• What’s going on in NYC?

    NOTE: After you finish reading this post, go read my follow-up.

    Mayor Bloomberg is getting a lot of heat for his recent decision to ban large soft drinks from sale in many sites in the city. He thinks that it will reduce obesity, and eventually make people healthier. Critics disagree.

    On the other hand, what’s up with this?

    That’s the life expectancy of people in the five boroughs of NYC compared to the rest of the country (red dotted line). Details:

    In the national context, the increase in New York City’s life expectancy stands out (figure). The Institute for Heath Metrics and Evaluation recently estimated the life expectancy for each of the USA’s 3147 independent cities and counties. Manhattan’s life expectancy rose 10 years between 1987 and 2009, the largest increase of any county, and the other four counties that make up New York City were all in the top percentile.

    By contrast, national life expectancy lengthened only 1·7 years per decade, and the USA—already trailing the world’s longest lived countries—dropped back further. “What we see in the United States sends an alarming, alarming message”, says Ali Mokdad, who led the research. “We are not catching up with what everyone else is achieving. And in many counties in the United States, we are falling behind: our life expectancy is going backward.” In this context it is all the more urgent to understand the improvements witnessed in New York City, and the lessons that can be applied elsewhere.

    Mokdad, and I’m sure NYC health officials, credit much of this to the many public health initiatives that have been enacted in city. These include things like calorie labels for food sold in chain restaurants, the banning of trans fats, prohibiting smoking in public spaces, high taxes on cigarettes, tons of bicycle lanes, and aggressive public information campaigns against obesity and for preventive health services. Being the skeptic I am, I think that’s far from proven. The population in NYC hasn’t been static for decades. People move in and out all the time. Moreover, other changes may have occured that we can’t track.

    That said, this is somewhat compelling. It’s important to remember that the Bronx is the poorest urban county in the United StatesAbout 30% of those living there do so below the federal poverty line, and and three quarters of them are black or Hispanic. While the life expectancy of that borough lags behind the other four, it has seen comparable increases in life expectancy to the other areas, and by 2009 had almost caught up to the national average.

    We can debate other explanations for this. But maybe, just possibly, New York is onto something.

    (h/t Beth Tarini)


    UPDATE: Let’s remember a few facts:

    1. Although homicide rates dropped, they were never high enough to affect the life expectancy of millions of people on this scale. To increase the life expectancy of one million people one year, about 20,000 fewer 25 year olds would need to be killed. In 2008, roughly 60 people were killed per one million citizens. This isn’t the cause.
    2. I agree that immigration could be a cause. But other cities get immigrants, too.
    3. It’s fine to try and say this is because of rich people replacing poor, but this is happening in Brooklyn the Bronx, too, which remains the poorest urban county in the US and is almost up to the national average now.
    4. Although accidents decreased, there were 237 traffic related fatalities last year. The same rule of 20,000 fewer 25 year dying olds per million people to raise life expectancy 1 year applies.
    Comments closed
    • I’d be interested to see how much of this can be explained by the huge drop in the murder rate in NYC.

      • Directly, none of it.

        But indirectly, probably a lot, because less *fear* of murder (and other crime) definitely made New York a much more desirable place to live for the wealthy and healthy.

    • Could it be the fact that you basically *have* to walk to get anywhere?

      Even people who are well above the national median income don’t have enough money to afford a car in NYC. It’s a few blocks to the bus or subway from your house, and a few blocks at the other end to your destination. Every time you go to the grocery store, you have to carry the stuff stuff home. Many people live in walk up apartments.

      This has always been the case, but it doesn’t surprise me that people in NYC are healither than average. Obviously city pollution (and crime) would ding the life expectency, but those have been declining over the last 20-30 years.

      • I’m with you on this one. I live in the midwest and consider myself healthy. I like to run and eat sort of healthy. Around here I’m probably seen as ‘thin’. When I visit NYC, I can definitely physically feel the result of the vast increase of walking a few blocks several times a day to do anything and see much fewer overweight people than around here. I also notice that grocery sources are set up to where people buy small amounts of food several times per week. As opposed to once a week or less frequently in the suburbs. For me, this would lead to eating more fresh fruits and veggies, since spoiling is less of an issue and you can’t do more impulse buying of junk food and sugary drinks because you have to carry what you buy.

