October 23 , 2019
When Separate Isn’t Equal: What Accounts For Health Disparities
By Barbara Caress
Sharp differences in Black and White life expectancy, infant mortality, and premature death in New York City are due to racism and its most vicious manifestation, poverty. For just about every leading cause of death in the city, there is a disadvantage by color and by neighborhood -- the consequences of a malignant double whammy of being Black and being poor.
The 2017 edition of the City’s annual Summary of Vital Statistics details the toll that racism and poverty take on Black New Yorkers. On average, White non-Hispanic New Yorkers live four to five years longer than do Black non-Hispanic residents. The difference by color is intensified by differences in neighborhood income. If you get off the “A” train at 14th Street in wealthy and mostly White Greenwich Village, for example, you’ll be in a community where residents lived an average of 86.7 years. Stay on the “A” to the end of the line in the far-less affluent Rockaways and you will be in a community where residents registered 10 fewer years (76.9 years).
The same pattern appears when looking at premature deaths – people dying before age 65. The premature death rate is a particularly meaningful measure because, in the words of the World Health Organization, many deaths before age 65 “should not have occurred in the presence of timely and effective health care.” The list of common causes of premature death considered amenable to health care is long. It includes stroke, heart disease, treatable cancers, HIV/AIDS, maternal and infant deaths, and 20 other conditions.
In 2017 there were 273 such deaths among every 100,000 Black City residents; that’s nearly 100 fewer than among Whites (179). Again, the differences are even starker between affluent and poorer neighborhoods. Greenwich Village is New York’s healthiest community; its premature death rate was 63/100,000. Compare that to the Bronx’s East Tremont (317/100,000) and Brownsville, Brooklyn (379/100,000).
Early death is an all-too-common experience in Black communities throughout our deeply segregated city. The premature death rate exceeds the citywide number (170 deaths/100,000 population) in eight of 10 communities where at least half the population is Black. That’s not true in any of the 16 neighborhoods where fewer than four percent of residents are Black.
Are outcomes like this inevitable in our increasingly segregated city? Not necessarily. A tantalizing new study holds up the possibility of amelioration. Well documented is the fact that, in the general population, Black patients undergoing coronary by-pass surgery have worse clinical results than White patients. The new study, reported in the August 2019 edition of the journal Health Affairs, examined coronary by-pass outcomes for patients insured through TRICARE (the health insurance system providing benefits to active and retired members of the US Armed Forces and their dependents), and mostly treated in military hospitals. It found that “There were no risk-adjusted differences in outcomes between African American and white patients insured through TRICARE.” Universal coverage and care in race-blind institutions might work wonders.
To achieve similar results, New York City policy makers will have to set their currently modest expectations much higher. Take Care NY 2020(TCNY2020), the City Department of Health’s self-described “blueprint for giving everyone the chance to live a healthier life” proposes to lower the rate of premature death and reduce disparities, but not eliminate them. Specifically, the City hopes to shave an additional 15 deaths off its overall premature death rate, and to reduce the disparity between citywide and Black premature deaths to 65/100,000 from its most recently measured difference of 94/100,000. And while TCNY2020 seeks to emulate Canada with a citywide infant mortality rate in 2020 of 4.4/100,000, it set its sights on a Black infant death rate comparable to what Costa Rica reported in 2017 (7.7/100,000).
New York City’s $125 billion health system ought to be held to a higher single standard, one that incorporates the elimination of avoidable deaths and the end to disparities attributable to skin color or income. There is no reason why all New Yorkers shouldn’t expect to live as long as residents of Greenwich Village.