Category Archives: New York (NY) MA
As scholars together at the Columbia Mailman School of Public Health in New York City, public health researchers Kimberley Roussin Isett, PhD, and Miriam Laugesen, PhD, watched major policy changes unfold across the city over the past several years. They decided to look at New York City as a model for improving public health that other cities could replicate. “Things were happening in New York City rapidly, and in a health-focused way that really not seen before,” says Isett. Since then, other cities across the country have enacted similar, comprehensive smoke-free policies. Voluntary calorie postings on restaurant menus were also integrated as a requirement in the Affordable Care Act. The researchers decided to look at New York City as a model for improving public health that other cities could replicate. NewPublicHealth recently spoke with Drs. Isett and Laugesen about their research. Dr. Isett recently took a new position as an Associate Professor in the School of Public Policy at the Georgia Institute of Technology in Atlanta, and Dr. Laugesen is an Assistant Professor of Health Policy and Management at Mailman and a former Robert Wood Johnson Foundation Health & Society Scholar.
NewPublicHealth: Because of its large budget and powerful public leaders, New York City isn’t always seen as a model for other, particularly smaller, health departments. But your work shows some of their efforts to be important, maybe critical for other departments to study and replicate. How did you come to that conclusion?
Miriam Laugesen: In our research, one theme that kept coming across again and again was the scientific basis—the amount of research and data—that the Bloomberg administration and staff had collected to justify and design their policies. That was a very big component, we thought, of many of their policies and that New York City had many innovative, interesting examples of how policymakers can base their policies on evidence.
Yesterday, New York State Health Commissioner Nirav R. Shah, MD, MPH, released the 2013-17 Prevention Agenda: New York State’s Health Improvement Plan—a statewide, five-year plan to improve the health and quality of life for everyone who lives in New York State. The plan is a blueprint for local community action to improve health and address health disparities.
Dr. Shah was joined by New York City Health Commissioner Thomas Farley, MD, MPH, and representatives from leading health care and community organizations at the Charles B. Wang Community Health Center in Manhattan. Among the other speakers were Jo Ivey Boufford, MD, president of The New York Academy of Medicine, and Daniel Sisto, president of the Healthcare Association of New York State.
>>Read a related Q&A with Commissioner Nirav Shah.
“We’ve all heard the adage—an ounce of prevention is worth a pound of cure,” said Commissioner Shah. “We need to fundamentally change the way we think about achieving better health in our society.”
That fundamental shift toward prevention, said Dr. Shah, requires setting clear goals, promoting active collaborations, and identifying policies and strategies that create opportunities for everyone to live a healthy life.
The Prevention Agenda identifies five priority areas:
- Prevent chronic disease
- Promote healthy and safe environments
- Promote healthy women, infants and children
- Promote mental health and prevent substance abuse
- Prevent HIV, STDs, vaccine-preventable diseases, and healthcare-associated infections
A health improvement plan like the one released by the New York Department of Health is a critical prerequisite for public health department accreditation. Recently, the Public Health Accreditation Board awarded five-year accreditation to 11 public health departments. Those 11 are the first of hundreds currently preparing to become accredited, including New York state.
"Completing the accreditation application, which includes our Prevention Agenda 2013-17, provides the Department of Health a valuable opportunity to engage partners and community stakeholders in our ongoing efforts to improve public health, evaluate the effectiveness of our services and showcase our successes," Commissioner Shah said.
Thomas Farley, MD, MPH, Health Commissioner of the New York City Department of Health and Mental Hygiene, is the keynote speaker at the opening session of the Public Health Law Research annual meeting that started yesterday afternoon in New Orleans. In advance of the meeting, NewPublicHealth spoke with Dr. Farley about the role of legal research in moving the public health agenda forward, how New York City is doing in the weeks following Hurricane Sandy, and the flu epidemic hitting the city that prompted New York State Governor Cuomo to declare a public health emergency earlier this week.
NewPublicHealth: What will you focus on during your address at the Public Health Law Research Program annual meeting?
Dr. Farley: I will be going through a number of policies that we have put in place here in New York City to promote health. Most of those will be around food, but some will be around tobacco. So that includes things such as our raising of tobacco taxes, our smoke-free air rule and around our prohibition on the use of trans fats in restaurants, our calorie labeling initiative and our portion rule [limits on beverage sizes at some food outlets]. And I will share some thoughts about the role researchers can play in policy development for an agency like ours.
NPH: How important has legal research been for some of the recent public health initiatives that have been introduced in New York City?