        But this hasn’t changed over the past 20 years. I would bet that improvements in health tech and research have raised everyone’s life expectancy, but in most other places this has been counter-acted by the drive-everywhere-eat-too-many-calories lifestyle that pretty much defines the rest of America at this point. In NYC, walking more isn’t a conscious choice, it’s required.

      • My thought exactly. People walk everywhere. Rare is the person who moves from NYC and doesn’t gain weight.

    • Most of this can probably be explained by gentrification. If you take a municipality and replace a significant portion of poor people with rich people the life expectancy of that municipality will go up.

      • Agreed. Even though The Bronx is relatively poorer, there has a been a massive gentrification in parts of the Bronx such as Riverdale.

        Run a correlation of this life expectancy data with average rents data for each borough.

    • Many factors as mentioned the decline in homicide rate and the inflow of more college grads. Another one could be that NY gets more immigration. Also gentrification of the parts of the city. Even the rise in the percent of Hasidic Jews could contribute something.

      From Wikipedia:
      While three-quarters of New York Jews do not consider themselves religiously observant, the Orthodox community is rapidly growing due to higher birthrates among Orthodox (especially Hasidic) Jews, while the numbers of Conservative and Reform Jews are declining.

    • I address some of these above

    • I am with del2124. I’d like to see the data on life expectancy nationally by income. Obviously a challenge as I would guess New York incomes are higher generally, so it can’t be just a simple comparison–it would be interesting to see it side by side with something like percentage change of income for all the boroughs.

      I also with Kevin and walking. A good comparison would be to compare something like the median bin of incomes or same income bins of different cities to see if there were unique factors of the city that gave it advantages beyond selection/composition of population changes.

    • I don’t believe the Bronx is the poorest county in the US. According to Wikipedia, New York doesn’t have one county on the list of 100 poorest counties.

      Source: http://en.wikipedia.org/wiki/List_of_lowest-income_counties_in_the_United_States#100_poorest_counties_by_median_household_income

    • There’s gentrification going on in the Bronx too. The author is attempting to explain the change right? The fact that the borough remains relatively poor explains why the line is still below the national average. The fact that it’s getting closer indicates something is changing.

      That being said, the interesting upswing here appears to occur between about 1994 and 2000, where the curve changed, particularly in the Bronx, Brooklyn, and Manhattan . I wonder specific policy changes there were during that period that could explain the shift. It’s not like people started walking more during that period.

    • Here is your answer:

      “The biggest factor in New Yorkers’ increased life expectancy was unrelated to any of these. Instead, officials attributed it to expanded H.I.V. testing and treatment, which resulted in a drastically reduced death rate from H.I.V. and AIDS. The mortality rate from H.I.V. infection in 2010 fell by 11.3 percent since 2009, and by 51.9 percent since 2002.

      Other significant factors are a decline in deaths from heart disease and cancer; a decline in drug-related deaths; and a decline in infant mortality.

      For much of the 20th century, New Yorkers lagged behind other Americans in life expectancy. The difference was greatest in 1990, when the AIDS crisis dragged down life expectancy in New York, particularly for men. The tide turned around 2000, when New York’s life-expectancy rate began surpassing the national rate.

      The new life-expectancy figures were released by the city’s Department of Health and Mental Hygiene on Tuesday as part of its 2010 Summary of Vital Statistics.”

    • I would be surprised if walking a lot more than the average american didn’t play a huge role in this.

    • These comparisons should be taken with a grain of salt as the data aren’t that precise and different places report things differently.

      OTOH, if you can find a U.S. state-by-state comparison you see some interesting things: the U.S. Plains states have some of the highest LE in the world, while the Lard Belt shows up pretty clearly.

      The U.S. ethnic breakdowns are also interesting: Asians and Latinos live longest, followed by whites, and blacks are way, way down (this may have to do with Vitamin D levels).

    • The biggest contributor to changes in life expectancy is infant mortality.

      When 1/3 of children die before age 2, for example, a life expectancy of 50 means that people after age two live to an average of 74.

    • There is a strong racial component to this. Those US counties with the worst life expectancies are generally in the South with large African American populations.

      The little reported trend in NYC is for African Americans to move out and move back down south. NYC is less black now than it was in the years when life expectancy lagged.

      Even if the folks replacing African Americans are themselves poor, and being recent immigrants they generally are, they are still healthier than African Americans, who are exceptionally unhealthy, even by American standards.

