Tuberculosis (TB) has killed millions of people all over the world throughout history. In 1786, there were 300 TB deaths for every 100,000 individuals reported in Massachusetts alone. Thanks to medical advances and public health efforts, we are now able to prevent and cure most TB. Although we have dramatically decreased the rates of TB in Massachusetts, it has not disappeared.
Anyone can get TB, but most cases in Boston are in foreign-born residents. The reason? Even though the United States now has relatively low TB rates, TB is much more common in other countries and continues to be a serious international public health problem! That is why it is important for everyone to understand what TB is, how to recognize the symptoms, and to understand what can be done to prevent the spread of it.
TB is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidneys, spine, or brain. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection (LTBI sometimes refer to as sleeping TB) and TB disease (active TB). If not treated properly, TB disease can be fatal.
Some people develop TB disease soon after becoming infected (within weeks). Other people may get sick years later, when their immune system weakens. Overall, about 5 to 10% of infected persons who do not receive treatment for latent TB infection will develop TB disease. For persons whose immune systems are weak, especially those with HIV infection, the risk of developing TB disease is much higher than for persons with healthy immune systems.
Symptoms of TB disease depend on where in the body the TB bacteria are growing. TB disease in the lungs may cause symptoms such as a bad cough that lasts 3 weeks or longer, pain in the chest, or coughing up blood or sputum (phlegm from deep inside the lungs). Other symptoms of TB disease of the lungs include weakness or fatigue, weight loss, no appetite, chills, fever and sweating at night. Symptoms of TB disease in the brain may include headaches, pain when moving the head, stiff neck and fever.
People with latent TB infection do not have symptoms, and cannot spread TB bacteria to others while it remains latent. However, if TB bacteria "wake up" in the body and multiply, the person will go from having latent TB infection to being sick with TB disease. For this reason, people with latent TB infection should be treated to prevent them from developing TB disease. Treatment of latent TB infection is important to control and eliminate TB in the United States. People who have TB disease need to be treated. It is important to not stop taking the medications until treatment is complete. If medication is stopped too soon, the TB germ can come back and become very hard to fight off.
A simple test on the arm (TB skin test) can tell if the TB bacteria are in the body. Additional tests such as a blood test, chest x-ray or sputum (phlegm) test may be needed for some people. People should be tested for TB if they have spent time with someone who has TB disease, are HIV positive or have another medical problem that weakens their immune system, have symptoms of TB disease (fever, night sweats, cough, and weight loss), are from a country where TB disease is common (most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia), live or work somewhere in the United States where TB disease is more common (such as homeless shelters, prison or jails, or some nursing homes) or use illegal drugs.
The Boston Public Health Commission operates a TB clinic that offers both diagnostic and therapeutic services for TB. Healthcare providers can refer their patients to the TB clinic. To schedule an urgent appointment for a suspected tuberculosis case, healthcare providers should contact the TB Clinic Triage nurse at (617) 534-4875.
Smiles, shades of blue, and selfie sticks, filled the Boston Public Health Commission offices on Friday March 3rd, as staff eagerly participated in Dress in Blue Day.
By wearing blue clothing, or "Getting Blued" as described by the Colon Cancer Alliance, BPHC staff showed awareness, commitment, and solidarity in creating a future free of colorectal cancer.
Colorectal cancer is the 2nd leading cause of cancer deaths in Boston. However, colorectal cancer is also largely preventable and highly treatable with early screening and diagnosis.
Let's start with the facts
Colorectal cancer refers to cancers originating in the colon or rectum. The colon is part of the large intestine, while the rectum is the connection of the colon to the anus (see image below). Often, colorectal cancers develop as polyps: abnormal growths that may later become cancerous if not removed.
The U.S. Preventive Services Task Force recommends screening for colorectal cancer for all adults ages 50 - 75.
- Tests that can find both colorectal polyps and cancer: There are several tests, including colonoscopy, which look for pre-cancerous polyps as well as cancer by examining the structure of the colon. Doctors can remove polyps while conducting the screening, which prevents possible cancers from developing. Due to the preventive value, these screening tests are highly encouraged. However, because they involve preparation to empty the colon and are more invasive, some people prefer other tests.
- Tests that find colorectal cancer (early detection): There are several screening tests that check the blood in stool (feces) to detect cancer. These tests can be done at home, so people may find this to be easier and less invasive than colonoscopies. These screening tests detect cancer, but are less likely to detect pre-cancerous polyps. Individuals with a positive screening result are referred for a colonoscopy.
