( Rogelio V. Solis/AP )
Ashwin Vasan, MD, PhD, commissioner of the New York City Department of Health and Mental Hygiene, talks about the city's plan to increase life expectancy, which has taken a hit since COVID, including what conditions they are targeting in order to lengthen the life spans of New Yorkers.
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Brian Lehrer: Brian Lehrer on WNYC. Last week, Mayor Adams signed Healthy NYC into law, codifying his goal of helping New Yorkers live to at least 83 years old by 2030. This is an explicit life expectancy goal, 83 on average. This comes after the city saw its average life expectancy drop to 78 in 2020 due to COVID-19. It started to recover since then, but not all the way.
It's not just COVID causing premature deaths, chronic illness and overdoses are sending many to an early grave, keeping lifespans below pre-pandemic levels. We're going to talk about some of the numbers, and of course, it's different by different groups. We'll delve into the specifics of the Healthy NYC plan and some other local public health news with the New York City Health and Mental Hygiene Commissioner, Dr. Ashwin Vasan. Dr. Vasan, always good to have you on the program. Welcome back to WNYC.
Ashwin Vasan: Great to be back, Brian.
Brian Lehrer: Do you want to do a quick top-line statistical overview of life expectancy among New York City residents, what was it, what is it?
Ashwin Vasan: Yes, absolutely. I think this plan comes out of this very basic realization that something's wrong when in the richest city in the richest country, in the most, I guess, ostensibly powerful nation in the world that our life expectancy is actually falling or flatlining nationally, and that it's not keeping pace with our peer country. A lot of this comes out of this very American story of stagnating life expectancy over the last decade. Then, of course, COVID hit and took a uniquely damaging toll on New York. In 2020 alone, this city lost 4.6 years of life expectancy dropping from 82.6 years in 2019 to 78 years.
Those drops were more dramatic for Black New Yorkers who not only experienced 5.5 years of life expectancy loss but started at a lower baseline. Six years drop for Latino New Yorkers. As you mentioned in your lead-up, the causes are not just COVID-related, but you start to see other causes of death moving in the wrong directions like overdose, suicide, chronic illnesses, widening Black maternal mortality.
While the numbers are a little bit encouraging that we regained some years of life expectancy to about 80.7 years citywide in 2021, what we said to ourselves and what's clear is that it's not inevitable that we are just going to get back to where we were prior to COVID. Frankly, the pre-COVID story wasn't all that encouraging. The American life expectancy is still stagnating around 76 years. While New York is better than the nation, over the last decade, we've seen a rising toll of things like deaths of despair due to suicide, the effects of alcoholism and overdose that are starting to see American life expectancy stagnate.
This is our GPS coordinates, this plan, Healthy NYC, is very much the north star of where we want to head as a city in the post-COVID era so that we can reset this expectation that healthier longer lives for all New Yorkers is a central organizing function of our city. The fact that the mayor signed the Healthy NYC bill into law is actually a wonderful codification of this. It means it's not going to die or be subject to the vagaries of any one political cycle or one administration, but that it's going to be a permanent feature of our planning for years and decades to come.
Brian Lehrer: We'll talk about what the plan actually entails and how you hope it will decrease premature deaths. I want to ask you to comment on the racial or ethnic disparities in longevity as they exist. One stat that I saw that's a New York stat is that Black New Yorkers had the lowest life expectancy among the major racial or ethnic groups at about 76 years, while white New Yorkers had the highest at about 82 years. That's such a big difference. Six years of life on average.
I saw some national statistics in an article, and tell me if these are right, that had Asian Americans with the longest life expectancy at around 85, then Latinos around 80, and then whites around 78, and then Black Americans around 73 nationally, and the shortest life expectancy, Native Americans at around 68. How much of any of that sounds right to you?
Ashwin Vasan: No, those are right. Those are correct numbers and very disturbing numbers. Any bad-faith actors out there who want to make statements that somehow racism isn't real and it isn't a public health crisis just needs to look at the data. Those are enormous gaps in life expectancy. We know here in the city of New York that that plays out block to block, zip code to zip code. If you take the subway from the Upper East Side to Central Brooklyn, the life expectancy gap is on the order of 10 to 11 years, and so we have real issues around racial equity.
