The Challenges We Face in the Fight Against Measles

The measles epidemic has grown rapidly over the past eight months; there are now over 550 cases in New York City alone. This outbreak has posed many challenges, particularly in combating the spread of anti-vaccine misinformation. Additionally, the City has had to question how to balance civil liberty with civic accountability, the right to refuse vaccination or the necessity to protect those who cannot receive vaccines. Dr. Oxiris Barbot, the Commissioner of the New York City Department of Health and Mental Hygiene, writes eloquently about these challenges, and opportunities, in her latest piece for Health Affairs.

You can access the article here.

Addressing the Risk for Falls for Seniors

May is Older Americans Month, a time to celebrate and look out for our older neighbors, friends, and loved ones. One significant risk seniors face is falling, which can lead to serious injury, hospitalization and even death. In the U.S., one in three older adults falls each year and there are nearly 300 falls-related deaths per year in New York City. Falls are the leading cause of injury hospitalization among older New Yorkers, but falls are preventable. With the population of older adults expected to increase by nearly half by 2030, it is vitally important to identify and address fall risks. Doing so will protect against cascading health care costs associated with a fall and will preserve quality of life.

In 2017, the Fund for Public Health in New York City (FPHNYC) collaborated with the New York City (NYC) Health Department to secure a grant from the Staten Island Foundation to study fall risks among Staten Island seniors.

Staten Island is an important place to study this problem. Of NYC’s five boroughs, Staten Island has the highest rate of falls-related deaths (33.5 per 100,000 aged 65+ years compared with 27.5 per 100,000 citywide), and Staten Island is the only borough where the falls hospitalization rate for older adults has increased in recent years.

During the year-long study, FPHNYC and the Health Department conducted in-person surveys of 203 Staten Island seniors aged 65 years and older, examining social engagement and support networks, overall health, and possible fall risks related to their home environment.

Among the study’s key findings: falls were most likely to occur at home, and 27% of falls occurred on and around stairs. Nearly half of the survey respondents lived in one- or two-family homes, making the exposure to stairs more likely. Nearly two-thirds of respondents who fell reported they were alone when they fell, while almost three-quarters of respondents reported they did not own a medical alert system.

These findings point to clear prevention messages for Staten Island seniors – messages that DOHMH is delivering to older adults, their formal and informal caregivers and their health care providers. Furthermore, these findings can inform planning for home-based falls prevention interventions. The Health Department is reviewing programmatic approaches to making improvements to homes of older adults when falls risks are identified.

The full report is available upon request.

To learn more about this important work, please visit the Health Department’s Preventing Falls in Older Adults page or download a falls prevention checklist.

Sparking and facilitating Health Department research projects is one key way that FPHNYC promotes public health across NYC. To learn about how you can support the health of older New Yorkers, please contact Aviva Goldstein at agoldstein@fphnyc.org.

Renewing Investment in Design for More Active, Healthier Lives

Maintaining a healthy lifestyle isn’t easy. It can be even more challenging to go for a walk when your neighborhood doesn’t feel safe, or visit the park if the closest green space is a subway ride away. The environments in which we work, live, and play can have a profound impact on our health and wellbeing.

In 2010, with the help of funding secured by the Fund for Public Health (FPHNYC), the NYC Department of Health, Department of Design and Construction, Department of Transportation, and Department of City Planning jointly published the New York City Active Design Guidelines (ADGs). The original Guidelines were the first of their kind, created for design professionals and policy makers with the goal of designing healthier communities from the ground up. The ADGs emphasized design strategies that increased opportunities for physical activity, including walking and exercise, more accessible green spaces, improved access to fresh food stores, and active transportation such as walking and biking.

The ADGs provided a comprehensive set of design guidelines for the built environment, focused on the promotion of health and grounded in scientific evidence. They have been incorporated into design projects here in NYC and adapted both nationwide and worldwide. Since publication, there has been more research on the importance of the built environment for health, particularly the impact of the built environment on mental and social wellbeing.

