New York City Demographics

Race and Ethnic Changes in the American Population : During the last four decades minorities have become the majority in many of the nation’s largest urban centers. Metropolitan and urban life has undergone dramatic changes since the 1960's. The increasing concentration of minority populations (native and newly immigrant) in the inner city has been accompanied by a growing social disorganization in many low-income neighborhoods, characterized in part by crime, drugs, homelessness, poverty and lack of access to the health care system. Because of shifts in population and immigration trends, the nation’s largest metropolitan areas now have heavy concentrations of African Americans, Latinos, Asian Americans, and other minority groups. (Given the emerging consensus that the term 'Latino' is the most appropriate term of reference for persons of Latin-American origin residing in the US, in this application we will use the terms Latino and Non-Latinos Whites.i)

Table I shows the sustained proportion of minorities and the growth of Latinos, living in the nation’s 10 largest cities according to the 2000 U.S. Census with 2005 reports. ii,iii

New York City , by far, was the largest city in the nation in 2005 . Los Angeles, the second largest city, had less than half of New York City’s population. If the New York City boroughs were considered cities for the purposes of comparison, with the exceptions of Staten Island, each borough would rank among the top ten cities in the United States. Brooklyn would rank fourth, Queens fifth, Manhattan seventh, and the Bronx ninth.iv The 2005 Community Survey Data of the U.S. Census documented the fact that over half of the New York City population is an ethnic minority. Of the nation’s ten largest cities with one million or more in population in 2005, only two ( Phoenix, AZ and San Diego, CA) were less than half minority. Many cities with populations between 500,000 and one million also have large minority concentrations. When the age, relative fertility trends and immigration patterns of minorities are considered, it is predictable that minorities will continue to account for a growing proportion of the total United States population in the decades ahead.

The changing demographics of the U.S. population will have a substantial effect on the medical care and public health sectors in the decades to come. In 2004 about half of persons 65+ lived in nine states. California had over 3.9 million; Florida 2.9 million; New York 2.5 million; Texas 2.2 million; and Pennsylvania 1.9 million.v Three of every four persons 65+ lived in metropolitan areas vi. The older Latino population is projected to become larger than the older black population by 2030. With such a clear population trend, it is imperative to prepare our national, state and local health systems with relevant health care personnel capable of providing clinical care as well as advance the research agenda.

The median income of older households was $23,787, in 2003. 5 In terms of the sources of income for older adults, according to U.S. Census 2001, 39% of older adults income is derived from social security, 24% from earnings, 18% from pensions, and 16% from assets. Social security constitutes from 50 to 100% of the total income of 65% of the US older adult population; 90% of all older adults received benefits. 5 Eleven (10.8%) percent of the older population has income below the poverty level. Eight percent of non-Latino Whites lived in poverty in 2003, compared to 23.7% of black and 19.5% of Latino elders. 5 Such disparities in income are likely to affect health care and health care delivery for substantial numbers of individuals.

The population of New York State (NYS) in 2015 is projected to number 18.9 million people – an increase of 3.6 percent since 2005. The aged 60+ minority population of NYS grew rapidly during the 1990’s increasing by 35.6 percent to 756,296, according to the 2000 Census. 23.6% of all older residents of NYS are of racial or Hispanic/ Latino minority heritage –compared to 17.5 percent in 1990. The minority aged-60 plus population as a whole is highly concentrated in the metropolitan counties of NYS, particularly those of New York City. More than three-fourths (77.2% or 583,828) of all minority aged 60-plus live in the five boroughs of New York City, comprising 46.6 percent of the City's total aged 60-plus population.vii

New York City with a census estimate of 8.2 million people in 2005, according to the Department of City Planning, has the largest number of minorities of any major city in the United States . They project the NYC population to reach 8.4 million in 2010 with estimated population growth to 8.7 million in 2020 and 9.1 million in 2030. The borough of Manhattan will see the second highest post-2000 growth, 18.8 percent, with its population projected to increase to 1.83 million in 2030 from an estimated at 1.61 million in 2005. viii While non-Latino whites are a large majority in the United States (75%), no single group was a majority in New York City. Non-Latino whites remained the largest racial group in the city, but accounted for just 44% of the city’s population. The proportion of Latinos (28%), Black non-Latinos (25%), and Asian (12%) and other non-White Latinos in the city’s population was approximately twice that of the U.S. as a whole.ix In 2000 the number of foreign-born New Yorkers rose to 35.9% from 28.4 in 1990; 52.6% are from Latin America while 23.9 are from Asia. x

The NYC Latino population has become more diverse since 1990, reflecting heavy immigration from Latin America in the 1990s, and large flows of domestic immigrants of Mexican origin. Puerto Ricans are still the largest Latino subgroup in New York City, but they no longer constitute a majority. About 37 percent of all Latinos were Puerto Rican in 2000, down from 50 percent in 1990. The Mexican population in the city more than tripled, from 61,700 in 1990 to 186,900 in 2000. This was primarily due to large domestic inflows of Mexicans, and an increasing number of births to Mexican women. Mexicans were the third largest Latino group in the city, comprising nine percent of all Latinos in 2000, compared to only four percent in 1990. 10

The Census 2000 statistics for the borough of Manhattan marked the first time Dominicans edged out Puerto Ricans to become the largest Latino group in Manhattan. Dominicans accounted for 43 percent of Manhattan’s Latinos in 2000, compared to a 29 percent share for Puerto Ricans. In Manhattan, Washington Heights and Inwood were the neighborhoods with the largest Dominican presence. xi

The City’s elderly population will increase from 11.7 percent in 2000 to 14.8 percent in 2030. Manhattan’s 2010 elderly population is projected to increase to 16.1 percent of the borough’s population, up from 12.2 percent in 2000. The increasing longevity of the population, combined with a more substantial share of the city’s population that is older, portends a new demographic era in the city’s history.

Projections show an increase in the growth of the 85 and older age group, and a rapid growth of younger elderly cohorts during the period from 2005 to 2015.xii The number of persons aged 65 and over is projected to rise 44.2 percent, from 938,000 in 2000 to 1.35 million in 2030. The aging of large baby boom cohorts, a decline in fertility, and improvements in life expectancy all contribute to a general aging of the population.

In Manhattan, 43% of persons 65 years and over lived alone versus 33% in the other boroughs. An additional one-third of the elderly population headed a household that contained at least one other person, usually a family member. Five percent of the City’s 65 and over population lived in senior citizen facilities in 2000. While NYC averaged 41.3 persons per acre in 2000, Manhattan’s population density stood at 104.6 per acre.

While progress has been made in reducing health disparities in New York City, substantial inequalities remain among New Yorkers of different economic and racial/ethnic groups. Poor New Yorkers, as well as African American and Latino New Yorkers, bear a disproportionate burden of illness and premature death. The poorest New Yorkers are four times more likely to report poor overall health than the wealthiest. The rate of new HIV diagnoses is about six times as high among Blacks as among Whites. Latino New Yorkers are more than twice as likely to have diabetes as White New Yorkers. Disparities in diabetes are widening: From 1999–2001, Black New Yorkers were about three times as likely to die from diabetes as Whites. It is also clear that poor health is concentrated in certain New York City neighborhoods. In 2001, the life expectancy in New York City’s poorest neighborhoods was 8 years shorter than in its wealthiest neighborhoods. 8 Factors associated with poor health, such as poor access to medical care, unhealthy behaviors, and poor living conditions, are more common among certain economic and racial/ethnic groups. In every racial/ethnic group, poor New Yorkers are the most likely to not have received needed medical care in the past year (i.e. wealthy New Yorkers are about twice as likely to exercise as poor New Yorkers. 8

The Columbia Center for the Active Life of Minority Elders (CALME) is established in the northern part of Manhattan, in the center of two contiguous large minority communities: Harlem and Washington Heights-Inwood ( WHI). CALME serves the Northern Manhattan Community Districts 9, 10, 11 and 12, which includes most of the 15 th Congressional District. Northern Manhattan is reflective of NYC’s racial and ethnic diversity. In 2000, of the 427,247 persons living in the Harlem and WHI sections, 32% were African American and 52% Latino. Residents of both Harlem and WHI are also poor, with 48% of all persons living in WHI and 45% of those living in Harlem receiving some sort of public assistance in 2005 (including TANF, SSI and Medicaid).xiii Both Harlem and WHI have been long-time HRSA designated Health Professional Shortage Area.