That's why Healthy NYC is explicit that there isn't a path to getting to healthier longer lives, there isn't a path to reaching our life expectancy goal in 2030 that doesn't center equity, and so what does that mean? That means really ensuring that our programs and our investments are getting into those zip codes and into the communities where we can start to stave off premature death, that is death below the age of 65, because we know that those premature deaths contribute disproportionately to the stagnating and falling life expectancy we're seeing. Racial equity is central to this plan, but there's also other strategies as well.
When we think about tobacco control or when we think about continued improvements in our food systems, reducing those risk factors for all New Yorkers citywide is also crucial. That's really what this plan is about. It's about prevention, it's about place-based investments, making sure that our programs and our dollars are getting into the communities where it'll make the biggest difference.
Also, we're very explicit, it's about the communities that are most vulnerable to begin with. People who live in congregate settings like shelters and nursing homes, people who live with disabilities, people who are unhoused or unstably housed. We need to be centering those people in our planning as well, so it's not a one-size-fits-all approach.
Brian Lehrer: If you're affirming those national numbers that I read, it would probably surprise people that Latinos live on average couple of more years than white Americans because there would be more of the racism that you cite and more poverty certainly in the Latino communities in the United States. I realize those communities are extremely diverse, but on average, is that true in New York? Do Latinos in New York live a little longer than whites on average?
Ashwin Vasan: Yes, but we know how fragile that is. Yes, Latinos are at or around the same levels as white New Yorkers, but they took the steepest drop in 2020, six years of life expectancy lost in one year. That's the steepest drop in the country and in the world in 2020 in any one group. New York City took the steepest drop in the country and in the world in one year, in 2020.
What that tells you about Hispanic New Yorkers and Latino New Yorkers is that while they might be healthier and living longer at baseline, it's incredibly precarious. We know that to be true. People working in the informal economy, people who are uninsured or unstably uninsured to receive basic healthcare and primary care and preventive screenings, all it takes is one big health shock like COVID or some other health issue to really make that much more precarious and to shorten lives. I don't think it tells the full picture. I wouldn't conclude from that that somehow Latino New Yorkers are permanently and fundamentally healthier, it's really about that precarity and that instability that so many people face.
Brian Lehrer: Right. I hear what you're saying about the precarity or precariousness, but what makes Latino New Yorkers-- What are the conditions that contribute to living about as long as white people who tend to have higher incomes, less risky jobs, those things? You have anything on that?
Dr. Ashwin Vasan: Look, first note Latinos are not a monolith. It's tens of countries around South America, even Western Europe, and other places around the world. That's an important caveat here, it's not a monolith. Number two, we know that just immigration patterns, people tend to come here earlier in life. Latino New Yorkers are structurally younger in New York City than other demographic groups on balance.
Whether they're a part of the formal economy or informal economy, Latino New Yorkers have higher workforce engagement than some other groups. I think all of that, even if income levels are not the same active, and also types of work as well, physical labor, manual labor, work in service industries, those are all contributing to more activity and certainly associated with some characteristics of better health. It's a complex story for sure.
Brian Lehrer: Listeners, who has a call about life expectancy in New York and what can improve it in general, and what can make it more equal across groups for the New York City Health and Mental Hygiene Commissioner, Dr. Ashwin Vasan, on the occasion of Mayor Adams signing healthy NYC into law which has a goal of average New York City life expectancy of 83? 212-433-WNYC. Call or text 212-433-9692. Listener writes, "How does the ability to eat healthy affect life expectancy in the different ethnic groups?"
Dr. Ashwin Vasan: Massively in general, and of course, there are group-specific differences. We set a goal within Healthy NYC. The way that Healthy NYC is structured is it sets out a life expectancy goal for the city by 2030. To reach that goal, it sets out very specific mortality reduction targets for the leading causes of death, premature death, and what we call excess deaths, so that's usually deaths that happen out of proportion than what we would expect.
One of the goals is to reduce heart disease and diabetes-related deaths by 5% by 2030. That might not sound like a lot, but it's actually profound because we've seen real persistent high levels of heart disease and diabetes-related deaths in our city, and we haven't really been able to move the needle. Diet is a major driver of both of those things. In fact, they're often colloquially referred to as diet-related diseases because we know that our diet is such a major contributor to the development of both stroke, heart disease, and diabetes.
