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Health Disparities in New York City Yvonne J. Graham, R.N., MPH Health Disparities Health disparities are differences in the incidence, prevalence, morbidity and mortality that exist among specific population groups.   What Causes Disparities in Health Status?

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Health disparities in new york city l.jpg

Health Disparitiesin New York City

Yvonne J. Graham, R.N., MPH


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Health Disparities

  • Health disparities are differences in the incidence, prevalence, morbidity and mortality that exist among specific population groups.  


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What Causes Disparities in Health Status?

  • Disparities in health status of communities are overwhelmingly socially related

  • Health care disparities arise from differences in:

    • Health care access

    • Insurance coverage

    • Availability and quality of treatment

    • Other social contexts


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Broader Social, Political, and Economic Contexts

  • Broader social, political, and economic forces result in health disparities, e.g.:

    • Poverty

    • Income inequality

    • Poor housing

    • Poor education

    • Discrimination and stigma

  • Addressing these broader forces can reduce disparities and improve health outcomes


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Race and Ethnicity

  • Brooklyn Overview

    • 34% White

      • 33% Black/African American

      • 20% Latino

      • 8% Asian

  • 41% of residents are foreign-born


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Population by Race/Hispanic OriginNew York City and Boroughs, 2006

Source: NYC Dept. of City Planning


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Top Countries of Birth for the Foreign-bornNew York City and Brooklyn, 2006

New York City

Brooklyn

Total = 3,038,073

Total = 948,680

Source: NYC Dept of City Planning

*Includes Mainland China, Hong Kong, and Taiwan


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White Nonhispanics by Census Tract

Brooklyn, 2000

BROOKLYN

NAVY YARD

PROSPECT

PARK

GREENWOOD

CEMETERY

JAMAICA BAY

DYKER

BEACH

GOLF

COURSE

FORT

HAMILTON

MARINE

PARK

FLOYD

BENNETT

FIELD

Source: NYC Department of City Planning


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Hispanics by Census Tract

Brooklyn, 2000

BROOKLYN

NAVY YARD

PROSPECT

PARK

GREENWOOD

CEMETERY

JAMAICA BAY

DYKER

BEACH

GOLF

COURSE

FORT

HAMILTON

MARINE

PARK

FLOYD

BENNETT

FIELD

Source: NYC Department of City Planning


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Asian Nonhispanics by Census Tract

Brooklyn, 2000

BROOKLYN

NAVY YARD

PROSPECT

PARK

GREENWOOD

CEMETERY

JAMAICA BAY

DYKER

BEACH

GOLF

COURSE

FORT

HAMILTON

MARINE

PARK

FLOYD

BENNETT

FIELD

Source: NYC Department of City Planning


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Black Nonhispanics by Census Tract

Brooklyn, 2000

BROOKLYN

NAVY YARD

PROSPECT

PARK

GREENWOOD

CEMETERY

JAMAICA BAY

DYKER

BEACH

GOLF

COURSE

FORT

HAMILTON

MARINE

PARK

FLOYD

BENNETT

FIELD

Source: NYC Department of City Planning


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Median Household IncomeNew York City and 5 Boroughs, 2006

$68,620

$60,017

$51,190

$46,480

$40,393

$31,494


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29.1

Percent of Persons Living Below the Poverty LevelNew York City and 5 Boroughs, 2006

22.6

19.2

18.3

12.2

9.2

Source: NYC Department of City Planning


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Access to health care

  • Poor New Yorkers have more trouble accessing health care than more affluent New Yorkers.

  • People without health coverage are less likely to receive preventive care than those with coverage.

  • Central Brooklyn residents experience more barriers to health care access than those in NYC overall, with nearly 3 in 10 without a regular doctor.

  • The percent of uninsured in Central Brooklyn nearly doubled between 2002 and 2004.

  • Currently, about 400,000 Brooklynites are uninsured or underinsured.



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Life Expectancy

Source: NYC Department of Health & Mental Hygiene


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Life Expectancy

Source: NYC Dept. of Health & Mental Hygiene


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Death Rates Higher inLow-Income Neighborhoods

Data for 2001


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Racial Disparities in All-Cause Mortality, NYC

14

12

30%

higher

10

20%

higher

8

Rate per 100,000 population

6

4

2

0

White

Black

White

Black

Men

Men

Women

Women

Every year, this disparity in mortality rates accounts for

more than 4000 deaths among African-American New Yorkers

Source: NYC Dept. of Health & Mental Hygiene




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Percent of New Yorkers who are Obese DOHMH HIV, October 2007NYC, by Neighborhood, 2003


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Medical Complications of Obesity DOHMH HIV, October 2007

Almost every organ system is affected

Source: Rudd Center for Food Policy and Obesity


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Mortality from Diabetes DOHMH HIV, October 2007

Mortality from AIDS

Source: Bureau of Vital Statistics, NYC DOHMH, 2002; US Census 2000 / NYC Dept of City Planning


