Health Disparities In New York City
A report issued by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute ranks the nation’s counties on various measures of health. As expected, the findings reveal deep health disparities among counties across the U.S., including those in New York State. Whether counties are ranked by “health outcomes” (rates of illness and death) or by “health factors” (characteristics that influence health), counties with large minority populations and high rates of poverty consistently rank least healthy. Among New York City’s five counties (boroughs), Manhattan, Queens and Staten Island land relatively high among New York’s 62 counties, while Brooklyn and the Bronx fall at or near the bottom.
In contrast to the rankings just released, Health Department data can be examined by year – without pooling multiple years of data – making trends easier to see. Over the past nine years, premature deaths have gone down in all boroughs. Infant deaths and HIV-related deaths have also declined. Smoking rates also have plunged – a change that will improve health outcomes in the coming years. An overview of the progress New York City has made in addressing health disparities and the challenges the city continues to face are detailed below.
From 1999 to 2008, NYC life expectancy at birth rose by more than two years for males and females. Life expectancy increases when fewer people die prematurely. Black and Hispanic New Yorkers, and those in high-poverty neighborhoods, have long suffered disproportionately from premature death (defined as death before age 65), yet improvement in premature death rates has been seen in all boroughs. Since 2002, both Brooklyn and the Bronx have seen premature death decline by 16 percent and 8 percent, respectively. New York City has mobilized to address many preventable causes of illness and premature death.
Smoking remains the leading cause of preventable death in New York City. It causes heart disease, stroke, cancer and many other illnesses. New York City’s anti-tobacco efforts – which include public education, cessation services, indoor and outdoor smoking restrictions and higher cigarette taxes – have helped reduce the citywide smoking rate by 27 percent (a decrease of about 341,000 smokers) since 2002. Adult smoking has declined by 29 percent in the Bronx during the same period, and since 2003, the Bronx has also seen a 51 percent reduction in teen smoking.
Obesity and its consequent health problems take a disproportionate toll on highpoverty areas. City agencies are working on many fronts to make low-income neighborhoods more conducive to regular and safe physical activity, while improving access to fresh fruits and vegetables.
While working to prevent cardiovascular disease, the Health Department also works to ensure that people with high blood pressure are aware of the condition and motivated to manage it. The agency has teamed up with pharmacies in the South Bronx, North and Central Brooklyn, and East and Central Harlem to provide blood pressure monitoring kiosks at no cost. Since 2002, deaths from cardiovascular disease have decreased in all five boroughs, including the Bronx and Brooklyn.
HIV disproportionately affects black and Hispanic New Yorkers and low-income communities, however the citywide death rate is falling. Since its launch in 2008, The Bronx Knows HIV testing initiative, the largest municipal testing scale-up in the city’s history, has conducted more than 400,000 voluntary HIV tests in the borough. The three-year initiative is a collaboration between the agency and more than 75 community partners, including all hospitals, major community health clinics, and community-based organizations, as well as educational institutions, faith-based organizations and local businesses. More than 1,200 individuals have been newly diagnosed with HIV through The Bronx Knows and at least two-thirds of these individuals had been linked to care by the end of the initiative’s second year. Between 2008 and 2009, The Bronx Knows partners increased testing by 26 percent while testing increased by another 8 percent between 2009 and 2010. Following the success of The Bronx Knows, the Health Department expanded its borough wide scale-up of HIV testing with Brooklyn Knows in 2010. Brooklyn Knows currently has 57 community partners including nine hospitals, 13 community health centers, 27 community-based organizations, as well as faith-based groups and educational institutions.
Since 2000, the birth rate among city teens has declined in all boroughs, going down by 27 percent overall. Teen births accounted for 6.1 percent of all births in 2009. The Health Department has a multi-pronged approach to reducing unintended teen pregnancy. It includes the distribution of a pocket-sized guide to clinics where teenagers can get medical care and low-cost or free contraception (information that is also available through the city’s 311 information line). The department also partners with clinics in the neighborhoods with the highest teen pregnancy rates, working to improve the quality of health care for teens.
New York City’s infant mortality rate declined by 22 percent from 1998 to 2009, from 6.8 to 5.3 deaths per 1,000 live births. Although the citywide rate reached an all-time low in 2009, large disparities persist among New Yorkers of different races and income levels. Overall, Puerto Rican and Black infants are 1.8 to 2.8 times more likely to die in the first year of life than are white infants.