View Full Version : New Yorkers' Health

October 4th, 2003, 11:08 PM
October 5, 2003

New York's Vital Signs



Interactive Feature: A Picture of New York's Health (http://www.nytimes.com/packages/html/nyregion/20031005_HEALTH/met_HEALTH_01_01.html)

SAVVY New Yorkers develop a richly textured, almost unconscious sense of the city's endlessly varied neighborhoods. They know where to find the best dim sum and where not to bother, where the greeting is likely to be in Greek and where it's likely to be in Fujianese, where the bookstores stock lefty-radical tracts and where they tilt toward C.E.O. memoirs.

But how many New Yorkers know that alcohol is a leading cause of hospitalization in Murray Hill and Gramercy Park, which are among the city's healthiest areas? Or that smoking rates are high throughout Staten Island, defying the usual pattern in which more affluent areas light up less? That residents of the Rockaways are far more likely to die of heart disease than other New Yorkers? Or that people in East Harlem are far more likely than those in central Harlem to get flu shots?

Historically, the public had no access to this kind of community-level detail about the city's health, even though such information is a natural companion to the often-published neighborhood breakdowns on income, race and crime. It was not just that such health information was never distributed; in some areas, it was not even collected.

Until now. Dividing the city into 42 segments, the New York City Department of Health and Mental Hygiene has just published a health report card on each district that is packed with fine-grained statistics on New Yorkers' well-being. The findings focus on the incidence of such problems as diabetes, lead poisoning and AIDS; on such risk factors as poverty, obesity and smoking; and on such measures of health care as how many people are uninsured and how many have gotten mammograms and flu shots.

The data for this dauntingly ambitious project came from a variety of sources, like the city's annual breakdown of all deaths and their causes, and hospitals' records of all the patients they admit. But the core of the community reports came from a telephone survey of 10,000 people conducted last year for the department by Baruch College, a survey that helped paint a far more detailed picture of New Yorkers' health, from safe sex practices to exercise habits, than had ever existed before.

The department has sent the reports to community groups and elected officials, and they are posted on its Web site, www.nyc.gov/health , along with a sortable database that allows anyone to rank the 42 areas in categories like cancer deaths, diabetes and early prenatal health care.

Department officials also plan to hold public forums in each of the 42 areas to discuss the findings and how to respond to them.

"We're the city's doctor, and we should be giving the diagnosis," said Dr. Thomas R. Frieden, the health commissioner. "The city is an agglomeration of neighborhoods that have drastically different health challenges and differences, and we need to be talking about those."

New York and some other cities have published area health profiles before, but city officials and public health experts said they do not know of any city that has attempted such detailed portraits. They hope the work will form a base line so that similar future efforts can track citywide and local changes.

The department will use the information, some of which surprised even health experts, to direct its resources.

"One of the things that jumps out is that there are certain neighborhoods that are particularly sick - South Bronx, East and central Harlem, and central and north Brooklyn - and this led us to open district public health offices in each of those three places," Dr. Frieden said. Those offices will focus mostly on behavioral changes that can have profound effects on health, like exercising, stopping smoking and getting vaccines, H.I.V. tests and colonoscopies.

Dr. Frieden said he was struck by the high smoking rates in some poor neighborhoods, in some cases above 30 percent of all adults. "Smoking is really in a league unto itself in terms of causing death and disease, and you'd have to go to Kentucky to get a higher adult smoking rate than in the South Bronx and Harlem," he said.

THE 42 reports feature lists of the top causes of death and some leading causes of hospitalization, adjusted for age. The differences are stark. In affluent areas like the lower two-thirds of Manhattan and parts of north and northeast Queens, frequent causes of death include neurological diseases, severe infections and emphysema or other chronic lung illnesses - all maladies most likely to afflict the elderly. Such infirmities rarely make the list of top causes of death in poor neighborhoods like East New York in Brooklyn and Mott Haven and Highbridge in the Bronx; in those areas, the leading causes include AIDS, diabetes and homicide.

Neighborhoods like Washington Heights, Astoria and Elmhurst, which are heavy with foreign-born residents, display a phenomenon that public health officials have seen before but do not fully understand. These immigrants, even when they are poor and have limited access to health care, tend to be healthier than native-born people. The pattern is important in New York, where 36 percent of residents were born abroad.

The survey also reveals the impact of lifestyle on health. For example, the six districts that posted the highest rates of regular exercise - covering Manhattan from Battery Park to the Upper East and West Sides - also had the lowest rates of obesity, and most of the lowest rates of diabetes.

One measure that almost did not make it into the survey was how people rated their own health; department officials originally thought such data might be too subjective.

To their surprise, the surveyors found that people's judgment of their own health produced a good reflection of their communities' health, as measured by more concrete standards. The worst self-appraisals came in the relatively unhealthy Bronx areas of Mott Haven and Hunts Point, and Highbridge and Morrisania, and in central Harlem; 36 percent of residents rated their health as only poor or fair in those areas. The best scores, with just 10 percent rating their health as poor or fair, were in the healthy districts of northeast and central Queens, the Upper East Side and Gramercy Park and Murray Hill.

Overall, the city's health does not depart greatly from national norms. One exception is its higher proportion of people, many of them immigrants, with no health insurance.

But the city's general profile conceals the tremendous local variation that Dr. Frieden described. The age-adjusted death rate is twice as high in East Harlem as on the neighboring Upper East Side. Obesity is three times as common in the central Bronx as in Greenwich Village and SoHo. Many of these differences follow predictable patterns; for example, the poorer the community, the worse are such problems as smoking, obesity, asthma, cancer and drug abuse, and the more limited the access to medical care. But there are striking exceptions, small and large, some of which the department cannot explain.

"These are things that need a certain amount of investigation to understand, and one of the points of the exercise was to identify them," said Dr. Adam Karpati, the assistant commissioner who headed the project. "These profiles are really the beginning of a conversation about neighborhood health, not the end."

The community reports, done at a cost of $550,000, underscore the desire of Dr. Frieden and Mayor Bloomberg to collect and analyze data and to use the results to direct policy. Another example of this is the Health Department's "syndromic surveillance system," which daily compiles mountains of data from 911 calls, emergency room visits, pharmacy sales and other sources to detect early signs of disease outbreaks in the city.

"The bottom line is to provide to New Yorkers the information that they need to be healthier," Dr. Frieden said. "You can't start to address a problem until you have the information about what and where the problem is."

Copyright 2003 The New York Times Company

October 9th, 2003, 05:04 AM
Report: New Yorkers Depressed

By Margaret Ramirez
Staff Writer

October 8, 2003, 10:16 PM EDT

Nearly 1.3 million New Yorkers suffer from psychiatric disorders, including 400,000 people with depression, according to a study released Wednesday by the city health department.

While other reports have documented mental disorders nationwide, health officials said this effort is the first to create estimates specific to New York City.

Dr. Lloyd Sederer, executive deputy commissioner for mental hygiene, said the data will help link individuals in need with appropriate treatment.

The report, which used data from the late 1990s and 2002, was compiled from national, state and local studies, including the city's Community Health Survey and the Vital Statistics Summary, as well as the Surgeon General's Report on Mental Health.

Other highlights of the report include:

An estimated 575,000 New Yorkers have a substance-use disorder.

Some 381,000 New Yorkers older than 18 report symptoms consistent with serious mental illness.

An estimated 119,000 New Yorkers are mentally retarded or have another developmental disability.

There were 2,367 alcohol and drug-related deaths citywide in 2001.
The report also estimates that the city spends more than $15 billion to treat and support the mentally ill.

Costs were estimated using data on direct treatment and services, medication, research and training, illness and death, lost wages and productivity and costs to criminal justice and social welfare systems.

Copyright © Newsday, Inc.

October 10th, 2003, 05:49 PM
October 12, 2003

Enough to Make You Sick?


Beverly Blagmon lives in the School Street housing projects in southwest Yonkers, a once-vibrant manufacturing area just north of New York City long mired in unemployment and poverty. Beverly has asthma, diabetes, high blood pressure, rheumatoid arthritis, gout and an enlarged heart, and her blood has a dangerous tendency to clot spontaneously. She is 48, and she had her first heart attack in her late 20's. One of her brothers died of heart failure at 50, and another died of kidney failure at 45, as did a sister who was 35. A young cousin recently died of cancer. In the past three years, at least 11 young people she knows have died, most of them not from gunshot wounds or drug overdoses, but from disease.

Monica, who asked that her last name not be used, moved to the Crown Heights section of Brooklyn from School Street a year ago. She has diabetes, arthritis and asthma. She is overweight, and the pain from a back injury that occurred four years ago makes it hard for her to walk or even bend over a stove. Her elaborately braided hair is tinged with gray. In the past year, six of her friends have died, all of them younger than she is. When asked simple questions about her life -- when she was born, where she grew up, when her three children were born -- Monica answers in short phrases, wiping tears from her eyes. She is 36.

Ebony Fasion, 22, and her friend Dominique Faulk, 17, both former residents of School Street, have asthma. Dominique's cousin Jo-Scama Wontong, 19, still lives in the School Street projects. Jo-Scama has lost so many people she loved to disease and accident recently that whenever she thinks about it, she is stricken with panic. ''My heart beats so fast, and I can't breathe, and there's just death going through my mind the whole time.''

Something is killing America's urban poor, but this is no ordinary epidemic. When diseases like AIDS, measles and polio strike, everyone's symptoms look more or less the same, but not in this case. It is as if the aging process in people like Beverly and Monica were accelerated. Even teenagers are afflicted with numerous health problems, including asthma, diabetes and high blood pressure. Poor urban blacks have the worst health of any ethnic group in America, with the possible exception of Native Americans. Some poor urban Hispanics suffer disproportionately from many health problems, too, although the groups that arrived most recently, like Dominicans, seem to be healthier, on average, than Puerto Ricans who have lived in the United States for many years. It makes you wonder whether there is something deadly in the American experience of urban poverty itself.

The neighborhoods where Beverly, Monica, Ebony, Dominique and Jo-Scama live look like poor urban areas all across the country, with bricked-up abandoned buildings, vacant storefronts, broken sidewalks and empty lots with mangy grass overgrowing the ruins of old cars, machine parts and heaps of garbage. Young men in black nylon skullcaps lurk around the pay-phones on street corners. These neighborhoods are as segregated from the more affluent, white sections of metropolitan New York as any township in South Africa under apartheid. Living in such neighborhoods as southwest Yonkers, central and East Harlem, central Brooklyn and the South Bronx is assumed to predispose the poor to a number of social ills, including drug abuse, truancy and the persistent joblessness that draws young people into a long cycle of crime and incarceration. Now it turns out these neighborhoods could be destroying people's health as well.