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Racial Disparities in DOHMH HIV, October 2007Colon Cancer Screening Compared with Death RatesNYC, 2002

Source: NYCDOHMH


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Hospitalizations for Asthma (children) DOHMH HIV, October 2007

Hospitalizations for Drug Use

Source: NYS DOH SPARCS, 2001; US Census 2000 / NYC Dept of City Planning


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Mental Health of New Yorkers DOHMH HIV, October 2007% of Adults Reporting 3 or More Days with Poor Mental Health in Past 30 Days, by Race/Ethnicity, 2004

Source: NYC Dept. of Health & Mental Hygiene


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Assault Injuries Among Women DOHMH HIV, October 2007Rates of Assault Injuries Requiring Hospital Care, per 10,000 Women, 2001

Source: NYC Dept. of Health & Mental Hygiene


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Infant Mortality by Ethnic Group, NYC 2006 DOHMH HIV, October 2007

Source: Bureau of Vital Statistics, NYC DOHMH


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Late or No Prenatal Care in NYC, DOHMH HIV, October 2007by Community District, 2006

East New York

Brownsville – 9.3%

Crown Heights South – 8.4%

East Flatbush – 9.4%

Source: Bureau of Vital Statistics, NYC DOHMH


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Health Behaviors Among Adolescents DOHMH HIV, October 2007

  • Teen pregnancy rates (2005) in the South Bronx, East and Central Harlem, Bedford Stuyvesant and Bushwick are much higher than both the national and New York City’s teen pregnancy rates.

  • Sexually transmitted disease (STD) among adolescents continues to be a problem—with approximately 3 million new STD cases per year nationally, and HIV infection is the sixth leading cause of death in people aged 15 to 24.

  • HIV infection is on the rise among young men who have sex with men (MSM) in New York City and more than 90% of the MSM under age 20 diagnosed with HIV in 2006 were Black or Hispanic. (NYCDOHMH)

  • One in 10 New York City teens reports having been hit, slapped or physically hurt on purpose by their boyfriend or girlfriend during the past year.

  • About 10% of domestic violence victims seen in the City’s public hospitals are under the age of 20. (Mayor’s Office to Combat Domestic Violence)

  • Citywide, attempted suicide is almost 4 times as prevalent among LGBT teens (31%) as among heterosexual youth (8%).

Source: NYC DOHMH District Public Health Office 2008


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Summary DOHMH HIV, October 2007

  • Substantial inequalities exist among New Yorkers of different economic and racial/ethnic groups.

  • Poor New Yorkers, as well as African-American and Hispanic New Yorkers, bear a disproportionate burden of illness and premature death.

  • Poor health is concentrated in certain New York City neighborhoods.

  • Factors associated with poor health, such as little or no access to medical care, unhealthy behaviors, and poor living conditions are more common among certain economic and racial/ethnic groups.

  • Eliminating health disparities in New York City would save thousands of lives each year.


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Recommendations DOHMH HIV, October 2007

Combine a multidisciplinary approach with traditional, proven public health strategies.

  • Certain communities consistently have

    poor health outcomes and would benefit most from targeted efforts to improve health and well-being.

  • Target resources and interventions to the

    neighborhoods and communities most at risk due to poor social and economic conditions.


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Policy for a Healthier DOHMH HIV, October 2007

New York City


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Take Care New York: DOHMH HIV, October 2007NYC Health Policy

10 priority interventions

  • Important and winnable battles

  • Proven to be amenable to intervention

  • Best addressed through coordinated action by City agencies, health care providers, community organizations, businesses, and individuals

  • Things we can do something about today

Source: NYCDOHMH


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Take Care New York DOHMH HIV, October 2007


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Take Care New York DOHMH HIV, October 2007


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Recommendations DOHMH HIV, October 2007

Utilize a holistic approach to improving health:

  • Ensure access to preventive and culturally competent medical care.

  • Ensure the physical and social conditions that enable healthy choices.

  • Reduce the burden of poverty and other social disadvantage.


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Recommendations DOHMH HIV, October 2007

Expand concern and responsibility for public

health beyond the health care and public health

communities.

  • Health is affected by more than genetics and medical care.

  • Education, housing, parks, employment, welfare, social equity, and economic development are all important for health, and health disparities cannot be addressed successfully without progress in, and collaboration across these fields.


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Recommendations DOHMH HIV, October 2007

Become part of the solution.

  • President Barack Obama has set up an executive office for healthcare reform in an effort to improve access to health care, the quality of such care, and the sustainability of the health care system.

  • We need to bring the dialogue from today’s proceedings to the table.


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Healthy Neighborhoods DOHMH HIV, October 2007

  • Healthy neighborhoods are those with civic resources such as libraries and parks, easy access to high-quality medical care, adequate and high-quality housing, places to exercise and purchase healthy foods, economic opportunities, safe and secure environments and strong community connectedness.


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