Health Disparities in New York City

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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
Brooklyn
New York City
Total 948,680
Total 3,038,073
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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Percent of Persons Living Below the Poverty
LevelNew York City and 5 Boroughs, 2006
29.1
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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Source NYC Department of Health Mental Hygiene
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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
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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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HIV and AIDS
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Source Epidemiology Field Services Semiannual
Report, NYC DOHMH HIV, October 2007
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Percent of New Yorkers who are ObeseNYC, by
Neighborhood, 2003
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Medical Complications of Obesity Almost every
organ system is affected
Source Rudd Center for Food Policy and Obesity
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Mortality from Diabetes
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 inColon Cancer Screening
Compared with Death RatesNYC, 2002
Source NYCDOHMH
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Hospitalizations for Asthma (children)
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 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 WomenRates 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
Source Bureau of Vital Statistics, NYC DOHMH
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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
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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 Citys teen pregnancy rates.
• Sexually transmitted disease (STD) among
  adolescents continues to be a problemwith
  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 Citys public hospitals are under the age of
  20. (Mayors 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

• 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

• 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 New York City
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Take Care New YorkNYC 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
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Take Care New York
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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.

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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.

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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 todays
  proceedings to the table.

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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.