The things we're doing and have done, the things that the Bloomberg administration was known for in terms of eliminating trans fats, their efforts to address sugar-sweetened beverages in society, the things that we're doing to increase incentives for people to get fresh and healthy foods, we launched a program called Groceries to Go during the pandemic, which was about getting people access to green grocery, basically, at a subsidized level, all of these things are really essential to not just manage and live with a chronic illness like heart disease or diabetes or diet-related diseases but, frankly and importantly, to prevent it.
It's also important to note the links between diet and cancer. We've set a goal to reduce screenable cancers by 20% by 2030. You can imagine some of those are incredibly related to diet, especially things like colon cancer. It's a huge issue. What you'll see in Healthy NYC is a set of strategies that are all the way upstream to things like food policy, tobacco control, big structural policy all the way down to access to care and very granular community-based programs.
Brian Lehrer: We're getting a lot of texts and calls on the question of why Latino New Yorkers and Latino Americans generally live as long as or longer than whites. A lot of them run along the lines of this text, which says, "We Latinos move more and have lifestyles of working physically demanding jobs, strong social connections, and eat more whole foods." A number of them highlight the social connections.
Another one says, "Regarding Latinos living longer, community. Community and close family relationships translates to longevity. One more on this track, Josie in Brooklyn, you're on WNYC. Josie, thank you for calling in. Hello.
Josie Hi. Good morning. I think about diet principally, immigrant Latinos, well, I'll speak for Mexicans, Mexicans have a very healthy diet. I think we are a young immigrant community here, and so they still eat their food, the practices they have from home. The reason our mortality rates were so high during COVID is because those undocumented workers were the essential workers, so they were more exposed to COVID.
What you find in the studies is that after a generation or two, then Latinos start eating really US kind of more American diets, but the first couple of generations eat beans, rice, tortillas, and the light protein. [chuckles]
Ashwin Vasan: Yes, I couldn't agree more, and thanks for making that comment. Without getting too wonky into demography and epidemiology, there's actually a phenomenon called the Hispanic Epidemiological Paradox, which is really, for the last three decades or more, people are trying to understand this question, four decades, really trying to understand this question, why, despite socioeconomic disadvantages, why do Latino Americans live as long or even in some populations around the country tend to outlive non-Hispanic whites?
A couple of things that have been mentioned, higher rates of physically demanding work, especially early in life, traditional diets, more whole foods in those diets, lower rates of smoking and tobacco use in the Latino community. Social networks, particularly through family and church is associated. Social connection and loneliness, of course, being factors for worsened health. I think there are some structural issues that also carry, despite the fact that Latinos are not a monolith, there's a lot of commonality in that.
The caller is absolutely right. That starts to fade over time. We've seen this in population after population, whether it's Asians coming over to the United States or Latinos. Over time, they adopt features of the uniquely American lifestyle, which is higher rates of processed foods and less activity and more sedentary lifestyle, which actually ends up negating some of those effects over time.
Brian Lehrer: Sam, in Manhattan, you're on WNYC with Health Commissioner Vasan. Hi, Sam.
Sam: Hi. Good morning. I was listening to this, and what I'm thinking is for the Black population is weathering. Number one, weathering is the premature aging of self. There's research being done on this that Black people in America experience biological aging of the cells based on all the stresses of having been a historically criminalized population. That historical criminalization that goes back several centuries, even in New York City, has created lack of access to affordable housing, to a decent housing and home ownership and the destruction of communities and equal medical care. The list just continues.
One other thing I would like to say is, as a Black mother myself, raising sons in particular is very stressful because once they get past a certain age, you see how people react to your sons differently. All of a sudden, once they get past six or seven, at best maybe nine, people see them differently. Now they're a threat. Your boys, as well as your girls, but your boys grow up not knowing if they're going to be shot by people on the street or by police officers, if they're going to be stopped when they go on the subway, when they get on the train, just living. Just doing normal things.