There are many different types of disadvantaged neighborhoods in America, but poor urban minority neighborhoods seem to be especially unhealthy. Some of these neighborhoods have the highest mortality rates in the country, but this is not, as many believe, mainly because of drug overdoses and gunshot wounds. It is because of chronic diseases -- mainly diseases of adulthood that are probably not caused by viruses, bacteria or other infections and that include stroke, diabetes, kidney disease, high blood pressure and certain types of cancer.

The problems start at birth. The black infant death rate in Westchester County is almost three times as high as the rate for the county as a whole. Black youths in Harlem, central Detroit, the South Side of Chicago and Watts have about the same probability of dying by age 45 as whites nationwide do by age 65, and most of this premature death is due not to violence, but to illness. A third of poor black 16-year-old girls in urban areas will not reach their 65th birthdays. Four times as many people die of diabetes in the largely black area of central Brooklyn as on the predominantly white Upper East Side of Manhattan, and one in three adults in Harlem report having high blood pressure. In 1990, two New York doctors found that so many poor African-Americans in Harlem were dying young from heart disease, cancer and cirrhosis of the liver that men there were less likely to reach age 65 than men in Bangladesh.

Since the time of slavery, physicians have noted that the health of impoverished blacks is, in general, worse than that of whites. Racist doctors proposed that the reasons were genetic, and that blacks were intrinsically inferior and physically weaker than whites. But there is very little evidence that poor blacks or Hispanics are genetically predisposed to the vast majority of the afflictions from which they disproportionately suffer. As the living conditions of blacks have improved over the past century, their health improved in step; when conditions deteriorated, health deteriorated, too. This has helped support the contention among researchers that much chronic disease among minority groups is caused not by genes, but by something else.

That something else may come down to geography. Ana Diez-Roux, an epidemiologist at the University of Michigan, has shown that people who live in disadvantaged neighborhoods are more likely to have heart attacks than people who live in middle-class neighborhoods, even taking income differences into account. Researchers from the Rand Corporation found that neighborhoods where many buildings are boarded up and abandoned have higher rates of early death from cancer and diabetes than neighborhoods with similar poverty rates and similar proportions of uninsured people, but intact housing. Abandoned buildings do not in themselves cause disease, of course, but they are an indicator of neighborhood deprivation and neglect -- and this does seem to be associated with poor health, though we don't know why.

In some ways, our public health institutions are in the same position they were in 150 years ago. In the mid-19th century, public health boards were established to fight the great killers of the day -- cholera and tuberculosis. The poor were more susceptible to these diseases then, just as they are more susceptible to chronic diseases now. And then, as now, the reasons were unknown. Some believed diseases were acts of God and the poor got what they deserved. If they would only drink less, go to church and stay out of brothels, they wouldn't get sick. Others maintained that the afflictions of poverty were environmental. A stinking mass of invisible vapor, referred to as ''miasma,'' hung in the air over the slums, they claimed, and sickened those who inhaled it.

It was not until the early 1880's, when the German scientist Robert Koch looked down his microscope at swirling cholera and tuberculosis bacteria, that everyone finally agreed about what was going on. The water the poor drank was full of sewage and contained deadly cholera germs; in overcrowded tenements, the poor breathed clouds of tuberculosis bacteria. Malnourished alcoholics tended to be more susceptible to these diseases, but immoral behavior was not their primary cause. Nor was miasma. The primary cause was germs.

We don't have a germ theory for chronic diseases like stroke, heart disease, diabetes and cancer. We know something about what can aggravate these diseases -- diet, smoking and so on -- but not enough about why they are so much more common among people who live in certain neighborhoods, or what makes, for example, a poor person who smokes the same number of cigarettes a day as a rich person more likely to get lung cancer. Or why several research studies show that smoking, eating, drinking and exercise habits do not fully account for why rich people are healthier than poor people. Even lack of health care cannot entirely explain the afflictions of the poor. Many poor people lack health insurance, and those who have it are often at the mercy of overworked doctors and nurses who provide indifferent care, but inadequate health care cannot explain why so many of them get so sick in the first place.

Most poor minority neighborhoods ''are less healthy,'' says Adam M. Karpati, who works in the Brooklyn office of the New York City Department of Health and Mental Hygiene. ''You walk down the street and you know it. But what is that thing that you know is going on? What's at play there? That thing you can't name? We don't know that.''

Clearly we need to examine this miasma with a different kind of microscope. The best we have at the moment are theories that fall into two main schools of thought. One school holds that the problem has mainly to do with stress; the other holds actual deprivation responsible. These two factors are often intertwined, but the emphasis is important. ''There are so many fists in the face of poor African-Americans,'' says Arline Geronimus, a professor of public health at the University of Michigan who leans toward the stress school, and she proceeded to list them for me. They have enormous family obligations, she explained, and while the middle class are able to purchase child care and care for elderly relatives, the poor cannot. The experience of racism and discrimination in everyday life is also still very real, and very stressful. She says that blacks are faced with a society that institutionalizes the idea ''that you are a menace -- and that demeans you,'' she says. Nancy Krieger, a Harvard researcher, found that working-class African-Americans who said they accepted unfair treatment as a fact of life had higher blood pressure than those who challenged it.

Geronimus calls the grinding everyday stress of being poor and marginalized in America ''weathering,'' a condition not unlike the effect of exposure to wind and rain on houses. Listening to Geronimus describe ''weathering,'' I found it hard not to wonder whether anyone really knows what it is. Stress is subjective, a feeling, and it means different things to different people. Philip Alcabes, associate professor of urban public health at Hunter College, says that stress is like the miasma that was once thought to cause cholera in 19th-century slums. ''You can't see it, you can't really measure it, but it floats over certain people, especially the poor, and makes them sick.''

If ''weathering'' and stress have their modern day Robert Koch, he is probably Bruce McEwen, a neuroendocrinologist at Rockefeller University in New York. McEwen argues that stress hormones threaten the health of poor people, especially blacks and the Hispanic poor. Stress hormones are produced by the adrenal glands in response to signals from the brain. When people feel frustrated, frightened or angry, stress hormones travel through the bloodstream and instruct different parts of the body to prepare for an emergency. They speed up the heart rate and narrow the arteries so that blood gets to the tissues faster; blood sugar rises, so that energy rushes to the muscles and other organs; and some bodily functions, like digestion and the mechanisms that maintain the strength of the bones and other tissues, are inhibited. But not all stress is the same. Occasional periods of intense stress, like what you feel during a near miss in a car, do no harm. However, McEwen's research suggests that constant exposure to stress hormones impairs the immune system and damages the brain and other organs.

Chronic stress also signals the body to accumulate abdominal fat around the waistline, which is more dangerous than fat that lies under the skin, or subcutaneous fat. Abdominal fat worsens many chronic health problems, including diabetes and heart disease, whereas subcutaneous fat does not. It's as if stress hormones were like lye, powerful stuff that in small amounts is useful for cleaning the stove, but that in large amounts will eat right through the floor.

Not everyone believes that stress is a major contributor to the health crisis among the poor. George Davey Smith, a professor of clinical epidemiology at the University of Bristol in England, agrees that the poor live very stressful lives, and that racism is an everyday reality for many people. However, in his view -- the second school of thought on the matter -- the health crisis among the poor has more to do with living in a deprived environment.

The experience of poverty in America has changed a great deal since the 19th century; the poor now have safe drinking water and live in less crowded dwellings, and many have cars and TV's. However, it's also true that many poor people eat unhealthful food, smoke and abuse drugs. Americans hear a great deal about the importance of making healthy choices in their lives; warnings about cigarettes and high-fat foods issue frequently from the surgeon general's office and fill the pages of magazines and best-selling advice books. There are plenty of people who feel little sympathy for overweight diabetic people, poor or not, who eat regularly at McDonald's. But while there is considerable controversy about the ideal lifestyle regimen, you don't need to know much about impoverished neighborhoods to see the absurdity of choosing to go Atkins or macrobiotic for a person like Beverly Blagmon, who subsists on disability payments. Poor people are more likely to have unhealthy habits because fast food and cigarettes are abundant and cheap in their neighborhoods, and healthy alternatives tend to be limited.

A recent survey conducted in four regions of the United States found that there were three times as many bars in poor neighborhoods as in rich ones, and four times as many supermarkets in white neighborhoods as in black ones. There are fewer parks in poor neighborhoods as well, so it is more difficult to find open spaces in which to exercise, and many of them are dangerous. Forty-one percent of New York's public elementary schools have no consistent physical education program. As Mary T. Bassett, a New York City deputy health commissioner, said to me, public health campaigns that tell people to ''just say no'' to smoking, or to change their diets and start exercising, can be cruel if they are indifferent to neighborhood circumstances.

Davey Smith also points out that many of the poor black people who are sick today grew up in the 40's, 50's and 60's, when many black people lived in overcrowded dwellings, and were more prone than affluent whites to childhood infections. Some of these infections may have long-term effects on health. Helicobacter pylori, a bacterium that has been associated with both ulcers and stomach cancer in adulthood, is most often acquired in childhood, and this may explain why poor blacks in particular have relatively high rates of both diseases. Adults who were poor as children, even if they are not poor now, are also more prone to stroke, kidney disease and hypertensive heart disease.

I wondered about these alternatives. Presumably both stress and material disadvantage are important causes of ill health among the poor. But which is more important? And what would be the best way to address these problems? If stress is a major cause of ill health, interventions to alleviate it -- counseling, antidepressants, even yoga -- might be beneficial. A recent article in The British Medical Journal suggested that building self-esteem actually helped a group of Native Americans manage their obesity and diabetes better than did conventional counseling about diet and exercise. On the other hand, if material disadvantage is a major cause of ill health among the poor, then extensive changes in the environment in which the poor live -- for example, cleaner buildings and more parks -- are needed.

Perhaps Beverly Blagmon, who lives in the midst of such problems, could help resolve this matter. I asked her what she thought the health crisis in southwest Yonkers was caused by, and she answered without missing a beat. ''Racism.'' We went on to talk about the lack of jobs in the area and the dilapidated state of the housing. I also learned that if stress is a killer, there is plenty of it on School Street, but yoga classes and motivational seminars are not likely to be of much help.

Beverly raised 10 children, eight orphaned nieces and nephews in addition to her own son and daughter. The kids were desperate for attention from the overextended Beverly. ''It was hard,'' she said. ''You had to deal with 10 different personalities.'' All the kids are grown now, and all but two have left home. Now she worries because some of them can't find jobs. When she was young, Yonkers was full of factories that hired many young people. But not anymore.

Then last year, disaster struck. Beverly's 21-year-old daughter was killed in a car accident; shortly thereafter, her nephew was shot and killed right outside her building. ''I was totally out of it,'' she said. ''People don't know how much a death can take from you. I went into the hospital right after my daughter's funeral. They didn't know if I'd had a mild stroke or not.''

