, family members and citizens to act in ways that
enhance health for themselves and their families. The program focuses on three core
concepts: health literacy, healthy self-management, and health promotion and advocacy.
The Coordinator of Health Education at the public schools works to coordinate efforts
among a variety of key programs (Health Education, Physical Education, Health
Services, Food and Nutrition Services, Counseling, Psychological and Social Services,
Parent/Community Involvement). Health education is provided at the elementary, middle
school, and high school levels.
■ Health Protection Advisory Committee
The Health Protection Advisory Committee develops plans and guidance for a variety of
school health programs. This committee is supported by funds from the Department of
Education.
Fire Prevention
The Fire Department carries out classes for elementary school children on fire prevention
and burn safety. The program is grant-funded.
Emergency Services
Emergency 911 Services are provided through the Fire Department. The Fire Chief is
also in charge of emergency response and preparedness for man-made and natural
disasters.
Appendix 3. Health Assessment Advisory Committee
The purpose of the Health Assessment Advisory Committee will be to assist the Board of
Health in gathering and evaluating information on the health status of the community, as
part of a comprehensive community health assessment. The Health Advisory Committee
will form one component of the overall assessment process, which will also include focus
groups, the Board of Health, town staff evaluations, and possibly surveys of residents.
The members of the Health Assessment Advisory committee will include residents of
Lexington with professional expertise or interest in a range of health perspectives, and
will contribute to the assessment process through the following steps:
• Offer input as residents and as experts in their specific health specialties on the health
status of the town and their recommendations as to actions/programs the town should
implement to improve the public health.
• Work with the Interagency Health Program Evaluation Committee, which will be
composed of Town staff members, to evaluate current health-related programs in the
town and Lexington's "healthcare budget".
• Provide input to the Board of Health on the health assessment process
The work of this committee will be connected to that of the town's Interagency Health
Committee. The committee will begin work late in August or early September, and will
meet approximately once or twice a month for 2-4 months, depending on the progress of
the committee. Individual members may also work with the Health Division staff to
address specific health issues.
Members,Health Assessment Advisory Committee
Martha Sheridan, M.D.
34 Lawrence Lane Email:jaspermassmed.org
Lexington, MA 02421
(781) 863-0518
Nancy Earsey
32 Parker St.
Lexington, MA 02421 Nancy@Earsy.com
(781) 862-8293
Wendy Heigger Bernays
67 Grant St. whb(cr�,bu.edu
Lexington, MA 02420
(781) 861-6463
(617) 638-7724
James Fearnside
19 Vinebrook Road jim_fearnsidejuno.com
Lexington, MA 02421
862-2696
Burt Perlmutter, M.D., Chair
8 Carnegie Place
Lexington, MA 02420 bmpr(cr�,massmed.org
862-9253
Beeper: 781-945-6424
Dr. Fred Mazer
87 Dewey Road
Lexington, MA
861-8639
862-6210 (Lahey)
Margaret Kennedy
33 Forest St.
Lexington, MA 02421
861-7850 makpak1231chi yahoo.com