Dispelling An Urban Legend: Frequent Emergency Department Users Have Substantial Burden Of Disease
Health Affairs, 32, no.12 (2013):2099-2108
Billings, John and Maria C. Raven
Urban legend has often characterized frequent emergency department (ED) patients as mentally ill substance users who are a costly drain on the health care system and who contribute to ED overcrowding because of unnecessary visits for conditions that could be treated more efficiently elsewhere. This study of Medicaid ED users in New York City shows that behavioral health conditions are responsible for a small share of ED visits by frequent users, and that ED use accounts for a small portion of these patients’ total Medicaid costs. Frequent ED users have a substantial burden of disease, and they have high rates of primary and specialty care use. They also have linkages to outpatient care that are comparable to those of other ED patients. It is possible to use predictive modeling to identify who will become a repeat ED user and thus to help target interventions. However, policy makers should view reducing frequent ED use as only one element of more-comprehensive intervention strategies for frequent health system users.
Residential Street Parking and Car Ownership
Journal of the American Planning Association 79.1 (2013): 32-48.
Problem, research strategy, and findings: Local governments’ minimum street-width standards may force developers to oversupply, and residents to pay excessively for, on-street parking in residential neighborhoods. Such oversupply is often presumed to both encourage car ownership and reduce housing affordability, although little useful evidence exists either way. This article examines the impact of street-parking supply on the car ownership of households with off-street parking in the New York City area.
The off- and on-street parking supply for each household was measured through Google Street View and Bing Maps. The impact of on-street parking on car ownership levels was then estimated in an innovative multivariate model. The unique set-up of the case study ensures 1) the weak endogeneity between parking supply and car ownership and 2) the low correlation between off-street and on-street parking supply, two major methodological challenges of the study. Results show that free residential street parking increases private car ownership by nearly 9%; that is, the availability of free street parking explains 1 out of 11 cars owned by households with off-street parking.
Takeaway for practice: These results offer support for community street standards that make on-street parking supply optional. They also suggest the merits of leaving the decisions of whether, and how many, on-street parking spaces to provide in new residential developments to private markets rather than regulations.
Research support: This project was supported by grants from the University Transportation Research Center (Region 2) and the Wagner School Faculty Research Fund.
Access to primary care in Hong Kong, Greater London and New York City
Cambridge University Press 2013. Health Economics, Policy and Law / Volume 8 / Issue 01 / January 2013, pp 95 109, Published online
Pui Hing Chau, Jean Woo, Michael K. Gusmano, Daniel Weisz, Victor G. Rodwin and Kam Che Chan
We investigate avoidable hospital conditions (AHC) in three world cities as a way to assess access to primary care. Residents of Hong Kong are healthier than their counterparts in Greater London or New York City. In contrast to their counterparts in New York City, residents of both Greater London and Hong Kong face no financial barriers to an extensive public hospital system. We compare residence-based hospital discharge rates for AHC, by age cohorts, in these cities and find that New York City has higher rates than Hong Kong and Greater London. Hong Kong has the lowest hospital discharge rates for AHC among the population 15–64, but its rates are nearly as high as those in New York City among the population 65 and over. Our findings suggest that in contrast to Greater London, older residents in Hong Kong and New York face significant barriers in accessing primary care. In all three cities, people living in lower socioeconomic status neighborhoods are more likely to be hospitalized for an AHC, but neighborhood inequalities are greater in Hong Kong and New York than in Greater London.
Urban Mobility in the 21st Century
The Furman Center for Transportationan and
Moss, Mitchell L. and Hugh O'Neil
Between 2010 and 2050, the number of people living in the world’s urban areas is expected to grow by 80 percent – from 3.5 billion to 6.3 billion. This growth will pose great challenges for urban mobility – for the networks of transportation facilities and services that maintain the flow of people and commerce into, out of and within the world’s cities.
Addressing the challenge of urban mobility is essential – for maintaining cities’ historic role as the world’s principal sources of innovation and economic growth, for improving the quality of life in urban areas and for mitigating the impact of climate change. It will require creative applications of new technologies, changes in the way transportation services are organized and delivered, and innovations in urban planning and design.
