Economic stability creates health

Health is determined by many factors, and people tend to be healthier when they have economic stability, live in quality housing and have access to public space and safe, connected communities. In 2020, the NYC Health Department held a series of community conversations with residents and local stakeholders across 26 neighborhoods. New Yorkers shared personal stories that illuminate their priorities for building healthier neighborhoods, healthier childhoods and more. This is one part of a three-part series on how housing, economic stability, and public space create health.

“It’s a constant struggle of like, that anxiety and stress and depression and all of those other mental health issues that happen because of how and where they’re living.”

17 percent of New Yorkers, or about 1,400,000 people, live in poverty. Living in poverty impacts health in many ways. These include:

  • Financial pressures: stress and anxiety from being unable to pay for all costs of living and having to choose whether to pay for rent, food, medical care or other necessities.

  • Unhealthy and unstable housing conditions: increased exposure to weather-related illnesses from not being able to afford air conditioning or heat. Lack of building maintenance can lead to housing conditions that result in pests, mold and dust that can worsen asthma and other medical conditions.

  • Food insecurity: lack of access to fresh food or enough food.

The combined effects of poverty are increased sickness and death.

Poverty forces people to do without necessities that keep them healthy, like food and medical care.

“[…] Adequate, decent, and fair gives folks the opportunity to think about something other than those basic needs.”

Nearly one-third of renting households in the City experience severe rent burden — spending at least half their income on rent.

We see severe rent burden among New Yorkers of all income levels — but low-income people feel these effects more. Severe rent burden impacts nearly half (44%) of households that earn between $25,000 and $50,000, and 85% of households that earn less than $25,000. People who are rent burdened must make difficult choices between housing and necessities that support health. For example, they may choose not to use an air conditioner because of the electricity bill despite this increasing their risk for heat-related illness and death.

One out of every 10 New Yorkers experiences food insecurity.

“I have to make sure that my children eat, I cannot see a starving child. I will go without food. If anything, I will go without a meal. But my children, I can’t see them without food. I just can’t.”

—Participant in the Qualitative Study to Enhance the NYCgov Poverty Measure

Low-income New Yorkers also have to make tradeoffs when it comes to food. Food insecurity (not always having enough food) became even worse during the COVID-19 pandemic.

Our health is shaped not just by having enough food to eat but also by having the right foods to eat. NYC is known for its bodegas (mini-markets) but they don’t always offer healthy staples. For foods that make up a healthy diet, New Yorkers need grocery stores. But most high-poverty neighborhoods in NYC have more bodegas than grocery stores – making healthier food harder to access than unhealthy food.

The City’s Shop Healthy NYC! initiative encourages residents to talk to their bodega owners about offering more healthy options.

With no money to spare after rent and food, many New Yorkers go without the health care or medicines they need.

Residents living in high-poverty neighborhoods are more likely to postpone health care. By going without these services, diseases can be more difficult to prevent, catch early, and treat, leading to more serious and costly health conditions.

Getting essential health care can mean the difference between staying afloat and winding up in medical debt.

“You go to some of these facilities and they tell they don’t take your insurance. I’m with my [11-year-old] child and even then, [it’s], ‘no, we don’t take that insurance.’ It’s like, oh my God, what world am I in? Where do I go?”

Getting care for a medical issue can be costly, even with insurance. Medical debt occurs when people can’t pay bills.

Medical debt creates stress and disproportionately affects people of color.

Six percent of all New Yorkers — about 1 in 20 people — have medical debt in collections. People living in communities of color tend to experience a higher rate of, and owe more money in, medical debt than people living in White communities. In Brooklyn, for example, communities of color have double the amount of residents with medical debt in collections. A medical debt relief program is planned to help alleviate some of this burden.

Chronic stress related to finances can be debilitating because the factors causing it are difficult to resolve, and many worsen over time. Long-term stress increases the risk of mental health issues and other health problems.

Racism shapes who experiences poverty — and its health effects — in NYC.

In NYC, as in most places in the United States, there are more Black and Latino residents living in poverty than residents of other races. This is a product of racism and a history of policies that deprive people of color of access to home ownership, education and jobs, and other opportunities to build wealth and economic stability.

This racial wealth gap persists across the United States ,and results in health inequities. White New Yorkers are much less likely than New Yorkers of color to report their health as fair or poor.

New Yorkers who participated in community conversations describe ways to decrease poverty and improve health

Increasing job opportunities:
“We need businesses to come here. We need jobs to come here. We need somewhere where kids can get work, have a little money in their pocket and make it less stressful on their families.”

Educating (and, potentially, regulating) employers:
“I think there needs to be legal organizations that are involved and that educate employers and employees on labor laws and rights, but also some sort of mechanism for these attorneys to be more regularly connected through action NYC. Like having some sort of resource for those who do not know what their rights are.”

Providing public services:
“...What’s the right bundle of services that someone needs in order to succeed and to progress?”

Public health is about searching for and addressing the root causes of different health outcomes. The data are clear, and so are the personal stories that were shared: increasing economic stability would greatly improve health for New Yorkers.

To hear more from New Yorkers about how they view economic stability and health, listen to recordings from the community conversations: