Farewell and Thanks to Commissioner Mary T. Bassett

On behalf of the FPHNYC Board of Directors and Staff, I would like to acknowledge the departure of Commissioner Mary T. Bassett and thank her for her extraordinary leadership during the last four and a half years as both Commissioner of the NYC Department of Health and Mental Hygiene and the President and Chair of the Fund for Public Health in New York City. Dr. Bassett’s tenure focused on health equity and under her leadership the Health Department launched the Center for Health Equity; opened the Neighborhood Health Action Centers; and partnered with community-based organizations to advance racial and social justice. Dr. Bassett oversaw a number of initiatives that focused on mental health, sexual health, chronic disease and substance use. During her tenure, her calm and clear communications helped the City navigate a number of outbreaks including Ebola, Legionella, and Zika. She shone a spotlight on enduring racism and the impact structural and institutional racism have on persistent and unfair heath disparities across our City. She challenged us to be better and to continue to pursue equity in all the work that we do in our communities, in our clinics, in our workplaces, and in all of our conversations. We will miss her!

Dr. Bassett, good luck in your new position as the Francois-Xavier Bagnoud Professor in the Department of Public Health and Human Rights at the Harvard T.H. Chan School of Public Health.

And, a warm welcome to First Deputy Commissioner Dr. Oxiris Barbot who will serve as Acting Health Commissioner and President and Chair of FPHNYC. Previously, Dr. Barbot served as Commissioner of Health for Baltimore City from 2010 to 2014. A native New Yorker, Dr. Barbot previously worked for the Health Department from 2003 to 2010 as the Medical Director for the Office of School Health. As First Deputy Commissioner, she has been overseeing a diverse portfolio encompassing health equity, health policy and emergency operations. The Board and Staff of FPHNYC look forward to working with Dr. Barbot!

Keeping NYC Students Healthy-Active Design in Schools

Soccer games have long dominated recess at P.S. 13’s (Clement C. Moore) blacktop, leaving some children sitting idle on the sidelines. The K-5 school wanted to make sure children uninterested in soccer still engaged in active play. The Active Design in Schools program at the New York City Department of Health and Mental Hygiene (NYC DOHMH), along with the Fund for Public Health in New York City (FPHNYC), and Building Healthy Communities, and ArtBridge transformed a previously unused schoolyard space into a colorful, interactive area with ground markings and a wall mural. These enhancements encourage students to play games such as “Red Light, Green Light” and hit a variety of targets with balls.

An interactive wall mural promotes physical activity at P.S. 13 (Clement C. Moore) elementary school in Elmhurst, Queens.

Physical activity is important for young people’s health; it helps them maintain strong bones and a healthy weight, and can improve concentration and memory. The Centers for Disease Control and Prevention (CDC) recommend that children and adolescents (ages 6-17) get at least 60 minutes of physical activity a day, yet many students in New York City do not meet these recommendations. Schools play a pivotal role in determining whether NYC’s children lead active and healthy lives.

Like P.S. 13’s ground markings and interactive wall mural, enhancements that encourage active play do not have to be complicated. From 2015-2017, FPHNYC collaborated with the Health Department’s Active Design program to raise and distribute funds and technical assistance to 74 NYC K-12 schools with support from Astoria Energy, New York State Health Foundation and the CDC. Schools received built environment enhancements that encourage increased physical activity and healthy eating. The enhancements fell under four categories: active recreation, healthy foods and beverages, green spaces and nature, and getting to and from school. Projects included painted markings for games, school gardens, new water fountains and safe routes to and from schools. Overall, these enhancements served over 70,000 residents, including over 40,000 children.

Schools are chosen through an open application process with a focus on sites that largely serve children from low-income families. Projects are developed based on the City’s 2010 Active Design Guidelines and the related Active Design Toolkit for Schools. In addition to strategic fundraising, FPHNYC assists with subcontracting, the distribution of grant funding and reporting back to funders. Demand for this project remains high; the program has received over 200 applications. FPHNYC is actively raising additional funds to distribute to schools. For information about how you can support the Active Design in Schools mini-grant program, contact agoldstein@fphnyc.org.

