June 2, 2020

Bronx Reality before Covid is Manifesting Devastating and Deadly Consequences

by UNHP
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from top left; Livery cabs line up at Kingsbridge Armory to receive food packages for delivery to the homebound, mask requirements on Kingsbridge Road, social distancing, and lines for the Kingsbridge Road Chase branch. May 13, 2020

Headlines about the impact of COVID-19 on the Bronx abound. Arguably, the most striking title was from the Washington Post: “The Bronx, long a symbol of American poverty, is now New York City’s Coronavirus Capital”. The Bronx has the highest rate of positive COVID-19 cases among New York City’s boroughs. As of June 1st, there have been 11,765 hospitalizations, 3,568 confirmed COVID-19 deaths, and 912 probable COVID-19 deaths. To UNHP, a community-based organization with a history in the Bronx dating back to the 1970s, these are more than just statistics. The numbers reflect our friends, family, neighbors, coworkers and program users.

At the Northwest Bronx Resource Center, we’ve worked directly with residents since 2012. Our busiest program is our free tax prep program. This year, along with our partners and volunteers, we assisted over 900 Bronx residents before we shut the program down on March 14th due to concerns about the coronavirus. In our blog post about the shortened program, we couldn’t help but notice that all of the tax filers we highlighted were vulnerable to COVID19 in some way; the senior with health issues in a group living accommodation, the healthcare worker and her daughter who rent a room, the postal worker who lives with his family, and self-employed immigrants without health insurance.

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Source: NYC Health

As the coronavirus pandemic has unfolded, it has shone a light on a variety of systemic issues throughout the country. The effects of long-standing inequalities have been brought into sharp focus in New York City as the discrepancy between COVID-19 outcomes has been startling. The outer boroughs and Harlem are bearing the brunt of the pandemic while Manhattan has had relatively few cases. Nowhere are the systemic issues more visible than in the Bronx. The Bronx “has the highest proportion of racial/ethnic minorities, the most persons living in poverty, and the lowest levels of educational attainment” of the five boroughs. A research letter entitled Variation in COVID-19 Hospitalizations and Deaths Across New York City Boroughs found that “factors such as underlying comorbid illnesses, occupational exposures, socioeconomic determinants, and race-based structural inequalities may explain the disparate outcomes [hospitalization and death rates] among the boroughs.”

We would like to look at these factors in the Bronx and identify policy implications that have the potential to help Bronx residents. It has always been our mission to amplify Bronx residents’ experiences by sharing their stories and analyzing the available data. It is important to consider the specific ways in which public policy and actions by private financial institutions will support recovery from this health and economic crisis which has devastated Bronx families, reduced already low household incomes, and exacerbated the existing affordable housing crisis.

Overview of the Northwest Bronx

UNHP works in the Northwest Bronx - mainly Community Boards 5, 6, and 7. This section of the Bronx is a very dense series of neighborhoods composed primarily of larger, older-stock, multifamily rental properties.

The neighborhoods we serve are among the few areas in the City that are still viewed as affordable for lower-income families and individuals. Rumors of gentrification abounded pre-Covid, but according to ACS data the income levels of the people moving into our community are lower than the people living here already.

The Bronx is predominantly non-white, only 9.1% of residents identify as white alone, not Hispanic or Latino. 56.4% of residents identify as Hispanic or Latinx. 43.6% of residents identify as Black or African American.

While the clear majority of Northwest Bronx households work, wages are very low - 19% of households make less than $10,000 annually and 24% of households make between $10,000 and $25,000 annually.

While household incomes are low, rents are relatively high. There is an affordable housing crisis in the Bronx which has been largely driven by rising rents and stagnant incomes. According to ACS data, from 2010 to 2018 median rent increased more than twice the amount that median household income increased. Over 35 percent of households are severely rent burdened in the Northwest Bronx.

The rest of this post will explore how the existing inequalities in the Bronx have been exacerbated by COVID-19. It will also consider how COVID-19 may result in a deepening of these inequalities unless they are addressed as we move forward.

Density vs Crowding

What is the difference between density and crowding? Density refers to the number of people living in an area. For example, you can look at the density of NYC boroughs - the Bronx has a density of 33,867 persons per square mile while Manhattan has a density of 71,341 persons per square mile. Crowding measures whether more people are living in a space than is considered safe. Instead of looking at the number of people in a large geographic area like density, crowding looks at the number of people within a dwelling. There are a few ways to measure crowding, a common technique is to look at persons-per-room. Typically, a household is considered to be crowded if there is more than one person per room. In other words, a 4 person household living in a three-room dwelling would be considered crowded.