''Life is taken stupidly'' all the time around School Street, Beverly said, but this doesn't make it easier to handle. Beverly struggles with these losses, and said her family, friends and even officials from the local Housing Authority have been supportive. But when Beverly talked about life on School Street, what she said is underscored with tension -- the constant strain of ''us versus them.'' She sees the police in particular as a constant source of grief. ''Some of them are very prejudiced, even now,'' she told me. She claimed that a few officers harassed children and teenagers, and have even been known to swear at kids and shove them. She recalled, as if it were yesterday, a 1997 fight at School Street. Someone called Beverly to come outside, which she did, along with a visiting friend. Police officers were on the street, some of them shouting, and in the chaos that ensued, she said, a policeman knocked down Beverly's friend, a older woman who is legally blind. ''I was freaked out,'' Beverly said. ''The main witnesses were drug dealers, and they couldn't say anything.'' (The Yonkers police confirmed that the woman later filed a complaint, but said an internal investigation found no wrongdoing.) Beverly said she was infuriated when, shortly after the incident, she saw the mayor of Yonkers praise the police in a televised speech.

People who are not poor often casually ascribe their aches, pains and even more serious afflictions to ''stress,'' but stress, if it is a killer, is a far more serious problem for people like Beverly. When middle-class people feel the police or other authorities treat them unfairly, they often have the resources to hire a lawyer and even effect change. But all too often poor blacks feel ignored when they complain about discrimination and abuse.

How might painful experiences like Beverly's be imprinted on the body? Laboratory animals suffer when stressed with electric shocks or when kept in isolated cages away from their peers, and they sometimes do develop symptoms that resemble human chronic diseases. But how does mouse stress compare to Beverly's stress? Or mine? Or yours? George Davey Smith would argue that it is entirely possible that the afflictions of poor people like Beverly are not due to stress, at all, but to old-fashioned deprivation: crowding, poor nutrition, lack of exercise and exposure to dirty air, germs and vermin. For a while, Beverly's family of 11 crowded into a two-bedroom apartment, until they were eventually moved into a six-room place. Once, money was so short that she begged the welfare office for food stamps. There is nowhere around School Street for kids to run around, Beverly says, except a concrete playground with a set of monkey bars. ''Why can't they put up some swings or build a basketball court? You see kids using garbage cans as basketball nets around here.'' Until two years ago, an incinerator in the building spewed forth horrible fumes that may have contributed to the high rates of asthma on School Street. ''When you got ready to polish the furniture, it was black with dust,'' Beverly recalled. ''Every day. Now, how much of that was getting in our lungs? I've been in the hospital every year with acute asthma.'' The incinerator has been replaced by a compactor, but as a result, life is a constant battle against roaches and mice, whose droppings also worsen asthma. Beverly told me that she recently caught three mice in one day. ''I put them on the maintenance people's desk,'' she said. The elevators are always breaking down, which is hard on the elderly. Once she saw human feces in the hallway.

After talking to Beverly, I could only conclude that her life was full of many sorts of trouble, any or all of which might be harmful to health. If only it were possible to devise an experiment that would examine the effects of stress and deprived living conditions on the health of the poor. For nearly 10 years, the U.S. Department of Housing and Urban Development has been conducting an experiment called Moving to Opportunity that seems to be doing just that. HUD researchers wanted to see what happens to poor urban families who move out of neighborhoods like Harlem in New York, Roxbury in Boston or the South Side of Chicago and settle in better neighborhoods. They wanted to know whether moving would help children do better in school, and escape being drawn into crime when they reached adolescence. They also wanted to know whether their parents would climb out of poverty.

HUD did find that people's lives improved in some ways. For example, the children who moved to better neighborhoods in Baltimore did better on standardized tests, and adults there were more likely to get off welfare. But HUD's most remarkable early findings had to do with health. In Boston, poor children who moved to low-poverty neighborhoods were less likely to experience severe asthma attacks. Adults in New York who moved were less likely to suffer from symptoms of depression and anxiety than those who stayed behind, and adults in Boston were more likely to report that they felt ''calm and peaceful.'' The HUD researchers who devised the experiment had not set out to study health, but their findings were so striking that they decided to expand their study to determine whether moving out of poor neighborhoods affected other aspects of health that they did not measure in the first round, including blood pressure, obesity and other factors associated with such chronic afflictions as heart disease, cancer and stroke, like smoking. Those results aren't available yet, but when I heard about the earlier study, I decided to conduct a small experiment of my own.

I wanted to talk to families, like those who had participated in the HUD program, who had recently moved out of the slums. Did the move affect their health? And if so, why? Did people experience less stress? Did they eat better food? Breathe better air? What might their experiences tell me about the mysterious miasma of contemporary poverty?

My investigation led me to Jerrold M. Levy, the general counsel of the Enhanced Section 8 Outreach Program, or ESOP, which helps low-income families move out of depressed, dangerous inner-city neighborhoods in Yonkers into middle-class areas. ESOP wasn't conducting any studies of these people, of course, but Levy was willing to put me in touch with 10 of the families he'd helped move. He had noticed that the people who moved out of dangerous neighborhoods seemed happier. ''A few weeks after they've moved,'' he says of his clients, who are mostly single mothers, ''they come into my office, and it's like one of those programs on late-night TV where they do the makeovers, you know? They have their hair done nicely, they're wearing high heels and makeup, it's like they're transformed. They have a new sense of self-worth and dignity. But will you see changes in their health? I don't think so.'' Depression and anxiety are major health problems that affect large numbers of poor people, so I thought I would be satisfied just to find people whose mental health improved. And I did find such people. But I also found that most people who moved gained far more than high spirits.

Of the 10 families I met, 9 had at least one member who suffered from a serious health problem before the move that required either medication or hospitalization. Of the 16 people in these families who had health problems, 12 told me that they felt better in significant ways -- either their symptoms were less severe so that they no longer required hospitalization, or they were taking less medication. Their health problems included severe asthma, diabetes, high blood pressure, liver cirrhosis and eczema. Emergency-room visits for the asthmatic kids virtually stopped, and some adults with high blood pressure or diabetes reduced the doses of their medications. This was hardly a rigorous scientific experiment. There was no control group, and I was not able to check medical records. Nevertheless, I was stunned by what people told me. These people felt better, and moving appeared to have made all the difference. If moving out of southwest Yonkers were a drug, I would bottle it, patent it and go on cable TV and sell it.

Juanita Moody is now 52. In the summer of 2001, she and her husband, William, moved to a middle-class section of Yonkers from a low-income housing complex on Nepperhan Avenue, where they lived for nearly 30 years. Juanita was crippled by polio when she was a teenager, and during an operation to adjust her spine, she was given a blood transfusion that contained hepatitis C. The virus lay dormant for many years. But two and a half years ago, Juanita's doctor told her that her liver was showing signs of damage and advised her to take interferon, a prescription drug for viral infections. When Juanita found out about the possible side effects, however, she refused. Today Juanita's liver tests are almost normal, suggesting that her hepatitis is not progressing rapidly. ''The doctor said I was fantastic, in terms of enzymes,'' Juanita told me. I did not speak to Juanita's doctor myself, so I could not confirm her diagnosis, but Juanita seemed energetic, and other doctors confirmed that it is possible for hepatitis to slow its progression. In addition, Juanita says that since she moved, her blood pressure has fallen from 140/90, which is considered high, to 130/78, which is almost normal, and the dose of blood-pressure pills she takes has been reduced by half.

Juanita, a born-again Christian, attributes her improved health to prayer and to the new regimen she has maintained since she moved. She has become a health-food nut. Before she moved, her daughter told me, ''everything was fried, fried, fried. Before she'd eat at McDonald's and stuff, but not now.'' Now she drinks fruit and vegetable juices, and her kitchen cabinets are full of natural remedies: vitamins C and E, zinc, magnesium, calcium, alpha lipoic acid and milk thistle, which she says is excellent for the liver.

Juanita says she began focusing more on her health after she moved. When she lived on Nepperhan, there were too many other things to worry about, including frequent robberies and killings in and around the complex itself. The building managers put up a fence to keep drug dealers out, ''but the crackheads living inside the building gave the dealers the keys.'' The elevators were often broken, which meant that someone would have to carry Juanita and her wheelchair up and down three flights of stairs.

Juanita's new apartment is not in a luxury building. It's on a busy road, near two gas stations and a shopping mall, and has few amenities. But it is safe and has nice, leafy views. On Nepperhan, ''it was stressful just to walk out of that place. You were always scared for the kids. . . . You wake up stressed, go to sleep stressed, you see all the garbage and the dealers. That is depressing. In a bad environment like that you say, 'What's the use of doing anything?' '' Living in her new apartment building gives her a very different feeling. ''It inspires you to do all you can -- spiritually, health-wise, any kind of way.''

It is well known that junk food can make anxious people feel better. Researchers from the University of California recently discovered one possible reason. In response to constant stress, the brain makes a hormone called corticotropin-releasing factor, which instructs the adrenal glands to manufacture stress hormones, including adrenaline and cortisol. These hormones cause a range of physiological changes that over long periods can be harmful. When people with high levels of cortisol eat sugary, fatty foods, fat is deposited in the abdomen. The researchers theorize that these abdominal fat cells can temporarily inhibit the brain from making corticotropin-releasing factor, reducing feelings of stress and anxiety. If this theory is correct, it could explain how the stress of poverty creates a biological urge to overeat, thus putting poor people at greater risk of obesity and its consequences -- diabetes, heart disease, stroke and certain types of cancer. Perhaps this explained why Juanita found it easier to change her diet once she moved out of the stressful atmosphere of Nepperhan Avenue. She admitted that doctors had been telling her over the years that she should consume less fattening food. ''But they can tell you, and you don't do it,'' Juanita said.

Noemi, 31, moved with her two teenage children and her 76-year-old aunt, Raimunda, from Burnham Street in Yonkers to a better neighborhood in northwest Yonkers only three months before I met her in August. Noemi, who asked that her last name not be used, has had diabetes since childhood. Shortly after she moved, her doctor reduced her dose of insulin by three units. Noemi thinks it's because she feels less stressed in the new neighborhood. ''Stress affects your blood sugar,'' she explained. ''It makes your sugar go up so you need more insulin.'' She drove me from her new neighborhood of neatly mowed lawns, bushy trees and two-car garages to the place she used to live. ''Look at the neighborhood here,'' she said, as we drove by industrial garages, boarded-up buildings and vacant lots. An enormous, dented, wheezing Lincoln car screeched by. ''I had to be worried all the time, you know. Are the children gonna get hit by a car? Is something gonna happen? We've lived in neighborhoods with a lot of drugs, a lot of people getting killed. You'd read about it in the paper the next day and think: Oh, God! That's only two blocks from here.''

Noemi's aunt Raimunda speaks no English, although she has lived in the United States for more than 15 years. She has high blood pressure and heart disease. I asked Noemi to ask Raimunda how she was feeling these days. ''She says her thing with the head is gone,'' Noemi translated. ''Before she used to get dizzy, but not anymore. Not for the past couple of months.'' When I asked Raimunda why she thought the dizzy spells went away, she, unlike Noemi and Juanita, did not mention stress. Instead, she said she thought the improvement had something to do with diet. ''She thinks the chicken is better here -- easier to digest,'' Noemi said. ''But what she doesn't know is that since we moved, I still buy the chicken in the same place.''

After meeting Noemi, Raimunda and Juanita, I began to see more clearly what Arline Geronimus, the University of Michigan researcher, was talking about. Perhaps the miasma that is killing the poor really is stress after all. Then I spoke to the mothers of six children who had severe asthma. Every one of them had significantly fewer and less severe attacks after the families moved out of southwest Yonkers. Reduced stress could be partly responsible -- stress can worsen asthma -- but it seemed clear to me a cleaner environment was also responsible. The children ranged in age from 3 to 16; they all moved out of southwest Yonkers and settled in different parts of Westchester. The mothers, who asked that their last names not be used, saw astonishing changes, and hearing their stories convinced me that the only way to deal with the staggering epidemic of asthma that afflicts 30 percent of children in some New York City neighborhoods is to clean up the rundown, roach-infested buildings where so many of these children live.

Carmen and her 4-year-old son moved to a middle-class section of Westchester in the spring of 2002. In Yonkers, her son would have severe asthma attacks every month and would have to sit for hours every day breathing through a nebulizer. Since they moved, she says he has needed the nebulizer only twice. Two years ago, Monique, her 3-year-old son and 8-year-old daughter moved from Cedar Street in Yonkers to Peekskill. When they lived on Cedar Street, her son's severe asthma came complete with projectile vomiting. The attacks started just a few months after he was born, and they terrified Monique. She blames her former landlord. ''There was no hot water for two weeks once, there were leaks in the roof, so it was damp all the time. Sometimes there was water coming through the roof, and mice playing in the living room,'' she says. ''There were cockroaches everywhere, even in the refrigerator. The landlord did nothing until I called the health department. It was stressful having all those roaches around. You didn't know if they were crawling all over you at night.'' As soon as the family moved up to Peekskill, the boy's attacks became less severe. Although he is still on medication, the violent attacks and the vomiting have stopped.

Cockroaches and vermin do worsen asthma, and this might explain why Monique's son was so sick. But there could be another reason that so many children in poor neighborhoods have asthma, and why they get better when they move. In the past decade, rates of childhood asthma, as well as obesity and diabetes, have soared in the very neighborhoods that were worst affected by the crime waves of the 70's, 80's and 90's. One possible explanation, says Daniel Kass, a research scientist for the New York City health department, ''is that asthma follows the crime epidemic, because it goes wherever people spend a lot of time indoors.''

Poor parents, terrified that their kids will be killed on the street, tend to keep them inside, with the windows shut and the TV on, where they are constantly exposed to contaminants in indoor air, which some researchers believe can be as damaging as industrial pollution. Not only are sedentary, overweight kids more at risk for asthma, but kids with severe asthma tend to exercise less and are thus prone to obesity. Mothers trying to protect their kids from crime may not realize they are putting their future health at risk. As Mindy Fullilove, professor of clinical psychiatry and public health at Columbia University explained, ''The best parents -- the people who are the most upright, the churchgoers, the most protective mothers -- keep their kids inside, and they are at the intersection of the asthma and obesity epidemics.''

I thought of Trevor Jackson Jr., a 14-year-old boy with serious eczema who moved from southwest Yonkers up to Cortland Manor in northern Westchester two years ago. ''This is a much better atmosphere,'' his mother, Dawn, told me. Their new apartment is in a large house with a wide sloping lawn surrounded by trees. ''The kids can just go outside anytime. The little one wouldn't go to sleep when we first got here.'' He wanted to be outside all the time. In Cortland Manor, ''kids have a better chance to grow,'' Trevor's father, Trevor Sr., says. ''We see deer in the yard, woodchucks, otters, frogs. There's just life up here.''

I was beginning to see that the problems of stress and material deprivation were inseparable parts of the contemporary miasma of poverty. But how did these neighborhoods become so unhealthy? New York City is one of the most segregated metropolitan areas in the country. Blacks, whites and other ethnic groups interact every day, but to a large extent they live separately. At the same time, the city has also become more segregated by wealth, so that many black and Hispanic neighborhoods are also the poorest.

The Harvard sociologist William Julius Wilson has described how, thanks to the civil rights movement of the 60's, many middle-class blacks have been able to find jobs and housing outside traditional black areas, leaving behind the most impoverished, poorly educated people. This concentration of disadvantage -- racial, social and economic -- combined with the loss of many unskilled manufacturing jobs, is what Wilson says contributed to the many social problems associated with poverty today, including drug abuse, crime and single motherhood. Mindy Fullilove says that these trends contributed to widening health inequalities as well. As racial and economic segregation increased, health problems became concentrated in the most deprived areas, as if the miasma were condensing over them. Indeed, I wondered if the miasma might not turn out to be segregation itself.

In order to understand the health crisis among America's urban poor, Fullilove explains, you can't just consider what's going on now. ''You have to look at the history of these neighborhoods'' and think about the people who live there and what has happened to them in the past. ''The history of each neighborhood will determine its pattern of disease. A city like New York suffers from an overlay of epidemics.''

In the 70's, 80's and 90's, poor minority neighborhoods throughout the country experienced a protean health crisis. Rates of some chronic and infectious diseases began increasing for the first time since World War II. Even older blacks who made it into their 60's, and who once had as good a chance of reaching their 75th birthdays as 60-year-old whites, began dying at higher rates.

Fullilove says that urban-renewal projects that helped create concentrated poverty, along with redlining -- discrimination by banks and insurance companies -- and public- service cuts in poor neighborhoods led to catastrophic changes in the way the poor lived, and destroyed the foundation that made poverty endurable. The migrancy of poor people, displaced by fires, evictions and other calamities, destroyed informal community mechanisms for caring for children and controlling the behavior of adolescents and young adults, and this made it harder than ever for the poor to cope. ''It was like a massive refugee situation,'' Fullilove says.

At the same time, as the middle class increasingly campaigned for restrictions on cigarette and alcohol advertising, those companies spent more of their marketing dollars in poor neighborhoods. As Rodrick and Deborah Wallace wrote in their book ''A Plague on Your Houses,'' politicians looked the other way when companies posted huge, colorful billboards -- depicting exuberant black people smoking cigarettes and drinking beer -- outside schools and churches in Harlem, Brooklyn and the South Bronx. Construction on central Harlem's first full-size supermarket did not begin until 2002, but in the 90's there were more than a hundred places where a child under 18 could buy cigarettes, including individual ''loosies,'' which are cheap but illegal.

The wave of crime and drugs of the 80's and 90's has subsided considerably, and some once-grim urban neighborhoods are even prospering. But poverty has risen in many suburban minority enclaves, and the health problems of the poor have not gone away.

Much has been written about how such social problems as joblessness and drug abuse worsen health problems, but it is also possible that the converse is true. Both Beverly and Monica have lost jobs as a result of illness, and many sick people fall into poverty. Anne Case, a Princeton University economist, has shown that unhealthy young people are far less likely to succeed in school and find good jobs later on. Thus, illness can trap poor families in cycles of disease, death and poverty for generations.

Adam Karpati of the New York City health department says that even though we don't know what the miasma is, there is still a great deal we can do to improve the well-being of the poor. In the 19th century, it was not the discovery of germs that led to the greatest advances in public health, but a series of profound changes in the way the poor lived -- a virtual social revolution. Then, as now, health and poverty were inseparable from each other, and better housing, sewers, decent wages, better working conditions and improved nutrition saved millions of lives. Today much could be done to improve the environment and make life less stressful for the poor. The health department is working to reduce mold and roach infestation in public housing, as well as encouraging doctors and community organizations to address such problems as obesity, asthma and diabetes. These admirable programs, however, are modest in scale, and in the current fiscal climate, their financing is far from secure.

More ambitious changes are needed, but at present, our government is permitting matters to get even worse. Since 2000, millions of jobs have been lost, and nearly three million people have joined the ranks of the poor, who now account for more than 12 percent of the U.S. population and 24 percent of African-Americans. This means fewer families will be able to move out of poor neighborhoods on their own. For now, the federal Section 8 program -- which provides subsidies for people to pay for private housing -- is the only hope most people have of getting out of these neighborhoods, but even its future is in doubt. Possible budget cuts could mean thousands of Section 8 recipients will lose their vouchers next year, and in the longer term, Republicans in Congress hope to devolve the program to the states. This will almost certainly mean the program will shrink. Last month, moreover, HUD also suspended rental supplements that Jerrold Levy says have made programs like ESOP possible. ''This will reinforce the ghettoization of poor people,'' Levy says.

Rising unemployment and budget cuts will not only harm people's health. They will also cost Americans money. Take diabetes and asthma as examples. Around one million people succumb to Type 2 diabetes each year, with African-Americans, Hispanics and Native Americans most at risk. The bill for treating the nation's 11 million known diabetics comes to $92 billion for medications and doctors' visits plus $40 billion in lost productivity due to absences from work and premature death. The yearly bill for the nation's asthma epidemic is $14 billion. As Beverly pointed out to me, shortsighted cuts, amounting to a few hundred million dollars, from the HUD budget mean programs to refurbish public housing, organize recreation for children and build playgrounds have been halted. The exterminator teams that used to come every month now come once every two months, and the roaches are flourishing as never before.

Whatever the miasma is that afflicts America's minority poor, it is at least partly a legacy of the segregation of America's cities. These neighborhoods, by concentrating the poor, also concentrate the mysterious, as yet poorly understood, factors that make them sick. You'd almost think this new miasma was caused by some sort of infection, because of the way it seems to strike certain neighborhoods and certain types of people. I recently came across a research article by Angus Deaton of Princeton University, reporting that white people who live in cities with large black populations have higher death rates than whites with the same income who live in cities with smaller black populations. It made me wonder whether the deprived, polluted, roach-infested, stressful conditions in which poor blacks live aren't affecting all of us, to some degree. And even if we never find out what the miasma is, this possibility should scare us into treating this as the health emergency it is -- if nothing else will.

Helen Epstein writes frequently about public health for The New York Review of Books. This is her first article for the magazine.

Copyright 2003 The New York Times Company

December 18th, 2003, 02:52 PM
October 21, 2003

Anatomy of a $133,000 Ambulance



Los Angeles buys them for $85,000 apiece. Detroit pays $84,000. Closer to home, a major New York hospital system spends less than $80,000.