*This program is supported in part by a grant funded by the Centers for Disease Control and Prevention.  The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the Centers of Disease Control and Prevention of the Department of Health and Human Services.

The Breakfast Club: Engaging Caregivers, Teachers, and Students through Nutrition Education

As back-to-school season begins, it’s good to remember that schools can serve as spaces to promote healthy habits. For residents of neighborhoods like East Harlem — where challenges such as poverty and lack of access to healthy foods put residents at higher risk for diabetes, hypertension and obesity — schools play an important role in improving health outcomes. When our New York City Department of Health and Mental Hygiene colleagues asked the Fund for Public Health in New York City (FPHNYC) to help raise support for an innovative program that promotes healthier habits, boosts parent engagement and provides access to fresh fruits and vegetables for East Harlem residents, we were eager to help. Together, we successfully secured a three-year grant for $1,536,000 through the Doris Duke Charitable Foundation that helped create ¡Buen Provecho! — Eat Well.

¡Buen Provecho! — Eat Well aims to improve healthy food choices; increase access to affordable, nutritious food; and foster family engagement in select East Harlem schools. The program originally focused on improving nutrition education for pre-K through first grade while engaging caregivers through breakfast clubs. ¡Buen Provecho! — Eat Well includes two curricula, The Breakfast Club, led by coordinators at parent breakfasts, and Eating Healthy for Success, a Department of Education-approved, common core-integrated curriculum for pre-K through first graders, led by teachers. The program is still going strong, with marked growth in parent attendance, and has distributed nearly 140,000 pounds of fruits and vegetables through a partnership with GrowNYC in East Harlem.

Another key component of ¡Buen Provecho! — Eat Well is the research study. Over the last three years, the program collected data six times from surveys of five partner schools and two comparison schools. A paper describing the program design and outcome measures will be submitted to the Journal of School Health, while program manager Andrea Levy works on additional manuscripts to help others duplicate the program and process.

FPHNYC currently serves as the grant manager, overseeing subcontracts with GrowNYC and reports to the funder. FPHNYC also assists with program operations planning, financial reporting, hiring and evaluating yearly budgets to ensure the program stays on track.

“FPHNYC helped to bring our ideas to reality, with both fundraising skills and operational know-how,” says Cathy Nonas, former senior advisor for the Health Department. This relationship has helped extend ¡Buen Provecho! — Eat Well funding for another year and expand the program into eight schools. The program prides itself on empowering and engaging community members while creating a sustainable model for the future. Looking ahead, ¡Buen Provecho! — Eat Well will focus on sustainability and ensuring residents continue to have access to the foods they need to be healthy, strong and ready to learn this new school year.

New Funding to Expand Support Services for New Yorkers Re-entering Communities from Jail

In the U.S., nearly 2.2 million persons are held in jail or prison, representing the largest incarcerated population in the world. Persons with justice involvement (PWJI) re-entering their communities after incarceration face many challenges and barriers to successful and long-term community re-integration, including poor physical, mental and social health. These challenges may contribute to further contact with the criminal justice system. Approximately 42 percent of people released from New York prisons return within three years.

Manhattan District Attorney Cyrus R. Vance Jr. has announced grants to four organizations under the District Attorney’s Criminal Justice Investment Initiative (CJII) to improve outcomes for individuals re-entering New York City (NYC) communities from jail or prison. These funds expand re-entry services and support these organizations in filling key gaps in the re-entry landscape. Doing so will help PWJI successfully re-integrate into the community, and ultimately increase public health and public safety in the city.

