The Unstable Public-Health Ecology of the New York Metropolitan Region: Implications for Accelerated National Spread of Emerging Infection

Abstract

Empirical techniques adapted from ecosystem-resilience theory allow estimation of how public health and public order within the New York Metropolitan Region respond to perturbations driven by changes in policy or economic structure. This approach constitutes a rigorous methodology for health-impact assessment, providing a quantitative measure of the stability of the region. Contrary to entrenched cultural assumption, affluent suburban counties and impoverished central-city neighborhoods remain strongly linked through a probability-of-contact matrix well indexed by the daily journey to work. The public-health ecology of the New York Metropolitan Region is remarkably unstable, greatly amplifying perturbations through mechanisms analogous to positive feedback in mechanical systems, with the single greatest influence being the percentage of the population living in poverty. Given the New York region's overwhelming dominance of national patterns for the hierarchical diffusion of disease and disorder this result has significant policy implication. More explicitly, lowering the rate of poverty in and near New York City would markedly reduce the vulnerability of the United States to emerging infection.