Autora: Jo Ivey Boufford

1. Preventing Chronic Disease:
A New York City Perspective
Dr Jo Ivey Boufford, President
The New York Academy of Medicine
January 18, 2012

2. New York City
• Population: 8.4 million
• Size: 305 square miles (790 km2)
• Diversity
• Wide income disparities

3. Opportunities:
Municipal Governance
• Strong Mayor
• Significant local authority
• Good information systems
• Incentives
– Health care costs
– Mayoral commitment to public health
– Public accountability

4. Leading Causes of Death
New York City, 2009
Source: NYC DOHMH Bureau of vital Statistics 2009

5. 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

6. Challenges
• Open Space
• Perceived and actual safety
• Time
• Gaining consensus
• Maintaining public awareness

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
Age
Source: Kalache and Kickbusch, 1997

8. 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

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. Effect of Environmental Approaches to
Smoking Prevention
NYC, 2002-2010
NYC and NYS
tax increases
24 Smoke-free
21.6% 21.5% 21.7% workplaces
3-yr average 3-yr average 3-yr average Free patch Hard-hitting
22
programs media
21.5% start campaigns
20
19.2% NYS Federal
Tax
18 18.9% increase tax increase
18.3%
17.5% NYS
16 16.9% tax increase
15.8%15.8%
14
14.0%
12

11. 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

12. Estimated Cumulative Deaths Prevented
Due to Decreased Smoking, NYC
2002-2010
Sources: NYC Community Health Survey 2002, 2010; US Census Intercensal Estimates Program, 2002.

14. Media Messages About Sugary Drinks

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

16. Strategies:
Greening thru PlaNYC
Goal: 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

17. Making Outdoor Environments
Healthier

18. Strategies: Exercise
• Shape Up New York
• Play Streets
• School Based Exercise

19. 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

20. 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

21. 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