Preventing Chronic Disease: A New York City Perspective


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Autora: Jo Ivey Boufford

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Preventing Chronic Disease: A New York City Perspective

  1. 1. Preventing Chronic Disease: A New York City Perspective Dr Jo Ivey Boufford, PresidentThe New York Academy of Medicine January 18, 2012
  2. 2. New York City• Population: 8.4 million• Size: 305 square miles (790 km2)• Diversity• Wide income disparities
  3. 3. Opportunities: Municipal Governance• Strong Mayor• Significant local authority• Good information systems• Incentives – Health care costs – Mayoral commitment to public health – Public accountability
  4. 4. Leading Causes of Death New York City, 2009Source: NYC DOHMH Bureau of vital Statistics 2009
  5. 5. Deaths Attributable to Risk Factors New Yorkers Aged 30-69 yearsSources: NYC DOHMH Bureau of Vital Statistics 2005-2007, NYC Community Health Survey 2005-2007, NYC Health and Nutrition Examination Survey2004, National Health and Nutrition Examination Survey 2003-2006, Continuing Survey of Food Intakes by Individuals 1989-1991
  6. 6. Challenges• Open Space• Perceived and actual safety• Time• Gaining consensus• Maintaining public awareness
  7. 7. A Life Course Approach to Chronic Disease Prevention Early Life Adult Life Older Age Growth and Maintaining highest Maintaining independence possible level of function development and preventing disability Disability threshold Rehabilitation and ensuring the quality of life AgeSource: Kalache and Kickbusch, 1997
  8. 8. Population Health GoalsTake 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
  9. 9. Selected Strategies to Promote Exercise and Prevent NCDs• Use of regulatory and taxing authority -tobacco and food• PlaNYC 2030• Transportation policy• Exercise programs
  10. 10. Effect of Environmental Approaches to Smoking Prevention NYC, 2002-2010 NYC and NYS tax increases24 Smoke-free 21.6% 21.5% 21.7% workplaces 3-yr average 3-yr average 3-yr average Free patch Hard-hitting22 programs media 21.5% start campaigns20 19.2% NYS Federal Tax18 18.9% increase tax increase 18.3% 17.5% NYS16 16.9% tax increase 15.8%15.8%14 14.0%12
  11. 11. Smoking Mass Media Campaign: Suffering Every Minute•Shows how smoking cancause long-term suffering•Focuses on emphysemaand stroke, which canrequire family members tocare for loved ones
  12. 12. Estimated Cumulative Deaths Prevented Due to Decreased Smoking, NYC 2002-2010Sources: NYC Community Health Survey 2002, 2010; US Census Intercensal Estimates Program, 2002.
  13. 13. Media Messages About Sugary Drinks
  14. 14. Decline in Sugary Drink Consumption in NYC 2005-2009 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.*Youth Risk Behavior Survey data refers to soda only**Take Care New York baseline***Includes adults who can be reached by cell phoneSources: NYC Community Health Survey 2002-2009. NYC Youth Risk Behavior Survey 2005, 2007, 2009.
  15. 15. Strategies: Greening thru PlaNYCGoal: all New Yorkers live • Doubled bike commuting within 10 minutes of green by adding 200 miles of space bike lanes, offering bike• 400 acres new parkland by racks, and requiring bike revitalizing waterfront storage in large office• New plazas through buildings reclamation of public right-of-way• 435,000 of 1 million trees planted
  16. 16. Making Outdoor Environments Healthier
  17. 17. Strategies: Exercise• Shape Up New York• Play Streets• School Based Exercise
  18. 18. 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
  19. 19. 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
  20. 20. 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