At the beginning of the pandemic, many believed that higher rates of COVID-19 cases would be found in densely populated areas. However, a study by the Furman Center, COVID-19 Cases in New York City, a Neighborhood - Level Analysis found that “overall population density is not associated with higher rates of COVID-19 cases”. Rather, they found that zip codes with high rates of infection had larger shares of crowded households. Below is a map showing crowding rates in NYC by PUMA, a close approximation to Community Districts. Larger and darker circles indicate higher rates of crowding. While Manhattan is the most dense borough, it has much lower rates of crowding than the less affluent outer boroughs.

Importantly, the Furman Center study notes that “living in close quarters may compound the risk of exposure. This risk would be even greater for households with non-remote [essential and face-to-face] workers, as those workers are more likely to become infected by the virus”.

UNHP Northwest Bronx Bronx Resource Center (NWBRC) has worked since 2017 as an HPD Housing Ambassador helping Bronx residents enroll in the NYC online affordable housing lottery known as Housing Connect. Across the City, demand for affordable housing and Housing Connect apartments is immense - in 2015, there were 181,229 applicants for 14 affordable units in Bushwick. In the Bronx, the individuals we work with often turn to Housing Connect because they are living in crowded conditions or renting rooms. Almost two-thirds of the over 500 applicants we helped before July 2019 indicated that they were looking to move because there was not enough space in their current apartment.

While demand for affordable housing is great in the Bronx, the apartments available through the lottery are often too expensive for Bronx residents. Housing Connect eligibility is determined by household size and income. UNHP helps all interested individuals create Housing Connect profiles, but if household size and income requirements are not met applications cannot be submitted. While in the past few months open lotteries like this one developed by Catholic Homes in Bronx Community Board 6 have reached the affordability levels needed for existing Bronx residents to apply, the majority of new construction properties are not affordable for the people in our community. The median income in the Bronx is $38,085. An individual earning the borough’s median income with a household size of 3 or less would only qualify for 9 percent of the units in this new Stagg Properties development. The development gives preference to individuals from Community Board 7 despite the fact that the “affordable” apartments are out of reach for many.

This article by Citizens Housing and Planning Council shares concerns about the many negative consequences if cities are no longer considered desirable places to live. UNHP shares that concern but feels there needs to be room in the conversation about liveability. Wealthier Manhattan residents left the City when COVID-19 struck to access more open space, bigger living quarters and other amenities. Bronx residents don’t have that luxury. The Bronx has seen unprecedented new construction in the past few years. When density is increased the quality of and community impact of new construction on the families that live in the community should be considered. Families need enough square footage for storage, study, sleep, and activities of daily living. The capacity of the neighborhood to carry the increased density must also be considered in terms of sufficient open spaces, quality public schools, adequate essential services, and reliable transportation.

Essential and Face - to - Face Workers

Many Bronx residents are considered essential workers - grocery store employees, health care workers, etc - who have continued to travel to work. These individuals provide services we all need and face an increased risk of exposure to the virus be it at work or on their commute. The map below, published in a Gothamist article, shows the change in MTA ridership by station - the darker the bubble, the less change there has been. Notably, the areas that still have relatively high rates of ridership are lower income areas where many essential workers live.

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Source: Gothamist

Additionally, many Bronx residents are face - to - face workers who are unable to work during the shutdown - (nonessential) retail employees, restaurant workers, etc. These individuals face an unexpected loss of income making it challenging to afford basic necessities let alone rent, especially since many Bronx households are severely rent-burdened. In conversations with community members as COVID-19 shutdown in NYC began concerns about being able to afford rent and food surfaced immediately.

Mr. Diaw, a longtime tax client with a large family, was laid off from his job as a result of COVID-19 with the promise of being rehired. “We are using the food programs at the local schools and putting the stimulus towards the rent. I hope to be back to work soon.”

The above map was created using data from the Department of Labor. It shows the percentage of essential, face - to - face, and remote workers in each borough. The categories are based on those outlined in the study The New Strain of Inequality: The Economic Impact of COVID-19 in New York City from the New School Center for New York City Affairs. The authors estimate a 27 percent job loss across all NYC private-sector jobs. They predict face - to - face industries will experience the highest percentage of job loss. The graph below shows the estimated loss for each industry within the three main categories - remote, face - to - face, and essential industries.