The Harlem Community : Harlem has long been one of America’s premiere African American communities and a national leader in cultural, political, and social trends-distinctions it retains to this day. During the last two decades the number of Latinos in Harlem has increased substantially, but African Americans remain the largest minority group. In 2000, the total population of Harlem was 218,823, with 54% African American and 30% Latino.The total population 60 years and over is 32,823 or 15%. Over one-third of Harlem residents fall below the 100% Federal poverty level (two thirds of this group below the 200%). In comparison, the citywide population that fall below the 100% Federal poverty level is approximately 19%. The Harlem community has high mortality rates in many disease categories, with the highest mortality rates in New York City for 15 causes of death. 7 Harlem is divided into East and Central Harlem Health districts.

NYC Department of Health Vital Statistics show Central Harlem District leads the city in infant mortality, cancer, cerebrovascular disease and cirrhosis mortality. Central Harlem residents aged 25 and older have completed fewer years of college education (20%) than those in Manhattan (49%) and NYC overall (27%). 12% of adults have diabetes, compared to 7% in Manhattan and 9% in New York City overall. 27% of Central Harlem residents are obese versus 20% in New York City overall. Central Harlem death rate due to drugs are more than twice as high in as in Manhattan and NYC overall (25/100,000 vs. 11/100,000 in Manhattan and 10/100,000 in NYC). Flu shot rates among older adults (54%) fall below the Dept of Health target rate and pneumococcal (pneumonia) immunizations are even lower (48%). 8

The East Harlem district fell below NYC Dept. of Health & Mental Hygiene key health indicator goals in 8 of 10 goals. The East Harlem district percent of residents living below the poverty level (38%) is nearly twice as high as in Manhattan and NYC overall. In 2003-2004, the average annual death rate in East Harlem was more than 50% higher than in both Manhattan and New York City overall (1,084/100,000 vs.697/100,000 in Manhattan and 718/100,000 in NYC).

The Washington Heights and Inwood Community ( WHI) : The WHI community was initially settled by European immigrants and began a transition to Latino residents from Puerto Rico, then Cubans in the early 1960’s. However, since the 1970s the largest group has been from the Dominican Republic whose residents continue to flee pervasive economic troubles in their native country. The total population of WHI grew to 208,414 in 2000, an increase of 5.2% from 1990. Racial/ethnic data from the 2000 Census show the following distribution: Latino 75% (up from 67% in 1990), African American 8.4% (down from 11.4% in 1990), and White non-Latino 13.6% (down from 18.7% in 1990). The community’s growing Latino population is predominately Dominican (55%) but there are also considerable numbers of Puerto Rican (8%), South American (4%), Mexican (3.3%) and Cuban (3%) residents. Census 2000 data indicates that 15 percent or 22,434 residents of Washington Heights & Inwood were aged 65 years and over, 11,724 of these are Latino elders.xvi

By most measures, economic disadvantage is much greater in Washington Heights and Inwood than in New York City as a whole. In WHI, the percent of residents living below the poverty level is higher (31%) than the city’s rate (21%). In NYC, the percent below poverty level of persons aged 65 years and over rose to 9.8% in 2000. 51% of WHI residents were born outside the U.S. WHI residents are more likely to be uninsured than those in Manhattan overall (20% vs. 13%) and nearly one-third more likely to be without a regular doctor than those in NYC overall (32% vs. 24%). The WHI rates of obesity are increasing rapidly making it a major public health concern as more than one fifth of adults (21%) are obese, which is one-third higher than in Manhattan (15%). The increasing prevalence of obesity has contributed to an epidemic of diabetes. About 95% of diabetes cases are type 2 diabetes, which is strongly associated with obesity. Uncontrolled diabetes can worsen the harmful effects of high blood pressure, high cholesterol, and other risk factors for heart disease. In Inwood and Washington Heights, 11% of adults have diabetes, compared to 7% in Manhattan. The 2004 WHI flu immunization rate among older adults (60%) falls short of the Dept of Health target rate by 25%. WHI older adults are less likely (38%) than those in Manhattan (51%) and NYC (48%) to have ever received the pneumococcal vaccine.xvii

The communities of WHI are characterized by poverty, low levels of education, and linguistic and social isolation. The social, economic, and linguistic issues permeating the neighborhood, combined with poor and overcrowded living conditions, interfere with the ability of some patients to use the healthcare system effectively. WHI residents aged 25 and older have completed fewer years of education than those in NYC overall. Many of the recent immigrants do not speak English; therefore their ability to negotiate the healthcare system can be impaired. Multiple economic indicators suggest that most community residents are economically disadvantaged (i.e. in 2000, 52.1% of New Yorkers who were not English proficient spoke Spanish). The main causes of death in descending order are heart disease, cancer, homicide, AIDS, pneumonia, strokes, and diabetes.

