What is killing blacks in higher numbers at younger ages are the same things that kill
all of us.
Mainly cardiovascular disease, that means heart disease and stroke, and cancer of all
kinds.
So the same thing that takes people prematurely is the same burden that’s borne by all of
us.
It’s not a set of exotic or special diseases.
Well New York has gotten healthier and healthier in recent years and our life expectancy now
exceeds that of the United States as a whole.
So on average New York City is definitely a place to life to be healthy.
But that average doesn’t disclose the huge variation that we see by neighborhood.
We have recently completed a whole set of community health profiles that gives people
information on their community district which along with the community boards are the smallest
unit of decision making in New York City.
And we find that the community district actually Brownsville which is the neighborhood that
I moved to when I was a little girl and I came to New York has a life expectancy that
is 11 years shorter than the financial district.
Now Brownsville if we considered it a country and is doing a little bit worse than Peru,
a little bit better than Samoa and about the same as Sri Lanka in terms of life expectancy.
We’re talking about in a city that is one of the richest cities in the world, in the
country, that is the richest country in the world we have neighborhoods where the patterns
of health look like those of a developing country.
That’s not acceptable.
In fact it’s unconscionable.
The first thing that people might think in trying to explain that is that the people
in Brownsville are making a whole set of bad choices.
They’re not careful about what they eat.
They smoke too much.
They don’t exercise enough.
And that’s why they’re unhealthy.
The lifestyle hypothesis is really powerful and in many ways it replaced the genetic hypothesis
as an explanation for the poor health of the black population.
But let’s unpack what we mean by lifestyle.
Nobody picks a substandard building to live in with terrible issues of rodent infestation
and indoor allergens that trigger asthma.
That’s not a lifestyle choice.
No one picks a neighborhood, you know, because they want to feel unsafe there so that they
won’t use the park.
Or no one picks a neighborhood where there are no grocery stores or supermarkets that
carry a range of vegetables that allow them to make the healthy choices we want them to
make.
So when we talk about lifestyle we’re often mixing it up with poverty and all the constraints
that poor segregated neighborhoods place on people’s ability to live a health life.
So it’s not about choice.
It’s about the fact that people don’t have enough choice.