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Source: The New Strain of Inequality: The Economic Impact of COVID-19 in New York City

The authors found that Black and Hispanic individuals and workers as well as those who are not college-educated are disproportionately affected when it comes to job losses. Latinx workers experienced 32 percent of job losses, but they only make up 26 percent of all NYC private-sector jobs. Additionally, 36 percent of NYC private workers without a college degree lost jobs whereas only 20 percent of workers with a four-year college degree or more experienced job loss.

The high percentage of essential and face-to-face workers living in the Bronx has made the community more vulnerable to the coronavirus in the short term as evidenced by the borough’s high case rate. The high rates of unexpected job loss will also make the Bronx more vulnerable to the economic fallout brought on by the pandemic. Targeted policies are needed to help those who have lost their jobs.

Health Inequalities

The Bronx ranks last for health outcomes in New York state. The ranking takes a variety of factors into account.

One aspect it considers is pollution. Black and Latinx people, as well as those living below the poverty line, have long been exposed to greater amounts of pollution in the United States. This environmental racism has a real effect on individuals’ health outcomes. Air pollution is an issue in the Bronx and can lead to asthma, hypertension, heart disease, and diabetes. According to the CDC, all of these conditions put individuals at a “higher risk of severe illness from COVID-19”. A study of hospitalized COVID-19 patients in NYC found that 56.6% of patients had hypertension and 33.8% were diabetic.

Housing quality is also widely considered to be a determinant of health and is considered in the ranking. As outlined in the article Housing and Health: Time Again for Public Health Action, poor housing quality has been shown to contribute “to the spread of infectious diseases and respiratory infections” as well as “an increased risk of chronic illness.” The map below is taken from a 2019 report by the United Hospital Fund and shows the percentage of homes with maintenance defects by community district. The Bronx has high percentages of homes with these serious maintenance issues.

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Source: United Hospital Fund

Another factor the ranking takes into account is access to health care. The ratio of residents to primary care physicians is 1,770 to 1 in Bronx county, higher than the overall NYC ratio of 1,220 to 1. The New Strain of Inequality study conducted by the New School also looked at health insurance coverage in NYC. Many face-to-face employees have employer-provided health insurance which will be lost. Notably, face-to-face workers were already the most likely to rely on Medicaid or be uninsured.

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Source: The New Strain of Inequality: The Economic Impact of COVID-19 in New York City

The implementation of the Affordable Care Act allowed UNHP to get a better sense of who is uninsured and why. UNHP runs a free tax prep program and when the ACA was enacted tax filers were required to provide information about their health insurance. Generally speaking, NYC residents who earned less than $10,000 in income were eligible for Medicaid. People who earned more than $10,000 might be eligible for subsidized healthcare, but often they still could not afford it. Some employers offered healthcare, but the portion required to be paid by the worker was unaffordable. Unionized workers often had the best and least costly insurance as well as other benefits like paid sick days. Undocumented immigrants are not eligible for Medicaid, Medicare, or CHIP. They also cannot purchase insurance through the ACA Marketplace, instead, they must turn to the more expensive private options or remain uninsured.

On April 13th, Dr. Vanessa Salcedo, Director of Wellness and Health Promotion at Union Community Health Center was interviewed on BronxNet. She highlighted the underlying health conditions that place many Bronx residents at higher risk. The high number of COVID-19 cases in the Bronx “are not surprising [to me] as a health professional. [It is] devastating for me as a pediatrician, a community doctor, and health worker. [These are] not only numbers, these are people from our community, our patients and our families.”

Community-based health centers like Union Community Health Center and Bronx Community Health Network (BCHN) will help Bronx residents regardless of their documentation, insurance status or ability to pay. Both healthcare programs offer a sliding scale for families, but even a sliding scale may make poor people ration care. Community-based health centers often offer care beyond the medical.

“Facility-based health care appropriately focuses on diagnosing and treating illness. However, there is growing recognition of the importance and value of incorporating outreach strategies that engage individuals and families in face-to-face community and in-home encounters in improving patient care quality, outcomes and reducing costs. BCHN has a foot in both camps. We are out in the community and in our partner health centers linking patients directly to the social support services they need. When their other issues are met, patients can focus more on their health leading to high compliance rates and better health.” Eleanor Larrier, MPA, CEO and Jay Izes, MD, Chief Medical Officer

Access to healthcare for every member of the community regardless of income or immigration status is a requirement for community health. Nine percent of residents in the Bronx are uninsured. This percentage is likely to increase due to residents losing employer-based healthcare. Policies to ensure access to healthcare for all are needed to help the Bronx fully recover from COVID-19.

