CITIES, HEALTH AND WELL-BEING NOVEMBER 2011 Cities, Population - PowerPoint PPT Presentation

CITIES, HEALTH AND WELL-BEING NOVEMBER 2011

Cities, Population Health and Health Care Systems: New York, London, Paris, Tokyo, Hong Kong November 16, 2011 Victor G. Rodwin Professor of Health Policy and Management http://wagner.nyu.edu/rodwin Wagner School/New York University

Increasing Attention to the Social and Environmental Determinants of Health

Relationships Among Cities, Population Health and Health System Characteristics Urban/Neighborhood Health System Characteristics Characteristics Economic base Health care resources Housing Organizational factors Transportation Health insurance coverage Socio-economic and demographic Social safety-net Physical environment

Measures of Population Health: New York, London, Paris, Tokyo and Hong Kong (2000 – 2004) Life expectancy at Life expectancy Infant mortality Life expectancy at Life expectancy at birth: males at birth: females (deaths before 65: males (years) 65: females (years) (years) (years) age 1 per 1,000 live births) New York 6.2 74.5 80.2 17.0 20.1 (2000) (2000) (2000) (2000) 5.4 76.1 80.9 15.6 19.2 Greater London (2000 – 2004) (2000 – 2004) (1997 – 1999) (1997 – 1999) 4.0 1 77.6 3 83.1 3 Paris and 17.7 21.7 First Ring** (2002) (2002) (1999) (1999) 2.8 77.7 NA 17.7 22.2 Tokyo (23 wards) (2001 – 2004) (2000) (2000) (2000) 3.0 78.0 83.9 17.35 21.53 Hong- Kong (2000) (2000) (2000) (2000) (2000)

Self-reported Chronic Conditions among Those Aged 65+* (2008) 70 61.0 60 Prevalence Rate (%) 52.2 50 41.6 HK 40 NYC 30 21.8 20 17.3 11.1 10.8 10 2.3 0 Hypertension Diabetes High Asthma Cholesterol *We did not have find comparable survey data for London 14 14

Self-Reported Health Status Population 65+, 2008 70 60.5 Hong Kong 60 50 New York City 38.6 40 36 35.3 30 20 16 9.4 10 3.8 0.3 0 Excellent Very Good Good Fair to Poor

Some Useful Distinctions in Comparing Cities, Population Health, and Health Care Systems City Categories Units of Analysis Megacity Metropolitan Region World City Urban Core Central Business Mid-size City District Smaller City Suburbs Distressed vs. Neighborhoods Prosperous City

New York, London Paris and Tokyo: Units of Analysis

FOUR WORLD CITIES: urban core and first ring populations (millions) New York City 8.0 million (2000) Paris and First Ring 6.2 million (1999) Bronx Seine-Saint Denis Manhattan Queens Hauts-de- 1.5 Seine Staten Island 4.0 2.1 Brooklyn 6.5 Val-de- Marne Greater London 7.3 million (2000) Central Tokyo 8.1 million (2000) Outer Outer London Inner Inner 4.7 Tokyo London Tokyo 6.0 2.6 2.1

Manhattan: Infant Mortality 1988-1997 7.4 11.2 18.3 15.4 5.8 3.9 Highest (red): 12.9 Community Districts: 5, 10, and 11. 9.1 Lowest (blue): 6.3 Community Districts: 1, 2, and 8. 4.8 6.7 5.5 5.5

Infant Mortality Rate in Paris By Arrondissement 1988-1997 6.8 Highest (red): 6.4 6.4 6.5 Arrondissements: II, V, and VIII. 6.0 Lowest (blue): 6.6 Arrondissements: III, IV, and VI. 7.5 7.6 6.8 4.4 6.8 6.8 7.1 7.6 6.3 7.1 7.0 2.5 4.7 7.8 7.8 5.6 6.1 6.6 6.7 Source: Rodwin and Neuberg, ” Infant Mortality and Income. ” American Journal of Public Health

1988-1992

1993-1997

Health Outcomes and Health System Performance - Life expectancy at birth - Probability of survival from specific diseases - Premature Mortality - Avoidable Mortality - Access to Primary Care - Access to Specialty Care

Defining “ Amenable/Avoidable Mortality ” • Premature death (prior to 75 years) from diseases amenable to screening and medical intervention • Examples include: – ischemic heart disease – several malignancies: breast, colon, cervix, skin – tuberculosis – Maternal deaths

Avoidable Mortality Rates in Four World Cities 0.93 1 Age-adjusted rate/1000 0.8 0.75 0.8 0.6 0.5 0.4 0.2 0 Manhattan Paris Inner London Hong Kong Average rates over 4 year period -- 1999-2003 Excludes deaths from IHD Source: Chau, Woo, Chan, Weisz and Gusmano. Avoidable mortality pattern in a Chinese population --Hong Kong, China. European J. of Public Health 1-6, 2010.

Avoidable Mortality as a Percent of Total Mortality in Four World Cities 50 40 Percentages 29.8 30 24.2 23.4 17.9 20 10 0 Manhattan Paris Inner London Hong Kong Source: Chau, Woo, Chan, Weisz and Gusmano. Avoidable mortality pattern in a Chinese population --Hong Kong, China. European J. of Public Health 1-6, 2010.

Avoidable Hospitalization: A Measure of Access to Primary Care Marker Avoidable Hospital Conditions Conditions Examples: Examples: • Bacterial Pneumonia • Acute Myocardial Infarction • Congestive Heart Failure • Appendicitis • Asthma • GI obstruction • Cellulitus • Hip fracture We use the list of ICD-9/ICD-10 Codes from the definition used by Dr. Joel Weissman and colleagues

AHC Rate in Population Aged 65+, 2006-2008 70 60 55.7 49.5 Rate* (per 1,000) 50 40 36.2 30 20 10 0 HK NYC London * Age Adjusted to 2000 WHO Population 29 29

Key Points • Hong Kong has better population health than other world cities but it ’ s difficult to disentangle role of the health care system from city and population characteristics, and other social and environmental factors. • We need more comparative research among cities and their neighborhoods, which examines alternative strategies to protect and promote population health and to deliver health care services. • A noteworthy convergent trend in NYC, London and Paris: Increasing recognition that the neighborhood is a critical unit for interventions targeted to improving the health of populations at highest risk.