Friday, June 15, 2012

New York City: Better Governance Leads to Better Health

We recently discussed the growing health issues from non-communicable diseases (NCDs) in developing countries (The Growing Global Threat from Non-Communicable Diseases). The issue arises because child mortality is decreasing, leading to longer-lived adults, but the healthcare systems and regulatory agencies are not yet in place to address the activities that can be deleterious to adult health. The NCDs are generally preventable. They include cardiovascular disease, cancer, diabetes, stroke, and respiratory illnesses. The discussion ended with this conclusion:
"The international community can do much to address this issue, but, ultimately, the responsibility lies with the developing countries themselves. Just as better governance led to the improvements is child mortality mentioned at the beginning, better governance will be required to address the more subtle issues associated with NCDs."

Natalie Wolchover provides an article that supports this notion using New York City as an example: Want to Live Longer? Move to NYC. She uses information provided by the University of Washington’s Institute of Health Metrics and Evaluation (IHME).

"While life expectancy in many parts of the United States is dropping, it has increased by 10 years in Manhattan since 1987. Researchers largely attribute that rise — the fastest in the nation — to a crackdown by the New York City health department on unhealthy behaviors."

"Manhattanites can now expect to live to the ripe old age of 82, and the average life expectancy across all five New York City boroughs is 80.6 years. That's three years beyond the national average, and a striking turnaround since the city's low point in 1990, when life expectancy there trailed the U.S. average by three years."

Most of the improvement in longevity can be attributed to improvement in individual health.

"Mirroring the national average, some 87 percent of deaths in the Big Apple result from noncommunicable diseases — preventable ailments such as heart disease and lung cancer — but the number of yearly deaths from those causes is steadily falling. The IHME researchers determined that more than 60 percent of the increase in New Yorkers' life expectancy since 2000 can be attributed to reductions in heart disease, cancer, diabetes and stroke."

And how were these reductions attained? It required aggressive good-governance actions by city officials.

"Lead researcher Ali Mokdad said the reduction is largely thanks to aggressive efforts by city health officials to simply take away unhealthy choices from residents. The health department has, for example, banned trans fats, prohibited smoking in public spaces and hiked taxes on cigarettes. It has also rolled out hundreds of miles of new bicycle lanes, mandated the use of calorie labels on menus in chain restaurants and plastered posters up in subways with information about the risks of obesity and the benefits of preventive health services."

NCDs are not only life threatening, they are expensive to deal with because they often lead to chronic conditions that require continual medical care.

The IHME data base provides data on life expectancy at the state level and at the county level for each state up through 2009. It is interesting, and disturbing, to note the amount of variation that exists within the states. Utah has the highest value of 78.8 years, while Mississippi comes in last at 71.8 years. In general, the states with the highest life expectancy tend to be what might be described as "activist government" states. Utah seems to be an interesting exception. The poorest performers tend to be "small government" states, mostly located in the South.

Wolchover uses data provided by the CIA World Fact Book to locate the US as a whole at number 50 worldwide in life expectancy. If Mississippi were a country it would be ranked 133, just below the Philippines. In Quitman or Tunica Counties in Mississippi, where the life expectancy is a mere 66.1 years, the rank would be 166 and fall just below Pakistan.

While these numbers are a source of embarrassment, they should also remind us that poor health costs money, and the states that insist on the right to allow their citizens to die young, are really depending on a subsidy from the other states in order to maintain their bad habits.

Perhaps "big" government and "small" government are the wrong categories. How about "good" government?

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