REDUCING INEQUALITIES AND IMPROVING NUTRITION IN NEW YORK CITYSonia Angell, MD, MPHDeputy Commissioner for the Division of Prevention and Primary CareNew York City Department of Health and Mental Hygiene

Premature Mortality Due to Heart Disease by Race/Ethnicity, 2005-2014

2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

10

20

30

40

50

60

70

80

Hispanic

Non-Hispanic White

Non-Hispanic Black

Asian & Pacific Is-lander

Overall

Age

-adj

uste

d R

ate

per

100,

000

Popu

lati

on

Bureau of Vital StatisticsNew York City Department of Health and Mental Hygiene

Social Determinants and Premature Mortality

Poverty

Race by Neighborho

od

Premature

MortalitySource: NYC DOHMH population estimates, matched from US Census Bureau intercensal population estimates, 2010-2013, updated June 2014. U.S. Census Bureau; American Community Survey, 2013 3-year Estimates, Table S1701; generated using American Fact Finder (http://factfinder2.census.gov/). Bureau of Vital Statistics, based on events occurring in 2014. Population (based on zip code) defined as percent of non-Hispanic black and Hispanic residents, per 2010 Census. : Neighborhood poverty (based on Community Districts) defined as percent of residents with incomes below 100% of the Federal Poverty Level, per American Community Survey 2011- 2013. Population (based on zip code) defined as percent of non-Hispanic black and Hispanic residents, per 2010 Census. Self-Reported health – NYC DOHMH Community Health Survey, 2011-2013

Make the Healthy Choice the Easiest Choice • Physical Access/Availability• Pricing/Economic• Communication/Media• Point of Decision • Education/Promotion

• Culture• Attitudes/Beliefs• Skills • Knowledge• Time• Affordability

Individual

Health Promoting Behaviors

Environment

Source: Adapted from presentation by Dr. Heidi Blanch, CDC, NCCHPDP, DNPAO

Community Environment and Systems

Spectrum of Opportunities• Industry reformulation• Procurement

– All of government• Vulnerable/select populations

– Private sector institutions• Feeding programs• Labeling (packaged and restaurant foods)• Marketing • Pricing• Media/awareness campaigns• Change ingredients for home prepared foods• Change habits of cooking for home prepared foods

Overview of ApproachesCitywide Local

Change the Environment

• Food Standards for NYC Agencies

• Trans Fat Restriction• Reformulation:

National Salt Reduction Initiative (National)

• Good Choice

• Food Standards for FBOs and CBOs

• Green Carts• Shop Healthy

Activate the Community

• Sodium Warning Label

• Calorie Labeling• Media/Awareness

Campaigns

• Health Bucks• Stellar

Farmer’s Markets

Leveraging Federal Assistance Programs: Health Bucks

• Health Bucks–For every $5 spent with Supplemental

Nutrition Assistance Program dollars customers receive a $2 Health Buck —a 40% increase in purchasing power

City Health Code: Work in Restaurants

• Sodium Warning Label

• Calorie Labeling• Trans Fat

Restriction

City Hall: NYC Food Standards• By Executive Order:– Meals/Snacks Purchased & Served– Food and Beverage Vending

Machines – Affects 260+ million meals and

snacks served by NYC agencies

• Collaboration and mentoring:– Community groups and hospitals in

NYC• Healthy Hospitals Initiative

– Localities across the US

Thank you!

Key Message: One size could fit all, but it doesn’t solve all. Multi-level approaches with concurrent attention to gaps and health equity is necessary.

Sonia Angell, MD, MPHDeputy Commissioner for the Division of Prevention and Primary CareNew York City Department of Health and Mental Hygiene