Poor New Yorkers Tend to Live Longer Than Other Poor Americans | Hacker News Reader

Poor New Yorkers Tend to Live Longer Than Other Poor Americans

nytimes.com

104 pointsAmorymeltzer100 comments

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.

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.

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.

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.

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

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.

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

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.

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

When I lived in Chicago, the State Street Subway at evening rush hour would have every car packed literally sardine tight. They could barely close the doors and there was barely room to breathe, forget about sitting down. I'm sure it was illegal but the conductors seemed to just pack people on until there wasn't room for one more.

Do you mean ask people to move in? Or actually ask that someone gets off for them?

I've also seen times when order has broken down during rush hour in Manhattan, and the transit employees start talking about calling the transit police. This was back in the early 90's, and from what I've seen, those guys were feared! People started backing away from the train and stopped crowding it after the mention.

I think you're hitting on the biggest contributor to this feeling of it being one city. In pretty much every city on the planet you have the different districts that are known for different things, predominantly the wealth of that area, but New York is somewhat unique in how intertwined and connected all of those distinct districts are in that city. As others point out, the same trains all go through the same areas, and everybody rides them. It's hard to develop the "little people" attitude when you spend so much time around said little people.

This is hardly unique to New York. Many European cities have this feature (it was deliberately designed into London, for example).

It may be unique to New York within the US.

Have you been to London lately? It's heavily segregated, and the only place I've seen much mixing is at the chip shop or curry joint.

I see what you mean. There's certainly a feeling of community that don't exist in other places but I still think the rich and the poor live very separate existences despite some proximity.

Actually, it reminds me of a "date" I had once in New York. One night I met a rich finance girl (from Craigslist!). It's a bit of a cliché, but when I left her luxurious penthouse and went back to my life, I couldn't help but think we lived in totally separate worlds!

> It's a bit of a cliché, but when I left her luxurious penthouse and saw the poor people on the street, I couldn't help but think we lived in totally separate worlds!

You still saw them though. In many places, the closest you'll come to poorer people is on a highway overpass.

Obviously the rich and poor don't have identical existences anywhere, but in New York there's a lot more commonality between the existences (everyone taking the subway, for example).

Another key element is that you have old style ethnic communities in NYC.

This was part of the social purpose of Central Park.

Frederick Olmstead advocated similar parks for San Francisco, writing that people could be found in public parks: "with a common purpose, not at all intellectual, competitive with none, disposing to jealousy and spiritual or intellectual pride toward none, each individual adding by his mere presence to the pleasure of all others, all helping to the greater happiness of each."

https://books.google.com/books?id=hAItCgAAQBAJ&pg=PA368&dq=%...

This is what I felt walking through Boston Commons, during my brief time as a SF resident. If only we could move Golden Gate Park a few miles East!

Don't worry, New York will get there eventually.

Having spent 30 years in this city, I've seen two ends of the spectrum in terms of class-mixing. In the 80s & early 90s it wasn't uncommon to go to a house party in some squat or slum and see social elite there (with their shared love of art, music or drugs) or go to a club/elite art gallery and see the misfits there.

This does not happen any more. At all. There are some of us remaining who straddled both circles that can fit in both places but the poor really do not socialize (as in parties) with the rich anymore.

But at least it's not like Atlanta where I see the middle class show open hostility to the homeless.

It's entirely possible that you are right. But have you considered the possibility that it's you that's changed instead of or in addition to the city? I certainly don't go to the same type of parties I did when I first moved to the city and that was only a dozen years ago.

I've considered that but my circles are pretty wide and I've been thinking about this for a long time and going out and verifying (asking absolutely everyone who will listen).

Consensus seems to be that we're trending towards homogeny.

I think you're probably right on this. I'm probably about a generation younger than the guy above you and I still see parties across the board. I've been with millionaires in Bushwick squats at avant-garde art shows and poor-as-s* immigrant artists in massively famous actor lofts. I'm a lower middle-class grandson of farmers and preachers, who's done OK for himself. I LOVE that New York lets me hang out with everyone without having to fake my way through any side.

(There are exceptions, but the ultra-wealthy are annoying as hell, even if they do have the drugs, music, booze etc.)

It could also be due to the fact that New Yorkers tend to walk much more than populations in other areas. My theory is that just walking a couple miles a day between subway stations is a great benefit to an aging population.

It's because they walk.

I would put a lot of money on this as well.

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.

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.

The walking and the stairs. So many stairs. I don't know many friends who live in buildings with elevators, especially in the outer boroughs. We live in a four-story walk-up in Brooklyn, have stairs in our duplex to go to the second story/loft, and walk up and down subway stairs on a daily basis. So all those stairs plus generally walking everywhere around the city equals a lot more exercise on a daily basis than the average person (is my guess).