The Fund for Public Health in New York City (FPHNYC) in collaboration with the NYC Department of Health and Mental Hygiene received $3,075,000 from the Manhattan District Attorney’s office to support the NYC Health Justice Network (HJN) over three and a half years. The HJN is an innovative new program that improves the health and well-being of PWJI by increasing their access to, engagement in and quality of community-based health and social services.

Primary care and community-based organizations (CBOs) with experience serving PWJI will partner to serve HJN clients, using an innovative client engagement strategy that includes:-

-Community health workers with personal experience, commonly referred to as “lived experience,” of the criminal justice system who will be embedded in clinical teams and function as navigators, educators and advocates between health and social service systems

-Trauma-informed care interventions in the clinical and social service environment that will enable service providers to be more aware of and able to address histories of trauma, recognizing its impact and associated health risks

“Good primary care improves health outcomes. This is especially important for people who have a history of involvement with the justice system, because they have high rates of diabetes, high blood pressure and smoking. The New York City Health Justice Network, to be piloted in Upper Manhattan, will make it easier for this population to engage consistently in high quality primary care and social services, including housing, transportation and employment support. I thank Manhattan District Attorney Cy Vance for his generous investment to launch this program,” said Health Commissioner Dr. Mary T. Bassett.

“We are pleased to collaborate with the Health Department to ensure that persons with justice involvement receive appropriate health and social services upon reentry,” said Sara Gardner, executive director of the Fund for Public Health in New York City. “This initiative builds on our belief that effective public health solutions are not punitive, but holistic, multi-layered and supportive.”

This work and these funds are a part of District Attorney Vance’s $250 million Criminal Justice Investment Initiative, which consists of a comprehensive set of strategic investments that, together, will have a significant, lasting impact on public safety and justice reform in New York City.

Visit cjii.org for more information about the Criminal Justice Investment Initiative.

Class Action Lawsuit Rules in Favor of Teen Pregnancy Prevention (TPP) Program Grantees

In July 2017, Sara Gardner, executive director of the Fund for Public Health in New York City (FPHNYC), shared the alarming news that the U.S. Department of Health and Human Services (HHS), under the leadership of the Trump administration, announced early termination of grants through the bipartisan and evidence-based Teen Pregnancy Prevention (TPP) Program. TPP was established in 2010 as a national program to fund youth-focused evidenced-based programs aimed at preventing teen pregnancy. In April 2018, HHS had announced changes to the TPP Program, which would shift future funding to organizations that emphasized abstinence or “sexual risk avoidance.”

In February 2018, FPHNYC joined in a class-action lawsuit that argued that HHS illegally ended grants to organizations participating in the original program. This month, the U.S. District Court for the District of Columbia ruled in favor of TPP Program grant recipients. The Court held that last year’s termination of TPP Program grants was unlawful, and ordered HHS to reinstate the grants. This was the fifth time in recent months that a federal judge ruled the cuts to be unlawful, meaning that virtually all of the current 84 grant recipients will have their funding restored.

FPHNYC has collaborated with the NYC Department of Health to implement programs such as Bronx Teens Connection and the current TPP-funded initiative called NYC Teens Connection, which expands important work piloted in the Bronx to Brooklyn and Staten Island. Bronx Teens Connection, which began in 2010, supports partnerships between 40 schools, clinics and youth-service organizations. These partners work together to connect young, at-risk students to school-based health centers and community clinics with a goal of reaching 15,000 youth annually.

The restored funding will allow NYC to continue to provide NYC youth with a chance for better health, educational attainment and economic opportunities. It will also ensure the continued success of the TPP program, which has contributed to a 53 percent decline in the city’s teen pregnancy rates since 2000. Learn more about the impact of Bronx Teens Connection here.

FPHNYC and NYC Department of Health Awarded Funding to Develop a Guide for the New York City Mural Arts Project

The Fund for Public Health in New York City (FPHNYC) and the New York City (NYC) Department of Health and Mental Hygiene have received funding from the Laurie M. Tisch Illumination Fund to support the development of a program facilitation manual for the New York City Mural Arts Project (NYCMAP).