Now, nearly ten years later, FPHNYC is again partnering with the Health Department to update the original ADGs with new research and recommendations for addressing additional priorities such as social cohesion and mental health. It is estimated that 20% of the adult working population has some type of mental health issue at any given time, and that three of the top five leading causes of disability in NYC are mental health related. The built environment can have an impact on these and other health outcomes. The updated ADGs, which will likely be published in late 2020, will go beyond just physical activity to address “whole person health,” which includes physical, mental, and social health, and will address the issues facing communities across NYC that still suffer from poor health. Solutions include improving access to green space, involving the community in the design process, and renewed investment in designing public spaces with an eye towards addressing health inequity while improving social cohesion.

Recently, Active Design was included in the OneNYC plan, demonstrating a commitment to these strategies in the Mayor’s vision for NYC. The updated and expanded ADGs (“ADG 2.0”) will offer design solutions to make the healthy choice the easy choice. FPHNYC is actively searching for philanthropic partners to support this essential work.

To learn more about how you can support emerging innovations in public health like the ADG 2.0, please contact Aviva Goldstein at agoldstein@fphnyc.org.

Welcoming the Commissioner’s Key Strategies for Public Health

On a crisp February morning, FPHNYC partnered with the Robin Hood Foundation to bring together some of our philanthropic partners to meet the new Commissioner of Health, Dr. Oxiris Barbot. The Commissioner spoke about her own personal experiences that drove her to public health, and outlined her vision for a healthier New York City during her tenure. She also shared her “key strategies” for the Health Department work, and emphasized an ongoing commitment to promoting health equity and community empowerment. Here are three of our main takeaways:

1. Dr. Barbot’s vision for NYC is a city where everyone can realize their full potential regardless of who they are or where they live. She emphasized her key strategies, which include continuing to promote health equity with an added focus on immigrant health, centering communities, infusing mental health into public health practice, bridging public health and healthcare delivery, and ending epidemics like obesity and hypertension.

2. The Health Department will address these strategies with a range of activities or “tactics,” including expanding and streamlining home visiting programs that improve the health and welfare of mothers and babies; leveraging the arts to promote mental health and social cohesion; developing a trauma-informed framework across all domains; focusing on the intersection of housing and health; and addressing each epidemic with innovative approaches.

3. Public-private partnerships remain essential. Grants and donations have helped raise awareness of key issues, test innovative projects that can be scaled into citywide initiatives, and change public policy on challenges such as smoking and food standards. As the city moves into a tighter budgetary period, private support will only become more critical for the Health Department’s ability to innovate and maintain its status as a model department nationally and internationally. By connecting private funders with city government, FPHNYC amplifies the Department of Health’s work to ensure all New Yorkers have the chance for a healthy life.

As public health professionals, it’s easy to sometimes get caught in the details of our day to day work. But when we take a step back and consider the individuals whose lives are changed because of improved access to prenatal care, rapid treatment for HIV, or information about a diet to control diabetes, we are reminded even more that this work is essential to making our city great. We continue to be inspired by the Commissioner of Health and her vision, and look forward to working with her to achieve a healthier NYC for all.

To learn more about how you can support emerging innovations in public health, please contact Aviva Goldstein at agoldstein@fphnyc.org.

A Vision for Public Health in NYC in 2019

The start of a new year means a flurry of resolutions and commitments to make this year even better than the last. As we kick off 2019, we asked our colleagues at the Department of Health what their resolutions were for public health in New York City. From improving healthy food access, to supporting mental health, to ending the HIV and AIDS epidemics, their responses reflect their continued commitment to and passion for improving the health of all New Yorkers.

Dr. Oxiris Barbot, the City’s new Commissioner of Health and the chair of FPHNYC’s board, advocated strongly for the continued efforts of the Department of Health to promote health equity and improve access to care. “Access to health is a human right,” she said. “In 2019, we will continue to serve New Yorkers, regardless of their immigrant or insurance status. Our mission stays the same – to promote and protect the health of all New Yorkers.”

In recent years, FPHNYC has worked closely with the Division of Prevention and Primary Care, which advances population health by promoting high quality primary care and prevention. “New Yorkers can’t make healthy choices if we don’t have healthy choices. Through initiatives like National Salt and Sugar Reduction Initiative (NSSRI) to address the widespread prevalence of added sugars and salt, efforts to reduce smoking, and initiatives to improve access to quality health care, I envision a city where the healthier choice is the easier choice for all,” said Sonia Angell, Deputy Commissioner for Prevention and Primary Care.