      • http://flowingdata.com/wp-content/uploads/2012/05/life-expectancy-changes.png

        If you look at all the counties where life expectancy decreased in the last ten years, it looks almost exclusively white, with the exception of northern Alabama. Oklahoma, Tennessee, West Virginia, Southern Georgia . . . if there’s a racial component here its not what we would expect.

        • You need to be careful with this since the map you showed are for differentials. Even if those counties are “white” as you wrote, are they more white, less white, or the same pallor beginning to end? It is the change over time that matters most, both in the longevity and the demographic composition.

    • To me this is irrelevant. I be much safer if people kept from doing things I like, for example SCUBA diving. If Mike Bloomberg kept everybody from SCUBA diving, no one would die SCUBA diving and life expectancy would increase. That is not the world/country/state/city I want to live in. And it would affect life expectancy, as I pay HIGHER life insurance due to this hobby.

    • All the people attributing the higher LE to walking are confusing NYC and Manhattan. There are plenty of cars in Queens (highest LE) and Staten Island.

      • “Plenty of cars” is imprecise. Sure, there are more cars here than in Manhattan but without a ratio this is a useless fact. Most people in Queens do NOT have a car, and we walk a lot. I am a good 5-6 blocks from the #7 train, and I have to carry by groceries home. I have to walk a lot but it is something I am used to. In addition, I can use my bicycle to get to places in Astoria and LIC. Queens rocks!

    • “To increase the life expectancy of one million people one year, about 20,000 fewer 25 year olds would need to be killed. ”

      Considering that in a population of 1 million statiistically only about 12-15.000 people die when the average life expectancy is 75-80, I believe you need to re-think that argument – and the one on traffic.

      Dont know where to start on the rest, but I would like to point out that the most significant change (and deviation from the national trend) occurred in 1995-99, when none of the current policies where in place. Also, improvements in diet and healthy ways of living take some time before they show significant effects on average life expectancy, so whilst the policies may be beneficial, it is likely to take some time to show up in the stats.

      • See my subsequent post. You need to add one million person-years to a population in order to increase the life expectancy of one million people one year. You can add one year of life to a million of them. Or, you can add 50 years of life to 20,000 of them. I chose 25 year-olds and a 75 year life expectancy to make the math easy. Regardless, you need many millions of person years to increase the life expectancy of all New Yorkers a decent amount.

        • While you need to add 1M person-years to a population of 1M to extend its life expectancy by 1 year, those person-years aren’t all added the same year. Ben is right, to increase the life expectancy by one year when it’s already 75 years, you need 20000 / 75 = 267 fewer 25-year-olds to die each year. It’s of the same order as your current number of traffic fatalities.

        • Are you accounting for time correctly when you write:


          We aren’t adding 1 year of LE/yr., we are adding about 1/3 year of LE/yr. And we are considering a trend that goes from 1987 to 2009. At the 2008 rate, that would be 1320 homicides/million people, and at the 1990 rate it would be about 5200 roughly speaking.

          I think it probably better to say that the drop in homicides isn’t the major operative cause as opposed to “isn’t the cause”. I second the comments above that pointed out the advent of AIDs testing and the arise of the RT inhibitors and protease inhibitors that cut the death rate from AIDs in New York City from about 8000/yr in 1995 to 2000/yr.

    • Having grown up/lived in NYC for virtually the whole time period: The burnout of the crack epidemic, protease inhibitors, and gentrification (Yes, happening in the Bronx too, though more slowly) are almost certainly doing the vast majority of the work, probably with some small boost of Wall-Street financed social services, and a negative inflection around 9/11. Remember that the homicides cut down a lot of people–including kids–in their prime, and of course that this is not the only way that illegal drugs kill people. Crack and heroin addicts have drastically reduced life expectancies if they’re on the drugs for any lengthy period of time, and there were many more users than there were drug-trade homicides. Crack users were also fairly notoriously bad at caring for children/elders.

      • I agree it’s possible it’s a combination of things. But the long-term effects of the crack epidemic, from a health perspective, may not be as far reaching as you think. As for homicides and such, yes, those cut down in their prime hurt life expectancy more than death at a later age, but there just aren’t enough murders to account for the 48 million person-years you’d need to increase the life expectancy of all of New York 6 years over the national average.

        See my follow-up post: http://theincidentaleconomist.com/wordpress/life-expectancy-is-a-population-metric/

        And congratulations on the new job!

        • To be sure, I’m literally just eyeballing the graph. But I lived in New York City in the late 1990s, and it’s hard to think of some public health initiative that could produce that kind of spike. It is, however, very easy to think of protease inhibitors, which didn’t merely reduce deaths, but improve the life expectancy of New York’s thousands of gay men.

          It’s also worth noticing that the changes are vastly less dramatic in Queens and Staten Island, the disproportionately middle-class, white ethnic boroughs. The change is most dramatic in Manhattan. To me, that says that’s what’s happening, is happening to poor people and gays.

          But New York already had extremely generous public services in the 1980s, and the nanny state stuff with food and cigarettes didn’t start until 2000. What’s happening in the 1990s that mainly affects Brooklyn, Bronx, and Manhattan? Crime is dropping, AIDS drugs are being developed, and poor people are being displaced by rich people (or in the northern reaches of the Bronx, by white ethnic immigrants–best Irish import markets in the country are now in Woodlawn.) Welfare reform is pushing people into work or out of the city.

          If it was food nannying and smoking taxes, it should show up more in Staten Island and Queens, where there are a lot of fat smokers. If it was some sort of major reform in the health care system itself, I’d have known about it, and so would at least a few of your readers. The public health things I do know about that seem initially plausible–like lead abatement–don’t have the right lag, and given the exodus of native born, also shouldn’t explain life expectancies 30 years later.

          It’s not that I’m ruling out a public health explanation, but I can’t find one that matches up with that chart. I can, however, find things that match up with the pieces, and they’re mostly gentrification/crack/AIDs linked.

          Of course this is all speculation, and I’m happy to be proven wrong. But I’d want a convincing story about a single initiative under four mayors–or even a handful of ’em–that changed New York health this radically.

          • I’m not claiming this is due to specific initiatives. I don’t know what is causing it. But I do know that the growth in life expectancy in NYC far surpasses the rest of the country, and I doubt it can be linked entirely to disease cures or crime.

            And if it can, why does NYC do so much better than the rest of the country now, even in the Bronx. There may be been “gentrification” as you claim, but it remains the poorest urban county in the country. It’s still doing shockingly well given that status.

            • It’s still well below the national average; it’s just having shocking improvement. Which looks to me like the expansion of the Irish/Israeli population and other non-third-world migrants, replacing an elderly Jewish population which contained a lot of Holocaust survivors who probably didn’t have great life expectancies, paired with a decline in the crack epidemic and then the AIDS epidemic among heroin users, both of which made the Bronx into a charnel house in the early 1980s.

              I might also toss in the enormous secular improvements in neonatal care which are going to disproportionately improve life expectancies in areas with a) a lot of drug use among expectant mothers and b) a high percentage of African American mothers, both of which describe these three boroughs, and not so much the other two.

              Again, in some sense this is just-so stories but otherwise: what did New York do that produced this change? What five things did it do? If you want a theory that is about public health, you need something specific that New York did and others didn’t, and which mostly affects boroughs that have more poor people/gay people. Things that don’t work, at least not on their own:

              1. Food labelling
              2. Soda taxes
              3. Walking (hasn’t changed, and Queens and Staten Island are quite suburban)
              4. Some massive change in heart attack/cancer treatment (would show up in Queens and Staten Island as much or more as other boroughs)

              I’m also not clear on the life-year math. You can see an inflection point at 9/11, which means that something under 2700 deaths of relatively young people for a single year noticeably kink the curve. That seems to suggest that saving 6,000 lives a year (including by lowering transmission rates) could give you a pretty substantial boost; likewise dropoffs in drug-related murders, overdoses, and premature births to addicts who aren’t maybe doing their best on the prenatal care front.

            • Well, it’s below national average, but not by that much. Especially given how much poorer a population the Bronx contains than the national average.

              The 9/11 point is interesting. But often, deaths from 9/11 are left out when looking at this kind of stuff. I know when I’ve looked at NYC death rates, they drop 9/11. I’m not saying that’s good or bad, I just don’t know if it’s included in here.

              I take your point on the math, though, if that’s 9/11 that’s causing the flatness of that year. I’m approaching life expectancy from the back-end population standpoint. If everyone in NYC lives an additional year, then we add on 8 million person-years, and life expectancy goes up a year. If half the people life an additional year, then we add on 4 million person-years, and life expectancy goes up half a year. So – to adjust life expectancy a decent amount, a lot of person-years need to be added.

