March 30, 2011 – In a report issued today, the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute rank 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.
“Today’s report shows significant health disparities across the nation, as well as here in New York,” said Dr. Thomas Farley, New York City Health Commissioner. “We have seen significant decreases in some of these health gaps among New Yorkers. Despite these gains, there is still much work to be done. Through innovative policy initiatives, programs, and education campaigns, the Health Department continues to make significant strides to improve the health of all New Yorkers.”
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.
The City’s comprehensive health policy, Take Care New York, tracks key health indicators and sets targets for promoting healthy behaviors, improving health care, reducing disparities, and improving the health of neighborhoods. The agency’s three District Public Health Offices – located in the South Bronx, Central Brooklyn, and Harlem – work with community residents to address priority health issues. 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.
Life Expectancy and Premature Death
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% and 8% respectively. New York City has mobilized to address many preventable causes of illness and premature death.
Reducing Tobacco Use
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% (a decrease of about 341,000 smokers) since 2002. Adult smoking has declined by 29% in the Bronx during the same period and since 2003, the Bronx has also seen a 51% reduction in teen smoking.
Promoting Physical Activity and Healthy Eating
Obesity and its consequent health problems take a disproportionate toll on high-poverty 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.
- Since 2005, the Healthy Bodegas Initiative has worked with more than 1,000 bodegas in East and Central Harlem, the South Bronx and Central Brooklyn to increase access to nutritious foods such as fresh produce, whole grain bread, low-fat milk and dairy products, and canned goods with less added salt and sugar.
- The NYC Green Carts initiative is expanding access to fresh fruits and vegetables in underserved neighborhoods by granting special permits to allow mobile vendors to sell them. The City also supports farmers markets, enabling residents to buy fresh, affordable produce while supporting regional farmers. Beginning last summer, the Health Department’s District Public Health Offices distribute Health Bucks, worth $2 each, which can be used to purchase fresh fruits and vegetables at participating locations.
- Shape Up New York offers free family-fitness programs in New York City parks, community centers and public housing sites. Classes are open to adults and children.
Improving Heart Health
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.
Fighting HIV and Other Sexually Transmitted Infections
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% while testing increased by another 8% 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 9 hospitals, 13 community health centers, 27 community-based organizations, as well as faith-based groups and educational institutions.
HIV screening is a critical component of the city’s HIV response because individuals who learn their HIV positive status early can get timely care and treatment. Earlier treatment has been shown to improve health outcomes and helps to prevent the spread of infection. In addition to HIV screening, the Health Department undertakes a variety of evidence-based prevention activities, including the provision of free male and female condoms throughout the city with concentrated efforts around District Public Health Office areas. A total of 20.5 million free male condoms were distributed throughout these boroughs in 2010.
Addressing Teen Pregnancy (ages 15-19)
Since 2000, the birth rate among city teens has declined in all boroughs, going down by 27% overall. Teen births accounted for 6.1% 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. In public schools, the Health Department supports the Department of Education’s school-based classes, which provide accurate science-based information and use role-playing to help teenagers learn how to negotiate relationships and practice the skills necessary to make important decisions around reproductive health. In addition, all public high schools distribute condoms in the health resource rooms in each school. Through a combination of increasing education, skills-based learning, and access to quality health care, the Health Department continues to work toward lowering teen pregnancy rates.
Raising Healthy Children
New York City’s infant mortality rate declined by 22% 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.
Much of the Health Department’s work to improve the health of children centers on reducing health disparities based on socioeconomic inequities and race/ethnicity. Populations at greatest risk are targeted with early childhood interventions, including the Nurse-Family Partnership (NFP) and safe sleep and breastfeeding initiatives. NFP provides low-income first-time mothers, their infants, and their families with nurse home visits during pregnancy until the child’s second birthday. The program helps families improve maternal and child health, build a secure and nurturing relationship between parent and child, and reach education and employment goals. The New York City Safe Sleep Initiative provides safe sleep education training to medical providers, social service agency staff, foster parents, and community health workers. In addition, the Health Department is establishing policy, systems and environmental changes in support of increased breastfeeding initiation, duration and exclusivity. The Breastfeeding Initiative has worked with 18 maternity hospitals to align policies and practices that encourage mothers to breastfeed while working to establish linkages between prenatal clinics, home visiting programs and other breastfeeding supports.
Improving Health Care
The Health Department’s Primary Care Information Project (PCIP) has developed electronic health records specifically to improve preventive and primary care in the city’s most disadvantaged neighborhoods. PCIP is part of an ongoing effort to enhance efficiency, make providers more accountable, and reduce emergency department visits and hospitalizations for preventable conditions. Between 2002 and 2006, the rate of preventable hospitalization among adults fell by 15% citywide, with declines of 4% in the Bronx and 19% in Brooklyn. In addition, New York City has seen increases in the proportion of adults who have a regular doctor. In 2002, 71% of Bronx residents reported having a primary-care physician. By 2009, the proportion had jumped to 82%.
Preventing and Detecting Cancer
One of the most common types of cancer – colorectal – is also one of the easiest to treat at its earliest stages. Colonoscopy screening can prevent colon cancer deaths by allowing a physician to spot and treat precancerous lesions before they become life threatening. New York City’s colonoscopy rates have increased significantly over the past nine years, and racial and ethnic disparities among black, white and Hispanic New Yorkers have almost disappeared. From 2003 to 2009, the screening rate among New Yorkers 50 and older (at least one exam in the past 10 years) rose from 43% to 64% in the Bronx and from 38% to 66% in Brooklyn.
Community-level data, including health information at the neighborhood level, are essential to accurately understand and responsibly address public health needs, especially for a population as large and diverse as New York City. For this reason, the Health Department has been closely tracking health indicators like those in the Robert Wood Johnson report for many years, using data to inform and monitor policies and programs aimed at bridging health disparities. The Health Department provides annual data on key health indicators to the public through online tools like its EpiQuery interactive health data system. These data identify priorities that guide strategy for a healthier New York. For more information on the work of the Health Department and the health of New Yorkers, visit nyc.gov.