Health and Wealth

Module 5 Lesson 9

LESSON 9: NEIGHBORHOOD HEALTH AND WEALTH OVERVIEW:

The purpose of this lesson is to explore the relationship between neighborhood wealth as determined by median income as well as the quality of the built environment and the overall health of the inhabitants. Recent studies have shown that great health disparities do exist within cities, often along lines of race and poverty. Furthermore, unhealthy neighborhoods can greatly influence individual health, either for the better or for the worse. In this lesson, students will conduct an investigation in a similar way that public health officials would, by examining three sets of data from New York City that look at the rate of diabetes and asthma rates in all of the neighborhoods of the boroughs of Brooklyn, Bronx, Manhattan, Staten Island and Queens in relation to the median income of those neighborhoods. By the end of the lesson students will have come to an initial correlation between health and wealth and identify areas for further investigation that might also support the proposed correlation.

SUB-QUESTION:
How can a range of data be used to show public health trends?

WAYS OF KNOWING URBAN ECOLOGY:

Understand Talk Do Act
Students will Understand that there is a relationship between neighborhood wealth and health. No specific goals connected with talking about urban ecology in this lesson. Summarize data and make correlations between neighborhood wealth and public health issues. No specific goals connected with acting on urban ecology in this lesson.

PREPARATION:
Time: Two 45-minute class periods Materials: Day 1: Activity 9.1 PowerPoint and projector (or overheads of slides and projector) Student Handout: New Yorks Asthma Rates article and questions Activity 9.2 PowerPoint and projector (or overheads of slides and projector)

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Module 5 Lesson 9

Student Handout: New Yorks Neighborhoods: Health and Wealth data tables Day 2: Activity 9.3 PowerPoint and projector (or overheads of slides and projector) Student Handout: New Yorks Neighborhoods: Health and Wealth- Further Investigations Activity 9.4 (optional) Student Handout Comparing two neighborhoods; additional factors to explore

INSTRUCTIONAL SEQUENCE
Activity 9.1: 1. Begin the lesson with the question: What Makes a Neighborhood Healthy? If students find it difficult, try something more nuanced: What features of a neighborhood promote individuals to live healthy lives? and, What features of a neighborhood are good for human health? Finally, ask the students what diseases or health issues might affect individuals living in an unhealthy neighborhood. After sufficient discussion, hand out the article to read in class. 2. Read the article out loud, pausing to define words as needed (asthma, preventative, air filters, hypo-allergenic, respiratory, correlation). Lead students through a discussion using the questions at the bottom of the article as a guide. Lead the discussion so that students begin to think more broadly about these factors and their effects on human health. For example ask, What sorts of effects might air pollution have on a neighborhood other than increased asthma? Have the students think back to the past lessons, including water and use of green space. This will lead to the tie in for diabetes. Activity 9.2: 1. Hand out packet of tables and graphs, New York City Neighborhoods: Health and Wealth. This handout should be used as a way of looking at the information that is displayed in the PowerPoint so that individual students can examine the data as it is being discussed with the class. 2. Begin the lesson by presenting the power point presentation. There is a slide that first presents the table of information on Diabetes. Before asking the students to examine the data, explain that the data represented in this chart, as well as all subsequent charts comes from the U.S. Census Bureau and the New York City Public Health Office. The information in the tables are always organized by the Borough and its neighborhoods. The median household income stays constant throughout the tables as well. The variables in the tables and charts are the public health issue at question. By examining the data, the students are doing exactly what public health officials do they are trying to find relationships and correlations with sets of data. After each slide, you may want to have students

Health and Wealth

Module 5 Lesson 9

3.

4.