The Digital Divide

With NYC on PAUSE, access to the internet is more important than ever. Key information about the pandemic and how to stay healthy is shared online. Additionally, schools have transitioned to remote learning and health care providers are emphasizing telemedicine services.

While reliable internet access is often taken for granted, many households do not have broadband internet access as shown in the map below from the Office of the Comptroller. Without broadband access, households must rely on mobile phones and wifi hotspots.

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Source: the Office of the Comptroller

Importantly, just because an individual may have access to the internet it does not mean that they feel comfortable using it. Technological literacy is an important concept to consider, especially with remote learning and telemedicine, as video calls and document sharing may be necessary. Unfortunately for those without broadband access, many of these services can be harder to navigate when using a mobile device instead of a laptop or computer.

Luz Correa, Vice President for Government and Community Affairs at Union Community Health Center (UCHC) shared her concerns about medical predictions about the return of the virus in the fall and what lack of face to face access to patients could mean.

As the COVID-19 health crisis hit the Bronx - overwhelming hospitals with residents sick with the Coronavirus, we had to reinvent our model of care. UCUH turned to outreach by phone to our patients, providing information on how to remain safe, connect with their doctors, and manage chronic illnesses at home ... but lack of in-house technical infrastructure, as well as a lack of patient internet access, smartphones, and technical skills, prevent us from fully using a telehealth system effectively.

UNHP has also seen the breadth of the digital divide in the Bronx. Many of the individuals who engage with our programs do not have access to the internet or are not comfortable using technology. Like Union Community Health, when our face - to - face programs were suspended we had to primarily rely on phone calls to reach our community members. Last month, 50 of our program users became eligible for a grant program. However, the application process required internet access and a relatively high level of technological literacy. Working with people over the phone, it took us over two weeks to help individuals through the process. A few were unable to receive the funds due to a variety of technical issues, and suspension of face - to - face contact.

At-home access to the internet is becoming a necessity in today’s society. Policymakers need to prioritize expanding access and educating new users who are technologically illiterate. However, in the short run, policymakers need to keep those without easy access to the internet and those who are not comfortable using it in mind when enacting legislation. Access to healthcare, social service programs, and education should not be determined by access to a computer.

Moving Forward

UNHP has long fought for the Bronx neighborhoods we serve. Decent affordable housing for neighborhood residents, appropriate private investment, fair wages, and access to healthcare are necessary to support a vibrant community. Unsurprisingly, inequalities in healthcare, income, and housing were part of what made our community particularly vulnerable to COVID-19. The only way to truly help the community recover from the pandemic is to address the long-standing inequities that have been part of the Bronx’s history.

Housing

  • Reduce overcrowding, caused by a lack of affordability, by making rent subsidies available and/or offering new construction units for the 30-50% of median income ranges.
  • New affordable construction should have Community Board preference and a majority of units should reflect the borough median income levels.
  • Increase open space.
  • Sufficient square footage for family living in new units.
  • Increase inspections to ensure the quality of the housing stock does not decline.

Jobs

  • Assist individuals who lost their job in a face - to - face industries gain other skills and provided targeted support

Access to Healthcare

  • Eliminate all barriers to healthcare - Community health depends on adequate healthcare for all regardless of ability to pay or immigration status.
  • Increase availability and capacity of community health programs
  • Increase technological resources and staffing for phone outreach so that healthcare providers are prepared for another wave of cases and able to provide non-COVID-19 related services.

Digital Divide

  • Expand broadband access to all Bronx households.
  • Provide training for individuals who are not technologically literate.
  • Include provisions in all policies and programs to accommodate those who do not have access to or cannot use a computer.
  • During Covid19 streamline requirements, extend filing requirements for social programs to address the suspension of face-to-face services

Further Reading

The NY Times and the Bronx Virus Hot Spot

Crucified, as usual: The coronavirus hits working-class New York hardest, of course

How The Crisis Is Making Racial Inequality Worse

Coronavirus is not fuel for urbanist fantasies

Coronavirus Takes $6 Billion Bite Out Of NYC’s Budget

NYC employment won’t reach pre-coronavirus levels until 2024: IBO

COVID-19 pandemic highlights longstanding health inequities in U.S.

Frontline Communities Hit Hardest by COVID-19

Why are so many people dying of COVID-19 in New York City?

Must Demographics be Destiny?

Written and researched by Caroline Kirk with assistance from Catherine Clarke

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