This report examines several aspects of the challenge of urban mobility in the twenty-first century – the growth of the world’s urban population, and changes in the characteristics of that population; emerging patterns of urban mobility; and changes in technology design and connectivity.
Hong Kong and Other World Cities
In Aging in Hong Kong (pp. 5 - 30). Springer Publishing Company
P.H. Chau, Jean Wook, M.K. Gusmano, and V.G. Rodwin
With population aging and increasing urbanization, it is important to examine the quality of life of older people living in cities, in particular world cities. However, few comparative studies of world cities examine their health, long-term care systems, or the characteristics of their older populations. To assess how well world cities are addressing the challenges associated with aging populations, it is helpful to review comparable data on the economic and health status of older persons, as well as the availability and use of health, social, and long-term care services. By extending the work of the “CADENZA: A Jockey Club Initiative for Seniors” Project and the World Cities Project, this chapter compares three world cities—Hong Kong, New York City, and London. The three world cities are similar in the size and proportion of their older populations, but the characteristics of older people and the health and long-term care systems available to them differ in signiﬁcant ways. These comparisons reveal how Hong Kong, New York City, and London are responding to a rapidly aging population. They should be valuable to other cities that face the challenges of population aging.
Growing Older in Hong Kong, New York and London
The Hong Kong Jockey Club Charities Trust. Hong Kong, 2012.
P. Chau, J. Woo, M. Gusmano, D. Weisz, and Rodwin, V.
Declining birth rates, increasing longevity and urbanization have created a new challenge for cities: how to respond to an ageing population. Although population ageing and urbanization are not new concerns for national governments around the world, the consequences of these trends for quality of life in cities has only recently started to receive attention from policy makers and researchers. Few comparative studies of world cities examine their health or long-term care systems; nor have comparisons of national systems for the provision of long-term care focused on cities, let alone world cities.
By extending the work of the CADENZA and World Cities Projects , this report investigates how three world cities -- Hong Kong, New York and London -- are coping with this challenge. These world cities are centers of finance, information, media, arts, education, specialized legal services and advanced business services, and contribute disproportionate shares of GDP to their national economies. But are these influential centers prepared to meet the challenge posed by the “revolution of longevity?” How will these world cities accommodate this revolutionary demographic change? Are they prepared to implement the health and social policy innovations that may be required to serve their residents, both old and young? Will they be able to identify the new opportunities that increased longevity may offer? Can they learn from one another as they seek to develop creative solutions to the myriad issues that arise? Finally, can other cities learn from the experience of these three cities as they confront this challenge?
To address these questions, we examine comparable data on the economic and health status of older persons, as well as the availability and use of health, social and long-term care across and within these cities. In the report “How Well Are Seniors in Hong Kong Doing? An International Comparison”, a first attempt was made to compare the situation in Hong Kong with five economically developed countries. This report extends this study by comparing the situation in Hong Kong with two other world cities—New York City and London, which are more comparable in terms of population size and economic characteristics.
New York City.
Encyclopedia of Homelessness. David Levinson, ed. Berkshire Publishing, 2004.
Weitzman BC and SN Fischer.
The Greatest Grid: The Master Plan of Manhattan, 1811-2011
Laying out Manhattan's street grid and providing a rationale for the growth of New York was the city's first great civic enterprise, not to mention a brazenly ambitious project and major milestone in the history of city planning. The grid created the physical conditions for business and society to flourish and embodied the drive and discipline for which the city would come to be known. Published to coincide with an exhibition at the Museum of the City of New York celebrating the bicentennial of the Commissioners' 1811 Plan of Manhattan, this volume does more than memorialize such a visionary effort, it serves as an enduring reference full of rare images and information.
The Greatest Grid shares the history of the Commissioners' plan, incorporating archival photos and illustrations, primary documents and testimony, and magnificent maps with essential analysis. The text, written by leading historians of New York City, follows the grid's initial design, implementation, and evolution, and then speaks to its enduring influence. A foldout map, accompanied by explanatory notes, reproduces the Commissioners' original plan, and additional maps and prints chart the city's pre-1811 irregular growth patterns and local precedent for the grid's design. Constituting the first sustained examination of this subject, this text describes the social, political, and intellectual figures who were instrumental in remaking early New York, not in the image of old Europe but as a reflection of other American cities and a distinct New World sensibility. The grid reaffirmed old hierarchies while creating new opportunities for power and advancement, giving rise to the multicultural, highly networked landscape New Yorkers thrive in today.
