Health Disparitiesin 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? • 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
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
Race and Ethnicity • Brooklyn Overview • 34% White • 33% Black/African American • 20% Latino • 8% Asian • 41% of residents are foreign-born
Population by Race/Hispanic OriginNew York City and Boroughs, 2006 Source: NYC Dept. of City Planning
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
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
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
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
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
Median Household IncomeNew York City and 5 Boroughs, 2006 $68,620 $60,017 $51,190 $46,480 $40,393 $31,494
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
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.
Life Expectancy Source: NYC Department of Health & Mental Hygiene
Life Expectancy Source: NYC Dept. of Health & Mental Hygiene
Death Rates Higher inLow-Income Neighborhoods Data for 2001
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
Source: Epidemiology & Field Services Semiannual Report, NYC DOHMH HIV, October 2007
Medical Complications of Obesity Almost every organ system is affected Source: Rudd Center for Food Policy and Obesity
Mortality from Diabetes Mortality from AIDS Source: Bureau of Vital Statistics, NYC DOHMH, 2002; US Census 2000 / NYC Dept of City Planning
Racial Disparities inColon Cancer Screening Compared with Death RatesNYC, 2002 Source: NYCDOHMH
Hospitalizations for Asthma (children) Hospitalizations for Drug Use Source: NYS DOH SPARCS, 2001; US Census 2000 / NYC Dept of City Planning
Mental Health of New Yorkers% 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
Assault Injuries Among WomenRates of Assault Injuries Requiring Hospital Care, per 10,000 Women, 2001 Source: NYC Dept. of Health & Mental Hygiene
Infant Mortality by Ethnic Group, NYC 2006 Source: Bureau of Vital Statistics, NYC DOHMH
Late or No Prenatal Care in NYC, by 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
Health Behaviors Among Adolescents • 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
Summary • 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.
Recommendations 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.
Policy for a Healthier New York City
Take Care New York:NYC 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
Recommendations 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.
Recommendations 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.
Recommendations 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.
Healthy Neighborhoods • 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.