This is public health as parlor game. The graph above uses new county-by-county data on life expectancy, and the dynamic it captures is that New York County — better known as Manhattan — started out worse than Suffolk County, the county that most overlaps with Boston. Then it shot up dramatically, so that it surpassed Boston, and the national average, and even notoriously healthy Massachusetts.
I’d wanted to compare the two cities because, well, of course, everything in Boston is really about the Red Sox, isn’t it? And this graph was reminiscent of far too many play-off seasons with the Yankees. But also because a recent article in The Lancet gave huge credit to Mayor Michael Bloomberg for New Yorkers’ longer lives. And I wondered whether Boston’s Mayor Thomas Menino, who is also very public-health-minded, could show similar gains.
When we floated this graph earlier this week and asked for reaction, a couple of commenters on The Washington Post’s Wonkblog, which linked to our post, lambasted us for mixing apples and oranges. Suffolk County includes some lower-income areas outside Boston, they pointed out, while Manhattan is rolling in riches. I consulted Goodarz Danaei, assistant professor of global health at the Harvard School of Public Health, and he confirmed the fruit problem.
“It’s an interesting comparison but not an easy one,” he said. “I agree with you and some of the commenters that it’s not quite apples to apples in this case, particularly because of the ways that counties are demarcated.”
“If you compare Suffolk with New York City, it’s not as dramatic as when you compare New York with the national numbers. Something has done much better in New York City for males — such as improvements in HIV treatment or the drop in homicides. But it’s hard to go beyond that without a rigorous analysis and with more comparable analytical units.”
For example. he said, the median household income in Manhattan is $97,000, compared to $45,000 in Suffolk. So “We’re picking up some of the worst parts of Boston and comparing them to the best parts of New York City.” Also, the graph could reflect population movements into and out of the cities, and there is no real way to track that.
Prof. Danaei praised Mayor Bloomberg’s public health programs, but was skeptical about claims that they have had a major effect on the life expectancy curves in the graph. Bloomberg took office in 2001, and the effects of public health programs could be expected to start being felt a few years later, he said, but in fact, the curve for male life expectancy somewhat flattens in the late 2000′s.
In his own research, he added, smoking and high blood pressure remain the main killers among non-communicable disease risk factors in New York City, mirroring the national picture. If public health programs there were so successful, “we would have expected preventable causes of death such as smoking and obesity to move down to lower ranks, and that doesn’t seem to be the case. So I’m personally skeptical at this stage to say this massive rise is all due to this particular set of public health programs.”
Life is complex — especially Manhattan life. Readers shared several other factors that could be at work:
I was under the impression that one of the major issues was that the deaths from AIDS in the 90s were being reduced by increasingly effective treatments, and that was one of the dramatic changes over that period, especially for younger males.
But it also seems to me that NYC might self-select folks who are healthier and more competitive to start with, with better financial resources. And are possibly at lower risk for fatal car accidents because nothing moves… I’d be interested to see it broken down by cause of death, especially at the older end.
It’s interesting how in the early 90s, NYC females beat out Boston females and then the same thing happened for males around the mid 90s. Knowing of any changes that went on during the 90s would be helpful. Or regarding tobacco use in particular, was there a large drop in smoking 20 years earlier? The statement about demographics and Manhattan pricing out poorer people, who are known to have poor health outcomes, seems to be critical.
Cigarette prices in NYC are incredibly high. I bet that reduces smoking and has something to do with it!
Restrictions on unhealthy foods would no doubt have an effect, but I am always struck by how much I walk when in Manhattan. I do wonder if New Yorkers just walk a whole lot more from place to place compared to other cities.
Readers, your own pet theories? Mine is that aside from HIV and homicides, Manhattan real estate just got so astronomically expensive that the city became ever more an enclave of the very rich, who tend to have better health. This is obviously just entertaining speculation, not serious analysis, but when you see how history converges with health in that graph, what does it make you think?
(Deep thanks to the Institute for Health Metrics and Evaluation at the University of Washington for sharing their data.)