5. 6.

write a sentence or two about their observations in regards to the data and what is tells us about the relationship of wealth and health. The second slide is the same data in a scatter form for the students to examine the patterns and correlations a little deeper. Before delving into the graph make sure students understand what they are looking at: each dot on the graph represents a different neighborhood on the spreadsheet. It is placed according to two scales: Its median household income (the average of all the household incomes in a neighborhood), and the rate of the particular illness. After explaining the graph to the students, ask, What does the graph show? How does it relate to what we just discussed with the data table? You may want to have students write a sentence describing the correlation between wealth and health in the graph. Repeat this process for the tables and graphs on Childhood Asthma Hospitalization. As a class, what statement can you make about the correlation between neighborhood wealth and public health based on the data that was examined in class? (ex. Neighborhood wealth affects public health by _________________ and ____________data supports this statement). Have the students record this statement as it will be reexamined during the second class.

Activity 9.3: 1. The Further Investigations handout and discussion are meant to delve into the nuances of public and wealth a little more deeply as well as provide a deeper examination of initial statement from the last class. Students can work individually, in small groups, or as a class to answer the questions posed on the handout. 2. Question 3 in the first section has the students looking at a linear trend line for the data on diabetes. The last slide of the Power Point is a graph of the diabetes data with a general linear trend line that the students are being asked to compare with their plot line. This should help students who may be struggling to see the comparisons. 3. Wrap up the lesson with having the students revisit the class statement on neighborhood wealth and public health. How confident do they feel about this statement? What other information would be helpful to know in order to determine whether this statement is true? 4. Spend some time discussing the last question on the student sheet. Ask students Does someones income cause certain diseases? For example, does having a low income cause someone to have asthma or diabetes? Or does having a low income tend to correlate with other factors, which are actually the causes of those diseases? Encourage students to think about some of the other characteristics of healthy cities that have been discussed throughout the module like air quality, healthy food and available green space. Neighborhoods with lower incomes are less likely to have healthy food, less likely to have green space and more likely to have poor air quality. These other factors are what actually causes the various health problems.

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Module 5 Lesson 9

Activity 9.4: Extending the lesson There is an additional activity with this lesson if time permits. The activity asks students to compare two neighborhoods and to think of some of the other factors aside from median income that may affect the public health concerns of asthma and diabetes, including the diversity of the neighborhood. More information can be found at the U.S. Census homepage at http://factfinder.census.gov/home/saff/main.html?_lang=en

Wealth & Health Name: _________________________________ Date: _________

Module 5 Lesson 9 Class/Period:________

Activity 9. 1: New Yorks Asthma Rates

New York's Asthma Rates

A report just issued by the Center for Children's Health and the Environment at Mount Sinai School of Medicine has concluded that the poor and minorities in New York City are 21 times more likely to be hospitalized for asthma than the affluent. For example, lower East Harlem, where the average household income was $18,732, had the most serious problem, with a rate of hospitalization of 222.28 per 10,000 per year. In a neighborhood like the Rockaways [in Queens], where the average household income was $103,125, the rate was zero, which means that not a single person had to be treated in a hospital for asthma in the last year. The report cited a previous study that has shown that asthma hospitalization rates were 7.5 times higher for minorities than for whites. The report offers three factors that could be responsible for the disparity in asthma rates. The first is that residents in the poorest neighborhoods lack access to proper preventative care. Asthma, if left untreated, can lead to wheezing attacks that restrict the victim's ability to breathe. However, the disease can be treated with careful and long-term monitoring in the home. Some of the measures that can be taken include the use of air filters and hypo-allergenic bedding. The authors of the Mount Sinai study cited previous studies that indicate that poor black and Hispanic families receive substandard care, and are therefore compelled to rely exclusively on the treatment they receive in an emergency hospital room. Proper follow-up care is rarely provided after the asthma attack is treated. A number of emergency room physicians have told the WSWS that the environment they work in simply does not give them the time or the opportunity to provide the necessary follow-up care. Second, poor housing is a critical factor for the high rates in certain areas. This is because buildings in low-income areas may have an increased exposure to air pollutants due to excess water created by water leaks and poor ventilation. This will increase exposure to indoor allergens. Experts, in general, have identified pesticides, dirt, dust mites, and cockroaches as major causes of respiratory problems. Third, there is significant evidence that minority and low-income people live in the most polluted areas in the city. They are exposed to the highest levels of toxic pollutants such as lead, ozone, carbon monoxide and particulates. Other studies have demonstrated a correlation between low air quality and respiratory diseases.
Excerpts from Allan Whytes New Yorks Asthma Rates Reveal Social Disparities as published on August 26, 1999 by World Socialist Web Site http://www.wsws.org/articles/1999/aug1999/asth-a26.shtml