Whichever test you end up choosing, the most important thing is that you do get tested. These tests save lives. For more info about colorectal cancer screening options, check out The American Cancer Society website.
Colorectal Cancer in Boston
The good news is that screening rates for colorectal cancer are higher in Boston compared to the United States. In 2013, 64% of Boston residents ages 50 to 75 had a recent colonoscopy or sigmoidoscopy compared to 58% of individuals in the U.S. Boston residents had similar screening rates across gender, race, and ethnicity. However, residents with higher levels of education and income were more likely to be screened.
In Boston, fewer people are getting colorectal cancer and deaths caused by colorectal cancer are decreasing. While most racial/ethnic groups experienced a decrease getting colorectal cancer, white residents were the only group that also saw a decrease in death caused by colorectal cancer over time. Today, rates of death caused by colorectal cancer are 44% higher for Black residents (compared to white residents).
Getting tested is the best way to decrease the chances of getting or dying from colorectal cancer.
Help Getting Tested
While there are many reasons that individuals may not get screened, the Colon Cancer Alliance highlights these major factors:
- Insurance coverage and cost
- Fears regarding the test or the preparation
- Your doctor hasn't suggested it
- Busy lives, not enough time
If you need help finding health care or have questions about your insurance coverage, call the Mayor's Health Line at 617-534-5050.
Most colorectal cancer screening tests are covered by your health plan due to Affordable Care Act requirements, but it is always best to check with your health plan.
BPHC has pledged to support the American Cancer Society and Colorectal Cancer Roundtable's 80% by 2018 Campaign. Along with more than 1,000 organizations, we embrace the shared goal to increase screening rates to 80% to save more than 200,000 lives by 2030 in the United States. In the case of Boston, this goal would mean that more than 19,000 additional individuals will be screened.
Join the cause, get screened, and encourage others to do the same!
 Colon Cancer Alliance - https://www.ccalliance.org/get-screened/prevention-and-screening/
 U.S. Preventive Services Task Force -https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening2?ds=1&s=colon%20cancer
 Boston Public Health Commission, Office of Research and Evaluation, Behavioral Risk Factors and Surveillance System, 2013.
 National Center for Health Statistics, Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD.
 Colon Cancer Alliance - https://www.ccalliance.org/get-screened/screening-methods/
In observance of World Water Day, Let's Get Healthy, Boston! joins the celebration by reminding Boston residents of the health benefits of drinking water. Let's Get Healthy, Boston! is a partnership of the Boston Alliance for Community Health and the Boston Public Health Commission, and our goal is to make it easier for residents to make healthy choices in physical activity, nutrition, and smoke-free housing. In promoting the nutrition of Bostonians, we have worked to raise awareness about healthy beverages and increase the consumption of water.
Let's Get Healthy, Boston! encourages people in Boston to drink water by using the ReThink Your Drink campaign. This campaign uses a "traffic light" icon to give customers quick and simple info about beverages sugar content and nutritional value of different types of beverages. High-sugar or "red" beverages should be consumed rarely, if at all. Lower sugar and diet "yellow" beverages should be consumed only occasionally. "Green" beverages, containing no sugar or artificial sweeteners, are the optimal choice. "Green" beverages include water, seltzer, 1% or skim milk, and unsweetened non-dairy beverages.
Here'show Let's Get Healthy, Boston! works to encourage Boston residents to drink more water:
- We partner with Walgreens pharmacies to offer price promotions on water products and place healthy beverage endcaps that promote water and seltzer water. An endcap is a product display located at the end of an aisle, products placed at a store's endcap tend to sell at a faster pace than products placed in other locations.
- We partner with Tropical Foods Supermarket (El Platanero) in Roxbury, to promote our ReThink Your Drink campaign via in-store healthy beverage promotions and community engagement. Some of our efforts include healthy beverage product placement and healthy grocery store tours.
- Corner Stores
- Let's Get Healthy, Boston!'s community partners, the Healthy Community Champions (HCC), work with corner stores to build new neighborhood partnerships and expand the use of our ReThink Your Drink campaign to city corner stores and bodegas. The energetic approach of the HCCs has resulted in partnerships with 27 corner stores. These corner stores have signed on to promote our ReThink Your Drink campaign.
- LGHB partners with Northeastern University's Bouvé College of Health Sciences, School of Pharmacy to create an online and in-person Continuing Pharmacy Education module, which highlights the health impact of sugary beverages and identifies strategies that pharmacists can follow to promote the consumption of healthy beverages. We have also partnered with student organizations to bring healthy beverage changes to current beverage policies at on-campus cafeterias and mini-marts.
