title: The impact of New York City's 1975 fiscal crisis on the tuberculosis, HIV, and homicide syndemic.
abstract: In 1975, New York City experienced a fiscal crisis rooted in long-term political and economic changes in the city. Budget and policy decisions designed to alleviate this fiscal crisis contributed to the subsequent epidemics of tuberculosis, human immunodeficiency virus (HIV) infection, and homicide in New York City. Because these conditions share underlying social determinants, we consider them a syndemic, i.e., all 3 combined to create an excess disease burden on the population. Cuts in services; the dismantling of health, public safety, and social service infrastructures; and the deterioration of living conditions for vulnerable populations contributed to the amplification of these health conditions over 2 decades. We estimate that the costs incurred in controlling these epidemics exceeded 50 billion US dollars (in 2004 dollars); in contrast, the overall budgetary saving during the fiscal crisis was 10 billion US dollars. This history has implications for public health professionals who must respond to current perceptions of local fiscal crises.
authors.affiliation: Program in Urban Public Health, Hunter College, City University of New York, 425 E 25th St, New York, NY 10010, USA. nfreuden@hunter.cuny.edu
authors.forename: Nicholas
authors.initials: N
authors.lastname: Freudenberg
authors.forename: Marianne
authors.initials: M
authors.lastname: Fahs
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
authors.forename: Andrew
authors.initials: A
authors.lastname: Greenberg
mesh_terms: D004196:Disease Outbreaks / Q000191:economics / Q000266:history* / Q000706:statistics & numerical data; D005376:Financial Management / Q000266:history; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000266:history*; D006291:Health Policy / Q000266:history; D049673:History, 20th Century; D006708:Homicide / Q000191:economics / Q000266:history* / Q000706:statistics & numerical data; D006801:Humans; D009519:New York City / Q000453:epidemiology; D011635:Public Health Administration / Q000266:history; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000266:history / Q000628:therapy; D014397:Tuberculosis, Pulmonary / Q000191:economics / Q000453:epidemiology / Q000266:history*