But the New York City Fire Department has them all beat, spending more $133,000 each for custom-made ambulances — all 480 of them. At $65 million, the department's new contract to replace its front-line fleet over five years is the largest and most costly municipal ambulance purchase in United States history, according to industry executives.

The five-year contract was approved in June and the new ambulances have begun to roll in.

At a time when budget cuts are closing firehouses, curbing daily ambulance runs and delaying construction of new emergency medical stations, the pricey ambulance purchases raise this question: What is New York getting for its money that other big cities are not?

Some of the answers are found in a thick set of specifications, drawn up by city fire and purchasing officials. Manufacturers say it is the most detailed and restrictive list of specs out there, dictating everything from the placement of the tailpipe to the vehicle's warranty. Fire Department officials say it ensures that New York gets a high-quality product.

Critics, however, say some requirements needlessly drive up costs and scare away competition, with bidding limited to those manufacturers willing to take on the risk and cost of retooling assembly lines to accommodate New York's desires for things like specialized interior cabinet doors or reinforced step wells. Some of the requirements are there at the insistence of the municipal labor unions.

Further limiting the bidding is the "aggravation factor" of dealing with New York's procurement bureaucracy, which frequently pays late.

A result has been that one ambulance manufacturer, Horton Emergency Vehicles of Ohio, has emerged the winning bidder time and again, fueling talk that the city favors that company. That talk has the effect of further tamping down competition.

"Everybody knows that New York buys Horton ambulances," said Battalion Chief Don Frazeur, who oversees the vehicle fleet for the Los Angeles Fire Department. "All the other companies drool over that contract, but it's so proprietary they feel they don't have a shot to get it."

Although more than a half-dozen manufacturers can build the quantity of customized ambulances sought by New York, only two, Horton and American LaFrance of South Carolina, submitted bids this year. Horton's price per vehicle beat American LaFrance, whose bid was about $150,000 each.

A third company, Wheeled Coach Industries of Florida, the world's largest ambulance manufacturer, took a close look at the specifications and decided not to bid. In a letter to the city, Wheeled Coach's president, Robert L. Collins, said some of New York's terms were "completely unreasonable and unheard of in this industry."

"Overall," Mr. Collins wrote, "it is New York City's taxpayers that will pay the premium. In a time of severe budget constraints, why isn't New York seeking better value rather than greater surety?"

New York City officials reject suggestions that they are spending too much or favor a specific manufacturer. They say they are seeking the vehicles that can best withstand a brutal working environment, are user-friendly for city employees and can be built quickly.

"You get what you pay for," said Assistant Fire Commissioner James Basile, who oversees the vehicle fleet. "I can comfortably say that we get 10 years out of these vehicles. There are no other roads like there are in New York City, and the vehicles we buy have to be able to withstand that."

Commissioner Basile said that, besides being sturdy, New York's ambulances are designed to make life easier for the mechanics who work on them and the emergency medical technicians who ride in them. He is proud of the demanding specifications, like two green indicator lights on the outside of an ambulance that let you know when its battery has been left on.

The lights were Commissioner Basile's idea.

"It's simple things like that, no one else has," he said. "Who knows how much we save each year by not having batteries going dead?"

Determining why New York's ambulances cost more is difficult, in part because the companies that bid to build them do not break out expenses for individual items. (Several company executives estimated that the cost of adding the green indicator lights, a relatively small item, could add $50,000 to $70,000 to New York's total contract price.)

Comparing contracts also can be tricky. New York's $133,000 contract price includes a two-way radio system.

Los Angeles' contract price of $85,000 per vehicle does not include radios, which, when added, bring the total price to about $111,000 — still below New York's. Detroit's $84,000 contract price includes a partial radio system. San Francisco's $98,000 ambulances come with a complete system.

The North Shore-Long Island Jewish Health System, which operates one of the largest hospital-based ambulance fleets in the country and responds to emergencies in parts of New York City, pays less than $80,000 for ambulances without radios. When radios and other equipment are added, the cost tops $100,000, said Brian O'Neill, the health system's vice president for emergency services.

Mr. O'Neill said the ambulances he buys are built with a van chassis, as opposed to the more expensive pickup truck chassis favored by the Fire Department, which says the cab's extended nose better protects occupants in a crash.

Other fire departments argue that the van design reduces the likelihood of collisions because its flattened nose allows for greater field of vision and a tighter turning radius.

That debate is moot in New York City, however. The firefighters' union has made it clear that it favors the truck design, which some company executives say could add as much as $1 million to the city's total contract price.

"When I buy ambulances, I don't have to deal with the union," Mr. O'Neill said. "If their union makes something a safety issue, then you can't fight it."

New York fire officials said that in addition to promoting safety, their specifications had the practical benefit of ensuring that every ambulance is built exactly the same way, making spare parts interchangeable. But they insist they are not wedded to Horton, which has been building ambulances for New York since at least the early 1980's.

"Over 20 years, we have evolved a spec that works for us," said Anthony DeMaio, the assistant deputy director of fleet services. "Anyone has the opportunity to build it for us — as long as it is to that spec."

When other companies tried to build ambulances for New York City in recent years, they did not get far.

In 1998, the city postponed plans to buy 400 ambulances after accusations from potential bidders that the specifications favored Horton. For example, one competitor said the Fire Department's vehicle design required rounded corner posts and Y-shaped braces made by Horton but not by other companies.

After the city revised its specifications and put the contract out to bid again in 1999, another company, McCoy Miller of Indiana, won with a low bid of $110,000 per vehicle. But the department soon complained that McCoy Miller was struggling to meet its production schedule, and that some vehicles were of poor quality. The company tried to mitigate those concerns by offering a $10,000 discount on each vehicle, but the city canceled the contract.

To pick up the slack left by the cancellation, the Fire Department awarded emergency no-bid contracts for 50 ambulances each to Horton and Wheeled Coach. However, Wheeled Coach backed out after the department found problems with a prototype ambulance it produced and refused to relax what the company considered insignificant yet time-consuming design requirements.

For instance, the department decided it wanted colored wiring instead of black, and a single exhaust tailpipe instead of two, Wheeled Coach said in a letter to the city. Specifications for double doors on a rear storage compartment were changed to a single door, and detailed requirements were added for the type of threaded fastener to be used to mount the vehicle's warning lights.

"The specifications do not describe warning light mounting," the company said in its letter, and "this adds additional material and cost."

A spokesman for Wheeled Coach declined to comment on the company's dealings with New York City.

Horton dismissed the complaints as sour grapes. David Lamon, Horton's vice president for sales and marketing, said New York's specifications did not favor his company, and that any advantage Horton may have comes from its long history of building ambulances for the department.

"We have more of an understanding of the demands of their system, what their problems are, what their needs are," Mr. Lamon said. Still, "they are a very difficult contract for us to do because it is so different."

Mr. DeMaio said Wheeled Coach was a chronic complainer that "wants to build the vehicles its way, and not our way." Other fire departments, including Los Angeles', say they have found Wheeled Coach cooperative and willing to accommodate their specifications.

"Wheeled Coach is like buying a Chevrolet," said Chief Frazeur, the Los Angeles battalion leader. "There are some more expensive cars out there, while others might not get you back and forth in as much comfort. It's hard to contrast quality and value, but there's a middle ground there somewhere."

Copyright 2003 The New York Times Company

December 18th, 2003, 09:33 PM
Gotham Gazette - http://www.gothamgazette.com/article/communitydevelopment/20031218/20/808

The “Food Justice” Movement: Trying To Break the Food Chains

by Mark Winston Griffith

December 12, 2003

One of the great, often unspoken, forms of oppression that low- and moderate-income communities suffer through is the lack of access to healthy food. When I moved back to Central Brooklyn in 1985, I was stuck by its barren nutritional landscape. It wasn’t just that options like fresh produce and organic foods were hard to come by. But the storefront food provision systems themselves - “bullet-proof” fast food joints, poorly stocked and over-crowded supermarkets, cruddy, stomach-curdling bodegas – seemed to represent a level of self-destruction and dietary corruption that went well beyond my inability to buy tofu on Nostrand Avenue. While most residents and activists look at conditions such as public safety, housing availability, public education, environmental concerns and economic opportunities when taking on community development issues, seldom do we consider one of the most basic elements – how an area feeds itself – as a sign of neighborhood well being.

Recently I stumbled upon a growing movement of activists who have coined a phrase - “food justice” - that I think places how and what a community eats squarely in the context of community building and social change. Up to now “food security (http://www.foodsecurity.org)” has been a more common term used to describe a similar, if not broader, area of social concern. While government bureaucrats and international non-governmental-organizations alike have been using food security to call attention to a whole host of agriculture- and hunger-related issues, activists have also used it to focus on creating community-based ways of producing food in an affordable, sustainable and environmentally-friendly manner. Along the way they have sought to create local jobs, promote good health and stress the importance of small, local farmers.

New Language and Icons

With the use of the term “food justice” this activism hasn’t changed so much as it has taken on fresh new political energy. In an increasing number of grassroots efforts in New York, local people are re-imagining their collective relationship to food. According to Bryant Terry, the founder of the youth-based, not-for profit B-Healthy (http://www.b-healthy.org), food justice starts from the conviction that access to healthy food is a human rights issue and that the “lack of access to food in a community is an indicator of material deprivation”. Food justice, Bryant suggests, goes beyond advocacy and direct service. It calls for organized responses to food security problems, responses that are locally driven and owned.

For its part, B-Healthy tries to offset the dominance of processed foods and fast food advertising in the lives of young people with political education and a sort of counter-insurgency culinary training. With a curriculum that includes books like Fast Food Nation (http://www.mcspotlight.org/media/books/schlosser.html), Diet for a Small Planet (http://www.amazon.com/exec/obidos/tg/detail/-/0345321200/103-8328298-7455031?v=glance) and Food Fight (http://www.amazon.com/exec/obidos/tg/detail/-/0071402500/103-8328298-7455031?v=glance), B-Healthy offers everything from cooking classes to tips on how to shop for pesticide-free, non-genetically modified foods.

With a Black founding director and a youth-of-color constituency, many of whom are immigrants, B-Healthy has implicitly challenged the popular image of health food consciousness as being the strict domain of WASPy vegans who listen to public radio and shop at the Park Slope Food Co-Op. And rather than try to introduce “culturally inappropriate’ foods into the lives of families, B-Healthy works with foods and seasonings that are familiar to them

Food System Alternatives

Education is perhaps the first line of offense in the long fight to change eating patterns and food distribution in any given neighborhood. But as most food justice advocates will tell you, this education has to be coupled with action – the creation of viable alternatives.