On this World Water Day we encourage you to ReThink Your Drink and Go on GREEN by choosing the healthiest choice, whether it be water, seltzer water, or 1% or skim milk.
To spice up your water and to add some flavor take a look at our fruit infused water recipes below!
On Wednesday March 1st, a group of BPHC staff, partners, and clients visited the Massachusetts State House to participate in the Prevention & Wellness Trust Fund (PWTF) Advocacy Day, an effort to promote its reauthorization. The PWTF has increased access to preventive services in pediatric asthma, tobacco cessation, elderly falls, and hypertension for nearly one million Massachusetts residents through a $60 million grant that will end this June. The Boston partnership is one of nine PWTF partnerships and has received $5.35 million in funding going directly to the Roxbury and Dorchester neighborhoods where these health conditions are most prevalent in the city.
During Advocacy Day, the BPHC group was able to speak with Representative Russell Holmes and the staff of Representative Liz Malia and Senator Linda Dorcena Forry about how PWTF is changing the lives of their constituents. PWTF clients were also present to voice how they are now better managing their asthma and hypertension. Fortunately, more than half of the state legislature currently supports reauthorization. PWTF is a first-in-the-nation effort to improve health outcomes by improving public health and healthcare linkages, which is also one of BPHC's strategic priorities. If you believe in the transformative work of PWTF, please urge your elected officials in MA to vote for its refunding. The bill is titled "An Act to Promote Public Health through the Prevention & Wellness Trust Fund (SD1482/HD2638)."
The East Middlesex and Suffolk County Mosquito Control Projects will be conducting helicopter applications of the biological larvicide, Bti, to control mosquito larvae in mid-April and following flooding summer rains. The applications will be conducted over specific large wetlands in Bedford, Belmont, Burlington, Concord, Framingham, Hyde Park, Lexington, Maynard, Medford, Melrose, Newton, North Reading, Reading, Sudbury, Wakefield, Waltham, Wayland, Wellesley, West Roxbury, Weston and Winchester. The trade name of the Bti formulation is Vectobac G (EPA Reg. #73049-10).
The Boston Public Health Commission is holding a meeting of the Boston Biosafety Committee, an advisory group appointed by the BPHC Executive Director under the Boston Biosafety Regulation. The meeting will take place on Monday, March 6, from 5:30pm-7:30pm, 1010 Massachusetts Avenue, 2nd floor, Hayes Conference Room.
The goal of this meeting is to allow BPHC staff along with expert biosafety consultants retained by BPHC to report on the review process and follow-up activities to date related to BU’s application to conduct BSL-4 research at the
National Emerging Infectious Diseases Laboratory. The meeting will also give the applicant and interested members of the public an opportunity to provide any additional information or feedback to BPHC.
The Boston Public Health Commission (BPHC) today announced a team of BPHC street outreach workers assigned to the Melnea Cass Boulevard and Newmarket Square neighborhood since August has made measurable impact in connecting people with recovery and homeless services.
In the first six months of the initiative, the four BPHC street outreach workers were directly involved in the reversal of more than 29 overdoses. The team had more than 600 encounters with individuals whom they were able to guide to services or to an emergency shelter. In an average week, the team successfully found shelter for at least two individuals who had previously been banned from area shelters.
"This team is providing a valuable service to our community, directly serving people who are battling one of the most difficult struggles of their lives, while also working to strengthen the community around them," said Mayor Martin J. Walsh. "These staff take pride in their work and show real compassion for those in need. I'm proud to have them on our team."
The street outreach workers are funded under the Boston Public Health Commission and Mayor Martin J. Walsh's initiatives to end chronic homelessness and provide recovery services to all residents. The teams canvas the neighborhood in pairs to offer guidance to people in need of recovery and homeless services, to direct residents to shelter, and to share resources like information on the Mayor's 311 for Recovery Services hotline.
"What's been incredible about the street outreach team's work is the immediate and measurable impact we've seen on the neighborhood," said BPHC Executive Director Monica Valdes Lupi, JD, MPH. "They are helping people find the services they need when they need them and linking people to a continuum of services that exist in this neighborhood and across the City."
The outreach team canvasses designated areas seven days a week, greeting individuals, picking up syringes they may find, and directing people to services. They also engage with neighborhood business leaders and providers to hear how they can support their work in the community.
