The neighborhoods are separated by only a few subway stops. All border on Central Park, and the people within them have access to the same major hospitals.
Yet when it comes to cancer deaths, Central and East Harlem — with majority black and Latino populations — can seem to be a world away from the mostly white Upper East Side.
According to a Mount Sinai Hospital study published in April, men in Harlem are 1.7 times more likely to die from cancer than their Upper East Side counterparts, while women are 1.4 times more likely. And race, according to the study, was the most prevailing factor, with blacks 72 percent more likely than whites to die from cancer across the three neighborhoods.
“This should not be happening,” said Dr. Dana Hashim, a postdoctoral fellow in the Department of Preventative Medicine at the Icahn School of Medicine at Mount Sinai, and the lead author of the study.
While racial disparities in health-related outcomes have long been a known issue in New York City and across the country, Dr. Hashim’s study provides insight into on-the-ground factors that contribute to the gap. In comparing Central and East Harlem to the Upper East Side, she found that eliminating disparities in things like access to healthy food, safe recreation and affordable health care could narrow the cancer mortality gap.
In Harlem, for instance, more than half the residents lived in poverty, compared with 4 percent of Upper East Siders, according to data obtained from the New York City Community Health Survey by researchers. Only 6 percent of survey respondents in Harlem reported eating more than five servings of fruits and vegetables per day, compared with 18 percent of respondents on the Upper East Side.
Still, much remains unknown about why some individuals are more prone to a cancer-related death than others.
“How much is it diet, racism or stress?” asked Malo Hutson, an associate professor of city planning who studies racial and ethnic inequalities at the University of California, Berkeley. “We don’t know.”
The most important question raised by this work is: what can be done, both at the policy level and community level, to reduce the health risk factors that minority and low-income populations face, Dr. Hutson said.
“Our institutions and our policies have the capability to make a big difference if we have to political will to do so,” he said. “One of the things we need to have a conversation about is how education policy, health care policy and housing policy can impact the quality of people’s lives.”
Dr. Hashim hopes that the results of her study will lead to more discussion of racial, ethnic and economic health inequalities in the United States, and provide an incentive for action at the local level to reduce risk factors that lead to higher mortality rates.
“If we just took care to make the situation more equal for these populations, a lot of these mortalities are preventable,” said Dr. Hashim.
Prevention could come, she said, in the form of educational programs to teach the importance of cancer screenings in low-income Harlem communities. This would help doctors catch the disease before it became difficult to treat, she said. Building community centers to promote exercise and providing greater access to affordable health insurance for preventative screenings could also help more Harlem residents, she added.
One organization already doing such grassroots work is the Boriken Neighborhood Health Center in East Harlem. Established four decades ago, it provides medical and dental care to those who cannot afford it, and organizes health education programs to prevent disease.
For instance, some East Harlem residents have said they feel unsafe exercising outdoors, so Boriken teaches them exercises that they can do inside, said Erika Estades, the chief operating officer.
And with the tight-knit families in the community, multiple generations often live under one roof, she said. This means health workers have to be strategic about promoting healthy eating habits that both young and old family members, with different dietary wants and needs, will accept. Boriken also teaches community members how to manage asthma and diabetes, and how to obtain health coverage.
“It’s palpable, still, the disparities,” Ms. Estades said. “I think people do want to be healthy and want the best for their kids. I remain hopeful.”