
Poor New Yorkers Tend to Live Longer Than Other Poor Americans - Amorymeltzer
http://nytimes.com/2016/04/11/upshot/poor-new-yorkers-tend-to-live-longer-than-other-poor-americans.html
======
morgante
In addition to the investments in social services which the government
provides, I suspect there's also a psychological element as well. New Yorkers,
rich and poor, share a common identity which I don't see in a lot of other
communities. There's an understanding that everyone lives in one city (even if
they live in different parts of it), and at least has a modicum of
responsibility to each other.

Contrast this with other cities like Detroit where the rich and poor live
entirely separate existences.

~~~
intsunny
Its interesting you mention this, because the same trains that the run through
some of the poorest areas of the city, also run through the wealthiest area of
the city. (D train, Norwood and UWS. 2/3 trains, Tribeca and East New York.)

The ability for any New Yorker to be just about anywhere regardless of income
is unparalleled.

~~~
morgante
Yup, it was always fun to see the bankers on the UES forced to stand in the
morning while Bronx commuters got to sit down.

Personally, I think the subway is a great force for egalitarianism.

~~~
giaour
During the periods of reduced service, I could always hop on a 6 train at
116th Street, while people who lived in the UES had to wait hours for a spot
on a train. I was pleasantly surprised to see that even the wealthiest and
most powerful New Yorkers respected the unwritten rules of MTA etiquette.

~~~
darkerside
What unwritten rule do you mean? They couldn't fit on the train in the first
place, right?

~~~
giaour
There's strong social pressure enforcing a first-come, first-serve rule on
seats and standing room. Seats are only surrendered for the pregnant or
disabled, and standing room is only surrendered if a child pushed his way onto
a train but his parent or guardian didn't quite make it.

In other cities, I've seen people ask for spots on an otherwise full bus or
train because they were running late. That would be unheard of in a NYC
subway.

~~~
colechristensen
Do people really have to wait _hours_ for a spot on a train?

~~~
bradleyjg
New Yorkers may exaggerate from time to time. But I have been at the 1st
Avenue L stop during the morning rush and had to let 3 trains go by before
getting on to the fourth (probably 20 minutes total waiting). I probably
should have walked at some point but then I would have had to pay again at
Union Square.

~~~
bwilliams18
1st Ave L is probably one of the most crowded stops in the morning for rush
hour in the city, probably competing closely with Lorimer and Bedford L stops.
In PM out of the city Union Square is similarly packed, and the train is
nearly empty once you pass Lorimer

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peg_leg
It's because they walk.

~~~
morgante
I'd expect that to apply equally to wealthier people too, but the inter-city
gap disappears at higher income levels. Wealthy New Yorkers also walk a lot
more than wealthy people in other countries.

New Yorkers definitely walk a lot more, but I don't think that explains the
full effect.

~~~
songshu
I have no idea what effect the walking is having, but would point out that
wealthy non-new Yorkers have other routes to attain the benefits of walking,
such as gym time and hiking trips. You can't say the same of poor non-new
Yorkers.

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davidw
Yet another reason to make it easier for the less well-off to live in places
like NY and San Francisco by building more housing.

~~~
Pxtl
There is nothing magical about NYC. It's just density and transit. Not
science-fiction. You can build that stuff anywhere, we just choose not to - to
entertain the conservatives who think transit is a social-program and social
programs are evil, to the NIMBYs who are terrified of buildings that could
cast a shadow in their neighborhood, to car-commuters who refuse to accept
that successful cities don't have free parking and fast traffic.

~~~
massysett
Or maybe people don't like density and transit?

~~~
Pxtl
The law of supply and demand and skyrocketing prices within major cities
implies that far more people _want_ to live in such environments than
currently do. Nothing wrong with the ones that don't, but the people who want
that lifestyle are apparently not being accommodated by current urban policy
in general.

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guyzero
Surprised the article doesn't try the hypothesis that the issue is access to
high-quality hospitals and medical schools.

Detroit is a nice enough town (in parts) but I'd rather get sick in New York
City.

~~~
Symmetry
No, they excplicitly address the hypothesis and reject it:

 _The findings underscore public health research showing that healthy habits
matter. The JAMA paper found that several measures of access to medical care
had no clear relationship with longevity among the poor. But there were
correlations with smoking, exercise and obesity.