              Regardless, I think you’re assuming I am attributing this to some agenda. I’m not. I have no idea what this is from. I’m quite positive it has nothing to do with food labeling, which I’ve written about skeptically many times. I also doubt it has to do with soda. I do think it has to be multi-factorial, because it’s too big to be any one thing. I also think it likely includes something that affects a large number of people. Based on the similarities of some of the borough lines, it’s things that are affecting all of them, and they’re not the same. Drug use, crime, premature births, HIV, race, socio-economic status – all of these things touched Manhattan, Brooklyn, and the Bronx quite differently.

              I still maintain that to adjust a population statistic so much, you have to affect the population. Raising life expectancy 8 years in two decades is something you expect to see in the third world as massive nutritional or public health things change.

            • Aaron– I’m sorry if I gave the impression that I thought this was agenda driven. I’m just having a spirited debate over the causes; I think we’re both appropriately skeptical. I’m just advancing reasons for my skepticism about some sort of health-care-system driven explanation. To be sure, I’m in general suspicious of “miracle institutional cure made people live loads longer” just because I think those stories usually overpromise and underdeliver, for reasons I’ve written about elsewhere. But that’s not to say that I think this is somehow impossible, that you’re obviously wrong about the cause or something (as you note, you’re not pushing a particular explanation). I assume we’re just engaging in some good old fashioned attempt to explain empirical facts by reasoning from first principles–futile, without testing, but interesting and fun, nonetheless.

              I agree that 9/11 probably should be knocked out, but I’d be astonished to find that there’s another reason that life expectancy plateaus for a year right after 9/11. Which I guess offers another possibility: we’re looking at a data set that maybe hasn’t been handled as carefully as we’d like.

              I do agree with you that when you see moves this big, you look for something that’s ubiquitous. I just think that this is complicated by the borough-level variations.

            • We’re on the same page. Spirited debate is valued. I was just reacting to a lot of comments claiming that I was putting this up in support of the soda ban (which I oppose), and perhaps I was misreading that into your comments, too.

              I’m just having a hard time attributing it to any of the usual socio-demographically related causes that might explain this. The similar gains across boroughs make me believe that it has to be something that reached across usually segmented groups. In the rest of the country, groups with different racial backgrounds are experiencing gains in life expectancy differently. But here, the gains look much more similar than I’d expect. The same makes me skeptical it’s drug or crime related. I could totally be wrong about this. But I’d expect that if it were crack-related, then boroughs more predominantly affected would see more gains.

              Or maybe I’m wrong on how that affected boroughs differently. Admittedly, it’s not my area of expertise. And you’re right, I’m not pushing an explanation. I don’t have one. Of the reasons postulated so far, I think that a combination of traffic fatality reductions (which hit a lot of kids), improvements in infant mortality (perhaps with drug use going down), reductions in HIV (which did hit NYC really hard), and maybe the smoking bans? I’d also like to see obesity trends nationally compared to NYC. Maybe that factor is holding the rest of the country back disproportionately.

              As for 9/11, if that is the cause of the complete flattening of lines that year, why did it affect Manhattan, Brooklyn, and the Bronx in the exact same way, while sparing Queens and Staten Island. Is that what you’d expect? And if that flattening isn’ t 9/11, WTF is it?

              Overall, I’m still stunned by the simple fact that life expectancy increased in NYC 8 years in two decades.

      • If the reduction of drug use, gun violence, prostitution, et al in NYC increased its life expectancy, does that mean the drug use, gun violence, prostitution, et al are much higher in the South?

        Compare and contrast is a highly effective investigative tool for highlighting the differences while holding certain factors constant.

        Health care access in NYC is much higher than in the South – more people in NYC have access through employer benefits, Medicare, and community public health services like trauma centers and clinics.

        Three dozen nations with more universal health care access systems have higher LE than the US. And on the whole, higher than NYC which doesn’t have near universal coverage.

        But that just leads to the question – why exactly does more health care access result in higher LE? It seems like scattershot bringing down the bid, but with no buckshot found in the bird.

    • Could it be the proximity to hospitals and health care facilities?
      It would be interesting to see the number of heart failure and infants emergency cases compared to national averages.

    • One other factor that might need some consideration. Life expectancy is a number determined by mortality statistics within the geographic region under consideration- a person who lived most of his life in Buffalo, but who dies in Fort Lauderdale affects the LE of Fort Lauderdale. For example, the southern coast of Florida shows a strong growth in life expectancy, too, but I wonder if this isn’t a result of the elderly from the rest of the country going there to die. I also wonder if we aren’t seeing a similar effect in a place like New York City that used to see a strong out migration of retirees prior to the mid 90s when the city’s livability started to show significant improvements for a variety of reasons, and this migration slowed significantly.