It's night and day versus growing up in Austin, where I drove everywhere, rarely used stairs, and walking consisted of taking out the garbage to the curb.

Absolutely this. Lots of people I know who've lost tons of weight started attempting to eat better and then walked an hour or more a day. I started walking every day and dropped my resting pulse into the 50's, and lowered my blood pressure from barely normal, to near athletic.

All that walking is just awesome for people's health. And most people in the US don't get much exercise.

I gained about 15 lb relocating out of NYC & working from home. Didn't change diet - I lost the ~30 minutes of NYC-fast-walking I did every day (to/from subway on each end).

Now, whenever I am out visiting clients etc. in the city I peg my Apple Watch's fitness meter - most days I barely get anywhere. Was eye opening - I now start my day with 45-60 minutes of moderate cycling and I've dropped back to my pre-work-from-home weight and noticeably/significantly raised my energy level.

I now acutely understand the plight facing our suburban citizens.

100% - when I go home to NYC average daily walking is 5-8 miles vs. 1-3 in Houston...an extra 5+ miles a day in walking adds up...

I came here to say this. The health benefits for the heart and lungs of "active walking" are well established and anecdotally, people in NYC just walk from place to place constantly vs. other cities. Even metros like SFO. It's even worse in places like Atlanta and Dallas where you basically have to drive from place to place.

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.

Not SF. SF is fat-friendly, by city policy. NYC is not.

What do you mean? How can a city be "fat-friendly" by policy?

San Francisco Human Rights Commission, "Compliance Guidelines To Prohibit Weight and Height Discrimination"[1]

"Medical providers must not make weight loss or weight gain related intervention a condition for treatment."

"Employers must strive to maintain a respectful, non-hostile environment related to weight and height. Verbal or written harassment against an employee based on weight or height is prohibited. Unsolicited comments, advice, or literature recommending weight loss or gain are inappropriate."

"If a tenant needs and requests an accommodation because of weight or height, it must be made if it is readily achievable. Some examples of alterations that are usually readily achievable include: installing offset hinges to widen doorways, rearranging furnishings, lowering mirrors or replacing shower doors with shower curtains. The need or potential need to make an accommodation may not be considered as a factor in the decision to select a tenant."

[1] http://sf-hrc.org/sites/sf-hrc.org/files/migrated/FileCenter...

I think I'd look at actual health outcomes as per the study, rather than policies like this, that may or may not make a difference.

Thanks. I don't necessarily see it as being "fat-friendly", they're just trying to prevent discrimination.

The "widening doorways" thing might be a bit too much unless the person in question actually has a medical condition though.

This is accomodating reality, not the cause. Nobody wants to be fat, but if the urban form means that most people living in your city are sedentary sitting in cars for a large portion of their day, being fat is an inevitable consequence of it. Fat-acceptance policies naturally fall out of that.

I can't see any reason to believe that discriminating against fat people is an effective strategy to curb obesity at a societal level.

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.

Perhaps they simply do not want to live in a "successful city," or one that is successful by this definition.

Or maybe people don't like density and transit?

Then they should stay away from cities. There are plenty of great places like Lakeview Oregon where that will not be a problem in the foreseeable future.

This is also probably a financial win for them, because a growing city means rising prices, making it easy to sell out and go live somewhere rural.

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.

> transit is a social-program and social programs are evil

That and racism and/or classism. Wealthier neighborhoods are afraid that a public train will be bring the poor through their neighborhoods therefore inviting crime. My friend's family who live in Arlington Texas told me how their community voted 'No' on building a sidewalk because of this very reason. A sidewalk!

http://www.citylab.com/crime/2014/12/the-myth-that-mass-tran...

I don't see anything wrong with a neighborhood democratically deciding they don't want sidewalks. Not much different than other covenants and restrictions many neighborhoods have, such as no vinyl siding, no boats parked in the driveway, etc.

Yea, but the goal was to keep "those people" (for whatever your value of "those" is) out of your neighborhood. I fail to see how that is not a discriminatory practice.

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.

Wayne State University has a good teaching hospital:

https://en.wikipedia.org/wiki/Wayne_State_University_School_...

Beaumont Health is an excellent system:

https://en.wikipedia.org/wiki/Beaumont_Health

And the University of Michigan Hospital is available to anyone with a car:

https://en.wikipedia.org/wiki/University_of_Michigan_Health_...

So the availability of care isn't going to be a problem in Detroit (access to care could be very different though).