Discussion Questions: What are the three factors the study cites as contributing to increased asthma rates? How might these factors play out differently in the neighborhood of East Harlem vs. The Rockaways? What other effects might these same factors have in a neighborhood?

Health and Wealth

Module 5 Lesson 9

Name: ___Teacher Version___________________

Date: _________

Class/Period:________

Activity 9.1: New Yorks Asthma Rates

New York's Asthma Rates

A report just issued by the Center for Children's Health and the Environment at Mount Sinai School of Medicine has concluded that the poor and minorities in New York City are 21 times more likely to be hospitalized for asthma than the affluent. For example, lower East Harlem, where the average household income was $18,732, had the most serious problem, with a rate of hospitalization of 222.28 per 10,000 per year. In a neighborhood like the Rockaways [in Queens], where the average household income was $103,125, the rate was zero, which means that not a single person had to be treated in a hospital for asthma in the last year. The report cited a previous study that has shown that asthma hospitalization rates were 7.5 times higher for minorities than for whites. The report offers three factors that could be responsible for the disparity in asthma rates. The first is that residents in the poorest neighborhoods lack access to proper preventative care. Asthma, if left untreated, can lead to wheezing attacks that restrict the victim's ability to breathe. However, the disease can be treated with careful and long-term monitoring in the home. Some of the measures that can be taken include the use of air filters and hypo-allergenic bedding. The authors of the Mount Sinai study cited previous studies that indicate that poor black and Hispanic families receive substandard care, and are therefore compelled to rely exclusively on the treatment they receive in an emergency hospital room. Proper follow-up care is rarely provided after the asthma attack is treated. A number of emergency room physicians have told the WSWS that the environment they work in simply does not give them the time or the opportunity to provide the necessary follow-up care. Second, poor housing is a critical factor for the high rates in certain areas. This is because buildings in low-income areas may have an increased exposure to air pollutants due to excess water created by water leaks and poor ventilation. This will increase exposure to indoor allergens. Experts, in general, have identified pesticides, dirt, dust mites, and cockroaches as major causes of respiratory problems. Third, there is significant evidence that minority and low-income people live in the most polluted areas in the city. They are exposed to the highest levels of toxic pollutants such as lead, ozone, carbon monoxide and particulates. Other studies have demonstrated a correlation between low air quality and respiratory diseases. These factors really address issues

of poverty and the differences between lower, middle and upper income households. Effects could include quality of education, violence, available green space, creative extra-curricular activities and community/social supports
Excerpts from Allan Whytes New Yorks Asthma Rates Reveal Social Disparities as published on August 26, 1999 by World Socialist Web Site http://www.wsws.org/articles/1999/aug1999/asth-a26.shtml

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Module 5 Lesson 9

Discussion Questions: What are the three factors the study cites as contributing to increased asthma rates?

Lack of access to proper preventative care, like air filters Poor indoor home conditions Air pollution

How might these factors play out differently in the neighborhood of East Harlem vs. The Rockaways? East Harlem has a very low median family income in comparison to the Rockaways, a difference of $84,393. A family that is living in Rockaway will more likely have access to better indoor home conditions, the public buildings and community spaces will also be in better condition, with air conditioning and will be cleaner. East Harlem has more major thoroughfares that go through that neighborhood, versus the Rockaways which is bordered by the Atlantic Ocean and no major thoroughfares.