A Canary in the Mortgage Market? Why the recent FHA and GSE loan limit reductions deserve attention
Furman Center White Paper
Madar, J. & Willis, M.A.
On October 1, 2011, the maximum loan size eligible for Federal Housing Administration (FHA) insurance or a guarantee from Fannie Mae or Freddie Mac (known as "Government-Sponsored Enterprises" or "GSEs") dropped in dozens of metropolitan areas around the country. When this change took effect, a segment of the mortgage market in each of these areas instantly lost some or all federal backing. If enough borrowers seeking loans in this segment are unable to find financing, the result will be further downward pressure on the corresponding segment of the housing market. In this report, we use recent mortgage origination data to explore some of the possible implications of this policy change for the housing market and the U.S. mortgage finance system.
Assessing the cost of transfer inconvenience in public transport systems: A case study of the London Underground
Transportation Research Part A: Policy and Practice, Vol. 45, 2, 91-104
Guo, Zhan and Nigel H.M. Wilson
Few studies have adequately assessed the cost of transfers in public transport systems, or provided useful guidance on transfer improvements, such as where to invest (which facility), how to invest (which aspect), and how much to invest (quantitative justification of the investment). This paper proposes a new method based on path choice,3 taking into account both the operator's service supply and the customers' subjective perceptions to assess transfer cost and to identify ways to reduce it. This method evaluates different transfer components (e.g., transfer walking, waiting, and penalty) with distinct policy solutions and differentiates between transfer stations and movements.
The method is applied to one of the largest and most complex public transport systems in the world, the London Underground (LUL), with a focus on 17 major transfer stations and 303 transfer movements. This study confirms that transfers pose a significant cost to LUL, and that cost is distributed unevenly across stations and across platforms at a station.
Transfer stations are perceived very differently by passengers in terms of their overall cost and composition. The case study suggests that a better understanding of transfer behavior and improvements to the transfer experience could significantly benefit public transport systems.
Mind the Map! The Impact of Transit Maps on Path Choice in Public Transit
Transportation Research Part A: Policy and Practice, Vol. 45, 7, 625–639
This paper investigates the impact of schematic transit maps on passengers' travel decisions. It does two things: First, it proposes an analysis framework that defines four types of information delivered from a transit map: distortion, restoration, codification, and cognition. It then considers the potential impact of this information on three types of travel decisions: location, mode, and path choices.1 Second, it conducts an empirical analysis to explore the impact of the famous London tube map on passengers' path choice in the London Underground (LUL). Using data collected by LUL from 1998 to 2005, the paper develops a path choice model and compares the influence between the distorted tube map (map distance) and reality (travel time) on passengers' path choice behavior. Results show that the elasticity of the map distance is twice that of the travel time, which suggests that passengers often trust the tube map more than their own travel experience on deciding the ‘‘best'' travel path. This is true even for the most experienced passengers using the system. The codification of transfer connections on the tube map, either as a simple dot or as an extended link, could affect passengers' transfer decisions. The implications to transit operation and planning, such as trip assignments, overcrowding mitigation, and the deployment of Advanced Transit Information System (ATIS), are also discussed.
Race Realities in New York City
The Human Rights Project At the Urban Justice Center
Women of Color Policy Network
Released in partnership with the Human Rights Project of the Urban Justice Center, this shadow report highlights the persistent discrimination experienced by people of color and immigrants in NYC and brings attention to the failure of the City to meet its full obligations under CERD.
Climate Change and Human Health in Cities
in Urban Climate Change Research Network (UCCRN), First UCCRN Assessment Report on Climate Change in Cities (ARC3), edited by C. Rosenzweig, W. D. Solecki, S. A. Hammer, and S. Mehrotra. New York, NY: Cambridge University Press, 2011, forthcoming, pp. 183-217
M. Barata (Rio de Janeiro), E. Ligeti (Toronto), Coordinating Lead Authors and G. De Simone (Rio de Janeiro), T. Dickinson (Toronto), D. Jack (New York City), J. Penney (Toronto), M. Rahman (Dhaka), and R. Zimmerman (New York City.)
