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New York, New York: A Helluva Town

July 31, 2013
Photo courtesy of Jeffery Turner

Photo courtesy of Jeffery Turner

New York City has been in the news lately, and for good reasons.

In the misty past of December, 2011, Mayor Bloomberg and Department of Health Commissioner Dr. Thomas Farley took justifiable pride in announcing that their years of sustained effort to strengthen nutritional standards and expand physical activity opportunities were paying off—New York City’s prevalence of childhood obesity decreased by 5.5% from 2007 to 2011.

But not content to rest on those laurels, they were back on the podium a couple of weeks ago (July 17), this time announcing a series of anti-obesity initiatives to promote physical activity through the design of buildings and public spaces. The initiatives include the creation of a Center for Active Design, a nonprofit organization that promotes changes to the built environment to fight obesity and related chronic diseases, and an Executive Order requiring all City agencies to use active design strategies for new construction and major renovation projects. The Mayor also announced two pieces of legislation to promote stairway access in all City buildings.

Recognizing that the built environment impacts health-related behavior, active design employs environmental cues to influence people’s food and physical activity decisions, and applies design strategies to make healthy choices easier, spontaneous and habitual. A mix of land uses, well-connected pedestrian and bicycle systems, accessible recreation spaces, stairs designed to encourage regular use, and healthy food options are all associated with increases in physical activity, healthier eating, and improved community health outcomes. Active design invites architects, urban planners, developers, and policymakers who shape the built environment to recognize how their roles affect community health, and enlists them to use their creativity to improve it.

The package of anti-obesity initiatives will promote active design through measures such as making stairways in City buildings more visible, creating more inviting streetscapes for pedestrians and bicyclists, and designing spaces suitable for physical activity for people of different ages, interests, and abilities. The Center for Active Design is the first of its kind in a major U.S. city, and probably anywhere else.

But wait, there’s more for Mayor Bloomberg and Dr. Farley to brag about. Just a day after their joint announcement, the New York Times ran a story about research that finds the five counties making up New York City had the fastest rate of increase in life expectancy in the U.S. Life expectancy has increased for both males and females, across all racial/ethnic groups, and neighborhood poverty levels. From 1985­–2010 the average lifespan in Manhattan rose nearly 13 years for men, and more than 8 years for women.

The Department of Health quietly published an Epi Research Report in March, titled “Increased Life Expectancy in New York City: What Accounts for the Gains?” Decreases in deaths due to heart disease, cancer, and HIV infection contributed to more than 70% of the increase in life expectancy at birth, which is consistent with improvements in risk factors for, or management of, chronic diseases, the major killers in older adults. Improved prevention, screening, and medical treatment for these diseases all likely played an important role in prolonging lives.

The Department of Health report was followed in July by a more detailed analysis from The University of Washington’s Institute for Health Metrics and Evaluation, (IHME). Their eminently readable study published in Population Health Metrics, “Left Behind: Widening Disparities for Males and Females in US County Life Expectancy, 1985-2010”, discusses some of the reasons for the encouraging New York results.

“Manhattan stands out,” said Dr. Christopher J. L. Murray, the director IHME. His communication director, William Heisel, added, “In Manhattan’s case, we think that the drive to implement smoking bans, trans fat bans, and to make the city more amenable to physical activity and healthy food choices has had and will have an impact. The early and aggressive interventions into the AIDS epidemic are part of the story, too.”

Tobacco control is one example of successful prevention efforts that have likely contributed to the observed reduction in heart disease and cancer deaths. From 2002 through 2010 smoking declined at a faster rate in NYC than in the U.S. as whole (35% vs. 25%) as a result of aggressive anti-smoking policies and campaigns.

These analyses document that the health of New Yorkers is continually improving, and suggest potential associations with both citywide and targeted policies and programs to address disparities. The authors of a study published in the European Journal of Public Health, “A Comparative Analysis of Health Policy Performance in 43 European Countries,” are not so tentative. They declare, “Substantial health gains can be achieved if all countries would follow best practice, but this probably requires the removal of barriers related to both the ‘will’ and the ‘means’ to implement health policies. NYC Health Commissioner Farley would surely agree; “New Yorkers today are living longer and healthier than ever before, and substantially longer than people in the rest of the country, in part because of public health initiatives to combat HIV infection, heart disease, cancer, smoking, unhealthy diet, and physical inactivity. We intend to continue these public health efforts, with a particular focus on the city’s twin epidemics of obesity and diabetes.”

— Michael Lytton, AJPM Blog Editor

Further Reading in AJPM:

McKinnon RA, Reedy J, Handy SL, Rodgers AB. Measurement of the Food and Physical Activity Environments: Enhancing Research Relevant to Policy on Diet, Physical Activity, and Weight. Am J Prev Med 2009; 36(4S):S81-S190.

Floyd M, Crespo C, Sallis J. Active Living Research in Diverse and Disadvantaged Communities. Am J Prev Med 2008; 34(4):271-372.

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