Hospital Closures in NYC

March 1, 2007 9:10 AM

A Google Map mash-up shows how hospital closures in NYC disproportionately effect the poor and people of colour. It's a pretty slick presentation of the data.
posted by chunking express (36 comments total)

via Social Design Notes, which is a great site.
posted by chunking express at 9:11 AM on March 1, 2007

I don't know a damned thing about anything, but WhyTF did they close Baptist Medical Center, which is way off by itself in the middle of nowhere and leave both Kings County and University Hospital of Brooklyn open, which look like they are next door to each other?
posted by DU at 9:22 AM on March 1, 2007

Yeah, but black people go to the Emergency Room just to get their prescriptions refilled.
posted by four panels at 9:22 AM on March 1, 2007

Six of the eight hospitals that closed between 1995 and 2005 were located in or near communities of color.

Looking at the map, this doesn't seem surprising or outrageous at all. Something like 90% of the open hospitals are also "in or near communities of color".
posted by Plutor at 9:31 AM on March 1, 2007

Plutor: I was going to say something similar, but: a) Baptist Medical Center has no reason to close (on geographic grounds) and b) check out the other big cluster in the white community, where nothing closed.
posted by DU at 9:33 AM on March 1, 2007

I'm screwed anyhow, because the place I'll probably get taken if I dial 911 is Killer County Woodhull.
posted by hermitosis at 9:38 AM on March 1, 2007

Stop. It's not about race, it's about class. There just happen to be correlations in our society. You may resume.
posted by betaray at 9:38 AM on March 1, 2007 [1 favorite]

I sympathize with the author's goals and pretty much agree with him.

I do have one little quibble, though:

These problems were made worse by the fact that six of the eight hospitals that closed between 1995 and 2005 were located in or near communities of color.

New York City has a lot of non-white residents, as a cursory view of the map (or, for that matter, a walk down the street) will demonstrate.

NYC is also geographically quite compact.

Everything is near a "community of color." The above quote is a little like saying that six of the eight hospitals were near an apartment building.
posted by jason's_planet at 9:40 AM on March 1, 2007 [1 favorite]

WhyTF did they close Baptist Medical Center, which is way off by itself in the middle of nowhere and leave both Kings County and University Hospital of Brooklyn open, which look like they are next door to each other?

Uh, who is "they?"
posted by grouse at 9:40 AM on March 1, 2007

You know....THEY
posted by DU at 9:42 AM on March 1, 2007

No, I don't.
posted by grouse at 9:43 AM on March 1, 2007

New Yorkers who live in predominantly minority communities face greater geographic barriers to accessing a hospital than those who live in predominantly white communities. These problems were made worse by the fact that six of the eight hospitals that closed between 1995 and 2005 were located in or near communities of color.

"Geographic grounds" doesn't really tell us much. It's not like hospitals are McDonalds serving the same fare. Closing a trauma center affects everyone in the city - white and "of colour" in pretty much the same way.

It looks like Baptist Medical center was closed due to "professional and administrative incompetence" and not geography.
posted by three blind mice at 9:43 AM on March 1, 2007

Kings County is the major city hospital of Brooklyn. It's one of the biggest employers in the city and one of the busiest trauma centers in the country. University Hospital of Brooklyn is the hospital for State University of New York (SUNY Downstate), a large research institution where a lot of the pioneering work on MRI, HIV, and dialysis treatment was done. I work at both of these ER's, and we've seen a tremendous increase in traffic in the last few years as these other hospitals have closed. Two nights ago every hospital ER in the burrough was on EMS diversion because of overcrowding, which essentially meant that everyone was forced open despite having declared that conditions were unsafe. I'm not a hospital administrator, I dont understand the calculations that go into these decisions, but the system has been stretched to the point where we can't deal with peak flow, let alone any kind of surge from a disaster.
posted by mert at 9:47 AM on March 1, 2007

Heh, the comments in here remind me of global warming skeptics. "There are two or three other possible explanations that don't really fit the data but kind of, therefore racism doesn't exist CASE CLOSED."
posted by DU at 9:51 AM on March 1, 2007

I'm screwed anyhow, because the place I'll probably get taken if I dial 911 is Killer County Woodhull.

I had a friend whose appendix was about to rupture and opted to take a livery cab to the hospital on 7th avenue in Brooklyn, rather than dial 911 and go to Woodhull.

I also had a friend who got lost in the system and practically trapped in the psych ward there. It's a truly awful place.
posted by milarepa at 9:52 AM on March 1, 2007

Yeah, but black people go to the Emergency Room just to get their prescriptions refilled.

I was doing an intake interview last week with a new client and when we got to the question about emergency room visits she paused, looking up at the ceiling while counting in her head. The grand total? 16, none for anything serious enough to warrant the visit. Helping clients not make the same poor decisions they've heretofore chronically made is part of my job description, so I guess we're going to work on that.
posted by The Straightener at 10:06 AM on March 1, 2007

Oh, sorry, that's 16 in the last twelve months.
posted by The Straightener at 10:07 AM on March 1, 2007

WhyTF did they close Baptist Medical Center, which is way off by itself in the middle of nowhere and leave both Kings County and University Hospital of Brooklyn open, which look like they are next door to each other?

Uh, who is "they?"

How about if we rephrase it to:

"Why was Baptist Medical Center--which is way off by itself in the middle of nowhere--closed, but not Kings County and University Hospital of Brooklyn (which look like they are right next door to eachother)?"

How's that?
posted by CitrusFreak12 at 10:12 AM on March 1, 2007

I've never lived in New York, so I can't comment on the accuracy of the data, but I find this to be the most interesting Google mashup I've seen to date.

Excellent presentation. And geez, I had no idea that there were so many hospitals in New York. We have nowhere near that many out here.
posted by drstein at 10:23 AM on March 1, 2007

BREAKING NEWS: Poor people are screwed.

From the Social Design Link:
Using this tool, visitors can visually see how hospital closures disproportionately impact poor neighborhoods and communities of color

Yes, but why did they close?
posted by Brandon Blatcher at 10:23 AM on March 1, 2007

They closed because poor people don't get sick; that's why they don't have health insurance too.
posted by zeoslap at 10:35 AM on March 1, 2007 [1 favorite]

I wish I better understood the legend on that map. Why is the cemetary near my house 100% "of color"? Or do the Xes mean something else?
posted by These Premises Are Alarmed at 10:55 AM on March 1, 2007

> Stop. It's not about race, it's about class.

That's largely true but it's an idea that will never sell to forward-thinkers because for purposes of organized protest, pressure, et al. racial/ethnic solidarity is achievable but class solidarity isn't. As poor old Marx can tell you (now) from his current vantage point in the Empyrean, if you wait until all flavors of the oppressed are ready to love one another and form a common front, well, the ruling class gets to sit on the veranda and sip its mint julep basically forever.
posted by jfuller at 11:15 AM on March 1, 2007 [3 favorites]

This is not a particularly compelling presentation of this data, for the reasons many people have stated:

(1) The designation of a closed hospital as "located in or near communities of color" is vague and subjective. Using GIS software this can actually be numerically calculated, but it doesn't appear that this site has done so.

(2) There seem to be as many "hospital deserts" in predominantly-white as predominantly-minority areas.

(3) Location geographically "near" a hospital is a useless designation without taking into account transportation, type of hospital, etc. A special-care institution like the Mabnhattan Eye Ear & Throat hospital might service a much larger geographic population than an acute-care facility. And public and private hospitals obviously have dramatically different clientele.

(4) Absolute distance only matters in a relatively small proportion of acute-care cases.

Far more important to the dramatic racial disparities in health are things like: the higher proportion of minority patients without health insurance; differential treatment by individual physicians and HC instiutions; differential burdens of disease among different ethnic and income groups; different living environments (there is empirical evidence that minorities are more likely to live near sites emitting toxic substances, for example); access to fresh produce and exercise facilities; and a host of other factors.

This presentation is actually counterproductive, because it makes a complex problem seem like a simplistic conspiracy theory. It thus lends credence to those who would (wrongly) dismiss discussions of health disparities as so much left-wing crackpottery.
posted by googly at 11:21 AM on March 1, 2007 [4 favorites]

The first observation that runs to mind is : these are closures, was there some opening in the same timeframe ? And if so, where ?

Second : I wouldn't buy into the usual distraction black vs white vs whatever ..it's the same old story, its is people with more money and steady cash flow can do a lot more then people with less money and uncertain (or often negative) cash flow, which is more descriptive than the usual poor vs rich.
posted by elpapacito at 11:27 AM on March 1, 2007

Yeah, but black people go to the Emergency Room just to get their prescriptions refilled.
...
Helping clients not make the same poor decisions they've heretofore chronically made is part of my job description, so I guess we're going to work on that.

Is that really a poor decision in the States, though? It doesn't sound like much of a 'decision' if that's the only option.
posted by kmennie at 11:29 AM on March 1, 2007

Fine, yes, it's about class. That doesn't mean it can't also be about race; if racial makeup plays a role in determining class, then to say that the hospital disparity is rooted in class divisions is also to say it's rooted in racial divisions.