Just Food (http://www.justfood.org), which has integrated a social justice mission into its name, has been the catalyst for the establishment of 30 CSAs – Community Supported Agriculture -throughout the city, some in areas like Harlem, Bushwick and East New York. CSAs are arrangements in which people living in a given area purchase “shares” of organically-grown produce directly from local sources. CSAs provide urban families with more healthy eating choices, while also supporting family-run farms. Just as importantly, CSAs, like other local food systems, eliminate a neighborhood’s dependence on far-flung corporate growers and a host of intervening processors, handlers, distributors, transporters and other middle people who have made the business of connecting urban America to food inefficient and environmentally taxing.

Just Food also works with a small number of community gardeners who are learning to market and distribute their produce in local settings. In most cases, local food justice efforts not only provide food, but often help strengthen neighborhood economies, provide employment and entrepreneurial opportunities for youth and offer innovative ways to utilize open space.

One text book example of a project that seeks to address a range of community needs through food activism has recently taken root in Red Hook, a mostly low-income neighborhood with a food terrain that is decidedly user-hostile. According to Ian Marvy co-director of Added Value (http://www.added-value.org), Red Hook has only one full-service, sit-down restaurant and no major grocery store, but is otherwise replete with bodegas, steam line eateries, pizza shops and fried chicken shops. On real estate that is being eyed by hungry developers seeking new water front opportunities, Added Value and a cadre of young people from the surrounding area maintain a modest farm with other local farmers and run a market where young people sell the farm’s collective harvest, as well as beef, chicken and fish from other local farms. Added Value is also making plans to build a green house and harvest fish itself.

Marvy is clear about what distinguishes his work and that of his colleagues. “Food security is more about analyzing problems, ameliorating issues and providing answers…Food Justice…involves local people from seed to sale. It educates, organizes and mobilizes new social relations around food. It touches hands, hearts and pockets.”

Bold New World

Efforts like B-Healthy, Just Food, Added Value and New York-based CSAs are all relatively young. And right now they are all looking to achieve justice through education and feeding, rather than agitation and confrontation. Ruth Katz, executive director of Just Food, is intent on rebuilding a demand for healthy foods and envisions a return to a time in our nation’s history when, in the midst of food shortages in the 1940s, forty percent of the nation’s food was supplied locally.

Still, some are hinting at a slightly more aggressive march towards progress. Terry sees the young people he works with as one day creating community organizing campaigns. He looks to take on the perpetrators of structural, food-based racism that, he feels, has kept areas like Red Hook and Central Brooklyn flooded with toxic foods and empty of choices. Of course, these days, racism is often easier to feel than prove. And while the economic development and food distribution visions of Terry and his peers are clear, a strategy of what public policies would be targeted by food-centered, grassroots organizing campaigns is far less so. Any way you look at it, America’s appetites for fast food and corporate farming - both defining aspects of American culture – are not retreating anytime soon.

But then again I still believe that one day I will help start a black-run food cooperative in Bed-Stuy; and that affordable, family-style, locally-owned restaurants will spring up while liquor stores and Burger Kings die a certain death; and that a loud chorus of my neighbors will compel my community board, City Council representative and Brooklyn Chamber of Commerce to establish a farmers market on local abandoned property.

New social realities always begin here, as somebody’s seemingly far-fetched dreams. In the meantime, I’m itching for a food fight.

Mark Winston Griffith, a writer whose work has appeared in the New York Times, Essence and Spin, is also founder of the non-profit Central Brooklyn Partnership, which organizes people to build economic power.

January 31st, 2004, 01:08 AM
January 31, 2004

New Yorkers Can't Beat Death, But Data Says They're Gaining


For the first time since the 19th century, when New York was a far different, far smaller place, fewer than 60,000 people died in the five boroughs in 2002, continuing a steady decline that began in the early 1990's and setting a record low for the city's death rate.

Infant mortality, too, reached a record low — less than half the rate of the 1980's. AIDS persisted as a leading killer of black and Hispanic New Yorkers — but less so in Queens. People in Manhattan were more likely than those in the other boroughs to take their own lives, but less likely to die of diabetes. New Yorkers were more likely than ever to die in nursing homes, and less likely to die at home. Men were more likely than women to be run over while crossing the street, and elderly pedestrians were much more likely to be killed than younger ones.

These nuggets and thousands more are found in the city's Summary of Vital Statistics for 2002, released yesterday by the Department of Health and Mental Hygiene. To the statistically minded or just plain morbid, the report is a treasure, 67 pages of revealing, quirky and sometimes startling numbers that illustrate how New Yorkers live and, mostly, how they die, broken down by cause, age, sex, race, borough and even neighborhood (see for yourself at www.nyc.gov/html/doh/pdf/vs/2002sum.pdf ).

News reports can give the impression that life in the city is dominated by ways to meet an early end — being hit by a cab, stabbed by a mugger, slipping on the ice. The civic culture tends to send the same signals, as New Yorkers compare urban horror stories and tell themselves what hardy souls they must be to survive.

But the main message that emerges from the hard data is that New Yorkers are on the whole safer and healthier than they used to be. Last year, the Health Department reported that a city resident's life expectancy had hit 77.6 years, up by five years in a decade, and that for the first time in six decades, New Yorkers were living longer than other Americans.

But like any good clinician, Thomas R. Frieden, the city health commissioner, is more interested in addressing the bad news that remains.

"The thing that's striking to me is causes of death under 65, which, no one would argue, are premature deaths," Dr. Frieden said. "When you look at them, it's just so dramatic, the things we can do something about: H.I.V., lung cancer, colon cancer, breast cancer, drug use, cardiovascular disease, liver disease. So many of those deaths are preventable."

In New York City, 59,651 people died in 2002 (compiling the report is an enormous task, and it always lags about a year behind). Even at the turn of the last century, when the five boroughs were newly united into a single city with less than half the population of eight million it has today, many more people died each year in New York City.

For 70 years, the city's death rate seemed almost impervious to change, fluctuating around 10 to 11 deaths for every 1,000 residents. Then, in the early 1990's, it began a long, steady slide, that continued in 2002, when the death rate hit 7.4 per 1,000, the lowest ever recorded. The difference between 10 and 7.4 may sound small, but in a city the size of New York, it translates to about 20,000 fewer deaths each year.

The year 2001 would have set the previous record low death rate, if not for the World Trade Center terror attack. (This year's Vital Statistics report includes a special section devoted to 9/11, including the fact that the birth rate dropped a bit nine months afterward, then rose again shortly after.)

In 2002, 122,937 babies were born in the city, the lowest birth rate since the "baby bust" of the 1970's and early 80's.

So how is it that New Yorkers — more obese, more sedentary and more likely to be uninsured than in years past — are living longer? The obvious factors are the steep drops in AIDS deaths and homicides, which together claimed 2,300 lives in 2002, down from more than 8,000 in some years in the 1990's.

With better prenatal and newborn care, infant mortality has dropped steadily for three decades, and the 2002 rate of 6 deaths per 1,000 babies was barely half what it was in 1990. Fewer New Yorkers smoke cigarettes, fewer smoke crack and fewer die in traffic accidents, thanks largely to increased use of air bags, seat belts and motorcycle helmets. For those with health care, there have been any number of technical advances.

But the benefits of all this progress are unevenly distributed among ethnic groups and neighborhoods. The Fort Greene section of Brooklyn had an infant mortality rate of 13.9 per 1,000, more than double the city average; citywide, black babies are most likely to die. Teenage motherhood is down sharply among women of Puerto Rican descent over the last decade, as it is in the city population over all, but it is up just as sharply among other Hispanics.

H.I.V. infection, which kills more than 1,700 New Yorkers yearly, also accounts for one of the most striking ethnic disparities. Among people under 65, it was blamed for 1.4 percent of deaths in Asians, 4 percent in non-Hispanic whites, 12 percent in non-Hispanic blacks, 16.4 percent in people of Puerto Rican heritage, and 8.6 percent in other Hispanics.

"Not only are blacks and Latinos more likely to have H.I.V., they are much more likely to die of it," Dr. Frieden said. "The tremendous advances in H.I.V.-AIDS treatment have not been spread equally."

Some differences are easily explained. Manhattan residents are less likely to be obese than residents of the other boroughs, so it makes sense that they would be less likely to die from heart disease and diabetes.

Other items are trickier, like the 209 pedestrian deaths in 2002. People over 65 accounted for nearly half the victims — no surprise, since they move more slowly, and are more likely to have trouble hearing or seeing.

But how to explain that among the pedestrian dead under age 55, men outnumbered women 3 to 1? Are men more likely to be too aggressive afoot, or less likely to be paying attention to their surroundings?

"I'm not going to touch that," Dr. Frieden said.


Copyright 2004 The New York Times Company

February 2nd, 2004, 11:23 AM
Report: New Yorkers Depressed
An estimated 119,000 New Yorkers are mentally retarded or have another developmental disability.

Somehow my day-to-day experience suggests that number should be so much higher. :wink:

TLOZ Link5
February 2nd, 2004, 01:40 PM
That's pretty much one in every seventy New Yorkers.

February 10th, 2004, 09:31 AM
Death In New York City (http://www.gothamgazette.com/article/health/20040210/9/867)

March 24th, 2004, 02:51 AM
March 24, 2004

City Sets Goals for the Health of New Yorkers


Officials identified major problem areas in a new health initiative, which includes a plan to distribute health "passports," above, as reminders.

The Bloomberg administration plans today to release an ambitious health initiative for New York City, setting aggressive four-year goals for residents to control their blood pressure, keep up their vaccinations and cancer screenings and have regular visits with the same doctor.

Among the changes the administration says it will pursue are more widespread and uniform sex education in public schools, creation of an Internet immunization registry for children that doctors can check and significant expansion of programs to test for H.I.V. and give away syringes and condoms.

The city will take steps to encourage enrollment in Medicaid and other government health plans and will give a provider directory to everyone enrolled in those plans — a far cry from the 1990's, when the Giuliani administration's policies had the effect of discouraging participation. The city will even look into ideas like requiring that all city contractors provide health coverage for their workers.

Coming after Mayor Michael R. Bloomberg's crackdown on public smoking and restaurant sanitation, the policy again demonstrates the administration's bent toward regulation, intervention and broadening social services in a manner not seen since the days of another liberal Republican mayor, John V. Lindsay. And it marks a return to the kind of activist health department for which the city was renowned throughout most of the 20th century, until budget crises and a more conservative outlook took hold in the 1970's.

"We now know more than we ever have before about the health of New Yorkers, and we know more about what works," said Dr. Thomas R. Frieden, the city health commissioner, explaining the need for the Department of Health and Mental Hygiene's higher profile. "Now we have to do something about it."

City officials say this effort, dubbed "Take Care New York," marks the first time the city has adopted a comprehensive policy on health care. The problems and goals, laid out in a 64-page document, contain hundreds of small plans, from providing free nicotine patches to people trying to quit smoking to giving the new one-hour H.I.V. tests to inmates at Rikers Island.

