In New York City, health is often determined by ZIP code. Central Harlem, which is mostly black, has a life expectancy of 75.1 years. In the Financial District, which is mostly white, it’s 85.4.
In almost every health category studied, Central Harlem and East Harlem rank as two of the unhealthiest places in Manhattan. They have some of the highest rates of diabetes, cancer and chronic diseases, according to the New York City Department of Health and Mental Hygiene’s 2015 community health profiles.
City officials and health professionals are trying to address those neighborhood disparities by training practitioners on racial justice. They’re also investing millions of dollars in building health centers in some of the most unhealthy communities.
The goal is to train health practitioners to “interact with patients in a way that’s culturally responsive,” said Aletha Maybank, a founding director of the Center for Health Equity, a section of the health department.
In April, the city invested $3 million in three Neighborhood Health Action Centers, including one in East Harlem, which the City Council provided $600,000 to help build.
The action center model — which provides medical care, health and wellness classes, and community space — has been used in other cities that have deep health inequities, like Philadelphia, Los Angeles and Chicago.
The health department is working to normalize conversations around race, power and privilege, Ms. Maybank said. But the disparities still shape everyday life for residents.
Annette Robinson, who has lived in Harlem her entire life, said “the care is different downtown.”
“I think like anything else, doctors are more prone with people of color to just tell them what they need to do,” she said. “They don’t give a lot of the options or all of the information, and we don’t ask the questions.”
Now in her 50s, Ms. Robinson said access to care was not the issue, pointing to five clinics within blocks of her home. She said paying the rent and getting through daily life often trumped going to the doctor and eating well.
“Folks are just busy trying to survive. A lot of folks are not doing preventive care in New York City,” she said. “You just kind of don’t think it’s a priority on the list of things you feel you need to do.”
The combination of rising income inequality and residential segregation by race has led to these inequities, according to Mary Bassett, commissioner of the health department.
“Poor health outcomes tend to cluster in places that people of color call home and where many residents live in poverty,” Ms. Bassett said.
Disadvantages for people of color in the public health system started in the early 1900s, when most minority residents in specific areas were denied housing loans, a practice known as redlining. This created neighborhoods with high concentrations of minorities, along with poverty, unemployment and unhealthy lifestyles. Such discrimination also extended to health care, as seen in the Tuskegee experiments and, more recently, from 2006 to 2010, forced sterilizations in two California prisons. These cases have contributed to a distrust of medical care among people of color.
The long-term health outcomes of residential segregation are “decreased longevity, increased risk of chronic disease, and increased rates of homicide and other crime,” according to a 2017 study by Ms. Bassett and a team of researchers, one of the few studies that have examined racism in public health systems.
Many academics, scientists and elected officials who have a growing interest in social factors that affect poor health “remain resistant to identify racism as a root cause of racial health inequities,” according to the study.
Ms. Maybank said, “If we’re going to do health justice and health equity work, we need to look at ourselves.” Physicians, nurses, social workers and administrators have already started mandatory trainings on racial equity.
The health department is going through an internal overhaul called “Race to Justice,” Ms. Maybank said, in an “effort to become a multicultural, anti-racist organization.”
“Part of our requirements for our partners to be in the building is that they have to participate in racial justice and equity training,” she said, referring to the health action centers.
“We’ve already hosted one race training with all of our partners in the building, and that will be an ongoing training.”
While the work to close the gap has gained traction, disparities are not found only in health statistics, such as life expectancy. They are also seen in unequal housing, high incarceration rates and unemployment rates, and lack of access to healthy food and good schools, Ms. Maybank said.
“People are very much impacted by the environments in which we live,” she said. “It’s not just the physical environment, but the structures around us that create opportunity.”