What other effects might these same factors have in a neighborhood?

Health and Wealth

Module 5 Lesson 9

9.2 New York City Neighborhoods: Health and Wealth DATA TABLE: % of Residents with Diabetes by Neighborhood
Borough BRONX Neighborhood Kingsbridge-Riverdale Northeast Bronx Fordham-Bronx Park Pelham-Throgs Neck South Bronx Greenpoint Williamsburg-Bushwick Downtown-Heights-Slope $ 46,479 Bedford Stuyvesant-Crown Heights East New York Sunset Park Borough Park East Flatbush Bensonhurst-Bay Ridge Coney Island-Sheepshead Bay Washington Heights-Inwood Central Harlem-Morningside Heights East Harlem Upper West Side Upper East Side Chelsea-Clinton Union Square-Lower East Side Lower Manhattan Long Island City-Astoria Flushing-Clearview Bayside-Little Neck Ridgewood-Forest Hills Southwest Queens Jamaica Southeast Queens Rockaway Northern Staten Island Southern Staten Island $ 27,002 $ 25,621 $ 29,274 $ 31,801 $ 33,248 $ 41,072 $ 30,553 $ 27,851 $ 21,508 $ 18,564 $ 66,741 $ 68,942 $ 51,464 $ 41,696 $ 85,920 $ 37,733 $ 47,970 $ 58,047 $ 44,466 $ 44,403 $ 41,764 $ 56,310 $ 40,244 $ 44,453 $ 62,354 11 15 10 6 11 6 10 11 16 13 6 5 6 6 5 10 8 6 6 10 10 12 9 8 8 5 Median Income $ 48,493 $ 39,559 $ 25,989 $ 38,028 $ 18,487 $ 28,573 $ 21,358 % Diabetes 5 14 15 11 14 8 18

BROOKLYN

MANHATTAN

QUEENS

STATEN ISLAND

Health and Wealth

Module 5 Lesson 9

NYC Neighborhoods: Wealth and Diabetes

20 18
Diabetes Rates (% pop.)

16 14 12 10 8 6 4 2 0 $$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000

Median Household Income

Health and Wealth

Module 5 Lesson 9

DATA TABLE: # of children (age 0-14) out of every 1000 children who have been hospitalized for asthma by Neighborhood
Borough Neighborhood Median Income Asthma hospitalizations per 1,000 children, age 014 5 4 9 9 10 2 10 5 10 9 3 1 8 6 2 5 13 18 4 2 8 4 4 5 4 3 4 4 7 5 8 4 2

BRONX

BROOKLYN

Kingsbridge-Riverdale Northeast Bronx Fordham-Bronx Park Pelham-Throgs Neck South Bronx Greenpoint Williamsburg-Bushwick Downtown-Heights-Slope Bedford Stuyvesant-Crown Heights East New York Sunset Park Borough Park East Flatbush Bensonhurst-Bay Ridge Coney Island-Sheepshead Bay Washington Heights-Inwood Central Harlem-Morningside Heights East Harlem Upper West Side Upper East Side Chelsea-Clinton Union Square-Lower East Side Lower Manhattan Long Island City-Astoria Flushing-Clearview Bayside-Little Neck Ridgewood-Forest Hills Southwest Queens Jamaica Southeast Queens Rockaway Northern Staten Island Southern Staten Island

MANHATTAN

$ 48,493 $ 39,559 $ 25,989 $ 38,028 $ 18,487 $ 28,573 $ 21,358 $ 46,479 $ 27,002 $ 25,621 $ 29,274 $ 31,801 $ 33,248 $ 41,072 $ 30,553 $ 27,851 $ 21,508 $ 18,564 $ 66,741 $ 68,942 $ 51,464 $ 41,696 $ 85,920 $ 37,733 $ 47,970 $ 58,047 $ 44,466 $ 44,403 $ 41,764 $ 56,310 $ 40,244 $ 44,453 $ 62,354