“There remains this misconception in our society that health is determined by
health care,” said Dr. Steven Woolf, a professor and director of the Center on
Society and Health at Virginia Commonwealth University, who wrote an editorial
commending the research but offering some methodological criticisms.
“Behaviors have a huge influence on health outcomes.”_

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davidf18
Mike Bloomberg donated $600 million (with an additional $125 million from Bill
Gates) to combat tobacco in low- and middle-income countries.

Here is the plan used in NYC based on the WHO MPOWER program:
[http://www.thelancet.com/article/S0140-6736(07)60782-X/abstr...](http://www.thelancet.com/article/S0140-6736\(07\)60782-X/abstract)

NYC also placed over 1,000 fruit and vegetable carts in poor parts of the city
where fruits and vegetables had not been readily available.

While the attempts to limit sugar-added beverage consumption failed, the
publicity over the 3 different attempts against Coke and Pepsi ultimately
resulted lower consumption.

An interesting behind-the-scenes story can be read if former NYC Health
Commissioner's new book, "Saving Gotham: A Billionaire Mayor, Activist
Doctors, and the Fight for Eight Million Lives"

~~~
tracker1
Regarding sugar consumption, I do wish that more efforts like Coca-Cola Life
were made... mixing lower-calorie sweeteners... and for that matter, making
things less sweet in general. The effects on gut flora from the artificial
sweeteners (according to recent studies) is scary. As a diabetic, I've leaned
towards far more water, and far less anything else (some tea, arnold palmers,
etc).

I wish that there was more effort to curve the marketing of anything using
refined sugars. Hell, just preventing the advertisement of any product that
has more than 50% of its' calories from refined sugar from shows airing before
8pm and those whose primary demographic is children would be incredibly
impactful.

------
Overtonwindow
I wonder if it's becuase living in a place like New York City requires one to
be a little stronger and resilant to every day things. I don't think it has
anything to do with tax dollars, city services, or even walking. Could be
totally wrong here, but I think living in New York City puts one on a more
defensive, "aware" footing, and builds resilancy.

Too far off the mark?

~~~
saulrh
> I wonder if it's becuase living in a place like New York City requires one
> to be a little stronger and resilant to every day things.

I would expect the opposite to happen - the extra grinding-down every day
would result in people devoting more resources and stress tolerance to "being
a little stronger and resilient", decreasing their ability to do other things
including maintain their health.

~~~
stevenmays
Except, hormesis -
[https://en.wikipedia.org/wiki/Hormesis](https://en.wikipedia.org/wiki/Hormesis)

~~~
saulrh
There is a paragraph in there about low levels of stress having an anti-aging
effect. Very interesting, thanks for the link. I guess the question, then, is
where the therapeutic/hormetic level of stress is. I'd have very much guessed
that it'd be well below the level an average dense-inner-city resident
suffers, based on studies regarding IQ loss due to stress and similar. _shrug_

------
Pxtl
Iirc, obesity statistics are about equal between the poorest parts of NYC and
the national average.

Sedentary, isolating suburbia is killing us all.

~~~
tracker1
Obesity is not the only indicator of health. For that matter being skinny
doesn't mean you won't suffer from metabolic syndrome, only that obesity as a
symptom doesn't present itself.

------
dexterdog
Poor New Yorkers are a lot richer than other poor Americans.

And why are the only graphical comparisons given comparing NY to Detroit?
That's a pretty low bar.

~~~
tricolon
On the face of it, your first statement seems to be false. New York's 15th
congressional district is the poorest in the country:
[http://talkpoverty.org/cd-year-report/new-york-cd-
report-15-...](http://talkpoverty.org/cd-year-report/new-york-cd-report-15-2/)

------
brudgers
Related article showing comparisons across the US:
[http://www.nytimes.com/interactive/2016/04/11/upshot/for-
the...](http://www.nytimes.com/interactive/2016/04/11/upshot/for-the-poor-
geography-is-life-and-death.html?_r=1)

------
yummyfajitas
The original paper is here:
[https://jama.jamanetwork.com/article.aspx?articleid=2513561](https://jama.jamanetwork.com/article.aspx?articleid=2513561)

I'm kind of wondering if the NYT reporter actually read it. From the article:
_differences in life expectancy for individuals in the lowest income quartile
were significantly correlated with health behaviors such as smoking (r =
−0.69, P < .001), but were not significantly correlated with access to medical
care, physical environmental factors, income inequality, or labor market
conditions._

Other factors which had no effect include residential segregation, health
insurance, and unemployment.

