Roots of increased health care inequality in New York

Abstract

During the 1970s, New York city experienced an epidemic of housing destruction by contagious fire and building abandonment. This epidemic was triggered by reductions in municipal services, especially fire control, in the poor areas of high population density and aging housing. The rapid loss of low rent housing led to a wave of forced internal migration of the poor within the city and overcrowding of areas adjacent to the burned out ones. The spread of overcrowding spread the high fire incidence. The massive upheaval resulted in destruction of social networks and in degraded living conditions. Public health, as measured by many indices such as disease incidence, substance abuse incidence, infant mortality, and incidence of homicide, deteriorated. This deterioration caused increased demand for hospital health care, especially emergency service. The data on average stay length in the poorest areas in comparison with wealthier areas hints that the overloading of the voluntary hospitals in the poorest areas has caused care rationing and greater inequality in access to care.