In summary, New York City, and in particular the communities of Harlem and Washington Heights/Inwood have high concentrations of elderly minorities whose social circumstances are tightly bound to health disparities. The involvement of the health care delivery system and its service population is critical in order to address the RCMAR general mandate: the promotion of minority health research to decrease the minority/non minority health disparities for older people, and more specifically the CALME theme of enhancing the active life, health and cognitive function of urban minority elderly.

i. Hayes-Bautista DE, Chapa J. Latino Terminology: Conceptual Bases for Standardized Terminology.   In LaVeist, TA ( ed) Race, Ethnicity and Health: A Public Health Reader. San Francisco: Josey Bass, 2002.

ii. US Census Bureau. American FactFinder. Available at http://factfinder.census.gov/servlet/BasicFactsServlet

iii. US Census Bureau. American FactFinder. 2005 American Community Survey Available at http://factfinder.census.gov/servlet/BasicFactsServlet

iv. Population Division-New York City Department of Planning (Oct 2001) http://www.nyc.gov/html/dcp/html/census/popdiv.shtml

v. US Census, Population Estimates by State, Age and Sex for States and Puerto Rico: April 1, 2000 to July 2004; Available at http://www.census.gov/popest/states/asrh/SC-est2004-02.html

vi. He W, Sengupta M, Velkoff VA, DeBarros KA, US Census Bureau, Current Population Reports, P23-209, 65+ in the United Stated:2005, U.S. Government Printing Office, Washington DC, 2005.

vii. New York City Population Projections by Age/Sex & Borough, 2000–2030 December 2006. http://www.nyc.gov/html/dcp/html/census/popdiv.shtml

viii. Karpati A, Kerker B, Mostashari F, Singh T, Hajat A, Thorpe L, Bassett M, Henning K, Frieden T. Health Disparities in New York City. New York: New York City Department of Health and Mental Hygiene, 2004. http://www.nyc.gov/html/doh/downloads/pdf/epi/disparities-2004.pdf

ix. US Census Bureau. American FactFinder. New York city, NY. 2005 American Community Survey: Available at http://factfinder.census.gov/servlet/BasicFactsServlet

x. New York City Population Projections by Age/Sex & Borough, 2000–2030 December 2006. http://www.nyc.gov/html/dcp/html/census/popdiv.shtml

xi. Older New Yorkers in 2000 OFFICIAL 2000 CENSUS COUNTS FOR New York STATE COUNTIES http://www.aging.state.ny.us/explore/projections/page4.htm

xii. New York State Office for the Aging. Explore Aging-Populations. Demographic projections to 2025 Available at http://www.aging.state.ny.us/explore/projections/page4.htm

xiii. Manhattan Community District Community Profiles. http://www.nyc.gov/html/dcp/. Accessed July 1, 2006.

xiv. Health Professional Shortage Areas, Ad-Hoc Database Query Selection HPSA Data Extract. http://hpsafind.hrsa.gov/HPSASearch.aspx. Accessed July 3, 2006. (Harlem HPSA ID # 1369993670, last updated 03/28/2002 and WHI HPSA ID # 136999368, last updated 02/09/2006), RFA Demographic Goal B

xv. New York City Department of Health and Mental Hygiene Community Health Profiles SECOND EDITION — 2006 East Harlem. http://www.nyc.gov/html/doh/downloads/pdf/data/2006chp-303.pdf

xvi. US Census Bureau American FactFinder Available at: http://factfinder.census.gov/servlet/BasicFactsServlet

xvii. New York City Department of Health and Mental Hygiene, Community Health Profile, Second Edition: Inwood and Washington Heights http://www.nyc.gov/html/doh/downloads/pdf/data/2006chp-301.pdf

xviiii. In: Washington Heights/Inwood: The Health of a Community II. Published by The Health of the Public Program at Columbia University. Richard Garfield, Danielle Greene, David Abramson and Susanne Burkhardt, editors. 1997