Three months have passed since Hurricane Sandy hit the East Coast. And while the number of people displaced by the storm has gone down from tens of thousands to the hundreds in different communities, some people are still without power or a permanent place to live. Others face the daunting task of rebuilding businesses and homes while protecting against mold and dust, which can cause or exacerbate respiratory problems. For many, the stress has rekindled mental health issues that might have been at bay, or created new ones or just made tough times even worse.
NewPublicHealth spoke with Patricia Yang, DrPH, Chief Operating Officer and Executive Deputy Commissioner at the New York City Department of Health and Mental Hygiene.
NewPublicHealth: Hurricane Sandy hit just over two months ago. How’s the city doing now?
Dr. Yang: There are people in parts of the city for whom the storm is a distant memory, and their daily lives are virtually unaffected apart from what they might hear on the news or read in the papers. But in the areas that were most directly affected by the hurricane, life for many is far from normal and may never return to what it was pre-storm. Those areas in particular are parts of the Rockaways and Coney Island and Staten Island. So there are still thousands of people who don’t have basic utilities and for whom grid power and heat have not returned. And we’re heading into the coldest winter months.
NPH: What’s the role of the public health department both now to help people deal with the aftermath, and looking ahead to prepare for the next disaster?
Just several weeks after Hurricane Sandy hit the New York City area, New York State Governor Andrew Cuomo appointed Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health, to co-chair the New York State Ready Commission. The role of the Commission is to determine ways to ensure that critical systems and services are in place to respond to future natural disasters and other emergencies.
The specific areas for which the commission was asked to make recommendations include:
- Addressing vulnerabilities in the state’s health care, energy, transportation, communications and other systems
- Ensuring that new, modified and existing construction is resilient
- Ensuring the availability of adequate equipment, fuel, food, water and other emergency supplies
- Ensuring that first responders and other critical personnel are able to communicate efficiently and have access to adequate resources
- Ensuring the availability of reliable real-time information for decision-makers
- Ensuring that lines of authority are clear and officials have the authority to react rapidly to emergency situations
Both the Ready Commission and the 2100 Commission, which was tasked with finding ways to improve the resilience and strength of the state’s infrastructure in the face of natural disasters and other emergencies, submitted their reports to the governor earlier this week. Recommendations of the Ready Commission included:
- Create a statewide network of unified emergency training, coordination, protocols and communication
- Update the New York State Building Code
- Expand use of Vulnerable Populations Databases so first responders; outreach workers; and health care and human services personnel can find and serve those who may need assistance
- Require that gas stations in strategic locations have access to onsite back-up power capacity
NewPublicHealth spoke with Dr. Redlener about the Commission and the storm’s impact on New York residents.
>>Read about the 2012 edition of its Ready or Not? report from Trust for America’s Health, which looks at strengths and vulnerabilities in each state’s emergency preparedness status.
NewPublicHealth: You were appointed to co-chair the Ready Commission by Governor Cuomo in November. What is the specific focus of the Commission?
Redlener: What we are going to do is assess the current resilience of the city in terms of its preparedness efforts. Are we ready? Are we prepared? What are the missing elements right now in trying to make us more prepared for the next events than we were for this one? Some of this is not all that complicated and unfortunately these are problems that we have seen in prior disasters. Some of the things that we are seeing here were basically exactly what we saw in the Gulf and in New Orleans after Katrina. It isn’t like we haven’t been thinking about these things. I think that is why we were able to provide some reasonable recommendations, because these are not altogether new problems or challenges.
NPH: How strong is disaster preparedness training at schools of public health and within governmental public health?
As the recovery efforts continue in the aftermath of Hurricane Sandy, NewPublicHealth is following the work of local and state health departments in the areas affected by the storm as they help their citizens regroup, recover and build community resilience. Read more on public health preparedness and response.
Three weeks after the storm the New York City Health Department has meaningful storm-related health use data that is valuable for both current health services delivery and future disaster planning:
- Emergency room visits for both mental and physical health concerns in New York City dropped on the day of the storm but have now returned to typical levels.
- There was a brief increase in cases of hypothermia immediately after the storm but no sustained increase since then.
- There is a continuing modest increase in visits for prescription medicine refills.
- There has not been an increase in injuries or illnesses overall.
- There has been a modest increase in asthma emergencies in the Rockaway section of New York, which was especially hard hit by flooding and storm debris during the period immediately following the storm, but rates seem to have returned to baseline. According to the health department, the increases likely were caused by people living in cold temperatures, using their stoves to heat their homes, dust from storm clean-up and reduced access to prescription medication for some people during the first days of the storm.