Creating a More Complete Picture of Health in NYC Neighborhoods

DASH Project Spotlight: Neighborhood Tabulation Areas: Enhancing Community Health Improvement Capacity in NYC through Shared Information at the Small Area Level

Source: NYC DOHMH Bureau of Vital Statistics; NYC Planning Population Estimates Adapted from the American Community Survey 2009-2013.

Source: NYC DOHMH Bureau of Vital Statistics; NYC Planning Population Estimates Adapted from the American Community Survey 2009-2013.

Lead agency: NYC Department of Health and Mental Hygiene

Partners/collaborators: NYC Center for Innovation through Data Intelligence, NYC Department of Planning, United Hospital Fund of New York, the New York Academy of Medicine, the Fund for Public Health in New York

The challenge

In New York City (NYC), residents living just a few subway stops apart can face large gaps in life expectancy. It’s a big city made up of smaller, diverse neighborhoods—each facing unique health challenges.

Currently, health data are presented in the Community Health Profiles by Community Districts, which contain approximately 140,000 residents. However, information at this level often masks pockets of residents that are burdened with high rates of disease. Furthermore, some datasets are not available at this level – including data from the city’s human service agencies.

In order to empower city and community leaders to address persistent health inequities, they need access to geographically specific data on the multiple determinants that shape the health of their neighborhoods. Making this micro level data available can help stakeholders drill down deeper to identify the most salient health concerns and allocate resources to areas with the greatest health needs.

The opportunity

To enable robust evaluation of the key drivers of health in NYC neighborhoods, the NYC Department of Health and Mental Hygiene (DOHMH) and its partners, including the New York Academy of Medicine, the United Hospital Fund, and the NYC Center for Innovation and Data Intelligence, are creating comprehensive small area health profiles of individual neighborhoods that reflect the potential impacts of social, economic, and other factors on community health.

As analysts geocode newly obtained and existing datasets at the Neighborhood Tabulation Area (NTA) level (approximately 30,000 residents)—including data from public health, clinical health care, and human/social services—they are able to increase the geographic granularity of the data and better identify specific health needs. Some of the data sources that will be made available at the NTA-level include inpatient services and emergency department visits, American Community Survey, Vital Statistics, Medicaid, lab reports, and human services data. The project team plans to make relevant data accessible to communities through an online tool that stakeholders can readily use. Project Director Tsu-Yu Tsao commented:

“The NTA-level profiles will enable enhanced analysis, monitoring, and planning to promote the health of all New Yorkers and reduce disparities in high-need communities.”

The datasets, which will be updated on a regular basis, can be used by the health department and its partners to guide program and policy priorities. For example, DOHMH recently used the NTA-level data to inform the development of the request of proposals for Take Care New York 2020, which provides funding for high-need neighborhoods to develop data-driven action plans that address local health needs. Additionally, NTAs were used for emergency response planning and to display Zika virus surveillance data. Tsao explained:

“As the benefits of triangulating data at the NTA level become increasingly known to researchers and decision makers, we anticipate that the data will be widely used for analysis and planning and make identification, design, and execution of strategies to reduce health risks and disparities more effective in NYC.”

Engaging sectors to work together

This project is a collaboration between the health department and several city human service agencies that have access to data related to multiple determinants of health including child services, aging, homelessness, and human resources administration. The NYC Center for Innovation through Data Intelligence (CIDI) plays a central role, acting as neutral convener that aims to support a culture of data sharing between city agencies—in this case, between the health department and human service agencies. CIDI harnesses relationships, obtains buy-in, and develops governance policies and procedures so that data from city agencies can be brought together in one central location.

The DASH project has given the health department a more nuanced perspective of the varying levels of readiness for data sharing among other city agencies, and for some, publicly releasing their data will be a monumental step forward. To gain buy-in for the project, CIDI leadership, as well as one staff member jointly supported by CIDI and the health department, works with a team of data stewards from each agency to understand what indicators are most meaningful for them and how the data can be utilized to support their internal objectives. CIDI also created a formal process to help data stewards present the project to leadership at their respective agencies.

Interest and enthusiasm is building among the various agencies as they realize how having access to each other’s data will provide a more comprehensive view of the factors driving health-related outcomes in particular neighborhoods. As momentum builds, the long-term aim is that agencies will work together to collectively analyze indicators and focus on cross-cutting issues that emerge from the data. The combined dataset can help agencies improve their service provision and make more informed decisions that result in better returns on public investment. Tsao noted:

“While important, data are only the first step to making a difference in community health. The ability to make a difference requires effective collaboration among partners with shared goals, understanding of one another’s work, and a commitment to working together to improve the welfare of their communities.”

Another entity that the project has engaged is the NYC Population Health Improvement Program (PHIP) Steering Committee, a regional health planning group with representatives from public health, health care, community development, and human services. The PHIP Steering Committee provides a neutral and transparent forum for reviewing and discussing population health issues and disseminating best practices.

PHIP partners, in particular the New York Academy of Medicine (NYAM) and United Hospital Fund (UHF) of New York, and a workgroup consisting of data and policy experts, meet regularly to discuss project use cases and help select priority indicators so that the analyses generated can be translated into public health solutions. For example, NYAM may leverage NTA data to engage communities in adapting proven community-based approaches to chronic disease prevention and to advance healthy aging work, and UHF could use the data to facilitate promotion of health care delivery transformation in New York State.

Looking to the future

Providing more detailed, actionable data will help city agencies and communities target their resources to the areas that need them most and track the impact of targeted health interventions and reforms. Project partners are committed to bringing sectors together to develop a strategic agenda to promote the health of NYC’s 8.4 million residents and reduce health disparities in high-need communities. Tsao commented:

“We would like the geocoding tools developed by the project to be widely used by city agencies, and thereby make NTA-level geocoding a standard practice that will facilitate sharing and dissemination of data pertinent to social determinants of health. In the long term, we hope that this project will help solidify sustainable partnerships committed to tackling root cause of disparities using multi-sector data.”

The project aims to provide a model that can be replicated by other regional planning groups in big cities that are aggregating datasets from multiple sectors for community-level analyses. The culture of data sharing in NYC will be strengthened as more individuals and organizations use NTA-level data to better understand their communities and expand their impact.

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