Demetre Daskalakis, Deputy Commissioner for Disease Control has his sights set on ending the spread of HIV and AIDS. “In 2019 we will continue our work towards our goal of ending the HIV and AIDS epidemics in NYC by 2020. I aspire to make New York a status-neutral city where the same approach is used in initial patient care regardless of one’s HIV status,” he said.

It’s still important to remember that not all New Yorkers have access to the same resources; one’s zip code is far too often a predictor of one’s health. To address these issues, Dr. Aletha Maybank, Deputy Commissioner for the Center for Health Equity, committed in 2019 to “Continue to provide support to some of the most resource-deprived neighborhoods in our City by expanding access and utilization of our Neighborhood Health Action Centers, which provide a host of different services and programming where people can connect with their neighbors in Tremont, East Harlem, and Brownsville and surrounding neighborhoods.”

To ensure the next generation of New Yorkers grows up healthy and happy, Roger Platt, Acting Deputy Commissioner for Family and Child Health set his 2019 resolution to “Make NYC a place where children and their families have the best opportunity to grow and thrive through a focus on maternal health, school health and early childhood.”

And with the recent announcement of the expansion of the ThriveNYC initiative, mental health remains a key focal point for the City. Hillary Kunins, Acting Executive Deputy Commissioner for the Division of Mental Hygiene, set out her goals for the New Year. “In 2019,” she said, “we are excited to venture into our 4th year of ThriveNYC and the 3rd year of HealingNYC. These initiatives – focused on mental health broadly and the opioid overdose epidemic respectively – are helping us to take innovative public mental health approaches to prevent illness and death, expand access to effective treatment, build a prepared workforce, and work collaboratively across government and with communities.”

FPHNYC is grateful to work with such inspiring and motivated public health professionals. In the spirit of reflection, here’s a resolution of our own; in 2019, we commit to ensuring even more innovative and exciting public health programs can get off the ground and serve the health needs of New Yorkers. With that goal in mind, we think this year is already looking bright.

If you’d like to support our resolution and contribute to our work, please consider making a donation to FPHNYC. Your gift will support a wide range of public health programs that promote innovation and improve the health and wellbeing of New Yorkers.

Working to Empower HIV Patients and End the Epidemic

As the first health department clinics in the United States to provide immediate on-site access to HIV treatment, the New York City Department of Health and Mental Hygiene (DOHMH)’s Sexual Health Clinics offer a lifeline to patients seeking HIV treatment. Patients who enter the clinics unaware that they are HIV-positive or who were previously unable to access HIV treatment (due to lack of access, stigma, or having had difficulty engaging in care) leave feeling empowered to take control of their sexual health. In the words of one 32-year-old patient, “You have no idea how long I have been waiting to start medication for my HIV. It is such a relief to be able to start treatment.”

FPHNYC helps identify funding and facilitates public-private partnerships to advance new public health initiatives. Since 2016, FPHNYC has received $1 million from MAC Cosmetic’s charitable foundation, the MAC AIDS Fund, to enhance DOHMH’s HIV and sexually transmitted infection (STI) services and programming. This funding facilitated immediate access to antiretroviral therapy (ART) for Sexual Health Clinic patients newly diagnosed with HIV, enabling them to control their HIV and achieve and maintain viral suppression so that they do not transmit HIV to their sexual partners. The funding has also helped DOHMH improve the patient experience at the Sexual Health Clinics. With eight locations throughout the city, the Sexual Health Clinics offer safe and affirming spaces to patients of all sexual orientations and gender identities and expressions to access high-quality, status neutral prevention and treatment services. The Sexual Health Clinics see patients who are underserved, underinsured and have barriers to seeking medical care at a primary care facility. Expanding HIV and STI services at the Sexual Health Clinics is one of several NYC Ending the Epidemic strategies to reduce the number new HIV infections in New York City to non-epidemic levels and improve the health and well-being of New Yorkers with HIV.

MAC AIDS Fund provided funding for one of the DOHMH Sexual Health Clinics to pilot JumpstART, a program providing immediate access to ART for patients newly diagnosed with HIV. The successful program has since expanded to all eight Sexual Health Clinics. In 2016 and 2017, the Sexual Health Clinics initiated a total of 149 patients on ART, with 66 percent of them being newly or recently diagnosed with HIV. The MAC AIDS Fund is also helping DOHMH build an online patient portal for Sexual Health Clinic patients to check their HIV and STI test results, communicate with staff, and access educational materials regarding their sexual health.

