All health is local, down to neighborhoods that shave years off life expectancy, public health officials in New York City assert in a new, data-driven strategy intended to reverse the trend toward shorter lifespans that accelerated during the pandemic.
“Health is as much about your neighborhood and your environment as it is about an individual checkup or prescription,” acting health commissioner Michelle Morse wrote in introducing a roadmap to better health. Called “Addressing Unacceptable Inequities: A Chronic Disease Strategy for New York City,” it charts where people can — or can’t — buy healthy food, find transportation to their doctor’s appointments, and be physically active in clean, safe parks.
The roadmap lays out 19 specific programs — from providing basic income to “prescribing parks” for social and health connections — led by multiple city agencies. The goal, first announced in November 2023, is to improve longevity and reduce disparities caused by heart- and diabetes-related diseases by 5% by 2030 and deaths due to screenable cancers by 20% by 2030.
That’s a challenge. Lifespan varies by as much as 20 years between predominantly Black and other neighborhoods in Boston, Chicago, and in New York City, Morse and her counterparts in those cities wrote in The Lancet in December. But as harrowing as early Covid-19 was for New Yorkers, by 2022 the racial inequities in Covid-19 mortality rates were nearly gone.
Morse, leader of the NYC Department of Health and Mental Hygiene, credits community health workers in the city’s Public Health Corps with helping to close that gap, and she envisions turning those workers and lessons learned in Covid to the ambitious longevity goals. In the past year, those community health workers have made more than 250,000 referrals for health and social needs as well as vaccinations, and done some 35,000 in-person community events. “It really does rebuild trust in government’s ability to get people what they need,” she said.
She is well aware that those goals, announced late last month, come as the Trump administration is issuing flurries of orders to end initiatives focused on diversity, equity, and inclusion.
“You can’t address longevity and inequities in longevity without looking at race and racism,” she said, before starting her day working at Kings County Hospital as an internal medicine hospitalist.
This interview has been lightly edited for length and clarity.
What is your point of departure to address chronic illness as a driver of longevity?
My career in medicine and public health and health equity has really been focused on this through line of understanding how social systems, structural systems, policy choices all shape an environment that creates conditions for health or not, and how those conditions are patterned by geography or neighborhoods, by race, by gender, by ability, and by so many other factors.
How does that translate into action?
Chronic disease doesn’t happen out of nowhere. We have very clear data that because about 2 million adults in New York City are at risk of food insecurity, that is directly related to the high rates of chronic diseases across 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 disease, of course, is not something the health department can tackle alone. It’s really a whole-of-government response.
The report has in its name “unacceptable inequities.” Given the Trump administration’s executive orders erasing diversity and equity from the federal government, has there been a chilling effect?
A new federal administration is going to have a significant impact on the conditions in which we work here in New York City. Withdrawing from the WHO is going to have an impact on our ability to coordinate on the threats of defunding the CDC. We do receive a large amount of federal grants. So these are all things that I’m extremely worried about.
How can you untangle longevity and racial inequities?
We have always said that our commitment and our mission is to protect and promote the health of all New Yorkers. And when we say all New Yorkers, that means people who are immigrants and undocumented, that means people who are of all races and origins, all genders, people who are seeking reproductive health care.
We are certainly looking for ways to partner with the federal government, but we have to acknowledge that our mission hasn’t changed and that we have to protect the health of New Yorkers. We have to find ways to do that, no matter what the shifts are and priorities at the federal level.
Increasing longevity is certainly an ambitious goal. How will you get there?
We are really focused on the social-structural policy context and not just individual behavior. This report is not just about wagging our finger at New Yorkers and saying, “Eat healthy.” It’s about saying, how do we make it easy for all New Yorkers, no matter their economic patterns or level of poverty, to eat healthy foods and acknowledge that that has not always been the case, that economic marginalization is a big driver of chronic disease.
You look further upstream, too.
Black Americans specifically have experienced marginalization over the past 400 years in this country. A number of the graphs in the report really demonstrate massive differences in disease burden by race/ethnicity. And that’s not biological. In communities of color that is really related to the story of marginalization.
How do you change that today?
We have extensive data, literally by community district, by borough, by neighborhood — data that showed us exactly where we need to focus our resources. That’s the point of equity, right? It’s resources according to need.
If I know that the rate of diabetes in the Bronx is two times that in other places, or that the rate of diabetes in high-poverty neighborhoods is two times that in low-poverty neighborhoods, that gives me a roadmap for exactly where I need to take my interventions.
Does that mean the community health initiative?
I learned about community health workers as a lifesaving and transformative public health intervention in rural Haiti over 15 years ago, working with Partners In Health, partnering with them to accompany neighbors to advance their health in all kinds of different ways.
It really does rebuild trust in government’s ability to get people what they need.
That initiative is not new in New York, is it?
The beauty of our community health worker initiative is that we launched it during Covid. We were able to improve vaccination rates in the neighborhoods that had the worst impact from Covid. Now that we’re out of the emergency phase of Covid, these community health workers have already been deployed, with the expertise that we need in other areas. We shifted that focus into chronic disease specifically.
What about guaranteed basic income as a tool?
We know there is a direct link between low income, poverty, and having a significant chronic disease burden. All across the country, whether it’s looking at pregnancy, chronic disease, or other outcomes, with guaranteed basic income, there is an actual improvement in chronic disease outcomes as well. That’s economic justice.
We’re hoping 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 in cancer?
We’ve made progress on tobacco use, but we still have a long way to go. We’re going to have a report coming out in the coming months that really details the racial inequities in screenable cancer across the city.
One of the paradoxes we see is that Black women have similar rates of mammography screening as everyone else, but they have higher rates of mortality from breast cancer. Those are the kinds of things that we want to begin to do something about, because that is a pattern that we find unacceptable.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.