Actually, the best controlled and pseudo-controlled studies show that, within the United States, access to medical care has negligible impact on life expectancy.

No, they excplicitly address the hypothesis and reject it:

“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.”

Hospitals add surprisingly little to health and longevity. The biggest factors are hygiene, exercise, diet, and pollution (including smoking). It's nice to get a speedy by-pass surgery when your heart clogs up, but it's even nicer to not get that heart attack in the first place.

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...

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"

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.

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?

> 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.

Except, hormesis - https://en.wikipedia.org/wiki/Hormesis

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

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

Sedentary, isolating suburbia is killing us all.

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.

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.

What do you mean by the first statement? Richer based on what numbers?

Title should probably be "..Than _Some_ Other Poor Americans".

I'm not sure about that. The cost of living is a lot higher in major cities like NYC. They may earn more in absolute dollars, but comparing the purchasing power with their counterparts in less populous parts of the country, I would guess that poor New Yorkers are much worse off, even when you consider the added costs for owning a decent used car in other areas.

The poor new yorkers living in project housing who work minimum wage jobs trying to support 2 kids with an absentee father?

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-...

Related article showing comparisons across the US: http://www.nytimes.com/interactive/2016/04/11/upshot/for-the...

The original paper is here: 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."

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...

Correlation vs causation

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

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.

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.

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.

Probably it has more to do with the amount of stair climbing that riding the subway requires

And also due to the extra half mile or so of walking to your local stop and final destination.

My guess would be more along the lines that people who walk/subway are generally more fit than those who take a car everywhere. NYC doesn't have a lot of fat people in general. (though it's worse than it used to be)

Exposure to infections does not make you stronger.

Immunity is highly specific. This is why the flu is a chronic problem, it mutates rapidly enough that exposure to previous generations of the virus does not confer immunity to current generations. Immunity is more like a collection of solutions to puzzles than it is a muscle.

Being infected while in a healthier state and thus gaining immunity with less risk might be beneficial later, but you can look at mortality statistics and see that while infections are a major cause of death, they aren't responsible for a large portion of deaths:

http://www.cdc.gov/nchs/fastats/deaths.htm

(Chronic lower respiratory disease there is stuff like COPD, not particularly infection related)

That's what I get for taking medical advice from a George Carlin stand-up...

That's a fair point, I'll admit I was mistaken.

> Exposure to infections does not make you stronger.

* As an adult

https://en.wikipedia.org/wiki/Hygiene_hypothesis

> 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.

Most of the cigarette trade here ends up being virginia taxed because of that cost for smokes.

I thought it was 500,000 Jewish persons but it looks like 1.1m checks out from a quick google search. That's a huge percentage of the population.

About 1 month ago, I moved to within a 15 minute walk of the Pittsburgh T. I really want to use it more. They allow bikes on the T, so I'm planning to get one to ride around downtown and out in the country. I am glad to get out of the suburban hell I was living in for 6 years.

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.

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

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.)

> 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.

Nope. Poor people in densely populated areas with strong public transportation networks are going to be able to get medical care more easily than poor people in less densely populated areas.

In fact, the poor people in the US with the highest death rates are those living in the rural US and in and around small cities.

http://www.washingtonpost.com/sf/national/2016/04/10/a-new-d...

That's not at all clear. The anti-obesity and anti-smoking campaigns, and the sheer walkability of New York compared to Detroit, mean you will face less pressure toward obesity and cardiovascular disease. Just moving there really might mean you live longer.

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.

Or are these people poor /because/ they don't exercise personal responsibility as diligently? I can easily see the arguments for the causation going either way

Yes, that's part of the implication the findings appear to make. I don't see what you're saying differently.

Which is completely absurd because not only were many of these laws recently enacted, but their the efficacy of some rules is also questionable (most notably the calorie count law).

I wouldn't be surprised if most of the difference cited by this study was due to walking. I know that I've had to exert extra effort living in SF to be more active than I had to when I lived in NYC.

I wonder if there will be a follow-up study looking into the actual reasons why life expectancy is higher in NYC.

> I wouldn't be surprised if most of the difference cited by this study was due to walking. I know that I've had to exert extra effort living in SF to be more active than I had to when I lived in NYC.

Wow I find this kinda surprising. I walk more or less as much in sf as in NY, if only because roughly 100% of the time, the weather is comfortable enough to enjoy walking in (as opposed to Manhattan in the summer.... Or the winter).

Then again, I think my house is unusually well connected to transit, so maybe where you live transit+walking isn't as feasible an option.

Easy to judge when you're doing well, eh?

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.

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.

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