Vulnerable Populations and Public Health  in New York City, 1975-2000
Philip Alcabes and Nicholas Freudenberg, Program in Urban Public Health,
Hunter College School of Health Sciences

In the last quarter of a century, the health profile of the New York City population changed significantly.  While overall mortality continued to decline, epidemics of infectious diseases, substance abuse, and homicide led to increases in death rates for certain sectors of the population. Morbidity  also increased for various conditions including childhood asthma, tuberculosis, and sexually transmitted diseases.  These excess illnesses and deaths were strikingly concentrated in specific sub-populations.

In this report, we describe changes in the last 25 years in the size of various vulnerable populations in New York City including homeless people,drug users, recent immigrants, those involved in the criminal justice system, and children living in poverty. Social and economic factors that contribute to the growth of these groups  are characterized.    We then
assess the contribution of these populations to changes in morbidity and mortality from various conditions.

Finally, based on this description of  the New York City experience,  we suggest a paradigm for public health in urban communities that emphasizes monitoring of vulnerable populations and the development of interventions to reduce vulnerability rather than the traditional public health surveillance of disease followed by case finding and treatment.