The Pandemic is Subsiding in New York City, but Health Inequity Remains In Focus
Your tax bracket, and your New York City neighborhood, may have more of an impact on your health than you realize.
By Chloe Conway
Children run around, parents enthusiastic about their energy expenditure. Teenage boys huddle on the basketball court, eager to prove their stamina and skills to their peers. An elderly woman sits on a bench, pulling off chunks of bread to feed to her pigeon friends.
In the background, exhaust wafts through the air. In the Hunts Point neighborhood of the Bronx, the Hunts Point Playground sits just a few blocks away from the largest wholesale produce market in the United States, the Hunts Point Terminal Market. A few hundred feet away from that market, is the Hunts Point Cooperative Market, one of the largest food distribution facilities in the whole world. These facilities cause an endless stream of delivery trucks to constantly pass through the neighborhood, their presence hard to ignore.
This has consequences, especially for the children. The asthma hospitalization rate for children in the Mott Haven/Hunts Point sections of the South Bronx is 23.2 per 1000 children, nearly 140% higher than New York City’s overall rate of 9.9 per 1000 children. The Mott Haven and Hunts Point neighborhoods of the Bronx are commonly referred to as “Asthma Alley.”
A borough away, on Manhattan’s Lower East Side, Connor Crennan steps out of a steam room at the Orchard St. location of the popular fitness club chain, Equinox. Kiehl’s skin care products, which retail for upwards of $30, lay out on display in the men’s locker room, ready to be used by paying members. Crennan is one of many who pay a monthly fee of $270 to belong to the club. Members receive access to all sorts of equipment, classes, and other luxuries. The club even promotes high-end athletic wear in its retail section, with brands like Lululemon, Vuori, and Alo dripping $118 tags, for a pair of leggings.
Most gyms, let alone Equinox, are too expensive for the average worker in New York City. East of Central Park, Google Maps shows not a single gym between 99th St. and 115th St.. In Hunts Point, only one gym is displayed, listed as “temporarily closed.”
New York City has come out as the third best city in the U.S. for an “active” lifestyle, according to an article published by Time Out. How? How is it that a short subway ride could lead to such dramatic differences in health? New York has always been a tale of two cities, but when it comes to health, it’s often a tale of two lives. And after a pandemic that claimed the lives of almost 46,000 New Yorkers — a death note written along racial and socioeconomic lines — closing that gap seems more important than ever.
The lessening concern with Covid in the medical community, relative to what it was, may mean more time to study, and shift, these long-standing patterns of health inequity in vulnerable communities. Air quality, food accessibility, and exercise are only some of the areas that are being researched by medical professionals and social justice advocates alike, and their importance has consistently been proven. The end goal here is change.
Still, where do we even begin?
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The city’s Health Department defines health equity as achieved “when disparities in health, and the key social determinants that shape these disparities, are eliminated.” The disparities are evident; it’s the “social determinants” that are more complicated.
In neighborhoods throughout the city — from Harlem and the South Bronx to Brownsville and Jamaica — what people are exposed to varies dramatically. First, you have the environmental factor, in terms of the air actually breathed.
“Warehouses, facilities that attract trucks, these will impact the air in a particular neighborhood,” says Sabah Usmani, a PhD candidate in Columbia University’s Climate and Health Program. Usmani is an urban planner whose research involves observing neighborhood influences on environmental health. “There is certainly more of a concentration of these facilities in the Bronx and northern Manhattan.”
The answer then may seem obvious: clean up those areas, and health will improve. But the prevalence of an environmental factor, in a certain area, does not necessarily equate to an increased risk of disease in that area. “Midtown Manhattan has the most air pollution, but it’s not the place with the greatest rates of asthma,” says Usmani. “A person’s socioeconomic status impacts how their health is affected by the air they breathe.”
So you have to untangle the economics — of the truck driver who needs to work at Hunts Point, or the intense traffic that jams Midtown — and that’s not always easy. “These are places where people are getting jobs,” Usmani added.
In 2021, during the second wave of the COVID-19 pandemic, almost 2.7 million New Yorkers lived in poverty, according to the Office of the New York State Comptroller. That’s almost 14% of all New Yorkers. Additionally, these poverty rates were higher in Black and Brown communities, and outsized amongst female heads of household, people with disabilities, and those with less than a high school education. These rates also include children.
And typically, income is correlative to health.
In East Harlem, where the median income sits just under $34,000, and the unemployment rate sits at about 12%, this is a harsh truth.
