Report analyzes the relationship between poverty
and 38 reportable infectious diseases
Data will be used to support programs that reduce health disparities by targeting disease-specific outreach, education efforts and other prevention measures
March 2, 2016 – The Health Department today released an Epi Data Brief entitled, “Neighborhood Poverty and Infectious Diseases: Health Disparities in New York City.” The data brief looks at the association between 38 specific diseases and poverty. The report examines rates by census tract-based poverty level of newly diagnosed cases from 2006 to 2013 for reportable diseases, such as HIV/AIDS and tuberculosis. Researchers found that New Yorkers residing in very high poverty neighborhoods were more likely to be diagnosed with 21 of the 38 infectious diseases examined, compared with persons residing in low poverty neighborhoods. The Health Department is using these data to support programs that reduce health disparities by targeting disease-specific outreach, educational efforts, and other prevention measures. The report can be found on the agency’s website, nyc.gov/health.
“We are committed to reducing the alarming health inequities present throughout many of our neighborhoods. These data will be used as an additional resource to guide the many programs we have to expand services and improve access to care,” said Health Commissioner Dr. Mary T. Bassett. “We will continue to take a community-based approach to improve the health of every New Yorker, and we look forward to working with organizations, businesses, and residents to achieve this.”
Twenty-one diseases were more likely to be associated with very high poverty neighborhoods than low poverty neighborhoods, including malaria, chronic hepatitis B and C, gonorrhea, chlamydia, HIV/AIDS, tuberculosis, and syphilis. Possible explanations for these associations with high poverty neighborhoods in New York City range from immigration patterns to increased exposure to risk factors, such as higher risk sexual networks or injection drug use. Poverty influences not only the risk of exposure to infectious diseases, but also susceptibility to illness following exposure.
“This innovative analysis helps us better understand the unfair and unnecessary impact that poverty has on the health of New Yorkers,” said Dr. Jay K. Varma, MD, Deputy Commissioner for Disease Control. “We are continuously working to tailor our infectious diseases prevention, diagnosis, and treatment programs for individuals and neighborhoods at highest risk.”
“Health disparities between our neighborhoods are among the most urgent problems facing our City," said Council Member Corey Johnson, Chair of the Council's Committee on Health. "Identifying the illnesses associated with these disparities is critical. The data in this report will help policy makers and community leaders address the root causes of these inequities. I thank the Department of Health and Mental Hygiene for this valuable report."
“By identifying the diseases and conditions that are disproportionately affecting high-poverty neighborhoods, the de Blasio administration and DOHMH are performing an invaluable public service by helping public health authorities minimize health disparities through targeted outreach, treatment, and prevention efforts aimed at low-income communities,” said Assembly Member Richard N. Gottfried, Chair of the Assembly Committee on Health.
“Today’s report confirming the high correlation between poverty and infectious disease underscores how much work is left in our fight to prevent the spread of STIs like HIV/AIDS,” said State Senator Brad Hoylman. “While New York City has made great strides in this fight, this report, coming just days after a shocking study from the Centers for Disease Control and Prevention showing how much more likely LGBT people of color are to contract HIV over the course of their lives, is proof positive that we must do more to protect vulnerable communities. I want to thank Mayor de Blasio and Commissioner Bassett for this report, which will help lawmakers dedicate targeted resources to finally end the scourge of AIDS in our city.”
• The association between chronic hepatitis C and poverty may be related to injection drug use. Injection drug use is a major risk factor for hepatitis C and is more common in higher poverty neighborhoods.
• Chronic hepatitis B primarily occurs among foreign-born populations in NYC, particularly immigrants from China; who tend to reside in neighborhoods with high poverty levels.
• Higher gonorrhea and chlamydia rates among persons living in higher poverty neighborhoods may be related to sexual networks; there is a higher risk of becoming infected if sexual partners in your neighborhood are already infected and untreated. Other contributing factors could include barriers to accessing and using risk reduction information and sexual health services.
• The recent high rates of HIV/AIDS diagnoses among persons living in higher poverty neighborhoods are likely related to a combination of population and socioeconomic factors (e.g., age, race/ethnicity, education, housing, and employment) that influence HIV/AIDS prevalence, sexual networks, and corresponding risk.
• Poverty influences not only the risk of exposure to infectious diseases, but also susceptibility to illness following exposure. Risks vary across all poverty levels; in addition to the 21 diseases associated with high poverty, an additional 10 diseases were associated with residing in low poverty areas.
The Health Department has taken several significant steps to address health inequities in NYC and connect New Yorkers to necessary testing and care. The agency has made progress in addressing health issues in every community, and promoting effective programs and initiatives, although many disparities remain.
To address health disparities in NYC, the Health Department launched the Center for Health Equity (CHE). CHE addresses health disparities that result in an excess burden of ill health and premature mortality in New York City’s communities of color. The Center focuses on three key areas: leveraging policy changes to better integrate primary care and public health to serve the health needs of communities, building interagency collaboration to address the root causes of health disparities, and increasing access to care by making services more accessible in neighborhoods with the worst health outcomes.
In 2015, the de Blasio administration unveiled One New York: The Plan for a Strong and Just City. One of many goals is to ensure that all New Yorkers live a long and healthy life. Premature mortality is closely tied to poverty and lack of access to critical service. The City is committed to reducing the premature mortality rate by 25 percent by 2040, so as to dramatically decrease disparities among racial/ethnic groups.
In October of last year, the City launched Take Care New York 2020 – a comprehensive health blueprint that identifies key areas for health improvement across the city and for advancing health equity. TCNY 2020 includes unprecedented community engagement approach, in which community members rank and prioritize health indicators for their neighborhood that they want to focus on and improve. These rankings are used to develop localized action plans that will be focused on health issues identified as top priority by residents during community consultations. As an additional resource in the community consultation process, the Health Department produced Community Health Profiles for every community district in the city. These profiles highlight inequities and are comprehensive reports that include 42 health and non-health indicators.
Earlier this year, during the State of the City address, Mayor de Blasio also announced the opening of new community health clinics under the Caring Neighborhoods plan – which will significantly expand primary care services in areas of the city with unmet healthcare needs – and the opening of three new Neighborhood Health Action Centers that will provide space for primary care and much-needed holistic non-clinical services in underutilized City-owned buildings located in communities with high rates of premature child and adult mortality.
The de Blasio administration has also committed to increasing access to testing and treatment for sexually transmitted diseases, including HIV/AIDS. On February 1st, the Health Department announced new expanded service hours for its STD clinics across the city. The new service enhancements are a component of the City’s effort to effectively end the AIDS epidemic. The NYC Plan to End the Epidemic includes a $23 million investment in Fiscal Year 2017 to increase HIV prevention and health care programming that will benefit nearly 200,000 New Yorkers per year when fully implemented. The plan aims to decrease HIV transmission in New York City by reducing the number of new annual HIV infections, part of a statewide goal of no more than 750 cases per year by 2020.
The most common barriers to hepatitis C treatment in NYC are active alcohol or drug use, other medical conditions, and mental health issues. The Health Department is helping to address this issue with Project INSPIRE, a three-year project that seeks to demonstrate that care coordination improves health care and lowers costs for hepatitis C patients. To date, Project INSPIRE has enrolled 1,370 patients in a program that supports patients before and during Hep C treatment while managing mental health, substance abuse, and other health issues. In addition, the agency is implementing direct efforts to control hepatitis C through its dedicated Viral Hepatitis Program and is planning to start offering testing for hepatitis C at its STD clinics.
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Christopher Miller/Julien Martinez: PressOffice@health.nyc.gov