QUEENS

STATEN ISLAND

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Module 5 Lesson 9

NYC Neighborhoods: Asthma Hospitalizations per 1,000 Children, age 0-14

20 18

Hospitalized Children per 1,000 Children

16 14 12 10 8 6 4 2 0 $$10,000 $20,000 $30,000 $40,000 $50,000 Median Income $60,000 $70,000 $80,000 $90,000 $100,000

Health and Wealth

Module 5 Lesson 9

DATA TABLE: New York City by Borough

Borough Neighborhood Median Income % Diabetes % Obesity Asthma hospitalizations per 1,000 children, age 014 5 4 9 9 10 2 10 5 10 9 3 1 8 6 2 5 13 18 4 2 8 4 4 5 4 3 4 4 7 5 8 4 2

BRONX

BROOKLYN

MANHATTAN

QUEENS

Kingsbridge-Riverdale Northeast Bronx Fordham-Bronx Park Pelham-Throgs Neck South Bronx Greenpoint Williamsburg-Bushwick Downtown-Heights-Slope Bedford Stuyvesant-Crown Heights East New York Sunset Park Borough Park East Flatbush Bensonhurst-Bay Ridge Coney Island-Sheepshead Bay Washington Heights-Inwood Central Harlem-Morningside Heights East Harlem Upper West Side Upper East Side Chelsea-Clinton Union Square-Lower East Side Lower Manhattan Long Island City-Astoria Flushing-Clearview Bayside-Little Neck Ridgewood-Forest Hills Southwest Queens Jamaica Southeast Queens Rockaway Northern Staten Island Southern Staten Island

$48,493 $39,559 $25,989 $38,028 $18,487 $28,573 $21,358 $46,479 $27,002 $25,621 $29,274 $31,801 $33,248 $41,072 $30,553 $27,851 $21,508 $18,564 $66,741 $68,942 $51,464 $41,696 $85,920 $37,733 $47,970 $58,047 $44,466 $44,403 $41,764 $56,310 $40,244 $44,453 $62,354

5 14 15 11 14 8 18 5 11 15 10 6 11 6 10 11 16
13

18 28 29 27 26 18 30 21 29 32 19 20 24 20 24 24 28 31 10 9 12 12 14 19 21 16 21
16

6 5
6 6 5 10 8 6 6 10 10 12 9 8 8

27 25 26
28 26

STATEN ISLAND

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Module 5 Lesson 9

New York City's Neighborhoods: Relationship between Median Household Income and selected public health issues
35

30

% of Diabetes

25 % of Obesity 20 # children per 1000 hospitalized with asthma

15

10

0 $$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 Median Household Income

Health and Wealth Name: ___________________________ Date: _________

Module 5 Lesson 9 Class/Period:________

Activity 9. 3: NYC Neighborhoods Health and Wealth Look at the graph titled, Wealth and Diabetes. 1. Which neighborhood suffers most from diabetes, proportionally? Which neighborhoods suffer the least? Looking at their median incomes, do your answers match your general statement on the relationship between wealth and health? If not, how do you need to change your statement to incorporate this new information?

2. Using the spreadsheet, find the neighborhoods Northeast Bronx and Borough Park. What is similar about them? What is different?

3. Draw a line between the two plot points from question 2. Does this line match with the general trend line that fits the whole graph? Does it match with your general statement on the relationship between health and wealth? What factors might be affecting the rate of diabetes in these neighborhoods.

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Module 5 Lesson 9

Look at the graph and corresponding spreadsheet titled, Asthma Hospitalizations. 1. Which neighborhood suffers the most from asthma? Which the least? Looking at their median incomes, do your answers match your general statement on the relationship between wealth and health? If not, how do you need to change your statement to incorporate this new information?

2. Look at the graph. How many neighborhoods suffer from childhood hospitalization rates of 4 per 1,000 children? What is the range of their median incomes?

3. Why might these neighborhoods, despite differences in income, experience similar rates of childhood asthma hospitalizations?

