All health is locally, to neighborhoods that shave years of life expectancy, public health officials in New York City claim in a new, data -driven strategy that is intended to turn the trend to shorter lifespan that accelerated during the pandemic.
“Health is just as good about your neighborhood and your environment as about an individual check or recipe,” wrote acting health commissioner Michelle Morse when introducing a Roadmap for better health. Called “Tackling unacceptable inequalities: a strategy for chronic diseases for New York City”, he is mapping where people can or can buy healthy food can find transport to the agreements of their doctor and are physically active in clean, safe parks.
The route map imposes 19 specific programs – from providing basic income to “prescribing parks” for social and health connections – led by several city agencies. The goal, announced for the first time in November 2023, is to improve the lifespan and reduce differences caused by heart and diabetes-related diseases by 5% by 2030 and deaths as a result of screening cancers by 20% by 2030 .
That is a challenge. The lifespan varies with no less than 20 years between predominantly black and other neighborhoods in Boston, Chicago, and in New York City, Morse and its counterparts in those cities wrote The Lancet in December. But as poignant as early Covid-19 was for New Yorkers, by 2022 the racial inequalities in the death rates of COVID-19 had almost disappeared.
Morse, leader of the NYC Department of Health and Mental Hygiene, credits health workers in the community in the Public Health Corps of the city to help close that gorge, and she thinks those employees and lessons in Covid are being taught in the ambitious lifestyles. In the past year, those health workers in the community have made more than 250,000 references for health and social needs and vaccinations and made around 35,000 personal community events. “It rebuilt confidence in government’s ability to get people what they need,” she said.
She is well aware that those goals, which were announced at the end of last month, come when the Trump administration carries out flowing orders to end initiatives aimed at diversity, fairness and inclusion.
“You can’t tackle lifespan and inequalities in the lifespan without looking at race and racism,” she said, before she started her day in the Kings County Hospital as an internal medicine hospital.
This interview is slightly processed for length and clarity.
What is your starting point to tackle chronic diseases as a driver of a long service life?
My career in medicine and public health and health and health, is really aimed at this by understanding how social systems, structural systems, policy choices all form an environment that creates health conditions or not, and how those disorders are formed by geography or neighborhoods, per Race, per gender, through competence and by so many other factors.
How does that translate into action?
Chronic illness does not happen out of the blue. We have very clear data that because about 2 million adults in New York City run the risk of food insecurity, which is directly related to the high percentages of chronic diseases in the city. The fact that 42% of black women in New York City have high blood pressure – these are things that are all related to social and environmental policy, structural and historical context.
Chronic illness is of course not something that can only tackle the health department. It is really a whole government response.
The report has ‘unacceptable inequalities’ in its name. Given the executive orders of the Trump government that delete diversity and fairness of the federal government, has there been a horrifying effect?
A new federal government will have a significant impact on the conditions in which we work here in New York City. While he withdraws from the WHO will have an impact on our ability to coordinate on the threats of cheating the CDC. We receive a large amount of federal subsidies. So these are all things that I am very worried about.
How can you unequy the lifetime and racial inequalities?
We have always said that our dedication and our mission is to protect and promote the health of all New Yorkers. And when we say all New Yorkers, it means that people who are immigrants and undocumented, that means that people are of all races and origin, all sexes, people looking for reproductive health care.
We are certainly looking for ways to work with the federal government, but we must acknowledge that our mission has not changed and that we have to protect the health of New Yorkers. We must find ways to do that, regardless of the shifts and priorities at the federal level.
Increasing the lifespan is certainly an ambitious goal. How do you get there?
We are really focused on the context of social-structural policy and not just individual behavior. This report is not just about wagging our finger at New Yorkers and say: “Eat healthy.” It is about saying, how do we make it easy for all New Yorkers, regardless of their economic patterns or level of poverty, to eat healthy food and to acknowledge that this has not always been the case that economic marginalization is a large engine of Chronic diseases.
You also look further upstream.
Black Americans have specifically experienced marginalization in this country over the past 400 years. A number of the graphs in the report show really enormous differences in disease burden due to race/ethnicity. And that is not organic. In communities of color that is really related to the story of marginalization.
How do you change that today?
We have extensive data, literally per community district, by Borough, per neighborhood – data that showed us exactly where we should concentrate our resources. That is the point of equity, right? They are means by need.
If I know that the speed of diabetes in the Bronx is twice in other places, or that the speed of diabetes in neighborhoods with high poverty is twice that in neighborhoods with a low poverty gives me a route map for exactly where I need To take my interventions.
Does that mean the Community Health Initiative?
More than 15 years ago I learned about health workers in the community as a life -saving and transforming public health intervention in the Haiti countryside, together with partners in health, together with them to accompany neighbors to promote their health in all kinds of different ways.
It rebuilt confidence in government’s ability to get people what they need.
That initiative is not new in New York, right?
The great thing about our initiative for the health workers in the community is that we have launched it during Covid. We were able to improve vaccination rates in the neighborhoods that had the worst impact of Covid. Now that we are out of the emergency phase of COVID, these health workers in the community have already been deployed, with the expertise that we need in other areas. We have specifically changed that focus to chronic diseases.
What about guaranteed basic income as an aid?
We know that there is a direct connection between a low income, poverty and a significant chronic disease burden. Everywhere in the country, whether it concerns pregnancy, chronic diseases or other results, with guaranteed basic income, there is also an actual improvement of the results of chronic diseases. That is economic justice.
We hope to be able to launch a very basic income program for people with diabetes in the Bronx as a pilot to look specifically at diabetes outcomes with guaranteed income. That will be a first.
And with cancer?
We have made progress when using tobacco, but we still have a long way to go. We will be a report in the coming months in which the racial inequalities in screen cancer in the city are really described.
One of the paradoxes that we see is that black women have similar percentages of mammography screening as everyone else, but they have higher death rates due to breast cancer. Those are the kind of things we want to do something about, because that is a pattern that we find unacceptable.
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