Intensive New York City housing remediation effort cut violations in half but did not yield immediate health improvements

Results highlight challenges of linking housing quality improvements to direct and speedy health system impacts

Columbia University's Mailman School of Public Health

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November 24, 2025-- New York City’s most aggressive housing quality enforcement programs reduced hazardous housing violations in targeted buildings but did not lead to measurable changes in short-run health care utilization, according to a new study at Columbia University Mailman School of Public Health. The findings are published in the Journal of Policy Analysis and Management.

Many housing and health initiatives had focused on publicly owned housing and, until now, there was little evidence on whether housing quality interventions could alter health care use in privately owned and managed, low-quality housing buildings.

“This study centers on tenants in privately owned buildings, a large but often overlooked segment of the low-income population where landlord oversight is weaker,” said Kacie Dragan, PhD, MPH assistant professor of Health Policy and Management and principal investigator. “However despite substantial building improvements under the law we found no evidence of changes in health care spending or emergency department visits among low-income residents in the years immediately following remediation,” said Dragan.

“These results suggest that housing remediation alone may not yield immediate reductions in health care utilization, particularly when improvements cannot fully resolve longstanding hazards,” noted Dragan.

The evaluation focused on the Alternative Enforcement Program (AEP), created under the NYC Safe Housing Law of 2007 to identify and remediate the city’s 250 most distressed privately owned residential buildings each year. Landlords selected into AEP are required—within four months—to address all heat and hot water violations and at least 80 percent of “immediately hazardous” issues such as serious mold, pest infestations, rodents, peeling lead paint, broken fixtures or windows, and water leaks. These program criteria are written into the City Charter.

Reports from the NYC Department of Housing Preservation and Development show that AEP has produced significant housing quality improvements. “Compliance rates are high, despite the fact that many AEP buildings are owned by the city’s most chronically neglectful landlords,” Dragan said.

The study followed 48,151 Medicaid enrollees linked to AEP-eligible buildings from 2007–2018. In the final analysis, there were 24,294 enrollees included—14,974 residents in untreated buildings and 9,320 residents of buildings that underwent housing improvements.

Using Medicaid eligibility and claims data from 2007–2019, Dragan also measured total health care spending, the number of emergency department visits, and all health system visits tied to conditions likely linked to housing quality—injuries, respiratory conditions, and anxiety.

Despite large reductions in hazardous violations—cut by half in the treated buildings—the analysis found no evidence of meaningful short-run changes in health care utilization.

“The existing literature offers limited insight into how quickly substandard housing conditions translate into health problems, and how quickly those health problems, in turn, translate into actual utilization of the health care system,” observed Dragan.

“However, the largely null results in this study shed light on what decision makers in the health and housing sectors could realistically expect from housing quality improvement interventions,” said Dragan.

These results have implications for policy debates. Health insurers like Medicare and Medicaid have begun piloting policies that pay for housing remediation services like pest control or ventilation, with the rationale that these services might save money by reducing health care utilization. “These findings indicate that the expectation of cost savings by insurers may not be appropriate. Still, improving the quality of low-income housing is important and worthwhile,” Dragan notes.

Even with directed repairs and heightened oversight, it is important to emphasize that tenants in AEP buildings continue to live in some of the worst housing in New York City. Eliminating half of all open violations still leaves residents in deeply distressed conditions—underscoring how challenging it is to fully remediate decades of disinvestment and neglect.

Nationwide, 42 percent of low-income households live in homes needing at least one major repair, and as many as 20 percent of homes in low-income neighborhoods have three or more serious hazards that pose well-established risks to health.

“These findings suggest that more comprehensive remediation efforts, paired with sustained follow-up, may be needed before measurable health improvements appear.”

The study was supported by the Agency for Healthcare Research and Quality (T32HS000055), the National Institute of Mental Health of the National Institutes of Health (T32MH019733), and the Harvard Radcliffe Institute for Advanced Study.

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the third largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.

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Journal

Journal of Policy Analysis and Management

DOI

10.1002/pam.70074 

 

Vegan diet—even with ‘unhealthy’ plant-based foods—is better for weight loss than Mediterranean diet, finds new study

Physicians Committee for Responsible Medicine

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WASHINGTON, D.C. — Eating a vegan diet increases consumption of plant-based foods—including those defined as “unhealthy” by the plant-based diet index—leading to greater weight loss than the Mediterranean diet, finds a new analysis by the Physicians Committee for Responsible Medicine published in Frontiers in Nutrition. 

Avoiding animal products; eating foods like potatoes and refined grains, which are defined as “unhealthy” by the plant-based diet index; and avoiding added oils and nuts, which are defined as “healthy” by the plant-based diet index, all contributed to weight loss.