It's also happening with the girls. The kids are growing up stressed. The parents are stressed. The stress leads to bad habits like smoking, drinking. It also increases mental illness, but then there's not effective care for people with mental illness. It's like a cycle. Then if you can't find a decent place to live or your rent goes up and your job is not paying enough, your income doesn't go up, if you're working very difficult physically demanding jobs and you don't have enough time to just relax, all of these things--
Brian Lehrer: It all contributes to the weathering [unintelligible 00:06:45].
Sam: All of it. Yes.
Brian Lehrer: Sam, thank you very much. Commissioner, I think you should hire Sam as the Assistant Deputy Health Commissioner, right, because there it all is.
Ashwin Vasan: Yes. Sam, that was so well said. So well said, Sam. Weathering is a well-described phenomenon that particularly affects communities that have been on the receiving end of injustice and racial injustice in specific in this country. Arline Geronimus at the University of Michigan wrote a fantastic book called Weathering on this very subject, and it's also related to this concept of allostatic load, which is essentially the wearing down of the body due to cumulative stress and stress hormones.
If you have higher rates of stress hormones like cortisol, for instance, in your body all the time, or more frequently than other groups, that really over time impacts your blood vessels, it impacts your cells. It shortens your telomeres, which are the ends of your chromosomes, which are associated with aging and premature aging. That is a very real phenomenon. It's why the health department and why the city declared racism a public health crisis.
People asked us when we launched that initiative, "Why did you do that? What does it actually mean?" This is what it means. It has a real toll on the body, the effects of racism. Intergenerational racism has an impact on the body. Now we know how to measure it biologically. Even if you control for these other factors of economics and educational status, you see the physiological effects of racism on the body.
It's very clear that weathering plays a role in the persistent lower life expectancy of Black New Yorkers. Again, it's why in Healthy NYC we are so focused on balancing overall approaches of the city with place-based approaches, really driving our work into the zip codes and into the neighborhoods that we know people already have worse underlying health status due to things like racism.
Brian Lehrer: For people interested in reading more about weathering, we've had New York Times journalist Linda Villarosa on the show. She writes a lot about weathering. Check out-
Ashwin Vasan: Yes, she's great.
Brian Lehrer: -Linda Villarosa's New York Times articles, I guess, on the web, on their site if you're interested in more on that. One more listener comment. Listener writes, "I have lost three friends in the last two years to drug overdoses. None of them are what you would consider an addict, just recreational users. I think the amount of fentanyl-laced drugs is obviously out of control."
I guess the question that I would ask out of that is, when we talk about life expectancy, if it's 76 years on average for Black New Yorkers, 82 years on average for white New Yorkers, or the overall stat for everybody as a whole, it doesn't mean that people are living to 76 and living to 82 necessarily and then succumbing earlier in old age. A lot of it is because some of these disparities are that people are dying young, right? People are dying young from maternal and infant mortality, being disparate from the fentanyl that the listener writes about, from gun violence. Are the solutions in Healthy NYC largely focused there?
Ashwin Vasan: Yes, very much so. It's a both-and question. We do need to protect vulnerable older adults who we saw bore the brunt of COVID, for instance. We need to protect them and center them in our population, in our health agenda, but make no mistake, premature death below age 65 in this city in particular, but around the country it's the same, disproportionately impacts communities of color, and so we have to center that work if we are going to reach our goals of life expectancy and mortality goals that we mentioned.
Brian Lehrer: We already have drug prevention plans. There are diet promotion campaigns always. There's all kinds of debate over how to prevent gun violence in the city. What's at the heart of Healthy NYC that you and the mayor and City Council hope will make a difference?
Ashwin Vasan: At the heart of Healthy NYC is actually taking the step of setting these goals and putting them out there, and then those plans that have been launched prior or will continue to get announced, it's about really laddering up to something bigger than any one initiative can achieve. It's really putting in the GPS coordinates for health in our city. One of the things that was so remarkable during COVID even though it was a really challenging time, is that everyone's focus was that one disease, and everyone really came around the table and said, "How do we attack this in an emergency?"
One of the questions we were asking as we exited the worst of the pandemic is, "What is our North Star? What's the direction and why are we doing this? What's the big why here?" Ultimately, if we're not living in a city and in a society where we can expect to live healthier and longer, where we can pass that expectation on to our children, then what are we doing this for? This is our response. This is going to now be a permanent feature of city planning. Every five years we have to come back to the table and establish a new goal or track our progress towards the existing one and reassess what's killing New Yorkers too soon.