Two additional BPHC street outreach workers, funded under the City's Department of Neighborhood Development and the Massachusetts Department of Public Health, have begun to perform similar outreach on the Boston Common. These two positions join street outreach teams from BCYF and partnering nonprofit organizations.
The City of Boston earned the highest ranking in a two-year analysis of US cities and the health policies of those cities that have policies in place to help communities thrive and residents live healthier lives.
CityHealth awarded gold, silver, and bronze medals to cities based on the number and strength of their policies in nine areas as well as overall medals. Boston was among five cities to receive the overall gold medal; five received silver; nine received bronze; and 21 did not have enough strong policies to warrant a medal.
"Every Bostonian deserves to have equal opportunities, and that begins with ensuring the good health of our residents," said Boston Mayor Martin J. Walsh. "I'm proud Boston has achieved this health ranking, and look forward to continuing our programs and initiatives that keep Boston healthy."
Boston was recognized as a leader specifically on policies that prevent tobacco use by young adults, regulate alcohol sales, create opportunities for all children to attend pre-kindergarten, empower consumers by creating a system of publicly posted restaurant grades, and provide access to healthy foods in city-owned buildings.
"Creating and supporting public policies that are rooted in health and opportunity for all residents, particularly those who have traditionally been most vulnerable or seen less opportunity, is key in our work toward achieving health equity," said Boston Public Health Commission (BPHC) Executive Director Monica Valdes Lupi, JD, MPH. "This study not only showcases our work toward creating a healthy city for all Boston residents, but also identifies other cities that are leading in each policy area, creating opportunity for collaboration and learning from one another."
CityHealth policies include recommendations on employment benefits, education, affordable housing, active living and transportation, public safety, tobacco control, clean indoor air, food safety and nutrition. Each recommendation is backed by evidence, supported by qualified experts, and has a track record of bipartisan support.
"We want every person, in every city, to live the healthiest possible life and we've identified ways that cities can make significant improvements," said Ed Hunter, president and CEO of the de Beaumont Foundation, the founder of the CityHealth initiative. "Good health extends into every aspect of our lives - from paid sick days to early education, from safe streets to safe food."
To earn the overall gold, Boston received gold medal ranking in five of the categories tracked, silver in three and bronze in one.
Alcohol Sales Control
High-Quality, Universal Pre-K
Healthy Food Procurement
Clean Indoor Air
Paid Sick Leave
While Boston is a leader on CityHealth's policy recommendations, the city continues to seize new opportunities to boost quality of life and build stronger communities with further policy steps. Mayor Walsh has announced a policy initiative that would create pre kindergarten opportunities for every Boston family. A BPHC program works with nail salon and auto shop owners to create healthier indoor air conditions for their employees and clients.
"Policy is a powerful lever for leaders looking to make a difference in people's well-being and make their cities great places to live. Boston has seized these opportunities to lift all neighborhoods. We congratulate this strong performance in our assessment, and look forward to working together to enhance policy areas like paid sick leave and public safety," said Dr. Shelley Hearne, CityHealth's principal investigator.
CityHealth will update its ratings again in three years. In the meantime, new resources from the de Beaumont Foundation will provide technical assistance and support to cities as they advance their policies on these target topic areas, with the goal of creating healthier lives, stronger communities and cities people are proud to call home.
The assessment and analysis was conducted as a project of the de Beaumont Foundation. As a gold medalist, Boston is joined by New York City, Los Angeles, Chicago and Washington, D.C. For more details on how Boston stacks up against other cities, visit the CityHealth website: www.cityhealth.org.
The Boston Public Health Commission (BPHC) is seeking new community members for its Boston Biosafety Committee (BBC) from the South End/Roxbury, Fenway, and/or Chinatown neighborhoods. The BBC provides technical assistance and advice on issues related to regulation and permitting of biological research laboratories in the City of Boston. Community members should be able to commit to two years on the committee.
BPHC permits and regulates research laboratories in Boston and the BBC has a role in advising the Executive Director of BPHC. Community members of the BBC have a role in communicating information on biological safety to the public and providing input on community concerns.
The BBC meets when required for review of research projects, laboratory permit applications, or other times requested by the BPHC Executive Director. The time commitment will average five hours a month, with some months having no meetings and some months having meetings with materials to review in advance.
Community members interested in being on the BBC should complete the brief application.
For questions, please contact Julien Farland, Boston Public Health Commission Director of Biological Safety, at firstname.lastname@example.org or 617-534-2814.
Deadline for applications is February 28, 2017