“Our research shows that even when a low-fat vegan diet includes so-called unhealthy plant-based foods—as defined by the plant-based diet index—like refined grains and potatoes, it’s better than the Mediterranean diet for weight loss, because it avoids animal products and added oils,” says Hana Kahleova, MD, PhD, director of clinical research at the Physicians Committee for Responsible Medicine and lead author of the study.

The new research is a secondary analysis of a previous Physicians Committee study comparing a low-fat vegan diet to a Mediterranean diet. The study randomly assigned 62 overweight adults to either a low-fat vegan diet, which consisted of fruits, vegetables, grains, and beans, or a Mediterranean diet, which focused on fruits, vegetables, legumes, fish, low-fat dairy, and extra-virgin olive oil, for 16 weeks. Neither group had a calorie limit. Participants then went back to their baseline diets for a four-week washout period before switching to the opposite group for an additional 16 weeks. The study found that a vegan diet is more effective for weight loss than a Mediterranean diet, and has better outcomes for weight, body composition, insulin sensitivity, and cholesterol levels.

In this secondary analysis, the participants’ dietary records were used to assess the relationship of a plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) with weight loss on both the vegan diet and Mediterranean diet. “Healthful” plant-based foods, as defined by the PDI system, include fruits, vegetables, whole grains, nuts, legumes, oils, coffee, and tea. “Unhealthful” plant-based foods include fruit juice, sugar-sweetened beverages, refined grains, potatoes, and sweets. The PDI system assigns scores as follows:

• PDI: Score increases with more plant-based foods overall.
• hPDI: Score increases with more “healthful” plant-based foods and fewer “unhealthful” plant-based foods.
• uPDI: Score increases with more “unhealthful” plant-based foods and fewer “healthful” plant-based foods.

In the analysis, the PDI score increased significantly on the vegan diet and did not change on the Mediterranean diet; the hPDI score increased on both diets; and uPDI increased on the vegan diet and decreased on the Mediterranean diet.

The increases in the PDI and uPDI scores, which were seen only the low-fat vegan diet, were associated with weight loss. The changes in hPDI, which were seen on both diets, were not associated with changes in body weight.

The majority of the increases in the PDI, hPDI, and uPDI scores came from avoiding animal foods on a vegan diet. Reducing the consumption of oils and nuts further increased the uPDI score by points on a vegan diet. These findings suggest that replacing animal products with plant-based foods, and reducing the consumption of oil and nuts, may be successful strategies for weight loss.

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Journal

Frontiers in Nutrition

DOI

10.3389/fnut.2025.1666807 

Method of Research

Randomized controlled/clinical trial

Subject of Research

People

Article Title

Plant-based dietary index on the Mediterranean and a vegan diet: a secondary analysis of a randomized, cross-over trial

Article Publication Date

18-Nov-2025

 

One in two people in the US is affected by a neurological disease or disorder

Most common conditions are tension-type headache, migraine and diabetic neuropathy

American Academy of Neurology

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• A new systematic analysis shows more than half the people living in the U.S., 54%, are affected by a neurological disease or disorder.
• Disorders of the nervous system impacted more than 180 million of the nearly 333 million Americans in 2021 and were the top cause of health loss in the U.S.
• The nervous system includes the brain, spinal cord and nerves.
• The most prevalent conditions were tension-type headache affecting 122 million Americans, migraine affecting 58 million and diabetic neuropathy affecting 17 million.
• The leading causes of health loss were stroke, Alzheimer’s disease and other dementias, diabetic neuropathy and migraine.

MINNEAPOLIS — One in two people in the United States, just over half of the population, is affected by a neurological disease or disorder, according to a new systematic analysis by the American Academy of Neurology and the Institute for Health Metrics and Evaluation published on November 24, 2025, in the journal JAMA Neurology. The nervous system is the body’s command center, directing how you move, think and feel. It includes the brain, spinal cord and nerves.

Researchers analyzed data from the Global Burden of Disease 2021 study, led by the Institute for Health Metrics and Evaluation at the University of Washington. It is the largest and most comprehensive effort to quantify health loss across places and over time, with more than 17,000 collaborators from 167 countries and territories around the world.

Using that study, researchers evaluated disability and mortality rates for 36 medical conditions that impact nervous system health across the U.S. population. In this analysis, they found over 180 million Americans, or 54% of the population, had at least one of these conditions.

“This new analysis showing one in two people in the U.S. is affected by a neurological disease or disorder is an urgent call to action,” said American Academy of Neurology President Natalia S. Rost, MD, MPH, FAAN, FAHA. “It emphasizes the importance of accelerating research and discovery to achieve scientific breakthroughs in preventing and treating neurological diseases and disorders. With these efforts, led by neurologists and neuroscientists, the experts in brain health, we can improve brain health for all.”

