Health Equity
Health equity means making sure there are conditions for optimal health and well-being for all people. Health equity is achieved when everyone can reach their highest level of health no matter who they are. A person’s health (and overall quality of life) should not depend on:
- Race
- Ethnicity
- Income
- Gender
- Sexual orientation
- Religion
- Where you live
Resources and opportunities are at the root of good health. These include:
- Secure jobs with benefits
- Well-maintained and affordable housing
- Safe neighborhoods with clean parks
- Accessible transportation
- Healthy and affordable food
- Quality education and health care
In New York City, access to these resources and opportunities are not equitably distributed. Neighborhoods of mostly Black and Latino residents often have fewer resources.
Learn more about the Health Department’s commitment to health equity and how we are promoting health equity in our work below.
Equality and Equity
Equality means the equal or same distribution of resources, opportunities, and treatment to everyone.
While in definition equality may promote fairness, it only works if everyone starts from the same place and needs the same things (for example, if all neighborhoods had the same resources, all schools were of similar quality, and all communities had access to fresh produce). Otherwise, equality only reinforces unequal resourcing and outcomes.
Health equality is not health equity. Health equity recognizes that people need different things to lead full, healthy lives.
Inequity and Disparity
Health disparities are population-based differences in health outcomes. A disparity is a difference between groups. Not all disparities reflect an inequity.
Health inequities are unjust differences in health outcomes and the opportunities groups have to be healthy. Inequities are rooted in avoidable, unjust, and unfair social and structural systems.
While both an inequity and a disparity imply a difference, these two terms should not be used interchangeably.
Racism
Racism is a system of power and oppression that structures opportunities and assigns value based on race and ethnicity, unfairly advantaging white people while unfairly disadvantaging people of color.
Racism occurs on different levels, including internalized, interpersonal, institutional, and structural racism.
Internalized racism operates on a psychological level within individuals. These may be conscious or unconscious beliefs about ourselves and others based on race.
Interpersonal racism occurs between people when we bring our private beliefs and biases into our communications and interactions with people of color.
Institutional racism occurs on the level of institutions, such as within government, hospitals, and schools. This is when policies, practices, and systems within institutions create and sustain different outcomes based on a person’s race.
Structural racism is the system of structures, institutions, and policies that work together to advantage white people and disadvantage people of color. It is the broadest manifestation of racism and encompasses multiple dimensions:
- Historical events
- Culture
- Interconnected policies and institutions
Structural racism has shaped where New Yorkers live and go to school, what jobs they have and what their neighborhoods look like. Over time, these policies and practices have built on each other to create deep inequity.
Anti-racism is actively identifying and opposing racism by changing the policies, institutions, and structures that disproportionately favor some racial groups while disadvantaging others.
Racism Is a Public Health Crisis
In 2021, the NYC Board of Health passed a resolution declaring racism a public health crisis. The resolution (PDF) recognizes the impact of racism on the health of New Yorkers. In response, the Health Department has expanded its anti-racism work.
Health Equity in Practice
To support New Yorkers in achieving their full health potential, the NYC Health Department:
- Produces evidence-based data on the health of populations across the city
- Provides direct neighborhood-based services and resources to address specific health inequities
- Advocates for policies to hold institutions and systems accountable to create environments that make it easier for New Yorkers to achieve their best health
By closing the gap in health inequities, we are working toward improving the health of our city.
Below are a few examples of how we are investing in physical and mental health to close gaps in inequitable health outcomes.
Chronic Disease Prevention
Chronic diseases, including diabetes and high blood pressure, have a much greater impact on some groups of New Yorkers than others.
For example, our data show that Asian or Pacific Islander, Black, and Latino New Yorkers have diabetes at twice the rate seen among white New Yorkers.
New Yorkers who live in very high-poverty neighborhoods were almost twice as likely to have diabetes, compared to those in low-poverty neighborhoods (15% compared to 8%).
High blood pressure (hypertension) is a leading cause of heart disease and stroke, which together kill more New Yorkers than any other disease.
The reason we see these outcomes is due to social and economic conditions, such as limited opportunities for physical activity and inequitable access to healthy foods and health care resources.
Our neighborhood health services help New Yorkers reach their full health potential. These offices are located in neighborhoods that have historically lacked investment. Neighborhood health services offerings include chronic disease prevention and management support, nutrition support, fitness activities, and wellness workshops, as well as primary care and social services.
Maternal Mortality
In NYC, extreme inequities in maternal mortality exist between racial groups: Black women are four times more likely to die from a maternal death than white women. This gap has widened in the last decade.
Racism drives maternal mortality disparities. This includes ongoing, intentional underinvestment in neighborhoods where Black, non-Hispanic people live, interpersonal racism that wears on the health of Black people, and anti-Blackness in health care.
Two key programs aimed at reducing maternal health inequities include the New Family Home Visits Initiative and Family Wellness Suites.
The New Family Home Visits Initiative offers support, services, and referrals to new and expectant parents. The initiative provides services to families who live in public housing or neighborhoods with high needs and families receiving support from the Administration for Children’s Services. Its programming includes the Citywide Doula Initiative, Newborn Home Visiting Program, and NYC Nurse-Family Partnership.
Family Wellness Suites, located at our Neighborhood Health Action Centers, are safe, welcoming, and supportive spaces for family members to receive services, health education, and connections to infant and maternal health community resources.
The suites provide education and connect parents, their families, and their clinical and social care providers to minimize gaps in support or medical care that may contribute to maternal and infant health inequities.
Health Care Access
Access to affordable health care lowers people’s risk of preventable illness, helps them manage chronic diseases, and promotes long, healthy lives.
Not everyone in NYC can access care when they need it. Although 88% of adult New Yorkers have health insurance, 8% report not seeking medical care because of cost. Disparities in insurance coverage and restrictions on coverage based on immigration status are often barriers to accessing affordable care.
Individuals who are uninsured or underinsured may face unaffordable bills that become medical debt. One in seven adult New Yorkers report owing at least $500 in unpaid medical bills. Black, Latino, and multiracial New Yorkers are the most likely to carry debt. This is due to structural racism, such as:
- Discriminatory policies and practices that limit opportunities for Black people to get jobs that provide insurance
- Barriers to building financial stability and wealth through homeownership
- Opportunities to live in communities with resources that prevent the development of chronic diseases that can lead to higher medical expenses
Transgender, nonbinary, and gender-nonconforming New Yorkers are also more likely to hold medical debt than cisgender New Yorkers. Cisgender women are more likely to hold debt than cisgender men.
In NYC, access to health care is a right. All New Yorkers have health coverage options they can enroll in, no matter their immigration status or income. The NYC Health Department offers New Yorkers free access to enrollment counselors who can assist with insurance options.
The NYC Health Department also provides low- and no-cost services at our health clinics. NYC Health Department clinics are safe, affirming spaces that offer patients sexual health, immunization, and tuberculosis (TB) services, regardless of immigration status. People without health insurance or those who cannot pay the fee can still get services.