Do you think neighborhood wealth causes public health problems like diabetes and asthma? Or do you think neighborhood wealth tends to correlate with other neighborhood characteristics that cause the health problems? Explain your response.

Wealth and Health

Module 5 Lesson 9

Name: __Teacher Version___________

Date: _________

Class/Period:________

Activity 9. 3: NYC Neighborhoods Health and Wealth Look at the graph titled, Wealth and Diabetes. 1. Which neighborhood suffers most from diabetes, proportionally? Which neighborhoods suffer the least? Looking at their median incomes, do your answers match your general statement on the relationship between wealth and health? If not, how do you need to change your statement to incorporate this new information? Williamsburg-Bushwick suffers the most with 18%. Four neighborhoods, KingsbridgeRiverdale, Downtown-Heights-Slope, Upper East Side, and Lower Manhattan suffer the least with 4% each. 2. Using the spreadsheet, find the neighborhoods Northeast Bronx and Borough Park. What is similar about them? What is different? Northeast Bronx has a median household income of $39,559. Fourteen percent of its population suffers from diabetes. Borough Park has a median income of $31,801. Six percent of its population suffers from diabetes 3. Draw a line between the two plot points from question 2. Does this line match with the general trend line that fits the whole graph? Does it match with your general statement on the relationship between health and wealth? What factors might be affecting the rate of diabetes in these neighborhoods. The line shows an upward slope, indicating that as median income increases in these two neighborhoods, so too does percentage of population that suffer from diabetes. This runs counter to the general statement that as median income increases, public illness decreases. This shows that several factors can affect this outcome, including demographics - a higher percentage of elderly in Northeast Bronx, for example.

Wealth and Health

Module 5 Lesson 9

Look at the graph and corresponding spreadsheet titled, Asthma Hospitalizations. 1. Which neighborhood suffers the most from asthma? Which the least? Looking at their median incomes, do your answers match your general statement on the relationship between wealth and health? If not, how do you need to change your statement to incorporate this new information? East Harlem suffers the most with 18%. Borough Park suffers the least with 1%; Yes, it should. 2. Look at the graph. How many neighborhoods suffer from childhood hospitalization rates of 4 per 1,000 children? What is the range of their median incomes? 6 neighborhoods, with a range of incomes from $39,559 to $85,999 3. Why might these neighborhoods, despite differences in income, experience similar rates of childhood asthma hospitalizations? Think back to the factors: newer homes with less indoor hazards, presence of polluting factories and major thoroughfares, access to hospitals and quality care. Do you think neighborhood wealth causes public health problems like diabetes and asthma? Or do you think neighborhood wealth tends to correlate with other neighborhood characteristics that cause the health problems? Explain your response. Neighborhoods with lower incomes are less likely to have healthy food, less likely to have green space and more likely to have poor air quality. These other factors are what actually causs the various health problems.

Health and Wealth Name: ___________________________ Date: _________

Module 5 Lesson 9 Class/Period:________

Lesson 9.4: Comparing Two NYC Neighborhoods

Comparing two neighborhoods- additional factors to explore

Choose two of the NYC neighborhoods that are of most interest to you. Complete the chart below and then compare the rates of public illnesses in them. Come up with a research proposal to determine what other factors beyond median income might be affecting the public health of the neighborhoods that would explain why these two neighborhoods have different rates of public illnesses. Median Income Neighborhood 1: Rate of Diabetes Childhood Asthma Hospitalizations per 1,000 children

Neighborhood 2:

Under each heading below determine one factor for each category that you would want to investigate further to determine why there might be public health disparities in these two neighborhoods, beyond median income. Example using Social Factor: I want to investigate the population of elderly in Long-Island Astoria. I think there might be a high percentage of elderly living there, which would help explain Long Islands high rate of diabetes. Social Factor and hypothesis:

Physical Environmental Factor and hypothesis:

Natural Environment Factor and hypothesis: