Health is not top of mind when discussing issues around inequality for many people. But there are some dramatic and stark examples of health disparities by race, gender, age, income, and immigration status in NYC. Access to quality medical care is a key health indicator. When people receive regular, preventive care they can detect problems early, improving health outcomes. This is especially true for NYC residents who live in low-income areas with chronic conditions like asthma and diabetes. Lifestyle choices also impact New Yorkers’ health; regular exercise, quitting smoking, avoiding sugary drinks, refraining from recreational drugs, and practicing safe sex go a long way in keeping people healthy.
Our indicators under the Health theme explore how disadvantaged groups like seniors, immigrants, racial and ethnic minorities, and women experience significant disparities in the topic areas of Access to Health Care,Quality of Health Care,Mortality, and Wellbeing.
You can see a snapshot of the indicators averaged in this theme in the chart to your right and then visit the sections below for more detail.
Heroin and Public Health In New York City (NYC), heroin overdose deaths are now more common than homicide. NYC drug overdose deaths hit a record high of 1,300 in 2016, an increase from 800 in 2014, and 937 in 2015.…
Exercise is an important measure of well-being. But in New York City, the Equality Indicators has found those at the bottom end of the income ladder are less likely to exercise than more affluent individuals. All age groups benefit from…
Despite passage of the Affordable Care Act, some New Yorkers have trouble accessing healthcare. At-risk groups include immigrants, seniors, and racial and ethnic minorities, all of whom may struggle with paying for out-of-pocket costs or knowing how to access services, particularly when they lack health insurance. If these groups live in poverty, they are highly likely to forego needed care. Senior flu vaccination rates are also a source of wide disparities by income.
To understand Access to Health Care in the context of inequality, we used four indicators:
Race & Health Insurance
Race & Medical Care
Income & Senior Flu Vaccination
Immigration Status/Gender & Personal Doctor
Take a look at the chart to your right for an overall picture of this topic, and then explore each indicator and the scores in context for more detail and additional findings.
What is Measured? Ratio between the percentages of Hispanics and whites who do not have health insurance.
What’s the Backstory? Lack of insurance and the high costs of medical care can prevent people from receiving needed treatment. Racial and ethnic minorities are more likely than whites to be uninsured and to have less access to medical care, with disparities particularly pronounced for Hispanics.
What Did We Find? Hispanics were the most likely not to have health insurance (8.7%), followed by blacks (6.3%). Asians were the least likely to be uninsured at 4.9%, while 5.4% of whites lacked health insurance. Uninsurance rates were lower for every racial and ethnic group compared to the baseline year, and the relatively large decrease in uninsurance among Hispanic New Yorkers contributed to the improvement in the disparity between Hispanics and whites. There were also inequalities by immigration and citizenship status: while 4.6% of New Yorkers born in the US did not have health insurance, 9.4% of immigrants were uninsured. Among immigrants, those that were naturalized citizens had an uninsurance rate of 5.0%, while 15.4% of non-citizens were uninsured.
What is Measured? Ratio between the percentages of Hispanics and whites who did not receive medical care they needed in the past year.
What’s the Backstory? Barriers to receiving needed medical care include lack of access to health facilities and services, and lack of language and cultural competence among healthcare providers. In the US, Hispanics and blacks are more likely not to have a regular source of medical care compared to whites.
What Did We Find? Hispanics and blacks were more likely to not have received needed medical care than whites (12.4%, 11.6%, and 8.1% respectively), as was the case in the baseline year. Among Asians/Pacific Islanders, 10.3% did not receive needed medical care, which was not statistically significantly different from the percentage among whites. A non-significant numerical decrease in percentage among Hispanics and a non-significant numerical increase in percentage among whites led to a moderate improvement in the score from baseline. The type of health insurance individuals had also affected the likelihood of not receiving medical care: 8.3% of those with private insurance did not receive care, compared to 12.1% of those with Medicaid and 19.2% of those who were uninsured.
What is Measured? Ratio between the influenza non-vaccination rates for people aged 65 and older in the bottom and top income groups.
What’s the Backstory? Influenza is a serious contagious disease that can lead to hospitalization and even death, especially among people aged 65 and older. Yearly vaccination can protect against many forms of the flu, and among seniors, vaccination rates are lower among people with lower incomes.
What Did We Find? While there were slight differences in senior flu vaccination rates across income groups (33.1% of those living at <100% of the FPL and 29.6% of those living at ≥ 600% of the FPL did not receive a flu vaccination), none of these differences were significant. While we did see improvement in the score, it was based on a non-significant numerical decrease in percentage for the bottom income group (from 40.8% at baseline) and a non-significant numerical increase in percentage for the top income group (from 25.3% at baseline). Looking at race and ethnicity, black seniors were more likely to be unvaccinated (45.0%) than white seniors (33.5%), Asian/Pacific Islander seniors (32.4%), and Hispanic seniors (24.5%).
What is Measured? Ratio between the percentages of foreign-born men and US-born women without a personal doctor or health care provider.
What’s the Backstory? People who have a regular doctor typically receive higher quality care and are less likely to be hospitalized for preventable conditions. Immigrants are less likely to have a regular doctor, and so are men regardless of their immigration status.
What Did We Find? When looking at a combination of gender and immigration status, foreign-born men were the most likely to report not having a regular doctor (26.4%), and US-born women were the least likely (9.5%). Among foreign-born women, 14.5% did not have a regular doctor, and among US-born men 12.1% did not have a regular doctor. While the percentage among foreign-born men was almost identical to the baseline year, the small, non-significant numerical increase in the percentage among US-born women compared to the baseline year (8.1%) contributed to a slight improvement in the score. In the current year, Hispanics were more likely to report not having a regular doctor (23.4%), compared to Asians/Pacific Islanders (15.0%), blacks (11.7%), and whites (11.6%).
Quality of Health Care
Diseases like asthma and diabetes can be managed with adequate healthcare, and those like chlamydia and chronic hepatitis B can be prevented or treated before they spread. Yet this is among the lowest scoring topics in the Equality Indicators. Race significantly impacts the likelihood one will be hospitalized for asthma or diabetes or contract a sexually transmitted disease. This speaks to disparities in the quality of healthcare by racial groups. Chronic hepatitis B is another preventable and treatable condition, yet the likelihood of getting it is considerably higher for those in low-income groups.
To understand Quality of Health Care in the context of inequality, we used four indicators:
Race & Asthma Hospitalization
Race & Diabetes Hospitalization
Race & Sexually Transmitted Diseases
Income & Chronic Hepatitis B
Take a look at the chart to your right for an overall picture of this topic, and then go to each indicator to find more detail and additional findings.
What is Measured? Ratio between blacks’ and whites’ hospitalization rates due to asthma.
What’s the Backstory? Large disparities among racial and ethnic groups exist in asthma rates and control of the condition, and hospitalization may be required when it is not adequately managed through treatment and preventive care. Blacks have the highest asthma rates and are most likely to be hospitalized for the disease.
What Did We Find? Blacks were almost seven times as likely as whites to be hospitalized due to asthma (289.918 per 100,000, compared to 42.210), while Hispanics were more than four times as likely (176.852). Rates decreased for all groups from the baseline year, but a larger decrease among whites (from 91.744 at baseline) than among blacks (from 476.328 at baseline) contributed to a larger disparity between the two groups in the current year. Women were more likely to be hospitalized due to asthma (186.485) than men (152.957) in the current year. The likelihood of being admitted through the emergency room was similar for blacks (98.1%), Hispanics (97.9%), and whites (96.9%), as was the average length of stay (3.0 days for whites, 2.7 days for Hispanics, and 2.6 days for blacks).
What is Measured? Ratio between blacks’ and whites’ hospitalization rates due to diabetes.
What’s the Backstory? Diabetes is the seventh-leading cause of death in the US, and uncontrolled diabetes often leads to avoidable hospitalizations. Blacks are more likely to be hospitalized, in addition to having higher costs related to their hospitalization.
What Did We Find? Blacks had the highest diabetes hospitalization rate (353.421 per 100,000), followed by Hispanics (153.992) and whites (105.119). Rates decreased for all racial and ethnic groups from baseline, and the disparity between blacks and whites remained largely the same. In the current year, Hispanics and blacks were similarly likely to be admitted through the emergency room (96.2% and 96.1%, respectively), and slightly more likely than whites (90.4%). However, blacks and Hispanics had slightly shorter lengths of stay (5.7 days), compared to whites (6.1 days).
What is Measured? Ratio between blacks’ and Asians’ chlamydia rates.
What’s the Backstory? Although chlamydia is preventable and easily cured, if left untreated this STD can cause infertility and chronic pelvic pain, as well as potentially fatal ectopic pregnancies. Blacks have been shown to have higher rates of chlamydia and some other STDs than Asians.
What Did We Find? There were large racial and ethnic differences in STD rates, with blacks more than six times as likely to be diagnosed with chlamydia (721.30 per 100,000) as Asians (111.63). The rate for Hispanics was also high (458.40), while the rate for whites was the second lowest (160.15). Blacks also had the highest rate of gonorrhea (311.74), compared to Hispanics (168.69), whites (123.08), and Asians (38.03). Chlamydia rates have increased from baseline for all racial and ethnic groups, except for blacks, which contributed to the small improvement in the indicator. Gonorrhea rates have increased from baseline for all groups.
What is Measured? Ratio between the rates of newly diagnosed chronic hepatitis B in the highest and lowest poverty areas.
What’s the Backstory? Hepatitis B is a preventable and treatable disease, but left untreated it can cause liver damage or failure, or death. The rates of hepatitis B infection are much higher among individuals born in foreign countries, and these populations are more likely to live in neighborhoods with higher levels of poverty.
What Did We Find? The rate of people newly reported with chronic hepatitis B was positively correlated with neighborhood poverty. Residents of very high poverty areas (≥30% of people living below the FPL) had the highest new chronic hepatitis B rate (114.6 per 100,000), compared to residents of high poverty areas (103.3), medium poverty areas (62.5), and low poverty areas (32.4) where <10% live below the FPL. When broken down by borough, Brooklyn residents had the highest new chronic hepatitis B rate (91.6), followed by Queens (86.4), the Bronx (74.7), Manhattan (52.7), and Staten Island (38.6).
Mortality
Life expectancy rates vary greatly from one neighborhood to another, reflecting income and racial disparities. Black populations face the greatest risk of dying from cardiovascular disease and HIV. Black mothers face the greatest risk of their infants dying prematurely. Living in a poor area also puts residents at risk of dying from heroin overdose; affluent areas have a considerably lower heroin death rate.
To understand Mortality in the context of inequality, we used four indicators:
Race & Cardiovascular Deaths
Race & Infant Mortality
Race & HIV-Related Deaths
Income & Heroin Deaths
Take a look at the chart to your right for an overall picture of this topic, and then look at each indicator and the scores in context for more detail and additional findings.
What is Measured? Ratio between blacks’ and Asians’ heart disease mortality rates.
What’s the Back Story? Cardiovascular disease (CVD) is the leading cause of death globally as well as in the US. In the US, disparities in CVD-related death rates across racial and ethnic groups are large, and blacks in particular are at increased risk of CVD-related mortality.
What Did We Find? Blacks had the highest heart disease mortality rate (210.9 per 100,000), followed by whites (194.0). Asians/Pacific Islanders had the lowest rate (99.1), while the rate for Hispanics fell in the middle (143.9). Rates for all groups were similar to rates at baseline, and the disparity between blacks and Asians remained unchanged. Men had a higher rate of heart disease mortality (220.9) than women (146.6), and when combined with race and ethnicity, black men had the highest rate (271.1) while Asian/Pacific Islander women had the lowest (82.6). There were also inequalities by borough: Staten Island residents had the highest rate (222.7), compared to the Bronx (188.7), Brooklyn (188.4), Queens (153.4), and Manhattan (134.7).
What is Measured? Ratio between the infant mortality rates for black and white mothers.
What’s the Backstory? Infant mortality refers to babies who die before their first birthday, and this rate may reflect the general state of a country’s health and wellbeing. In the US, the infant mortality rate is highest among babies born to black mothers.
What Did We Find? There were considerable racial and ethnic disparities in infant mortality rates with black infants three times more likely to die in infancy (8.0 per 1,000 live births) than white infants (2.6). Infant mortality is also much higher among black babies than Asian/Pacific Islander (2.9), Puerto Rican (3.4), and other Hispanic (3.8) babies. Infants of US-born mothers had a higher mortality rate (4.1) than those of foreignborn mothers (3.4), although infant mortality rates differed by maternal birthplace (7.2 among mothers from Trinidad and Tobago, 7.0 among those from Haiti, and 6.8 among those from Jamaica). There were also differences by maternal education level: infants born to mothers with less than a bachelor’s degree had a rate of 4.5, compared to 2.4 for those whose mothers had a bachelor’s degree or above.
What is Measured? Ratio between blacks’ and whites’ HIV-related death rates.
What’s the Backstory? HIV infection leads to the weakening of the immune system and eventually to AIDS, which can be fatal. Although it is preventable, HIV currently has no cure. In the US, blacks and Hispanics have a disproportionately high rate of HIV infection and HIV-related death.
What Did We Find? There were 432 HIV-related deaths in NYC in the current year. The HIV-related mortality rate was almost eight times higher among blacks (11.0 per 100,000) than whites (1.4), and more than twice as high as the rate for Hispanics (5.2). Rates decreased from baseline for all racial and ethnic groups, but whites saw more improvement (from 2.3 in the baseline year) than blacks (from 14.8 at baseline), contributing to an increased disparity between the two groups. In the current year, men were more likely than women to die from HIV (6.9 compared to 2.8), and the poorest neighborhoods had a much higher rate (12.1) than the wealthiest neighborhoods (1.7).
What is Measured? Ratio between the rates of heroin overdose deaths in the highest and lowest neighborhood poverty areas.
What’s the Backstory? Heroin overdoses are often fatal, and deaths related to this opiate drug have increased greatly in the US in recent years. Deaths due to heroin overdose in NYC are consistently highest in poor neighborhoods.
What Did We Find? There were 1,487 drug overdose deaths in NYC in the current year, with 771 (52%) involving heroin. The heroin-related death rate in the city’s poorest areas (≥30% living below the federal poverty level) was more than two times higher than the rate in its most affluent areas (<10% living below the federal poverty level), with rates of 17.7 per 100,000 and 7.5, respectively. Rates increased from baseline across all neighborhood poverty areas. When broken down by borough, rates remained highest in the Bronx (17.7) and Staten Island (16.0), while rates were considerably lower in Brooklyn (8.6), Manhattan (8.1), and Queens (6.6). There were also racial and ethnic disparities, with whites (14.3) and Hispanics (13.0) at greater risk than blacks (10.6).
Wellbeing
Satisfaction with life depends greatly on levels of wellbeing. While some define wellbeing as the absence of disease, it can also mean feeling able to make positive changes and improvements. Race and income can affect wellbeing levels in NYC. Low birthweight impacts black babies at a rate two times that of white babies. This speaks to the earliest stages of wellbeing. Sugary drink consumption, which contributes to obesity, also affects black and Hispanic populations at higher rates than others. Smoking, which is now directly linked to lung cancer, disproportionately affects those at the lowest ends of the income ladder. Similarly, exercise, known to be one of the best forms of preventive medicine, is not practiced as often among those in the bottom income groups as those at the top.
To understand Wellbeing in the context of inequality, we used four indicators:
Race & Low Birthweight
Race & Sugary Drink Consumption
Income & Smoking
Income & Exercise
Look at the chart to your right for an overall picture of this topic, and then explore each indicator and the scores in context for more detail and additional findings.
