Urban health

Addressing root causes in New York, US

21 April 2021

4 min read

In New York, we dove deeper into the role of anchor organisations, with deep roots in local communities, in supporting health.

This city profile is part of a series of ten, exploring how cities around the world are addressing health inequalities. Read the full report and sign up to receive more insights from us.

About New York

New York City is the largest and most populous city in the United States. While New York’s population of 8.4 million is comparable to London, its five boroughs cover half the land area and are considerably denser. One in five New Yorkers fall beneath the poverty threshold and almost half of all households are considered to be marginally above the poverty line.

New York is one of the most racially diverse cities in the United States. While the majority racial group is white (42%), Hispanic/Latino (29%), Black (24%) and Asian (14%) residents make up large pluralities of the population. Race-based planning legacies, foreign investment and a corporate-growth city agenda have led to high rates of income inequality in the city. Unlike London, ethnic diversity and economic deprivation are often concentrated, especially in the outer boroughs of the Bronx and Queens.

Given New York’s size and density, individual and public health have long been concerns, but social, structural and political factors have led to highly inequitable health outcomes across the city. Much of this inequality is spatially driven. As a result of decades of development policies, such as redlining, up-zoning and neglecting public housing, New York City today is the fourth most segregated city in the country.

While non-white New Yorkers are more than six times as likely to be hospitalised for asthma complications and three times more likely to be hospitalised for diabetes-related complications, the neighbourhoods in which they predominantly live have lost thousands of hospital beds in recent years due to state healthcare funding priorities.

In numbers

8.4m

residents in New York

800

languages spoken in New York

2.2m

the average income of the wealthiest 1%, versus an average of 44.6k for the 99%

Addressing the social determinants of health

Anchor organisations support local people throughout their lives, recognising how related issues like precarious housing and lack of access to nutritional food can be systemic drivers of poor health, and must be addressed to improve health outcomes.

In New York, we looked at two initiatives in depth. They took an equitable approach to supporting individuals and communities to access fundamental services and by providing support throughout people’s lives, they are able to focus on root causes of inequality that significantly impact the health outcomes of communities but are not automatically seen as health issues. Improving health and wellbeing often means supporting people and whole communities across the different contexts of their life.

Woman and child at Pride celebration in New York

Initiatives explored: Queens Community House and Harlem Children’s Zone

Queens Community House (QCH) is a multi-site, multi-service settlement house that serves residents of all ages, races, faiths and ethnicities in the neighbourhoods of Queens. They promote neighbourhood stability in the face of increasing gentrification.

Queens is the most racially and ethnically diverse borough in New York and the most diverse county in the US69. QCH recognises the relationship between health, housing, employment, education, self-esteem and financial wellbeing and works to ensure people in Queens have access to a full range of resources to help them achieve wellness and life-long security. For example, they address the security needs of individual households and support recently evicted families to find new homes, while also advocating for more affordable housing and stronger tenant protection for the borough of Queens.

Having identified that a lack of access to affordable fresh produce was contributing to the community’s overreliance on fast food, QCH worked in partnership with residents to introduce an affordable farmers market selling fresh produce which has been running for over nine years. Queens Community House has also trained three community chefs to run cooking classes on how to prepare and make healthy food.

However, for community-led organisations like QCH and HCZ, this presents challenges around funding. Siloed funding streams can make it difficult to work holistically on cross-sector issues in a community or place. Through their work, these two anchor organisations have upskilled and nurtured talent from within the community. This not only builds additional capacity within programmes and develops transferable skills in communities facing high levels of employment, importantly it also reinvests knowledge and builds community leadership who can continue to advocate on behalf of residents and their needs.

Our challenge, given these siloed funding streams and sometimes siloed populations, is how do we connect it all together? How do we do something more holistic and comprehensive that tries to really deepen our work in that community and have a greater impact?

Dennis Redmond Queen’s Community House, New York City

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