The New York City Mural Arts Project, which began in November 2016, uses a collaborative mural-making process to discuss mental health and foster new social interactions in New York City, where one in five New Yorkers suffer from some kind of mental health disorder and at least eight percent suffer from depression.

The program connects people living with mental health conditions, mental health service providers, artists, peer specialists (people who have experienced mental illness and are trained to support others), City government agencies, and community members, to break down misconceptions and stigma. NYCMAP then translates the discussion themes into murals that incorporate the diversity and strength of everyone involved in the mural-making process.

The one-year award from the Laurie M. Tisch Illumination Fund is one of the first grants in the Illumination Fund’s new Arts in Health initiative. It will support the creation of a facilitation manual to guide future NYCMAP peer specialists and artists in their activities and interactions with participating communities. Developed by a leading scholar on mental health and stigma practices, the manual will standardize program implementation.

“We are excited about this new phase of the NYC Mural Arts Project,” said Sara Gardner, executive director of the Fund for Public Health in New York City. “This support will enhance a remarkable program that is helping to elevate a broader and more open discussion about mental health and community health.”

Turning The Tide on Swimming Fatalities

Drowning is the second leading cause of accidental deaths among children aged 1 to 19 years old in the United States. These fatalities are even more prevalent among African American youth aged 5 to 19 years old. They are six times more likely to fatally drown than Whites and Hispanics of the same age, according to the Centers for Disease Control and Prevention (CDC).

In New York City (NYC), many communities of color have limited access to swimming pools as a result of underinvestment in these communities, and a history of racial discrimination that limited access for African Americans and other minorities to swimming pools. Additionally, in many of these areas, the only publicly accessible pools are located in school buildings, which aren’t open during the summer months when schools aren’t in session.

To address these issues, in 2015, the Health Department (along with the NYC Department of Education, the Department of Parks and Recreation, and the Department of Youth and Community Development) launched Making Waves, a program that provides free water safety and swim instruction to children 6 to 18 years old from low-income neighborhoods. The program aims to reduce the disproportionate risk of unintentional drowning among Black and Latino youth, as well as provide opportunities for physical activity and recreation.

Since the start of the program, participation has nearly tripled – from 524 children in 2015 to more than 1,400 in the summer of 2017. The Health Department plans to work with the Department of Education to expand the program from five to 25 pools, increasing enrollment to 9,000 young people annually. As a long-term goal, Making Waves hopes to offer an after-school program at select schools where students can train to become certified instructors and lifeguards.

“The risk of drowning is a serious health concern, particularly in low income Black communities,” said Sara Gardner, executive director of the Fund for Public Health in New York City. “Making Waves helps address a historical wrong with a recreational program that improves safety and is fun!”

New York City’s Public Health Laboratory Helps Train the Next Generation of Laboratory Microbiologists

This week Marvin Rivera spent almost 40 hours processing and testing various samples at the New York City Public Health Laboratory (PHL), where he is one of several newly hired laboratory microbiologists to join PHL. What might seem like a monotonous job to some is just what Rivera hoped for when he began working at the lab as a trainee last summer.

“I always knew I wanted to do this work,” he said. “I worked in labs in high school and in college  and I always preferred the testing and diagnosis part to the patient interaction part.”

The PHL opened in 1892 as the Municipal Bacteriological Lab, working to control diphtheria, a deadly infectious disease that, five years prior, had led to more than 4,500 deaths in New York City (NYC). Since then, PHL has successfully tested, analyzed and reported results on emerging viruses, diseases and environmental agents, and works to control outbreaks such as Zika, Ebola and Legionnaires’ disease. In fact, it is the only laboratory in the city equipped to handle testing for “white powder jobs,” a term coined after the 2001 anthrax attacks.

Despite extensive technological resources and the ability to review and test some of the most dangerous pathogens, public health labs often struggle to stay adequately staffed. Public health laboratories across the nation face a shortage of qualified individuals at both leadership and technical levels.