Contrast this with the NYT: "New York is a city with some of the worst income
inequality in the country." "We should really be thinking about how do we
build up the public health infrastructure."

------
rbcgerard
Another piece of the puzzle is access to to cheap non-fast food
options...there are not a lot of American cities that have an abundance of
fruit cart vendors as an example...

------
intrasight
Correlation vs causation

~~~
mfringel
....is not some magical incantation. Please state your point, in the context
of the article.

~~~
intrasight
Yes, yes - sometimes my incantations are too brief.

There are a lot of factors that may have correlation to health outcome. The
fact that something is correlated does not, as journalists will often suggest,
imply that there is a causation effect. The fact that the poor in some
locations are more healthy is a good hint that being poor is not the direct
cause of their health issues. But being poor is a root cause of many
adversities in any society that doesn't treat health, education, and other
such things as basic human rights.

~~~
giaour
I didn't get any sense from the article that the authors thought they had
identified the root cause of poverty and/or reduced life expectancy. They're
pointing out a rather chilling correlation.

------
tombert
I have to wonder if this, in part, has to do with the fact that poorer people
here tend to ride the subway, and get exposed to a larger number of viruses,
and building up an more immunities.

I'm no doctor, but it at least seems plausible from a lay-man's perspective.

~~~
drzaiusapelord
> ride the subway

If you take public trans all the time, then you're doing a lot of walking.
Trans takes you close enough but the 'last mile' is always on foot. That's a
decent amount of exercise, at least compared to someone who is always driving.
This is how I grew up and when I was older, the move to the suburbs was pretty
jarring. Everyone got fatter as we stopped getting all that city walking.
Worse, the suburbs didn't have a lot of healthy food options. So you drove
more and ate crappier.

A pack of cigarettes in NYC is around $13. In a poor rural or suburban
community, its half that. A lot of the urban poor simply can't afford smoking
anymore. This must certainly affect things, at least as much as anti-smoking
PSAs.

NYC also has 1.1m Jews, who tend to have a slightly higher than average life
expectancy, especially the religiously observant who follow strict dietary
limits. That might skew things a little as well.

~~~
zhemao
The strict dietary laws make their diet less healthy, generally. Orthodox Jews
have a very restricted diet which is heavy on starch and fat. When you can't
eat fresh fruit or vegetables because of the possibility of accidentally
consuming insects, your diet isn't going to be the healthiest.

~~~
eric_h
Agreed, and I would also suggest that the number of strictly observant jews is
a small fraction of the New York population that identify as jewish and would
be counted as such in a survey

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nxzero
There's clearly some sort of selection bias going on, since I would hope it's
obvious that simply moving NYC will not help you live longer.

(My guess is that people that live longer end up moving in with someone they
know, and given that NYC has so many people, it's more likely that they'd move
to NYC than another city.)

~~~
pavel_lishin
> _There 's clearly some sort of selection bias going on, since I would hope
> it's obvious that simply moving NYC will not help you live longer._

If you live a sedentary, car-centered lifestyle and are a heavy smoker, then
moving to NYC may indeed help you by forcing you to get more exercise and quit
smoking due to the costs.

------
lr4444lr
_The findings underscore public health research showing that healthy habits
matter. The JAMA paper found that several measures of access to medical care
had no clear relationship with longevity among the poor. But there were
correlations with smoking, exercise and obesity. ... The city also imposed
novel regulations on restaurants and food, banning trans fats that are
associated with heart disease, and requiring chain restaurants to post calorie
counts on menus. Efforts to tax or limit soda sales were unsuccessful, but
public campaigns to discourage unhealthy eating were widespread._

The implication is that the nanny state has to step in because the poor don't
exercise personal responsibility as diligently as the non-poor. Sad.

~~~
kaonashi
Yea, has nothing to do with the relative costs of each type of food.

I've also heard people bitch about seeing SNAP-card holders shop at Whole
Foods, so I guess both choices are wrong.

~~~
cylinder
Literally just saw this an hour ago. When SNAP carders are spending freely on
Whole Foods prepared meals I'd never touch, and I'm walking around the city
for 30min trying to find a decent lunch under $8, I find my anger to be
reasonable.

