I can think of no one more fitting to provide the broad perspective on the City's health system, as well as a specific analysis of the current state of affairs. --James R. Tallone, Jr., President, United Hospital FundFor the three decades since passage of Medicare and Medicaid, health care service to the American people has expanded. Relatively few studies have assessed the extent to which access to health care have actually improved for specific groups, such as the poor and the middle class. This book is an in-depth assessment of the extent to which Medicare and Medicaid have met expectations of citizens. New York City is the focus because of its long-standing commitment to provide essential health care to all citizens irrespective of ability to pay, its hospital system composed of voluntary and public sectors, and its vast governmental and private funding.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.