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With more than 30 years in public health in America and Africa, NYC Department of Health & Mental Hygiene Commissioner Dr. Mary Travis Bassett says that the same diseases — heart disease, stroke, and cancer of all kinds — that are killing white Americans are killing black Americans younger and in higher numbers. Historically, public health has tended to “blame the victim,” pointing the finger at lifestyle choices like diet. But, says Bassett, the conditions that lead to those choices, and other environmental factors contributing to the disparity, are often beyond the control of the people at risk.

It’s not about making poor choices, says Mary Bassett. It’s about the fact that people in the hardest hit neighborhoods (like Brownsville, Brooklyn) don’t have enough options to choose from.

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Mary Bassett: What is killing blacks in higher numbers at younger ages are the same things that kill all of us. Mainly cardiovascular disease, that means heart disease and stroke, and cancer of all kinds. So the same thing that takes people prematurely is the same burden that’s borne by all of us. It’s not a set of exotic or special diseases. Well New York has gotten healthier and healthier in recent years and our life expectancy now exceeds that of the United States as a whole. So on average New York City is definitely a place to live to be healthy. But that average doesn’t disclose the huge variation that we see by neighborhood.

We have recently completed a whole set of community health profiles that gives people information on their community district which along with the community boards are the smallest unit of decision-making in New York City. And we find that the community district actually Brownsville, which is the neighborhood that I moved to when I was a little girl and I came to New York, has a life expectancy that is 11 years shorter than the financial district. Now Brownsville, if we considered it a country and is doing a little bit worse than Peru, a little bit better than Samoa and about the same as Sri Lanka in terms of life expectancy. We’re talking about in a city that is one of the richest cities in the world, in the country, that is the richest country in the world, we have neighborhoods where the patterns of health look like those of a developing country. That’s not acceptable. In fact, it’s unconscionable. The first thing that people might think in trying to explain that is that the people in Brownsville are making a whole set of bad choices. They’re not careful about what they eat. They smoke too much. They don’t exercise enough. And that’s why they’re unhealthy. The lifestyle hypothesis is really powerful and in many ways, it replaced the genetic hypothesis as an explanation for the poor health of the black population. But let’s unpack what we mean by lifestyle. Nobody picks a substandard building to live in with terrible issues of rodent infestation and indoor allergens that trigger asthma. That’s not a lifestyle choice. No one picks a neighborhood, you know, because they want to feel unsafe there so that they won’t use the park. Or no one picks a neighborhood where there are no grocery stores or supermarkets that carry a range of vegetables that allow them to make the healthy choices we want them to make. So when we talk about lifestyle, we’re often mixing it up with poverty and all the constraints that poor, segregated neighborhoods place on people’s ability to live a health life. So it’s not about choice. It’s about the fact that people don’t have enough choice.