The U.S. Department of Health and Human Services Region 2 consists of two states (New York and New Jersey), one commonwealth (Puerto Rico) and one territory (U.S. Virgin Islands). The total population in Region 2 is 32,216,258.1 Of the ten HHS Regions, Region 2 is the fourth most populated and has the third largest governmental public health workforce.
New York (NY) is the largest and most populous part of Region 2. Covering an area of 54,556 square miles, NY is the 27th largest state, but with 19,576,125 people, it ranks as the 3rd most populous state in the country.1 The population density in NY is 411.2 people per square mile.1 Approximately 12% of NY’s residents (~2.35 million) live in rural areas. Of the entire population of NY, 17.63% are Hispanic, and the largest racial/ethnic groups in NY are White (65.75%), Black/African-American (15.86%), and Asian (7.33%). Approximately 14% of the population is age 65 or older. The top 3 leading causes of mortality in NY State are heart disease, cancer, and chronic lower respiratory diseases (CLRD).2 New York City (NYC) is the most populous city in the US with a population of 8,336,6971 in only 303 square miles. In NYC, there are 27,547 people per square mile. Approximately 60% of the entire state’s population lives in the NYC-metropolitan area, comprising the 5 boroughs of NYC, Long Island and the Lower Hudson Valley. Of the population in NYC alone, 29% are Hispanic, and the largest racial/ethnic groups are White (44.0%), Black/African-American (25.5%), and Asian (12.7%). Approximately, 12% of the population is age 65 or older. The top 3 leading causes of mortality in NYC are heart disease, cancer, and other natural causes.3
In NY, 3,864 full-time public health workers are employed by the New York State Department of Health (NYSDOH), including those assigned to its regional offices and affiliates.4 An additional 11,126 are employed in NY’s 58 Local Health Departments (LHDs), which include 57 county health departments and the NYC Department of Health & Mental Hygiene (NYC DOHMH).5 Of that figure, more than 50% (5767 workers) are employed by NYC DOHMH, the second largest LHD in the country. NY’s 58 LHDs are all locally governed and 83% of LHDs also have a local board of health.5 In NY, leaders of LHDs are called Health Commissioners for counties above 250,000 in population and Public Health Directors for counties with less than 250,000 residents.
New Jersey (NJ) neighbors NY on its north and east borders. It is 8,722 square miles with a population of 8,791,894 (in 2012).9 NJ has a population density of 1,008 people per square mile, and only 5% (~468,000) of residents live in rural areas.1 Importantly 7 in 10 people employed in Manhattan commute from a different county, including over 400,000 NJ residents. This emphasizes the need for regional collaboration between NYC and NJ. Of the entire population of NJ, 17.69% are Hispanic, and the largest racial/ethnic groups are White (68.58%), Black/African-American (13.7%), and Asian (8.25%). Approximately, 13% of the population is age 65 or older. The top 3 leading causes of mortality in NJ are heart disease, cancer, and stroke.6 NJ has several large urban areas, including Newark, Camden, Trenton, and Atlantic City, which have all traditionally been impacted more significantly by poor health status. The populations in these communities are largely minority and low income, and are affected by issues associated with poverty, crime, and lack of resources.
In NJ, 800 full-time public health workers are employed by the New Jersey Department of Health (NJDOH)7 and 3,046 are employed in the state’s LHDs.8 The public health infrastructure in NJ is de-centralized, with one state health department and 89 LHDs. The LHDs consist of a mix of single municipality, regional, and county-level departments. A county health department may serve both ‘county-level’ operations, as well as local level (municipal) public health services. However, the county-level health departments do not have oversight of the municipal health departments.
Puerto Rico (PR) is an archipelago that consists of the main island and a number of smaller islands. Together, the islands of PR have a total area of 3,515 square miles and a combined population of 3,667,084.2 Over 230,000 Puerto Ricans (6.2%) live in rural areas. Of the top 50 most populous cities in the United States, San Juan, PR ranks #50 with 382,000 residents.1 98.99% of the total population are Hispanic, and the largest racial/ethnic groups are White (75.83%) and Black/African-American (12.39%). Approximately, 15% of the population is age 65 or older. In 2010, the top 3 leading causes of mortality in PR were heart disease, cancer, and diabetes.9
An estimated 2,686 public health workers are employed by the Puerto Rico Department of Health (PRDOH), the regulating public health agency in PR. This agency is headed by a Secretary of Health, appointed by the Governor of PR. An additional 916 workers are employed by the San Juan Department of Health (SJDOH), which serves only the city of San Juan. Finally, an estimated 2,225 individuals work in Federally Qualified Health Centers (FQHCs). In 1995, the government of PR privatized health services leading to a substantial decline in public sector health services employment and growth in private sector employment. At present, 5% of the public health workforce is employed at the federal level, 10% at state level, and 85% by the private sector in PR. The composition of the Health Professions registered and active in PR is distributed approximately as follows: 7,623 physicians, 15,711 registered nurses, 2,352 pharmacists, 1,097 psychologists, 2,243 allied health professions, 616 other non-physicians clinicians, and 4,541 other professions.
Finally, the U.S. Virgin Islands (USVI) consists of the main residential islands of Saint Thomas, Saint Croix, Saint John, and Water Island, as well as roughly 50 other minor islands and cays. Significantly smaller than the other areas of Region 2, the USVI is only 134 square miles with a population of 105,300. Here the largest racial/ethnic groups are Black/African-American (76.0%), White (15.6%), and Asian (1.4%). Approximately, 18% of the population is age 65 or older.1 The three leading causes of death in the USVI are heart disease, diabetes, and stroke.
In the USVI, 507 public health workers are employed by the U.S. Virgin Islands Department of Health (USVI-DOH), including those assigned to the local health agencies.4 According to its website, the USVI-DOH includes 3 health care facilities, 2 district offices and field offices, as well as the central office, located on St. Thomas. The current Commissioner of Health is Dr. Michelle Davis, PhD. The USVI public health workforce functions as an allied health workforce, providing health care services in addition to public health services.
1. US Census Bureau. Census 2012 Quick Facts. Washington, DC: US Census Bureau; 2014.
2. NYSDOH. Leading Causes of Death, New York State, 2002-2011. Albany, NY: NSYDOH; 2013.
3. NYCDOHMH. 10 Leading Causes of Death, New York City, 2009–2011. New York, NY: NYCDOHMH.
4. ASTHO. Profile of State Public Health, Volume Two. Arlington, VA: ASTHO; 2011.
5. NACCHO. 2013 National Profile of Local Health Departments. Washington, DC: NACCHO; 2013.
6. NJDOH. Mortality and Leading Causes of Death Categorized Index. Trenton, NJ: NJDOH; 2014.
7. ASTHO. Profile of State Public Health, Volume Two. Arlington, VA: ASTHO; 2011.
8. NACCHO. 2013 National Profile of Local Health Departments. Washington, DC: NACCHO; 2013.
9. PRDOH. Puerto Rico Community Health Assessment: Secondary Data Profile. San Juan, PR: PRDOH; 2012.