At its core, the initiative sets out 10 major problem areas that researchers have found can be widely curbed - from drug use to AIDS deaths to depression - and sets a goal for improving each one. Notably missing among the 10 is obesity, because city officials say science has found no reliable way to address it.

"It sets an agenda, and that's the fundamental concept here," said Dr. Frieden, the chief architect of the policy, which was drafted with help from a number of city agencies. "It sets an agenda based on science, based on the evidence of what kills people, and what is amenable to intervention."

If the goals occasionally sound out of reach, Dr. Frieden said, that is fine with him. "We think these are attainable, but that is the reason for setting goals," he said. "Hold us to them."

City officials and public health experts said they knew of no other city - or even anystate - with such a broad, aggressive public health agenda.

"I think this is a very bold vision, and I hope they can produce," said Dr. Allan Rosenfield, dean of the Mailman School of Public Health at Columbia University. "I think they're very serious about it doing it. Each of the 10 priority areas is a serious problem with attainable goals. They're focusing mostly on prevention, which is smart because prevention can save thousands and thousands of lives a lot faster than curative medicine."

Many of the items in the policy will cost money, like printing pamphlets, distributing syringes and dispatching department workers to various projects. Officials said they were not yet able to say what the overall cost of the policy would be, and it is not clear how the city will pay for all the proposals. Dr. Frieden said some of the expense would be covered simply through eliminating duplication or contradictory work by different city agencies. He added that in the long run, many of the measures will save money not only for the health care system in general, but also for the city.

By setting 2008 as the target date for seeing improvements, the policy assumes either that Mayor Michael R. Bloomberg will be re-elected next year, or that his positions will outlast his administration.

Dr. Frieden conceded that some elements of the policy would be controversial, like a more aggressive sex-education program that he said his department was developing with the Department of Education, and for which no details are available yet. "We expect some heat," he said.

Beyond the city's own actions, the policy calls for changes in state and federal law - and, in fact, many items put the administration of Mr. Bloomberg, a Republican, squarely at odds with the thinking of Republicans and conservatives in Albany and Washington. The policy advocates requiring health insurers to track and report their performance in areas like having their members screened for colon cancer and vaccinated for the flu, mandating nutrition labeling on restaurant meals, outlawing discount tobacco products and a presumption by government that children qualify for Medicaid until it is proved otherwise, to name just a few recommendations.

Republicans in Albany have resisted calls to allow Medicaid recipients to prove their eligibility less often than every year, and Republicans in Washington have opposed proposals to give the Food and Drug Administration jurisdiction over tobacco.

The central elements of the policy that the city proposes to achieve on its own rely heavily on changing the behavior and the thinking of doctors, nurses and patients. In a society already filled with the background noise of health messages - lose weight, exercise, eat vegetables, take vitamins - this may be the greatest challenge of all.

"We're laying it all out there now, these 10 commandments of health, and yes, it's a lot, but we're going to highlight one piece at a time," said Dr. Benjamin K. Chu, president of the New York City Health and Hospitals Corporation, which helped draft the policy and will play a central role in attempting to carry it out. "This month it's been colon cancer screening, in May it will be mammograms, then depression, then flu shots, and on. So we plan to build these programs year-round, repeating a list of clear messages, and over the years it will sink in."

Dr. Frieden pointed to studies showing that the average doctor's visit covers only half the ground that it should, and that doctors simply do not have the time to ask all the recommended questions and touch on all the recommended subjects with each patient. As a result, he said, most people receive only the health care they demand, and the city intends to teach them to demand it.

Surveys have shown that most people with high blood pressure, high cholesterol, high blood sugar and other danger signs do not have them under control - that in fact, many do not even know how serious their problems are.

"Doctors are going to start checking cholesterol when people walk in and say, 'Hey, doc, what's my cholesterol?' " Dr. Frieden said.

To that end, the city has created a health "passport," much like the checkup and immunization cards many parents have for their children, and will make them available through community groups and doctors' offices. The city has printed 400,000 of the palm-size or wallet-size fold-out cards, in English and Spanish, and will encourage people to bring them to doctor visits to use as checklists.

In some instances, the city plans limited advertising to educate people about health concerns. But more often, officials say, they will rely on the help of hospitals, neighborhood groups, labor unions and businesses. They plan, for instance, to use "envelope stuffers" in utility bills and paychecks, reminding people to have various tests and vaccinations.

The city health department already sends a monthly newsletter to all the city's doctors and many of its nurses, and Dr. Frieden said it would soon have an Internet-based system for communicating with them.

Some elements of the health policy are already in place. The menu of foods served in city schools is being revamped to eliminate junk food in vending machines and create more nutritious cafeteria meals. City clinics distributed their first round of free nicotine patches to 35,000 people last year.

The health department has started a program in Harlem of home visits to every new mother and hopes to expand it to other poor neighborhoods. And in cooperation with neighborhood groups, doctors and clinics, the department is using press conferences and fliers to urge people to have colon cancer screenings, starting with Bronx neighborhoods where screening rates are lowest.

On every page, the policy reflects Mr. Bloomberg's, Dr. Frieden's and Dr. Chu's shared mania for gathering and analyzing data, and for using the results to direct policy and gauge what programs are working.

The health department has conducted a detailed, 10,000-household survey that allows it to see, for example, how many Asian-Americans over 65 in Queens fail to get flu and pneumonia vaccines, or how many African-American mothers in Brooklyn have no prenatal health care.


Copyright 2004 The New York Times Company

April 7th, 2004, 02:27 AM
“Take Care New York” New Health Program; Old Diseases (http://www.gothamgazette.com/article/health/20040407/9/943)

April 28th, 2004, 03:18 PM
Immigrant children suffer more bad health

Staff Writer

April 28, 2004, 2:12 AM EDT

New York's immigrant children suffer disproportionately from an array of environmental health problems, including asthma, lead poisoning and complications from pesticide exposure, a new study has found.

Illnesses are often exacerbated by poverty, poor housing conditions and cultural practices unique to certain immigrant groups — such as the use of lead-contaminated ceramic bowls by Mexican families, according to researchers at New School University's Center for New York City Affairs.

City health department statistics from 2002 showed that lead poisoning in city neighborhoods was clustered largely in African-American communities.

A handful of Haitian, South Asian and Latino neighborhoods in Queens and Brooklyn also were affected.

"More than anything, there needs to be a ratchetting up of focus on lead-prevention programs and other health measures in immigrant neighborhoods," said Andrew White, the center's director. "We need to tailor our efforts at helping the children of immigrants."

Immigrant children represented 138, or 22 percent, of the 628 new pediatric lead cases identified by the city Department of Public Health in 2002, the most recent year for which statistics are available. African-American children made up more than a third of all cases.

Lead, whether ingested or inhaled, causes significant health problems in children, including serious neurological disorders and learning impairments. Overall rates have fallen in the city in recent years.

Much of that lead comes from peeling paint or dust from paint chips, and city officials have traced some of it to imported Mexican pottery. City Health Commissioner Thomas Frieden is reportedly focusing his agency's anti-lead initiatives on Mexicans, who also often live in poorly maintained buildings.

City officials found similar threats in other communities. In at least one case, an Afghan child was found to have a high lead level after playing on a hand-woven rug contaminated with lead-based pigments.

The report also singled out the use of cheap, illegal and toxic pesticides in Dominican and Asian neighborhoods, which has been linked to low-birth-weight babies. The report also cited a 1999 study by NYU professor Michael Schill that found immigrants from the Caribbean, Africa and Latin America often lived in badly maintained housing with pest infestation, mold and dust mites, which have all been linked to asthma.

Copyright © 2004, Newsday, Inc.

May 13th, 2004, 04:25 AM
Immigrant Children’s Illnesses and Access To Health Care (http://gothamgazette.com/article/children/20040513/2/978)

May 28th, 2004, 12:10 AM
May 28, 2004

Say 'Aaaah,' New Yorkers, It's a Citywide Health Checkup


New York City health workers will be knocking on doors across the five boroughs this summer to identify residents with diabetes, high blood pressure and high cholesterol as part of what officials are calling the most comprehensive health survey in the city's history.

Health Commissioner Thomas R. Frieden announced yesterday that 2,000 adults would be interviewed in depth about their medical histories and undergo physical exams at the city's health clinics for the New York City Health and Nutrition Examination Survey, which will be conducted through September. The first participants were contacted yesterday in Park Slope, Brooklyn.

"This is probably the most important thing the Health Department will do this year," Dr. Frieden said. "We're going to answer questions that we don't have the answers to. This is a diagnosis for New York City to a level that we've never done."

Dr. Frieden said the new survey would yield far more accurate information about the health of city residents than is currently available through phone surveys, which rely on self-reported information. It is modeled after similar efforts on the national level by the Centers for Disease Control and Prevention.

Dr. Frieden said the survey would cost more than $1.5 million, of which $1 million would come from the Department of Health and Mental Hygiene's budget. State health officials will also contribute about $500,000, including money that will be used to underwrite all tobacco-related questions.

In addition, Dr. Frieden said C.D.C. officials had supplied millions of dollars' worth of technical support, including computer software programs to record the data. "They built the car, and now we're about to take the car out for a ride," Dr. Frieden said.

Edward J. Sondik, director of the National Center for Health Statistics, who appeared with Dr. Frieden at a news conference at the Health Department, said that while C.D.C. officials have conducted similar surveys for more than 30 years to inform health policy, this was the first time that it had been tried at a local level.

City health officials said letters were being mailed out to 5,000 randomly selected households, and health workers would follow up by knocking on doors. Each survey participant will be paid $100 for reporting to a Health Department clinic to answer medical questions and undergo a physical exam. The entire process is expected to take about 90 minutes.

Health officials said participation in the survey would be kept confidential, and would not include any questions about immigration status.

The wide-ranging survey will collect information including height, weight, arm and waist circumference, blood pressure and cholesterol level. It will address whether the person has had depression, alcohol and drug use, or sexually transmitted diseases, among other things. In some cases, participants will also be tested for exposure to pesticides and heavy metals like mercury.

Copyright 2004 The New York Times Company

June 3rd, 2004, 09:47 PM
New York Daily News
June 3, 2004

Most NYers wash hands, but many don't use soap

Associated Press

Most New Yorkers wash their hands with water after using public restrooms, but about one quarter of them don’t bother to use soap, according to a study released Thursday.
The nonscientific study, by Hunter College students enrolled in a basic research methods course, concluded that only a small percentage (7.4 percent) of women did not wash their hands at all, while 26.1 percent used only water and no soap. That compared with 33.7 percent of men who used water but no soap, and 19.5 percent who didn’t wash their hands at all.