Social problems don't have a single, clear-cut cause. It's never "just" about class or "just" about race or "just" about income.
posted by chrominance at 11:32 AM on March 1, 2007

kmennie: Is that really a poor decision in the States, though? It doesn't sound like much of a 'decision' if that's the only option.

You quoted The Straightener, who I guess is in Philadelphia. And yeah, health care in the US is messy. However, in NYC, where this map is, getting health care in the ED is not the only option.
posted by These Premises Are Alarmed at 11:39 AM on March 1, 2007

Ok, as someone who works in one of the hospitals in a big cluster one the Upper east side you all are missing some important points:

1) this data is uselss without population density being included. Yes, poor people are still going to have less hospitals per area, but the difference will not be so dramatic. The area around NY presbyterian is all 20+ story buildings, I doubt the same is true in brookyln

2) Most of the hospitals in manhattan are research/teaching hospitals, due to the schools associated with them and rich donors in manhattan liking to pass by buildings with their name on them (tisch, weill?). These are going to be more stable than a facility which is simply a hospital.
posted by slapshot57 at 11:44 AM on March 1, 2007

slapshot57 raises some excellent points.

On further reflection, I think this particular mashup raises an important question regarding style over substance. I'm a big fan of google earth mashups in general, but in this case I think the "wow cool" factor makes it too easy to overlook the problems with the claim. I'll admit that, upon firswt looking at it, I thought "damn, they're right!" in part because, well, its just such a neat use of the technology. Who cares if they're right or wrong? Who cares whether this claim is actually meaningful in some way? Its just so damn hip and cutting-edge?

But, in fact, their claim is at best drastically oversimplified and of questionable relevance to the problem of health disparities in the U.S.; more likely it is just dead wrong. In this case, a sophisticated technological presentation merely obfuscates the questionable nature of the underlying claim.
posted by googly at 12:17 PM on March 1, 2007

It doesn't sound like much of a 'decision' if that's the only option.

I see where you're coming from but like I said the clients I have who really beat up the emergency rooms do so usually with no legitimate reason at all. I mean, it would be a bad decision for me to go to the emergency room with a little sniffle or a headache, too, but I don't do that.

Yes, if there was better primary care for the underserved and proper outreach to teach the underserved which medical professionals you see for what and when then unnecessary emergency room visits probably wouldn't be such a costly problem.

So that leaves me, their caseworker in a housing program completely divoriced from any health care services, to explain where the district health centers are why it's better from a cost perspective to go there and have a doctor tell you to drink chicken soup or take advil than a hospital emergency room that's already strained with actual emergency and trauma cases. I do that just because it's simple and after a brief explanation clients generally respond. This is an information problem. Some people just don't know these things because they're very socially isolated.
posted by The Straightener at 12:55 PM on March 1, 2007

Nobody has snarked about effects affecting?
posted by Burhanistan at 1:00 PM on March 1, 2007

U.S. economy leaving record numbers in severe poverty
posted by stammer at 1:29 PM on March 1, 2007

DU: WhyTF did they close Baptist Medical Center, which is way off by itself in the middle of nowhere and leave both Kings County and University Hospital of Brooklyn open, which look like they are next door to each other?

grouse: Uh, who is "they?"

CitrusFreak: How about if we rephrase it to:... "Why was Baptist Medical Center--which is way off by itself in the middle of nowhere--closed, but not Kings County and University Hospital of Brooklyn (which look like they are right next door to eachother)?"

No, knowing who "they" refers to is important if it implies that there is one organization deciding to close Baptist Medical Center, but leave open two hospitals basically next to each other. Of course, there is no such organization. Kings County and University Hospital of Brooklyn are run by different groups.

So I guess that is the answer to your question CitrusFreak: because they are not all run by the same people.
posted by grouse at 1:35 PM on March 1, 2007

This mashup reminds of these maps that I saw on NPR a while back.
posted by mindless progress at 6:53 PM on March 1, 2007

Who cares if they're right or wrong? Who cares whether this claim is actually meaningful in some way? Its just so damn hip and cutting-edge?

I think googly has it. Google Maps (and mashups thereof) aren't some amazing new breakthrough application of technology, bringing power to the people. Google Maps is the Duplo Blocks of geographical analysis. I mean, sure, I know ArcGIS is kinda expensive, but there are other options if you actually want to throw shit that sticks. Real GIS software is just not as good at producing click-and-drag maps that you can show in a browser.
posted by Jimbob at 8:09 PM on March 1, 2007