Preventing Chronic Disease:

A New York City Perspective

Dr Jo Ivey Boufford, President

The New York Academy of Medicine

January 18, 2012

New York City

• Population: 8.4 million• Size: 305 square miles (790 km2)

• Diversity• Wide income disparities

Opportunities: Municipal Governance

• Strong Mayor • Significant local authority• Good information systems• Incentives

–Health care costs–Mayoral commitment to public

health–Public accountability

Leading Causes of Death New York City, 2009

Source: NYC DOHMH Bureau of vital Statistics 2009

Deaths Attributable to Risk Factors

New Yorkers Aged 30-69 years

Sources: NYC DOHMH Bureau of Vital Statistics 2005-2007, NYC Community Health Survey 2005-2007, NYC Health and Nutrition Examination Survey 2004, National Health and Nutrition Examination Survey 2003-2006, Continuing Survey of Food Intakes by Individuals 1989-1991

Challenges

• Open Space• Perceived and actual safety • Time• Gaining consensus• Maintaining public

awareness

A Life Course Approach to Chronic Disease Prevention

Age

Fu

nct

ion

al

cap

aci

ty

Early Life

Growth and developme

nt

Adult Life Maintaining highest

possible level of function

Older Age

Maintaining independence and

preventing disability

Rehabilitation and ensuring the quality of

life

Disability threshold

Range of functionin individuals

Source: Kalache and Kickbusch, 1997

Population Health Goals

Take Care NY – 10 Goals: metrics reported annually

• Quality Health Care• Tobacco Free• Promote Physical activity and Healthy

Eating• Reduce Risky Alcohol and Drug Use• Recognize and Treat Depression• Heart Healthy; Prevent Cancers, HIV and

STDs• Healthy Children & Healthy

Neighborhoods

Selected Strategies to Promote Exercise and

Prevent NCDs• Use of regulatory and taxing authority

-tobacco and food • PlaNYC 2030• Transportation policy• Exercise programs

Effect of Environmental Approaches to Smoking Prevention

NYC, 2002-2010

21.6% 21.5% 21.7%

21.5%

19.2%

18.3%18.9%

17.5%16.9%

15.8%15.8%

14.0%

12

14

16

18

20

22

24

3-yr average 3-yr average 3-yr average

NYC and NYS

tax increasesSmoke-

free workplaces

Free patch

programs start

Hard-hitting

media campaign

sNYS Tax increase

Federal

tax increase

NYS

tax increase

Smoking Mass Media Campaign:

Suffering Every Minute• Shows how smoking can cause long-term suffering

• Focuses on emphysema and stroke, which can require family members to care for loved ones

Estimated Cumulative Deaths Prevented

Due to Decreased Smoking, NYC2002-2010

Sources: NYC Community Health Survey 2002, 2010; US Census Intercensal Estimates Program, 2002.

Media Messages About Sugary Drinks

Decline in Sugary Drink Consumption in NYC

2005-2009*Youth Risk Behavior Survey data refers to soda only

**Take Care New York baseline

***Includes adults who can be reached by cell phone

Sources: NYC Community Health Survey 2002-2009. NYC Youth Risk Behavior Survey 2005, 2007, 2009.

*Youth Risk Behavior Survey data refers to soda only

**Take Care New York baseline

***Includes adults who can be reached by cell phone

Sources: NYC Community Health Survey 2002-2009. NYC Youth Risk Behavior Survey 2005, 2007, 2009.

*Youth Risk Behavior Survey data refers to soda only

**Take Care New York baseline

***Includes adults who can be reached by cell phone

Sources: NYC Community Health Survey 2002-2009. NYC Youth Risk Behavior Survey 2005, 2007, 2009.

Community Health Survey

*Youth Risk Behavior Survey data refers to soda only

**Take Care New York baseline

***Includes adults who can be reached by cell phone

Sources: NYC Community Health Survey 2002-2009. NYC Youth Risk Behavior Survey 2005, 2007, 2009.

Strategies:Greening thru PlaNYC

Goal: all New Yorkers live within 10 minutes of green space

• 400 acres new parkland by revitalizing waterfront

• New plazas through reclamation of public right-of-way

• 435,000 of 1 million trees planted

• Doubled bike commuting by adding 200 miles of bike lanes, offering bike racks, and requiring bike storage in large office buildings

Making Outdoor Environments Healthier

Strategies: Exercise

• Shape Up New York• Play Streets• School Based Exercise

Remaining Issues for New York City

• Disparities–Which neighborhoods get the innovations?

• Sustainability–Community buy-in is needed (esp. for post-Bloomberg era)

• Results–Impact evaluations are not yet in

Lessons Learned• Approaches that change environment more effective than efforts to change individual behavior • Improvements require support from the highest levels of government and agencies beyond health• Partnerships beyond government key for sustainability• Preventing non-communicable diseases is not necessarily costly

Thoughts for National Leadership

• Development of an Urban Policy• Develop An Active Aging Policy• Encourage place based strategies • Apply a “health lens” to

infrastructure investments and government policy

• Promote inter-sectoral governance models