The study, conducted between March 29 and April 19, observed 2,341 people, a majority estimated to be 18 years or older. About 184 individuals in the sample were estimated to be 12 to 17 years old.

The surveyors observed people in public restrooms at Grand Central Terminal, the Port Authority Bus Terminal, the city’s major museums, a food court and two department stores, one described as “upscale.” While other studies have recorded the hand washing habits of people using public restrooms, those studies did not differentiate between those who simply rinsed their hands with water and those who washed their hands with both soap and water.

Other findings of the Hunter College study:

- Individuals who walked into the restroom with a family member or friend were more likely to wash their hands with soap and water than those who entered without someone they knew.

- Teens had poorer hygienic habits than adults. Almost half (46.4%) of those 12 to 17 years old did not wash their hands with both soap and water compared to 36.6 percent in the adult group.

- People in transportation centers were less likely to wash their hands with soap and water than people in other settings, particularly the “upscale” department store.

Copyright 2004 Daily News, L.P.

June 4th, 2004, 12:52 AM
Well I am glad I wasn't survey. But just to let you know if I was....I do use soap. :wink:

July 16th, 2004, 01:30 AM

July 16th, 2004, 08:18 AM
Report finds disparities in health by income, ethnicity

Staff Writer

July 16, 2004

What's the price of being poor in New York City? Eight years off of your life.

That's the sobering conclusion of new health department report highlighting extreme disparities in the physical well-being based on race, income, and ethnicity.

The report -- the first of its kind -- used a variety of health and demographic data to track common diseases and conditions, including diabetes, HIV, obesity, heart problems, lead poisoning, asthma, infant mortality and low birth weight.

The department gathered the information in order to better target resources and to make the case for increased funding from private foundations, Albany and Washington, city officials said.

"What we're doing is getting information out there to tell it what it is," said Health Commissioner Thomas Frieden. "The disparity is not only unfair, it highlights where we need to target our resources."

Key findings include: Affluent New Yorkers live about 81 years on average compared with 73 for people with "very low" incomes. Male blacks fared worst, living an average of 69 years, according to report.

Diabetes death rates among blacks are more than twice that of whites. Puerto Ricans suffer disproportional health woes compared to other Hispanics, living an average of 76 years, compared with 84 for other Hispanic groups.

94 percent of lead poisoning cases were reported in black, Hispanic or Asian households.

Six times as many blacks have been newly diagnosed for HIV than whites. Liver disease, which is often attributable to alcohol or drug abuse, is nearly four times more prevalent in poor neighborhoods than high-income areas.

Nearly one in three Hispanic children are obese compared with 14 percent of Asians, 16 percent of whites and 23 percent of blacks.

The report was partly funded by the Commonwealth Foundation, which is subsidizing upcoming studies of access to health care and women's medical issues, Kerker said.

Copyright © 2004, Newsday, Inc.

August 9th, 2004, 06:21 AM
The Urban Health Challenge (http://www.gothamgazette.com/article/issueoftheweek/20040809/200/1082)

December 23rd, 2004, 12:01 AM
December 23, 2004

Diabetes Is Gaining as a Cause of Death, City Health Data Say


Diabetes killed an increasing number of New York City residents last year, ranking for the first time among the five leading causes of death in an annual summary of vital statistics released yesterday by the health department.

Diabetes was identified as the fourth-leading cause with 1,891 deaths in 2003, an 11 percent increase from the previous year, when the disease was ranked sixth, according to the summary. Of those deaths, 1,024 were women and 867 were men.

Health officials attributed the increase to rising levels of obesity among New Yorkers, and also to a higher risk of the disease in a population that is living longer. Diabetes was the third-leading cause of death among those between 55 and 74.

Health Commissioner Thomas R. Frieden warned that diabetes remained an underdiagnosed condition that had been linked to heart disease. He also said that it was more likely to affect Hispanics and blacks because of the greater incidence of obesity among those groups. "What it means is that we need to do a much better job of both preventing and treating," he said at a news briefing at City Hall.

The 67-page vital statistics survey (www.nyc.gov/html/doh/pdf/vs /2003sum.pdf) showed that the top three causes of death among city residents remained the same from the year before: Heart disease was again the leading killer, causing 23,875 deaths last year. Cancer was second with 13,826 deaths, and influenza and pneumonia was third with 2,692 deaths.

Alzheimer's disease was identified for the first time as a leading cause of death in people over age 75.

Still, there were small victories revealed by the data. H.I.V. and AIDS-related deaths slipped two places to seventh last year, accounting for 1,656 deaths, compared with 1,713 the year before. Health officials pointed out that it remained the leading killer of residents between 35 and 44.

Fewer teenagers gave birth last year, continuing a long-term national and citywide trend. But Dr. Frieden said that teenage pregnancy remained a problem, especially in the Bronx, in part because teenagers were not using condoms as often as they should. Teenage births have declined 36 percent in the city over the last decade, the survey found.

In general, the data suggested that New York remained a healthy and safe place to live, Dr. Frieden said. The total number of deaths dipped once again this year to a historic low of 59,213 deaths, compared with 59,651 in 2002.

In addition, the survey studied the aftereffects of the August 2003 blackout and debunked at least one urban myth. "People may have had fun in other ways, but there was no increase in births," Dr. Frieden said.

The study also found that six people - three men and three women - died from causes associated with the blackout. Those causes included accidental carbon monoxide poisoning, heart attack, excessive heat in the absence of air-conditioning and mechanical respirator failure.

Dr. Nathaniel Clark, a vice president with the American Diabetes Association, said the increase in diabetes-related deaths in New York City was not surprising, since the disease had become more common. He said people could reduce their risk of developing it by losing weight and exercising regularly.

"This type of wake-up call is not necessarily negative," he said. "The positive message is that we know diabetes can be controlled in those who have it, and prevented or delayed in those who are at risk for it by changes in lifestyle."


Copyright 2004 The New York Times Company

June 21st, 2006, 04:09 AM
June 21, 2006
Health Report Paints a Mostly Positive Picture

New York City residents take markedly better care of their health than they did just a few years ago by several important measures, according to a city report scheduled to be released today. But at the same time, a few other important gauges have barely budged.

In 2005, a New Yorker was significantly more likely than in 2002 to have a regular doctor and get a colon cancer screening, less likely to smoke or have lead poisoning, and less likely to die from AIDS or drug and alcohol abuse, the report says.

Indicators that resisted significant improvement over that period included the number of women having Pap smears, infant mortality rates and the number of cases of fatal domestic violence. The number of women having mammograms actually fell slightly, mirroring a national trend, while the number of older people who received flu shots fell, most likely because of the vaccine shortages of the last two years.

The findings by the city's Department of Health and Mental Hygiene amount to a mixed but mostly positive midterm report card on an ambitious list of goals, called Take Care New York, which was created two years ago. The list consisted of a top 10 list of problems to address, like controlling heart disease and making vaccinations more widespread. For each problem, the department announced a numerical goal that it hoped to reach by 2008.

Under Mayor Michael R. Bloomberg and the health commissioner, Dr. Thomas R. Frieden, the department has become more active than it has been in decades, advocating increased cigarette taxes, collecting reams of health data that no one had gathered before, lobbying the state to change its laws on H.I.V. testing, and pushing doctors to change the ways they deal with patients.

"In terms of the regular doctor, smoking, H.I.V. deaths and alcohol and lead poisoning, those are all real successes," based in part on the department's actions, Dr. Frieden said in an interview yesterday.

Department officials said that they were not sure what drove some of the changes, good and bad. In other areas they were fighting lifestyle forces, like the way people eat.

Some of the report card numbers stemmed from an annual survey of 10,000 households conducted since 2002, while others came from traditional record-keeping like the city's lead poisoning registry and its annual study of all the deaths in the five boroughs.

Another new tool was a physical examination, including blood tests, of a 2,000-person cross-section of the city's population, conducted in 2003 and 2004. The results of that effort were still being analyzed and will be published later this year. Until then, no figures have been available to measure two of the 10 items on the department's list, improving cardiac health (Dr. Frieden said he does not expect much progress there) and treating depression.

The health habits of millions of people tend to change slowly, but in some areas, New York City has made remarkably positive changes. People who did not have regular doctors dropped to 21 percent of the city's population in 2005 from 25 percent in 2002. City officials said that was largely because of city efforts to enroll more people in Medicaid and other government-sponsored programs, and Medicaid's shift to managed care, which requires each patient to have a primary doctor.

Smokers fell to 19 percent of the adult population from 22 percent, one of the steepest declines ever documented, after the city and state raised tobacco taxes and banned smoking in restaurants and bars. City officials heavily promoted colonoscopies for people over age 50, and the number of people having the screenings rose sharply. They did not push as hard on mammograms and Pap smears, and those numbers did not change much.

Some improvements were harder to tie to recent city policies, like the drop in alcohol-related deaths, an area the department has not traditionally focused on.

In several categories, the city is using a new program that sends health department officers into neighborhoods with particularly serious problems to meet with primary care doctors and urge them to bring up subjects with their patients that are often overlooked, like H.I.V. testing, vaccinations for older people, depression and drinking.


Copyright 2006 The New York Times Company

August 29th, 2008, 07:26 AM
Staten Island Resident With West Nile Virus Dies

By E.B. SOLOMONT (http://www.nysun.com/authors/E.B.+Solomont), Staff Reporter of the Sun | August 29, 2008

A Staten Island (http://www.nysun.com/related_results.php?term=Staten+Island) man with West Nile virus has died, the city's health department confirmed.

City health officials, who did not identify the 65-year-old, said he became ill and died earlier this month. "An investigation into whether the death was in fact related to the virus is ongoing," officials said in a statement.

According to the health department, there have been five other cases of West Nile virus this season. Last week, the department confirmed that a 73-year-old Queens (http://www.nysun.com/related_results.php?term=Queens+County) woman and a 60-year-old Bronx (http://www.nysun.com/related_results.php?term=The+Bronx) man were infected.

The Staten Island man would be the city's first known fatal case this year. In Nassau County, health officials confirmed two deaths linked to the virus, of a 75-year-old man and an 80-year-old woman.

West Nile virus, which is transmitted by mosquitoes during the summer months, can cause flu-like symptoms. In severe cases, the virus can infect a person's brain or spinal cord.

With origins in Africa, Asia, and the Middle East, the virus was first reported in North America in 1999. In New York, there was a surge of cases in 2003, when 71 were reported statewide and 31 were reported in New York City (http://www.nysun.com/related_results.php?term=New+York+City). That year, six cases in New York City were fatal.

Last year, three city residents died after contracting West Nile virus, and 15 others became ill. This summer, city health officials said infected mosquitoes have been found in Brooklyn, Staten Island, Queens, and the Bronx. The city has been spraying affected areas with larvicides.


© 2008 The New York Sun,