Climate Change and Urban Transportation Systems
in Urban Climate Change Research Network (UCCRN), First UCCRN Assessment Report on Climate Change in Cities (ARC3), edited by C. Rosenzweig, W. D. Solecki, S. A. Hammer, and S. Mehrotra. New York, NY: Cambridge University Press, 2011, forthcoming, pp. 143- 182.
S. Mehrotra (Nairobi, Mexico City), B. Lefevre (Paris), R. Zimmerman (New York City, Coordinating Lead Authors and H. Gercek, K. Jacob, and S. Srinivasan.
Climate Change Mitigation and Adaptation in North American Cities
Available on line January 7, 2011, Current Opinion in Environmental Sustainability, Vol. 3, 2011, pp. 181-187 doi:10.1016/j.cosust.2010.12.004
R. Zimmerman and C. Faris.
Climate change mitigation and adaptation action plans are developing at a rapid pace, being driven by both local initiatives and emerging alliances and support organizations that cut across multiple jurisdictions. These plans include a broad range of approaches, many of which are evolving into best or leading practices and which will be increasingly used as a model for the plans of other locales. This paper draws attention to several best practices in both mitigation and adaptation for North American cities, and also highlights many of the supporting alliances and groups that disseminate key practices and drive potential synergies. Additionally, it is noted that despite the increasing rate of plan development, a continuing need exists for increased attention to adaptation at the local level.
To Leave An Area After Disaster: How Evacuees from the WTC Buildings Left the WTC Area Following the Attacks.
Risk Analysis, Vol. 31, Issue 5, 2011, published on line December 8, 2010. doi:10.1111/j.1539-6924.2010.01537
R. Zimmerman and M. Sherman.
How people leave a devastated area after a disaster is critical to understanding their ability to cope with risks they face while evacuating. Knowledge of their needs for communications about these risks is particularly crucial in planning for emergency responses. A convenience sample of 1,444 persons who survived the World Trade Center (WTC) attacks on September 11, 2001 were surveyed to ascertain their initial and ultimate destinations once they had left the buildings, how they arrived there, the role of types of obstacles they encountered, and the need for information and the seeking of other people as potential factors in influencing the process of leaving immediately. This survey was part of a larger, original survey. Results showed differences in how people traveled by mode to initial and ultimate destinations, how immediately they left the area, and factors associated with when they left. How they traveled and when they left were associated with where people lived, their tendency in times of stress to seek out other people including who they knew in the immediate area (e.g., co-workers or friends), the physical conditions surrounding them, and the importance to some of waiting for more information. Many people indicated they did not leave immediately because they had no information about where to go or what services would be available to them. Perceptions and communications about risks they were facing were reflected in the choices they considered in how and when to leave the area. These findings have numerous ramifications for understanding and guiding personal behavior in catastrophic situations.
Are Land Use Planning and Congestion Pricing Mutually Supportive? Evidence From a Pilot Mileage Fee Program in Portland, OR
Journal of American Planning Association, Vol. 77, 3, 232-250
Guo, Zhan, Asha W. Agrawal & Jennifer Dill
Congestion pricing and land use planning have been proposed as two promising strategies to reduce the externalities associated with driving, including traffic congestion, air pollution, and greenhouse gas emissions. However, they are often viewed by their proponents as substitutive instead of complementary to each other. Using data from a pilot mileage fee program run in Portland, OR, we explored whether congestion pricing and land use planning were mutually supportive in terms of vehicle miles traveled (VMT) reduction. We examined whether effective land use planning could reinforce the benefit of congestion pricing, and whether congestion pricing could strengthen the role of land use planning in encouraging travelers to reduce driving.
VMT data were collected over 10 months from 130 households, which were divided into two groups: those who paid a mileage charge with rates that varied by congestion level (i.e., congestion pricing) and those who paid a mileage charge with a flat structure. Using regression models to compare the two groups, we tested the effect of congestion pricing on VMT reduction across different land use patterns, and the effect of land use on VMT reduction with and without congestion pricing. With congestion pricing, the VMT reduction is greater in traditional (dense and mixed-use) neighborhoods than in suburban (single use, low-density) neighborhoods, probably because of the availability of travel alternatives in the former. Under the same land use pattern, land use attributes explain more variance of household VMT when congestion pricing is implemented, suggesting that this form of mileage fee could make land use planning a more effective mechanism to reduce VMT. In summary, land use planning and congestion pricing appear to be mutually supportive.