    • To measure life expectancy don’t you subtract the number of deaths from your starting population and see who is left alive?

      If your old people are moving to FL or AZ when and how are their deaths counted?

      Population migration would easily be large enough to have that large of an effect.

      “In New York, the population change reveals that while there was population growth due to the natural growth and arrival of foreign immigrants, the net domestic migration was negative as many as about 3 million left the state for the net domestic migration to be about 1.5 million. A great proportion of those exiting New York are taxpayers age 55 and older.”

      • From the article;

        ” In the past decade, death rates for heart disease alone fell by some 25%.”

        Because a lower % died or because 1/2 million elderly moved to another state and another 2.5 million left the city?

        “Nationally most people moving to another state are over 55; out of three million people that moved in 2007-2008, about 466,000 moved to another state – or about 1/6 of the moving population.”

        from the asbbs study above

    • Maybe unhealthy people are leaving NY because they can’t be productive enough to afford NY real estate.

      Maybe the quality of care in NY is not that good or not affordable. I know one person in her 70’s that left NY because she needed special care and it was cheaper in another state.

      If more sick people leaves NY, then it can explain the trend.

    • Several things are going on: Asians and wealthy whites are pushing out African-Americans. Asians, especially female non-smokers, live a long time. Suburban Fort Lee, NJ has an astronomical life expectancy for Asian women. New York City’s native-born American black population has been dropping since 1979.

      On the other hand, African-Americans hit rock bottom on a number of measures of social ills, such as homicide and teen pregnancy, around 1991 and have stabilized somewhat since that annus horribilis. In contrast, as Charles Murray pointed out in Coming Apart, the white working class is deteriorating, while the white upper middle class is thriving. White people in New York City are increasingly upper middle class.

      Also, New York’s large homosexual population isn’t dying of AIDS as much.

    • From the NYT in 2011:

      “Just 14 percent of New York City adults said they were smokers in 2010, the lowest level since the city began tracking the smoking rate nearly two decades ago, according to a survey released on Thursday. … Smoking has also declined across the country in recent years, though not to the levels in New York City. Nationally, 19.3 percent of Americans still smoked in 2010, down from 20.9 percent in 2005, and those who smoke every day are smoking fewer cigarettes, according to the federal Centers for Disease Control and Prevention.”

    • When I visited Manhattan in 1979-1982, coming from L.A., my impression of the locals was: “There are a few models and rich folks, but mostly a whole bunch of funny-looking, beaten-down looking people.” In contrast, not long ago I drove across the country, noticing how fat Americans had become, then popped up out of the Holland Tunnel on a Thursday evening. Lower Manhattan now looks like a giant set for a romantic comedy movie, with countless good-looking people.

      Wall Street sucking in all the money for a generation sucks in a lot of healthy, energetic people, too.

    • Asians and Hispanics tend to live longer than blacks on average. The former have replaced the latter to a large extent in New York. As Sailer said, Asians especially can have very long life expectancies throughout the world.

    • The Bronx in particular have become heavily Hispanic, versus heavily black previously.


      Manhattan has rocketed upward socioeconomically.

    • Questions:
      1) Has the price of food/alcohol in the New York area increased at a substantially faster pace then the price of food in the country as a whole?
      2) Cigarettes?
      3) inter-generational family habitation? More old people living with their grandkids?

    • Seems that the increase in life expectancy has gone up across the country, with even some southern counties breaking the 65 YO barrier.

      NYC, it may be due to a decrease in air pollution which is a known to be not heart healthy, and maybe access to better healthcare even among the poorest NY’rs. In the South? Better access to refrigeration, clean water, sanitation, health care??

    • January 1, 1994 – December 31, 2001
      Rudy Giuliani
      107th Mayor of New York City

    • Wasn’t there a big push towards lowering infant mortality in the early 90s? I remember that the numbers for some parts of NYC were considered 3rd world, particularly in the Bronx, Manhattan and parts of Brooklyn. Saving 20,000 or so infants a year could have the effect we’ve seen. This would also have been a low key initiative, since it involved improved maternal care and delivery care for poorer women, simply extending programs and practices already existing for better off women. Combine that with high birth rate immigrants, and you might have an explanation. This may also have had something to do with the number of school kids going from 1,000,000 to about 1,100,000 during that period.