New York’s terrible health inequity costs lives

Almost 60 years ago, at a press conference in Chicago, Dr. Martin Luther King Jr. addressed race-based health inequities in American society by declaring, “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.”

Sadly, the inequities of health have not narrowed in these six decades. If anything, the COVID-19 pandemic has magnified these disparities in our communities. Through the first year of the pandemic, while Blacks and Hispanics represented, respectively, 14% and 19% of New York State’s population, Blacks suffered 23% of the deaths and 29% of the hospitalizations, and Hispanics endured 23% of the deaths and 35% of the hospitalizations. Whites, who represented 56% of New York’s population, experienced 40% of the deaths and 26% of the hospitalizations. Undoubtedly, numerous factors — from an inability to work from home, higher-density households, lack of access to personal protective equipment and health care, or preexisting health conditions like asthma — account for these numbers.

A deeper understanding of these discrepancies in health is critical. U.S. News & World Report on Wednesday released its 2022 Healthiest Communities rankings, an annual county-by-county assessment of how communities and their residents have fared in 10 categories and 89 metrics. The data shines a light on the key social determinants — such as population health, equity, education, economy, housing, food and nutrition, environment, public safety, community vitality and infrastructure — that impact life expectancy and quality of life.

Collectively, New York’s counties fall at about the middle of the pack in the Healthiest Communities analysis, while Rhode Island’s are the top performers. Within the Empire State, Saratoga is the top-ranked county at No. 60 overall. Residents have a life expectancy of 81 years, many engage in leisure activities and the county has had a low prevalence of diabetes and a low poverty rate. But Montgomery County, which abuts Saratoga County, is 61st of New York’s 62 counties. Life expectancy there was 78 years, a lower share of residents were active, and the county has seen higher rates of diabetes and poverty, as well as a higher prevalence of obesity and a lower high school graduation rate.

In a state with as many resources in New York, including outstanding medical care, it is unconscionable that where you live can have such dire life-and-death consequences.

New York City sees similar stark divergences. The borough of Manhattan has the ninth-highest score in the state, while the Bronx has the lowest. If you are a resident of Manhattan, your life expectancy in recent years was 85; in the Bronx, your life expectancy was 81. Residents of Manhattan have a higher median income than their neighbors in the Bronx, spend a much higher percentage of at-home food expenditures on fruits and vegetables, and have a lower prevalence of heart disease.

This data reinforces why Mayor Adams is advocating a food-forward agenda that addresses access and affordability, seeking to not only bring more grocery stores to lower-income communities but also supporting more nutritious food programs in schools and other city-run institutions.

Disparities can be stark even at the neighborhood level. Data from past research has shown gaps in life expectancy of up to 33 years between neighborhoods within miles of each other in Boston, with a high of 92 in Back Bay and a low of 59 in Roxbury.

Of course, no county is perfect: Even the country’s top-ranked county, Los Alamos County, New Mexico, could improve its performance in areas like education and food and nutrition.

Overall, the data makes it clear that your ZIP code has a much greater impact on your health than your genetic code.

The good news is that our analysis provides the data and insight essential to creating a road map for change. For example, local officials can see how their county is performing in a certain category, assess what metrics define that category, and then think holistically about programs to seek improvement across that category. Investing in solving these issues now will not only save lives, but also will cut costs throughout the health-care ecosystem.

As we enter a post-COVID world, our political leaders — working with community partners and the business community — need to do much more to provide resources and to make policy changes that will help residents throughout the state live healthier and longer lives. This is especially true in those communities that have long suffered due to the inequities in health care.

We are at a moment in our history where Dr. King’s admonition might finally yield the progress that is critically needed. We know what we need to do, and we have the tools. Do we have the will?