This is thousands of people, 7,000 people or more. We can avert preventable deaths if we achieve all of our Healthy NYC goals. That's brothers, sisters, mothers, children who would be otherwise taken from us too soon. This is our North Star. This is our GPS coordinates for health in New York City now and into the future.
Brian Lehrer: We have two minutes left in the segment. Let me get you quickly briefly on two other health-related news stories. One is, the CDC recently changed the COVID isolation guidelines. If you're fever-free for 24 hours, even if you're coughing and testing positive, you can go back to school, go back to work at the same time that they've now recommended that senior citizens over 65 get another COVID shot of the same vaccine that people got in the fall. Does that make any sense? It seems like mixed messages. Be more concerned, be less concerned.
Ashwin Vasan: I think the adaptation of the isolation guidance is really about, when can people get back to everyday life and how do we live with COVID in a way that is commensurate with its risk to the general population. For high-risk New Yorkers, particularly people over 65, people with underlying chronic conditions, immunosuppression, what have you, taking that extra booster, that extra dose, I should say, of the updated COVID-19 vaccine, is really about updating your immunity so you can prevent severe illness and death.
Brian Lehrer: Right, but I thought we've been--
Ashwin Vasan: I don't think it's mixed messaging. I think it's actually about where we are in terms of where COVID is and its generalized risk and where people want to be in terms of getting back to some [unintelligible 00:14:39].
Brian Lehrer: Maybe if society is allowing more COVID-contagious people to go back into the workplace, into schools and to everywhere, then the most vulnerable need to protect themselves more. Maybe it's consistent on that basis.
Ashwin Vasan: Brian, it's clear that in the guidance, the guidance is not saying, "Do nothing." The guidance says, "If you're going to go back to work, wear a mask for five days until you're totally symptom-free." It says, "Stay away from people who you know are older and have vulnerable conditions."
Brian Lehrer: I'm glad you made that point. I thought we've also been told that for people who've gotten most of their series of COVID shots since the beginning of the pandemic, the protection against serious illness persists, and the new boosters or new rounds of shots are mostly to prevent you from getting it at all. Is that wrong?
Ashwin Vasan: That's not entirely accurate. Certainly, your risk of getting it is reduced, but if you've been taking all of your shots, you have fairly significant immunity. One thing is clear about the vaccine-derived immunity as well as infection-derived immunity. It's not permanent, and so it does fade over time. These neutralizing antibodies that the vaccine is meant to elicit, they don't last forever.
It's not like a measles vaccine or a polio vaccine which has 10 years of immunity or more. This is a shorter-term vaccine like a flu shot, which you need to update every year. The mode we're moving to is this annualized COVID vaccine and high-risk people need to take another dose.
Brian Lehrer: Or every six months. You've segued into my last question, and we're over time, so if you can do this in like 30 seconds.
Ashwin Vasan: Sure.
Brian Lehrer: You're concerned about the measles, mumps, rubella vaccine for babies and toddlers, right? Is that declining in use?
Ashwin Vasan: New York is still doing pretty well, but yes, we're seeing declines all across this country, slight declines all across this country. Honestly, the anti-vax movement has become stronger and stronger, and we need parents in particular to redouble their efforts. We need to redouble our efforts in public health departments to get people vaccinated, get young people vaccinated prior to school, to get young babies up to date on their measles vaccines as well as many other because these are diseases of the past which are now coming back in pockets. Luckily, New York City is not--
Brian Lehrer: Do you think that the anti-COVID vaccine movement has now generalized even more to these newborn and--
Ashwin Vasan: Yes, it's very clear, and the data's very clear that it's had a contagious effect on overall vaccine confidence, and so it's on us to build back that confidence and to talk about why it's so important to stay up to date on routine childhood immunizations.
Brian Lehrer: New York City Health and Mental Hygiene Commissioner, Dr. Ashwin Vasan. We've covered a lot of ground. We always appreciate when you come on with us and do that. Thank you so much.
Ashwin Vasan: I appreciate you, Brian. Thank you so much.
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