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

• f Health

Urban/Neighborhood Characteristics Health System Characteristics

Economic base Health care resources Housing Organizational factors Transportation Health insurance coverage Socio-economic and demographic Social safety-net Physical environment

Relationships Among Cities, Population Health and Health System Characteristics

Measures of Population Health: New York, London, Paris, Tokyo and Hong Kong

(2000–2004)

Infant mortality (deaths before age 1 per 1,000 live births) Life expectancy at birth: males (years) Life expectancy at birth: females (years) Life expectancy at 65: males (years) Life expectancy at 65: females (years)

New York

6.2 74.5 (2000) 80.2 (2000) 17.0 (2000) 20.1 (2000)

Greater London

5.4 76.1 (2000–2004) 80.9 (2000–2004) 15.6 (1997–1999) 19.2 (1997–1999)

Paris and First Ring**

4.01 77.63 (2002) 83.13 (2002) 17.7 (1999) 21.7 (1999)

Tokyo (23 wards)

2.8 (2001–2004) 77.7 (2000) NA 17.7 (2000) 22.2 (2000)

Hong- Kong

3.0 (2000) 78.0 (2000) 83.9 (2000) 17.35 (2000) 21.53 (2000)

14 14

Self-reported Chronic Conditions among Those Aged 65+* (2008)

41.6 17.3 11.1 2.3 61.0 21.8 52.2 10.8

10 20 30 40 50 60 70

Hypertension Diabetes High Cholesterol Asthma Prevalence Rate (%) HK NYC

*We did not have find comparable survey data for London

Self-Reported Health Status Population 65+, 2008

0.3 3.8 35.3 60.5 9.4 16 36 38.6

10 20 30 40 50 60 70

Excellent Very Good Good Fair to Poor Hong Kong New York City

City Categories Units of Analysis Megacity Metropolitan Region World City Urban Core Mid-size City Central Business District Smaller City Suburbs Distressed vs. Prosperous City Neighborhoods

Some Useful Distinctions in Comparing Cities, Population Health, and Health Care Systems

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) Central Tokyo 8.1 million (2000) Paris and First Ring 6.2 million (1999) Greater London 7.3 million (2000)

4.7 2.6 2.1 6.0 4.0 2.1

Hauts-de- Seine Val-de- Marne Seine-Saint Denis Bronx Manhattan Queens Brooklyn Staten Island

1.5 6.5

Inner Tokyo Outer Tokyo Outer London Inner London

Manhattan: Infant Mortality 1988-1997

5.5

5.5 9.1 5.8 3.9

12.9

11.2

18.3 15.4

7.4

4.8 6.3

6.7

Highest (red): Community Districts: 5, 10, and 11. Lowest (blue): Community Districts: 1, 2, and 8.

Infant Mortality Rate in Paris By Arrondissement 1988-1997

Source: Rodwin and Neuberg,” Infant Mortality and Income.” American Journal of Public Health

6.1 4.4 6.6 6.5 6.8 6.8 7.1 7.1 7.8 2.5 6.7 7.8 7.6 6.0 7.6 6.8 4.7 6.6 6.4 7.5 6.4 7.0 5.6 6.3 6.8

Highest (red): Arrondissements: II, V, and VIII. Lowest (blue): Arrondissements: III, IV, and VI.

1988-1992

1993-1997

• Life expectancy at birth
• Probability of survival

from specific diseases

• Premature Mortality
• Avoidable Mortality
• Access to Primary

Care

• Access to Specialty

Care

Health Outcomes and Health System Performance

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

0.8 0.5 0.93 0.75 0.2 0.4 0.6 0.8 1 Manhattan Paris Inner London Hong Kong Age-adjusted rate/1000

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.

23.4 17.9 24.2 29.8 10 20 30 40 50 Manhattan Paris Inner London Hong Kong Percentages

Avoidable Mortality as a Percent of Total Mortality in Four World Cities

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 Hospital Conditions Examples:

• Bacterial Pneumonia
• Congestive Heart

Failure

• Asthma
• Cellulitus

Marker Conditions Examples:

• Acute Myocardial

Infarction

• Appendicitis
• GI obstruction
• Hip fracture

Avoidable Hospitalization: A Measure of Access to Primary Care

We use the list of ICD-9/ICD-10 Codes from the definition used by Dr. Joel Weissman and colleagues

29 29

AHC Rate in Population Aged 65+, 2006-2008

49.5 55.7 36.2

10 20 30 40 50 60 70 HK NYC London

Rate* (per 1,000)

* Age Adjusted to 2000 WHO Population

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

• ther 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.