On Demand
Big Apple Health Disparities
Friday, September 28, 2007
Dr. Nick Freudenberg, professor of public health at Hunter College and president of the Public Health Association of New York City, talks about the health disparities in New York City between the rich and the poor.
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I don't think "care" - which is "reactive" - is the issue.
I think the issue is diet - which is pro-active in nature.
We wouldn't need so much "care" if people were taught to eat better - regardless of income-class.
It seems to me that the increase in diabetes in the lowest sixth would be due in part to the "food deserts" in the cities where there's no healthy food from supermarkets available. In these areas, the choices are virtually fast food and junk food or nothing. The wealthy, on the other hand, have access to better food as well as more leisure time for proper exercise.
I am a family doctor doing a Masters in Public Health and Preventive Medicine Residency at Mount Sinai.
It is important to be careful in looking at incidence (number of new cases per year) versus prevalence (total number of people with the disease, some who have had it for many years). If care for diabetic patients had improved over the years, there will be fewer deaths. Incidence will remain the same, but as more diabetics live longer, the prevalence will increase as you have new people diagnosed each year. If they were dying, prevalence would go down. If prevalence of diabetes increases, this may mean that we are keeping people from dying better than in the past. This may also lead to more hospitalizations for diabetes (whereas in the past there would have been more funerals).
These statistics do not surprise me. I am an artist, and did not have health insurance until the past year, when I got on my boyfriend's via a domestic partnership. When I was uninsured, I went to clinics for healthcare. The clinic I went to in Brooklyn was a nightmare, in the sense they always overbooked, so even if you had an appointment, you waited a minimum of an hour and a half to see a doctor. People in the waiting area often complained they had to take a day off from work just to devote the hours it took to see a doctor here. This clinic also was so chaotic, they often lost people's charts, and I can't imagine the doctors had much time to read people's charts. There was also a turnover of doctors there, so that you often had no continuity in terms of a known doctor tracking your health over the years.
If you're poor, or a freelancer who does not get sick pay or personal health day pay (which I still do not), also factor in that the "underinsured" also don't want to miss work, and getting paid, in order to spend 1.5-3 hours waiting to be seen in a clinic.
As one who had both carotid arteries replaced, I strongly recommend smoking cessation. I don't preach just suggest. I smoked 37 years and no longer do I after that experience.
Don't people with more money live longer lives than poor people? If so, eventually the rich will die of something and perhaps the type of disease that does them in will affect the numbers.
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