“Chronic illnesses are dominant in East Harlem,” says Dr. Yasmin Meah, Professor of Medicine, Medical Education, Geriatrics and Palliative care at Mount Sinai’s Icahn School of Medicine.
Dr. Meah is another leading figure in the fight for health equity, having founded the East Harlem Health Outreach Partnership back in 2004. She is intent on providing health care for as many people in the city, who need the assistance, as she can. “The Partnership is basically a joint venture between myself, the faculty, and the students at Mount Sinai to create a free clinic that really emphasizes chronic illness management,” says Dr. Meah.
Dr. Meah’s efforts to help vulnerable community members, like those in East Harlem, are a part of what she hopes is a larger movement amongst members of the medical community.
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But it’s not just what people are exposed to, advocates say. Equity is about access — what residents can attain in their neighborhood, and what feels far out of reach. Transportation is one such example.
Lyft’s partnership with the New York City Department of Transportation, through Citi Bike, has received tons of attention from New Yorkers in recent years. The partnership launched 10 years ago this month, and the number of bikes made available to New Yorkers is estimated to reach over 40,000 by the end of 2023.
Still, there are heavier concentrations of these docking stations in downtown Manhattan and Brooklyn. Installation is no simple feat, though.
“Bike lanes are challenging to put in, there’s a whole process that involves community boards, and elected officials,” says Inbar Kishoni, Community & Equity Programs Manager at Lyft. Kishoni, who previously worked for the Department of Transportation for over a decade, has a passion for improving the streets of the city, and thus the lives of those who inhabit them. “It often does come down to political will, in dedicating time and space.”
Kishoni has a goal — make this city a safe place to walk and bike for everyone. A safer city is a healthier one.
“Pollution, social isolation, and lack of movement are only some of the problems that motor vehicles present,” says Kishoni. “We can mitigate that, and empower communities in the process.”
With regards to bike accessibility, Kishoni emphasizes the importance of asking questions.
“What barriers might one have, which we can break down, to make it as easy as possible to access this tool?” she asks. “This is a tool that can be used for transportation, for exercise, or even just for fun.”
Walking and cycling are known “stress relievers” and “depression fighters,” among other things, and the expansion of Citi Bike may prove to be extremely beneficial for suffering individuals, in any neighborhood. Citi Bike has a large network of supporters, too, including politicians like Mayor Eric Adams. Mayor Adams has been vocal about “transit equity,” and the need for these stations in low-income neighborhoods. In districts where the majority of residents are Black, there are 68 percent fewer streets with a protected bike lane, 53 percent fewer bike parking spaces per capita, and a 39 percent higher rate of traffic injuries, according to a summary on the Transportation Alternatives website.
Crennan feels confident to walk and bike in his neighborhood.
“The city is a different place when it warms up and people can actually be outside comfortably,” says Crennan. “It’s an invigorating feeling, finding an open street to explore.”
Still, the concentration of Open Streets unsurprisingly decreases as you travel farther uptown, or across the East River.
But in some neighborhoods, many who reside in public housing are not eager to leave the confines of their walls, for safety reasons. “Crime rates and drug-use make it so that a lot of my patients are hesitant to go outside,” says Dr. Meah. “They don’t want to interact or engage, and not from a place of judgment, but from a place of fear.”
And that sort of environment carries with it health implications of its own. “The literature is clear that more-stressful living conditions do trigger depression, although when this is normal misery versus a mental disorder is controversial,” says Dr. Jerome Wakefield, Professor of Conceptual Foundations of Psychiatry at the NYU School of Medicine. “Both depression, and taking of antidepressants, are higher in lower socioeconomic groups.”
In recent years, policymakers have prioritized equity in decisions of resource allocations. Trees are a vivid example of that. “Parks is celebrating a massive climate milestone reached in tree canopy expansion,” said a spokesperson for the NYC Parks Department, in a press release from last September. “More trees have been planted on city streets this past fiscal year than in the past five fiscal years, with over 13,000 planted in FY22.”
For Dr. Meah, trees are indicative of how the built environment affects our health outcomes. The Heat Island Effect, for example, details that urban environments experience higher temperatures, due to absorption and re-emission of heat by built structures. Trees can help.
“I used to get so frustrated about the lack of tree canopy, but believe it or not, they are here!” says Dr. Meah. “The thing is, they are baby trees so they have not reached the height to provide heat protection just yet. In a few years, though, there will be some serious heat mitigation.”
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But like most things in America, health is a cost. It is something bought and sold, with a price tag attached. And nowhere is that more apparent than what we eat.
