Why are New Yorkers living longer?
It’s a question that deserves a deeper look in the wake of a widely publicized recent article in The Lancet showing that life expectancy in New York City rose to a historic high of 80.6 years in 2009, surpassing the national average.
As recently as 1990, life expectancy in NYC trailed the national average by three years. The Lancet article suggests that the latest remarkable increase in life expectancy is due to health department efforts to reshape the city’s social environment.
As a public health professional at the Center for Public Health Sciences at Albert Einstein College of Medicine, I recognize the importance of creating conditions that promote health across the population and the need for strong leadership by health departments. However, the empiricist in me wonders: can incremental public health actions really result in such rapid and large improvements?
New York City, like the U.S. as a whole, has experienced increasing life expectancies over the past several decades (although the U.S. still lags behind other developed nations). As the graph contained in this link shows, the rate of increase in N.Y.C. accelerated starting around 1995 while remaining steady nationwide. Since then, life expectancy in each New York City borough has surpassed the national average, with the exception of The Bronx, the city’s poorest borough, where life expectancy is lower than that for the nation and far below the rest of the city.
Recent public health efforts to prevent obesity in New York City most likely have had a limited impact on current life expectancy statistics—obesity has increased among adult New Yorkers in the past decade, and the small but promising reduction found among young school-age children would not affect life-span estimates.
The city’s life expectancy trends may be explained in part by a combination of factors unique to New York. Since the 1990s, a variety of dynamics has been in play:
- Demographic changes driven by large influxes of Asian and Latino immigrants, who have higher life expectancies than the average resident, including whites.
- Development of effective therapies for HIV/AIDS and vigorous community advocacy around the AIDS crisis, which lengthened life expectancy among young adults in NYC.
- Large declines in drug-related deaths and homicides, leading causes of death among young adults, as the city’s crack epidemic waned.
- Steady annual declines in infant mortality.
New York City does benefit from one of the most proactive public health departments in the country. Over the past decade, the city’s Department of Health and Mental Hygiene has removed artificial trans-fat from restaurants, required calorie labeling in food service establishments and helped phase out whole milk from public schools. The city’s forceful tobacco-control efforts, beginning in 2002 with an increase in the cigarette excise tax (now the highest in the nation), probably contributed to the sizable decrease in deaths between 2001 and 2010 due to heart disease, the city’s leading cause of mortality.
But the short-term aim of public health campaigns, such as the health department’s current proposal to limit the size of sugary drinks sold in restaurants, movie theaters, delis and other locations to 16 ounces, is to begin changing social norms by altering the environment that shapes norms and behaviors. This can eventually lead to public support for policy change and the adoption of healthier behaviors.
As with tobacco-control efforts, which unfolded over decades and eventually showed success, the impact of current small steps will take time to accumulate and detect.
The challenge will be to maintain the political will to allow our health department to experiment with and evaluate different approaches, including those that confront corporate interests, and sustain the most promising programs and policies.
JOIN THE DISCUSSION: What do you think of efforts to improve public health via government campaigns such as those in New York?