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New York Times, September 28, 2007: Gap in Illness Rates Between Rich and Poor New Yorkers Is Widening, Study Shows

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By SARAH KERSHAW

The gap between the healthof New Yorkers living in poverty and those with higher incomes haswidened since the early 1990s, according to a survey releasedyesterday. It found that residents of poor neighborhoods in the cityare experiencing alarming rates of diabetesand steady increases in other chronic illnesses like heart disease,while other residents have seen slower increases or even declines.

Health disparities are not new, but experts say the report by the city comptroller, William C. Thompson Jr., sharply underscores a greater gulf.

It also shows a costly and dangerous trend in health care today:preventable and manageable chronic illnesses are rapidly rising amonglow-income uninsured residents and are often not treated until theyescalate to crises.

However, the report also showed that hospitalizations for asthma,a scourge of poorer neighborhoods, have plummeted and that infantmortality rates have also declined, as a result of aggressive communityhealth campaigns.

City health officials have also recently reported success inreducing gaps in life expectancy, heart disease deaths and access to cancer screening.

“We will continue working to reduce disparities and help all NewYorkers live longer, healthier lives,” according to a statementreleased by the Department of Health and Mental Hygiene.

Still, the contrast between rich and poor neighborhoods in the rateof serious and deadly diseases portrayed in Mr. Thompson۪s report wasstark, according to data covering a 15-year period, 1990 to 2005.

Adult-onset diabetes, known as Type 2 diabetes, has skyrocketed atall but the highest income levels, with an 82 percent increase inhospitalizations in all 42 New York areas defined by the survey overthe 15-year period. But in 2005, the increase in the city۪s poorestareas Hunts Point-Mott Haven; High Bridge-Morrisania;Crotona-Tremont; East Harlem; Williamsburg-Bushwick; Central Harlem;and East New York was 5 times the increase in the city۪s wealthiestcommunities Greenwich Village-SoHo; Willowbrook; SouthBeach-Tottenville; the Upper West Side; Lower Manhattan; and GramercyPark-Murray Hill.

In the poorest neighborhoods in 2005, there were 686.6hospitalizations for diabetes per 100,000 people, compared with 51.2 inthe richest neighborhoods. The diabetes death rate was 125.2 per100,000 in the poorest neighborhoods and 14.8 in the richestneighborhoods.

“You are looking at a city that needs to do a better job ofproviding primary care and preventive care,” Mr. Thompson said in aninterview. “We can do it. It۪s a question of creating the focus, but itcan be done.”

He urged city and state health officials to increase publicfinancing and reimbursement to doctors who provide primary andpreventive care for poor patients. He said that although New York۪sspending on Medicaid is among the highest in the nation, the state is not investing enough in primary care.

State health officials said they had already been working to addressthe disparities in health care, particularly as they move to expandcoverage for the uninsured, especially children, and tackle the mammothtask of reforming the state۪s troubled $47 billion Medicaid program.

They said they agreed that doctors, who typically receive low feesfrom Medicaid for routine care and wellness visits and higher fees forprocedures like emergency services, should be rewarded for preventingemergencies, and that they were working on several pilot projects.However, cost is a potential hurdle, state officials said, becausehigher fees for each visit to a doctor could require higher totalpayments by the state.

“We are looking at Medicaid reimbursement reform,” said Claudia S.Hutton, a spokeswoman for the State Department of Health. “But we wantto reform it in a way that is affordable.”

A state commission that last year recommended the closing of several New York hospitals some of them in poor neighborhoods also called for opening morecommunity clinics, and state officials said they would be seekingproposals for grants to finance such clinics in the next year.

Mr. Thompson also said that the expansion of walk-in drugstorehealth clinics, which have begun to open in New York City and are onthe rise and supermarket-based clinics, would go a long way towardsupplementing the primary care clinics.

Many poor residents have no primary doctors and little choice but to wait at overcrowded clinics or in an emergency room.

The retail clinics can provide preventive care, includingimmunizations, and treatment for routine illnesses. Duane Reade, thecity۪s largest drugstore chain, has opened four in mid-Manhattan and onthe Upper West Side, and plans to open as many as 60 more in the next18 months, including one in Brooklyn and one in Queens next month.

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