New York City will reduce inequities in health outcomes by addressing their root causes in residents' daily lives, guaranteeing health care, and facilitating both healthy lifestyles and a healthy physical environment.
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In many ways, New York City has never been healthier.
New Yorkers have a longer life expectancy than residents of other big American cities and record low rates of infant mortality. But a closer look reveals large gaps in the health outcomes of different groups, especially across racial and ethnic groups.
That’s why we worry about people without health insurance foregoing their family’s health care or building up huge medical bills they cannot pay. Women of color often do not receive the best prenatal care simply because they live in high-poverty areas with too few specialized health clinics, in addition to a range of other economic and social factors that may prevent access. For a teenager with mental health needs, or a loved one with substance misuse needs, help is not always available — or it comes too late.
OneNYC 2050 takes a holistic approach, focusing on health care as well as building healthy communities with recreational opportunities and strong social connections, ensuring economic security, and advancing environmental justice. Our goal is to achieve health equity among all New Yorkers, regardless of race, ethnicity, zip code, age, gender, or socioeconomic status. We will formulate policies based on the belief that good health is part of a fair and equitable society, and address the root causes of health inequities, so all New Yorkers have an opportunity to live healthy lives.
CONTEXT
Every New Yorker deserves to be healthier, but not every resident has that opportunity because where they live within New York City has a strong influence on health. Health outcomes can differ significantly between geographically close neighborhoods, according to the New York City Community Health Profiles. In addition, not all neighborhoods have equal access to clean air, affordable and nutritious food, or safe and well-maintained housing and public spaces. A neighborhood’s built environment can impact how much people exercise, or even the quality of their relationships with neighbors.
Inequities in neighborhood conditions have been shaped over decades by historical and ongoing racism. Discriminatory policies such as redlining, as well as a lack of investment in neighborhood sustainability, have historically disadvantaged many communities, particularly low- income communities of color, leaving these communities without adequate local services, housing, parks, or playgrounds, which contribute to health.
Studies show income inequality and high rates of poverty are connected to poorer health outcomes such as reduced life expectancy, and increased infant mortality, obesity, and mental illness. Life expectancy in East Harlem, where residents are predominantly black and Hispanic, and poverty is more prevalent, is 8.6 years shorter than on the Upper East Side, a predominantly white community with lower poverty just a few blocks south. Black women are eight times more likely to die from pregnancy-related causes than white women, and babies born to black mothers are three times as likely to die in their first year of life as babies born to white mothers.
By adopting a holistic approach with OneNYC, we will address a range of factors that impact our health. These include gun violence and traffic fatalities, intensive heat waves due to climate change, and air pollution that exacerbates heart and lung problems, particularly for children with asthma.
PROGRESS
We cannot achieve health equity without guaranteeing the right to quality health care, and enrolling as many New Yorkers as possible in health insurance. New York City has steadily reduced the number of uninsured residents since the Affordable Care Act was launched in 2013 — with nearly 70,000 enrolled in the past year alone — but there are still an estimated 600,000 New Yorkers without health insurance, and roughly 300,000 of them are considered “uninsurable.” We are working to ensure all New Yorkers can access high quality primary care, regardless of their immigration status, through NYC Care.
The City has also launched initiatives to protect residents from the harmful effects of tobacco use, redoubled efforts to end the AIDS epidemic, and created new air quality standards. We have started programs to expand mental health services and combat the opioid epidemic. Child exposure to lead has dropped by 90 percent since 2005.
In addition, the City has begun confronting pervasive racial and ethnic inequities in maternal morbidity and mortality, and infant mortality, launching a comprehensive strategy to improve health outcomes for mothers and babies, especially among women of color. Much of the focus has been on community health, with policies and programs informed by community members. Our Neighborhood Health Action Centers, for example, include Women’s Health Suites, and also provide services ranging from primary care and mental health care to wellness classes and are connected to neighborhood-based social services.
Since 2015, we have seen improvements on many key health indicators, including the number of homes with no maintenance deficits, such as water leaks and pests, as well as reductions in children’s visits to an emergency department for asthma. Other improvements include reductions in the smoking rate and teen pregnancy, and increases in the number of high school students getting adequate physical activity.
What We Heard from New Yorkers
Of the more than 14,000 respondents to our citywide survey, 29 percent selected health care as one of the City’s greatest challenges. The key themes expressed include a call for affordable and universal health care, better access to care at the local neighborhood level, and targeted support for marginalized groups, including the need for better systems to help those dealing with mental health issues. As one New Yorker said, “Our health care system is expensive, confusing, and out of reach for too many,” while others emphatically called on the state to take bold action to address health care access and affordability. ” A second New Yorker shared, “Health care outreach is needed in underserved communities — access for primary care services should be increased via transportation assistance and community advocates.”
WHAT WE WILL DO
OneNYC 2050 will ensure all New Yorkers have the opportunity to live healthy lives by taking an interdisciplinary approach to advance health equity and create a more equitable society. Building on our commitment to guaranteed care, New York City will ensure access to high quality primary care. We will launch and expand programs to improve the health of marginalized communities, and address urgent issues such as the opioid overdose epidemic, mental health, and child exposure to lead. Embracing an interagency approach, we will also look at ways to improve air and water quality, mitigate heat exposure, and address the social and economic factors that drive poor health outcomes.
Where we live impacts how long we live.
Source: DOHMH
Where we live impacts how long we live.
HEALTH EQUITY AND THE SOCIAL DETERMINANTS OF HEALTH
Every New Yorker deserves to be healthy. However, long-term disinvestment from low-income neighborhoods and communities of color, have created inequities in health outcomes. As a result, geographically close neighborhoods can present large gaps in how long people live and how healthy they are. The Community Health Profiles, developed by the Department of Health and Mental Hygiene, have put a spotlight on these gaps. For example, East Harlem is mostly black and Hispanic, and nearly a quarter of its residents live in poverty. The Upper East Side, a neighborhood just to the south is mostly white and wealthy. Even though these neighborhoods are close in proximity, people in East Harlem can expect to live eight fewer years than their neighbors on the Upper East Side. Addressing these kinds of inequities in life-expectancy requires focusing on the social determinants of health — the conditions in which people are born, grow, live, work, and age.
