Sara Gardner, MPH
Overall, New York City residents are living longer, healthier lives. Though the city’s health is improving, marked disparities in key health indicators persist. Thirteen years ago the NYC Health Department established a comprehensive blueprint to improve the health of all New Yorkers and has tracked progress over time.
In 2004, the NYC Health Department launched its first comprehensive policy agenda called Take Care New York to set priorities and focus on the leading preventable causes of illness and death. The initiative identified ten priority areas for action to improve health and called on all New Yorkers to adopt them. In September 2009, Take Care New York 2012 was launched to build on the success of the initial four years and broaden its scope to include a new focus on children’s health with an emphasis on eliminating health disparities and addressing neighborhood conditions that adversely affect health. In both cases, specific and measurable objectives were established and indicators tracked to show progress over time.
TCNY 2020 was launched at the start of the de Blasio administration and represents a further evolution of the original Take Care New York policy agenda. Whereas the earlier versions focused more on what individuals and providers could do, TCNY 2020 recognizes that health outcomes are influenced by many factors outside of an individual’s control like neighborhood safety, access to healthy food, and housing quality. To achieve the twin goal of improving everyone’s health and making greater strides in reducing health disparities, it becomes imperative to engage with community stakeholders to build strong, structured cross-sector partnerships.
In response, under TCNY 2020, the Health Department has employed a more intentional approach to community engagement including holding a series of 28 community meetings for residents across the five boroughs. The resident meetings provided the opportunity for health department staff to learn from community members regarding neighborhood needs, assets, and resources and to hear directly from residents about how they experience health inequities. During a six-month period, over 1,000 New Yorkers participated in the sessions and provided input identifying reducing obesity; improving air quality; meeting mental health needs; increasing physical activity and reducing cigarette smoking as their top priorities.
Under TCNY 2020, there has also been an expanded approach to working with community-based organizations, in total over 9,000 nonprofit organizations, local businesses, schools, health care providers, faith-based institutions and community leaders have engaged on a variety of programs, policies and initiatives. For example, to address the high rate of childhood asthma hospitalizations in the South Bronx, the Health Department has partnered with the Department of Transportation and two local trucking companies to upgrade their trucks to reduce harmful emissions. Results to date show a significant reduction in nitric oxide emissions and air particulate matter, which will reduce the risk of respiratory problems and asthma attacks.
A second example is in Staten Island where the Health Department is working with the Department of Education and a local nonprofit to address the issue of childhood obesity by building school gardens, bringing nutrition education into classrooms and making sure kids are connected to primary care.
This past December, the DOHMH released its second annual update on TCNY 2020. The report updates progress across 25 key indicators that impact people’s health. Overall, New York City is getting healthier: more New Yorkers self-reported as feeling healthier than in previous years (78 percent citywide); the teen pregnancy rate is at an all time low (40.6 per 1,000) falling almost 50% between 2011 and 2015; high school graduation rates have increased from 66 percent in 2013 to 73 percent in 2016; and air quality city-wide has already surpassed the 2020 goal. A full list of the 25 indicators and most recent data can be found in Appendix 1 of the TCNY 2020 report.
In this era of chronic disease, local public health departments are frequently playing the role of “chief health strategists” in order to lead community health promotion efforts. In partnership with health care providers and leaders across a range of sectors including social services, education, transportation, public safety, and community development, public health departments are more likely to convene and work as part of coalitions than to work alone. This requires a new orientation and skill set where public health leaders are adept at building and nurturing strategic partnerships to bring about collective impact.
At the heart of this new approach is the notion that communities will drive and sustain change. Just as the health care system has adopted a patient or client-centered approach to health care service delivery; the evolving nature of public health work calls for a community-centered approach requiring authentic community engagement to both identify priority issues and to develop strategies and actions to address them. Progress will not happen overnight and as we have seen over the last 13 years of TCNY, careful goal-setting, tracking of indicators over time and applying a community approach is the blueprint for a healthier city.