Therefore, in 2016, the New York City PHL and the Fund for Public Health in New York City, with $100,000 in funding from the Doris Duke Charitable Foundation, developed a one-year pilot program, “Creating Career Pathways to the New York City Public Health Laboratory.” The program trains recent Hunter College Medical Laboratory Sciences program graduates, aiming to ultimately hire them as full-time Laboratory Microbiologists within the NYC Health Department.

“Public health laboratory science is a very specific field, and not every school has a medical laboratory science program,” said Andrea DeVito, special assistant to the assistant commissioner at the NYC Public Health Laboratory. “As a result, many students aren’t familiar with it when they begin undergrad, and often go into more popular areas of study such as pre-medicine.” In addition, public health labs compete with high-paying private hospital and clinical labs for new hires.

DeVito manages the grant and the program, which is currently wrapping up its inaugural year of recruiting and training three recent Hunter College graduates, who all come from underrepresented communities.

Laboratory microbiologists Marvin Rivera and Mously Lo are part of that inaugural class. Last summer, they began working as paid trainees at the PHL where they learned the ropes and studied for their New York State (NYS) clinical licensure exam. Over six months, they worked closely with laboratory staff and administrators for 25 hours a week, rotating through lab sections such as microbiology and virology. They learned to identify bacterial pathogens like salmonella, Neisseria gonorrhea and Mycobacterium tuberculosis, and detect viruses like Zika and measles.

“It’s great,” said Lo. “You get to see something every day and you’re constantly working on new things.”

All three trainees passed their NYS licensure exam (a requirement for testing clinical specimens in NYS). NYC PHL hired two of the three trainees as full-time laboratory microbiologists. The third trainee accepted a position at a hospital laboratory. The new hires will contribute to the work that helps keep 8.5 million New Yorkers safe and healthy.

“This pilot has been a resounding success,” said Dr. Jennifer Rakeman, assistant commissioner and laboratory director at PHL. “The long-term goal is to sustain the program so that PHL can continue to develop talented microbiologists and further strengthen the relationship between the Medical Laboratory Science program at Hunter College and the NYC PHL.”

Sounding the Alarm on America’s Alcohol Problem

At this point in time, no matter where you live in this country, you are probably aware that we are in the throes of a major opioid epidemic. You may know that drug overdoses are now the leading cause of death among Americans under 50. You may know that in 2016, more than 42,000 people died from an opioid overdose. You may also know, that earlier this month, the United States Surgeon General, Jerome M. Adams, issued a national advisory urging Americans to carry and learn how to use naloxone, a life-saving drug which can reverse the effects of an opioid overdose.

What you may not know, is that we are also in the midst of another deadly crisis: excessive alcohol use. In 2015, more than 33,000 Americans died from alcohol-induced causes, including alcohol poisoning and liver disease. And if this tally included deaths from drunk driving, other accidents, and homicides committed under the influence of alcohol that number swells to 88,000. In fact, today excessive alcohol use is the fourth leading preventable cause of death in the United States. Over the past decade, the alcohol death rate has continually gone up at an average of 4 percent a year with a 40 percent total increase during the 10-year period.

So why is the alcohol crisis, which is responsible for twice as many American deaths as opioid overdoses, less visible? Why hasn’t anyone sounded the alarm?

The truth is drinking is ingrained in our culture. Because alcohol in moderation is not harmful, it has been normalized in our society. For many, turning 21 and gaining the right to drink is on par with getting one’s license or becoming eligible to vote. It’s a rite of passage that anchors many of life’s greatest celebrations. We raise a glass to celebrate a job promotion, we toast to the New Year, we buy beers at baseball games, and knock a few back with each birthday. In addition, alcoholic beverages are promoted through all major media, available anywhere from the grocery store to our favorite restaurants, to the sports arena. In New York City, the City that never sleeps, you can order a drink between 8 am and 4 am—20 hours out of the day.  However, alcohol can be addictive and dangerous if abused.