According to the U.S. Bureau of Labor Statistics, prices in the New York City area increased by 4.6% between March 2022 and March 2023, and food prices alone saw an increase of 8% over the last year. Rising prices these days may make it feel as if everything is expensive.
That inability to afford healthy food is at the heart of why Liz Alvarez and her team helped to establish The Connected Chef, a food distribution program that focuses on delivering fresh produce, and other nutritionally-dense foods, to families in need in the Queens borough. It initially began, seven years ago, as food-education classes given to both adults and children. They were originally taught how to make all sorts of healthy foods.
“When Covid hit, the mission pivoted closer into what it is today,” says Alvarez. “It became about getting nutritionally-dense food, and fresh produce, to 50 families. Then, at the height of Covid, it grew to 700 families.”
In April of 2020, researchers at NYU surveyed 5,600 adults from across the country, to assess their food insecurity. The study found that 14.7 percent of participants reported having “low” or “very low” food security in their households. This number grew to 17.5 percent among households with children.
The Connected Chef already had members within the organization that were chefs, or line cooks, or held other positions in the service and culinary industries. The pandemic infamously hit these industries particularly hard.
“Sometimes the folks affected were not able to receive government assistance, due to immigration status, and so it really became about helping the community,” says Alvarez. “The only parameters for these deliveries were that you were unemployed due to Covid, and that you did not qualify for government assistance. We did not ask for verification, or paperwork. It was about trust within the community.”
Rising food prices presented challenges for the Connected Chef, but this did not stop the organization from continuing to help communities in Queens.
“Last year, we had to stop doing deliveries to these homes,” says Alvarez, “but due to funding we received from a private donor last year, we have been able to reinstitute free deliveries. We relaunched in March, and we’re delivering free grocery boxes, 100 per week, to about 100 families.”
The work that the organization does extends beyond households, though. “We also deliver boxes to three different schools here in Queens, and we let the communities there decide where the boxes should go,” says Alvarez. “It’s really about getting people involved, letting folks have those conversations, and encouraging them to work together with each other, and with us.”
Action around health equity tends to be thought of as a national problem, but often the issues are hyperlocal, advocates say. That gap in awareness has ripple effects. “The majority of policy makers in the United States, whether federal, state, or local, made it to the government by way of institutions and professions that are out of reach for most Americans,” claims Daniel E. Dawes, in his book The Political Determinants of Health. “They tend to be more educated and affluent than the people they represent, and they tend to focus on informing, developing, or executing policies that govern their professional backgrounds and experiences.”
To solve health equities, advocates say, solutions have to come from those closest to the problem. “Often, these communities know about the issues present,” says Usmani. “It’s about educating others.”
In the Bronx, Alexander Levine, a medical student at the Albert Einstein School of Medicine, wanted to do just that. “I was interested in looking at how infrastructure, and transportation, impact health,” says Levine. “I got several classmates involved. I found good, local, public health research, as well as information on a more national scale.”
Levine is now the Director and Founder of Bronx One Policy Group, a group of leaders advocating for health efforts in hospital systems throughout the borough.
Levine noticed that more attention was being brought to these issues, and he was inspired to join the effort.
“A lot of policymakers in the Bronx have been doing work around thinking of the built environment as a health issue,” says Levine. “The Green New Deal is a good example of that. Because they were interested in it, I thought that it would be a good time to create momentum.”
On the Bronx One Policy Group website, there are podcast episodes with prominent political representatives, medical experts, and other important figures, all of whom discuss issues relating to infrastructure, and overall health, in the Bronx.
Representative Ritchie Torres, of New York’s 15th congressional district, was one such podcast guest, appearing on an episode titled “Capping the Cross Bronx Part II.” In the episode, discussion about the harmful effects of the Cross Bronx Expressway is had. Torres refers to it as a “plague.” He, too, makes the argument that the public health of the Bronx has more to do with “structural barrier” than it does “personal behavior,” and Torres has continuously pushed for air-quality monitoring in underserved communities.
As Dawes points out, it takes a change in consciousness from those higher up to make the difference on the ground. “If you don’t care about food insecurity, job insecurity, housing insecurity, then you really don’t care much for health,” says Dr. Meah. “You aren’t looking out for the city, and those who occupy it.”
If other politicians follow in Rep. Torres’ footsteps, or even in Mayor Adams’, the structure of the city might really shift, for the better. Some of those aforementioned “barriers” could come down.
“The built environment historically has not responded favorably to the needs of vulnerable populations here. Whether they’re disabled, or socioeconomically vulnerable, there’s a misalignment between design and health,” says Dr. Meah. “But that is changing.”