For policymakers considering mileage pricing, land use planning affects not only the economic viability but also the political feasibility of a pricing scheme. For urban planners, congestion pricing provides both opportunities and challenges to crafting land use policies that will reduce VMT. For example, a pricing zone that overlaps with dense, mixed-use and transit-accessible development, can reinforce the benefits of these development patterns and encourage greater behavioral changes.
Geographic Variations in Health Care Workforce Training in the US: The Case of Registered Nurses (RNs)
Med Care. 2011 Aug;49(8):769-74.
Background: In the United States, registered nurses [RNs] are trained through one of three educational pathways: a diploma course; an associate's degree, or a baccalaureate degree in nursing (the BSN). A national consensus has emerged that the proportion of RNs that are baccalaureate-trained should be substantially increased. Yet achieving that goal may be difficult in areas where college graduates are unlikely to reside.
Objectives: To determine whether the level of training of the hospital registered nurse [RN] workforce varies geographically, along with the education of the local general workforce.
Research design: Cross sectional, ecological study.
Subjects: Hospital nurses who participated in the National Sample Survey of Registered Nurses [NSSRN] in 2004 (n = 16,567).
Measures. Registered Nurse training was measured as Diploma, Associates degree, or Baccalaureate degree or above. County-level general workforce quality was assessed as the adult college graduation rate. Counties were divided into US population quartiles, with the highest quartile (Q4) having more than 29.3% college graduates, and the lowest quartile (Q1) having fewer than 16.93% college graduates.
Results: Hospital RNs have a higher level of training in counties where the general population is better
educated. For example, in Q4, 55.2% of hospital RNs are baccalaureate-trained, in Q3, 50.2%; in Q2,45.2%; and in Q1, 34.9% (p < .001 for all pairwise comparisons). The association between RN training and general workforce education is found in cities, towns and rural areas.
Conclusions: Nationwide, there are substantial geographic variations in the training of hospital RNs. Educational segregation (the tendency for educated people to cluster geographically) may make it more difficult to achieve a BSN-rich nursing workforce in some areas of the US. Further work is needed to assess whether educational segregation similarly influences the distribution of other health care professionals, and whether it leads to variations in the local quality of care.
New York City Quarterly Housing Update 2010: 3rd Quarter
Furman Center for Real Estate and Urban Policy.
After analyzing six key indicators of housing market performance for the third quarter of 2010, NYU's Furman Center finds that New York City home prices are stabilizing, but still remain 22% below peak. The report also finds that a decrease in third-quarter foreclosure filings compared to last year may point to a slowdown in the foreclosure crisis. The Quarterly Housing Update incorporates sales data, development indicators and foreclosures, and presents a repeat sales index for each borough to capture price appreciation while controlling for housing quality.
The Rise and Fall of a Micro-Learning Region: Mexican Immigrants and Construction in Center-South Philadelphia
2010. Environment and Planning A, Volume 42, Number 7
Iskander, Natasha, Nichola Lowe, and Christine Riordan
This paper documents the rise and fall of a micro-learning region in Philadelphia. The central actors in this region are undocumented Mexican immigrants who until recently were able to draw on the intensity of their workplace interactions and their heterodox knowledge to produce new and innovative building techniques in the city's residential construction. The new knowledge they developed was primarily tacit. More significantly, the learning practices through which immigrant workers developed skill and innovated new techniques were also heavily tacit. Because these practices were never made formal and were never made explicit, they remained invisible and difficult to defend. With the housing market collapse and subsequent decline in housing renovation in south-center region of Philadelphia, this tacit knowledge and the practices that gave it shape and significance, are no longer easily accessible. We draw on this case to demonstrate the importance of access to the political and economic resources to turn learning practices into visible structured institutions that protect knowledge and skill. Whether or not the practices that support knowledge development are themselves made explicit can determine whether the knowledge they produce becomes an innovation that is recognized and adopted or whether it remains confined to a set of ephemeral practices that exist only so long as they are being enacted.