In 2014, the New York City Health Department found that nearly one third of New Yorkers engaged in high-risk or binge drinking, which is defined as consuming five or more drinks for men or four or more drinks for women, within two hours.

Turns out, the rest of America likes to drink as well.

According to a study published by JAMA Psychiatry, in 2017, the percentage of American adults who consume alcohol increased from 65 to 73 percent from 2002 to 2013. Though the majority of Americans who drink do so without causing significant risks or health problems, this study makes a compelling case that the United States is currently facing a crisis with alcohol abuse that is getting worse. It documents substantial increases in the prevalence of drinking  in general, increases in high-risk (or binge) drinking, and increases in the prevalence of alcohol use disorders (AUDs), with the biggest changes related to AUDs, the most serious condition.

Alcohol Use Disorder, the medical term used by medical professionals to describe someone with an alcohol problem, is diagnosed as either mild, moderate, or severe based on the number of eleven different symptoms an individual has experienced in the past twelve months. According to the study, which reviewed data from two nationally representative surveys of US adults, prevalence of AUDs increased nearly 50 percent during the time period 2001-2002 to 2012 to 2013. The researchers concluded that “substantial increases in alcohol use, high-risk drinking, and alcohol use disorder constitute a public health crisis”. They go on to say that with the increase in alcohol use and abuse, we can expect increases in related and co-occurring chronic disease, especially among woman, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged.

It’s time for a national wake-up call.

It is the role of public health to sound the alarm and to elevate a national conversation around alcohol abuse. We need a national strategy to address the alarming increase in high-risk drinking and AUDs.

It is essential for public health to advocate for policies and programs that support the creation of healthy environments that encourage healthy practices over unhealthy ones. We need to adopt and implement effective messages and programs that help people understand and avoid the dangers. We also need to adopt evidence-based policies that create and support environments where the healthy choice is the easiest. Though certain to elicit resistance  and cause controversy, this may mean closing bars earlier or opening them later in the day,  changing serving sizes, limiting the number of liquor licenses, or increasing the alcohol tax.

This month, when the surgeon general announced the new advisory related to opioid use, he became part of a chorus of public health professionals advocating for different policies and societal behaviors with the potential to upend a deadly crisis.

We should be doing the same thing with alcohol abuse.

New Funding to Support Study on Collaborative Care Delivery in East Harlem

Lack of coordination between health and community service agencies often leads to service duplication and gaps, missed opportunities, wasted resources and poor outcomes for the most vulnerable populations. A place-based model, where providers collaborate in one location to improve the health and well-being of the populations they serve, can help address these challenges.

The Fund for Public Health in New York City has received a $250,000 award from the Robert Wood Johnson Foundation, managed by its Systems for Action national program office. The award supports Partnerships to Encourage Actionable Cultures of Health (PEACH), a study by the New York City Department of Health’s Center for Health Equity.  PEACH will investigate how aligning a city health department, clinical service and cross-sector community organizations with shared governance can improve efficiencies as well as health in the neighborhood.

The research team will examine the Center for Health Equity’s East Harlem Neighborhood Health Action Center, which includes services provided by: the Department of Health; clinical and non-clinical partners; community health workers; faith- and community-based organizations. The Health Action Center keeps a database and referral system that helps connect East Harlem residents to clinical services or non-clinical services (e.g., food pantries, transportation, child care).

The research team will also assess the community health outcomes and satisfaction, partner success in linking clients to needed services and system coordination to improve service efficiency and neighborhood health. The study results will help inform best practices for replicating this model in other neighborhoods across NYC and the U.S.

“This study will help us better understand how to support the integration of health care and social services to address the needs of community residents and improve neighborhood health,” said Sara Gardner, executive director of the Fund for Public Health in New York City. “To achieve neighborhood level impact, work across multiple partners — government and non-government, must be aligned.”