What is Measured? Ratio between the percentages of black and white children born with low birthweight.
What’s the Backstory? Low birthweight can lead to health and developmental complications and even death, in addition to other serious health-related consequences later in life. In the US, black mothers are more likely than mothers from other racial or ethnic groups to deliver low birthweight babies.
What Did We Find? The percentage of infants born with low birthweight, meaning they weigh less than 2,500 grams, was highest for black infants (12.2%), followed by Asian/Pacific Islander (8.4%), Hispanic (8.0%), and white (6.2%) infants. The percentages decreased slightly from baseline for both black and white infants (from 12.6% and 6.6%, respectively), and the disparity between the two groups was similar. A higher percentage of preterm birth (<37 weeks) among black women (12.2%) compared to white women (7.3%) may have contributed to the disparity in low birthweight. Looking at nativity, 8.6% of US-born women had low birthweight babies, compared to 7.9% of foreign-born women.
What is Measured? Ratio between the percentages of Hispanics and whites who consume one or more sugary drinks a day.
What’s the Backstory? Consumption of sugary drinks contributes to obesity in the US and can increase the risk of weight gain, type 2 diabetes, heart disease, and gout. Nationwide, blacks and Hispanics report consuming more sugar-sweetened beverages on average than people from other racial or ethnic groups.
What Did We Find? Among all New Yorkers, 22.9% reported consuming at least one sugary drink a day in the past year. When broken down by race and ethnicity, blacks had the highest percentage of sugary drink consumption (35.0%), followed by Hispanics (28.9%), Asians/Pacific Islanders (16.3%), and whites (13.2%), though the difference between Asians/Pacific Islanders and whites was not significant. Whites and Hispanics saw small decreases from baseline, while blacks and Asians/Pacific Islanders saw small increases, though only the increase among blacks was significant. Differences by household poverty level were not significant in the current year.
What is Measured? Ratio between the percentages of people in the bottom and top income groups who smoke.
What’s the Backstory? Cigarette smoking is the leading preventable cause of death in the US. It greatly increases the risk of lung cancer, coronary heart disease, and stroke, in addition to a host of other health problems. Nationwide, adults who live in poverty are more likely to smoke than those with higher incomes.
What Did We Find? Citywide, 13.5% of New Yorkers were current smokers in the current year, similar to the baseline year (14.0%). There was a significant difference by poverty level, with 15.0% of individuals in the lowest income group (<100% of the FPL) and 9.8% of individuals in the highest income group (≥600% of the FPL) reporting that they were current smokers. While we saw some improvement in the score, it was based on a small, non-significant numerical decrease in percentage for the bottom income group and a small, nonsignificant numerical increase for the top income group. Looking at educational attainment, individuals with a bachelor’s degree were less likely to smoke (9.3%) than those with less than a bachelor’s degree (15.8%).
What is Measured? Ratio between the percentages of people in the bottom and top income groups who do not exercise.
What’s the Backstory? Regular physical activity has a number of health benefits including reducing the risk of cardiovascular diseases, diabetes, colon and breast cancer, and depression. People with low income are less likely to exercise and disproportionately likely to have health problems related to physical inactivity.
What Did We Find? One in four New Yorkers (25.5%) reported no exercise in the past 30 days. Individuals living at the highest poverty level (<100% of the FPL) were the most likely to not exercise (33.0%), followed by 30.7% at high (100 – <200% of the FPL), 26.0% at medium (200 – <400% of the FPL), 21.7% at low (400 – <600% of the FPL), and 13.6% at the lowest poverty level (≥600% of the FPL), though the difference between those at the highest and second-highest poverty levels was not significant. A small but significant increase among those in the top income group (from 10.2% at baseline) contributed to a small improvement in the score. There was also a difference by educational attainment, with 29.3% of those without a bachelor’s degree and 18.1% of those with a bachelor’s degree reporting they did not exercise.