The 36 medical conditions included in the systematic analysis cover the lifespan, from birth defects and neurodevelopmental disorders like attention-deficit/hyperactivity disorder to migraine, which can begin in teen years and often peak in a person’s 30s, to Parkinson’s disease and Alzheimer’s disease, which can occur later in life.

Researchers found the most prevalent conditions were tension-type headache affecting 122 million Americans, migraine affecting 58 million and diabetic neuropathy affecting 17 million.

“Disorders of the nervous system are highly prevalent and cause disability for millions of Americans,” said author John P. Ney, MD, MPH, FAAN, of Yale University in New Haven, Connecticut. “Healthy brain, spinal cord and nerve function allows for greater participation in employment, relationships and improved quality of life. Increasing access to neurological and disability care could have substantial benefits for people across the United States.”

The prevalence of conditions affecting the nervous system was higher in the U.S. population than in the global population, which was 43%. This is largely driven by tension-type headaches, which are very common but carry a lower burden of disability compared to many other neurological conditions. The authors note while these 36 neurological diseases and disorders are widespread, the U.S. performs relatively well in preventing deaths and long-term disability from these conditions. For example, the stroke rate is higher in the U.S. than in some other world regions, but the death rate is comparatively low.

“Neurological and neurodevelopmental disorders account for a disproportionate share of disability, illness and death across the United States,” said author Jaimie Steinmetz, PhD, MSc, of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. “Our analysis, the most comprehensive assessment of neurological burden in the U.S. to date, highlights the importance of investing in neurological health, including prevention, early detection and equitable neurological care.”

Researchers looked at disability-adjusted life-years, a metric that captures total health loss in the population. It accounts for the frequency and severity of disease and the number of years of life lost due to early death. Conditions with the greatest collective health loss were stroke with 3.9 million disability-adjusted life-years, Alzheimer’s disease and other dementias with 3.3 million, diabetic neuropathy with 2.2 million and migraine with 2.1 million disability-adjusted life-years.

After adjusting for changes in the age composition of the U.S. population, researchers found that the prevalence rate of neurological diseases and disorders has remained stable over time, with only a 0.2% decrease between 1990 and 2021. Over the same period, deaths from neurological diseases and disorders declined by 15%, meaning more people are living longer with these conditions. As a result, the number of years lived with disability increased by 10%.  

“Our analysis found that total disability-adjusted life-years from neurological diseases and disorders in the U.S. increased by 55% between 1990 and 2021,” said Ney. “However, when accounting for the effects of an aging population, the increase was much smaller. This pattern shows that much of the rise in neurological disease burden is linked to an older U.S. population that is more vulnerable to conditions affecting the nervous system.”

A limitation of the systematic analysis was that some diseases and disorders that affect multiple systems of the body, such as HIV, were excluded because the neurological component could not be easily isolated.

The systematic analysis was funded by the Bill & Melinda Gates Foundation.

Discover more about brain health at Brain & Life®, from the American Academy of Neurology. This resource offers a website, podcast, and books that connect patients, caregivers and anyone interested in brain health with the most trusted information, straight from the world’s leading experts in brain health. Follow Brain & Life® on Facebook, X, and Instagram.

About the American Academy of Neurology
The American Academy of Neurology is the leading voice in brain health. As the world’s largest association of neurologists and neuroscience professionals with more than 40,000 members, the AAN provides access to the latest news, science and research affecting neurology for patients, caregivers, physicians and professionals alike. The AAN’s mission is to enhance member career fulfillment and promote brain health for all. A neurologist is a doctor who specializes in the diagnosis, care and treatment of brain, spinal cord and nervous system diseases such as Alzheimer's disease, stroke, concussion, epilepsy, Parkinson's disease, multiple sclerosis, headache and migraine.

Explore the latest in neurological disease and brain health, from the minds at the AAN at AAN.com or find us on Facebook, X, Instagram, LinkedIn, and YouTube.

About IHME
An independent population health research organization based at the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME) works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health.

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Journal

JAMA Neurology

 

Social media detox and youth mental health

JAMA Network Open

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About The Study: 

In this cohort of young adults, reducing social media use for 1 week was associated with reductions in symptoms of depression, anxiety, and insomnia; however, the durability of these therapeutic outcomes and their associations with behavior warrant further study, particularly in more diverse populations. 

Corresponding Author: To contact the corresponding author, John Torous, MD, MBI, email torous@bidmc.harvard.edu.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2025.45245)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

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Journal

JAMA Network Open