In 2017, DOHMH announced that 2,157 people were newly diagnosed with HIV in New York City, down 5.4 percent from 2016. More New Yorkers with HIV are receiving care and achieving viral suppression. Also in 2017, 80 percent of people were linked to care within 30 days of their HIV diagnosis, compared to 65 percent in 2013; and among people receiving HIV medical care in New York City in 2017, 85 percent were virally suppressed, compared to 79 percent in 2013. These data show that New York City is on track to achieving our ambitious NYC Ending the Epidemic goals. Together, FPHNYC, DOHMH, and the MAC AIDS Fund provided proof of concept before City funds committed to bringing JumpstART to scale, a critical step in our efforts to end the epidemic.

A New Vision for Salt and Sugar Reduction

Around the holidays it can feel like sugary treats are there to tempt us at every turn. But this time of year, and all year round, it’s important to be mindful of the sugar we consume. Added sugars have become widespread in our food supply, and excess sugar consumption is harming our health nationwide. Even products perceived as healthy may contain more sugar than we realize. Sugar is sometimes added to foods like yogurts, cereals, and muffins at levels similar to what you might find in cupcakes, cookies, or candy bars. This makes it challenging for most Americans to know what’s really heathy.

In the U.S., adults consume 35% more calories from added sugar than the daily recommended limit, often through processed foods and sweetened drinks. Even more startling, 68% of packaged foods and beverages purchased in the U.S. contain additional caloric sweeteners. This added sugar consumption is associated with increased risk of excess weight, type 2 diabetes, hypertension, stroke, heart disease, and cavities.

To make the healthier choice the easier choice and address the widespread prevalence of added sugars, the Department of Health and Mental Hygiene recently announced the expansion of the National Salt Reduction Initiative (NSRI) to the National Salt and Sugar Reduction Initiative (NSSRI). The NSSRI is a national partnership—convened by the Health Department of nearly 100 local city and state health departments, associations, and health organizations—that calls upon the food and beverage industry to voluntarily lower sugar in packaged foods by 20% and in beverages by 40% by 2025.

FPHNYC understands the powerful impact this kind of campaign can have on our food supply and our health. In 2009, we played a significant role in raising support for the launch of the NSRI, which used a voluntary target-setting framework to encourage the food industry to reduce the amount of salt in their products by setting reduction targets for specific food categories. 70% of sodium is added to food outside the home, and diets high in sodium can increase blood pressure and the risk for heart disease and stroke. Nearly 30 companies committed to meeting the sodium reduction targets, and a reduction of nearly 7% was observed from 2009-2014.

Private donations to the Fund transformed the initiative from strategy to reality, allowing for the purchase of sales and nutrition data that made it possible for the Health Department to develop two innovative and sophisticated databases to analyze sodium in packaged and restaurant foods. Private foundation and federal grant funding supported a critical evaluation of sodium intake across New York City that helped establish a baseline for the project, while seed funding secured by FPHNYC from individual donors provided the Health Department with the resources to refine the database and perform critical analyses that led to the initiative’s success.

“NSRI established a bold national precedent of local and regional public health collaboration to support industry reformulation our country’s food supply. Our data driven approach required investment in the creation of new databases and the addition of technical staff, only made possible by the generosity of foundations.” says Dr. Sonia Angell, Deputy Commissioner of Prevention and Primary Care. “Our demonstrated NSRI success is the foundation for our burgeoning initiative to address excess sugar in foods. The NSRI is a great example of how donor investments in local initiatives can have national import and provide a basis for future innovation.”

The success of the NSRI to decrease the presence of sodium in packaged foods demonstrated that this model is feasible and effective. In 2016, the FDA proposed voluntary sodium reduction goals, including both short and long term targets, which were partially informed by the NSRI targets. As we look to the future, we’re excited to see where this vision for salt and sugar reduction will lead, and how it will empower us all to make better decisions for our health.

For more information, please visit www.nyc.gov/health/nssri or email sugar@health.nyc.gov.

Farms at NYCHA – Bringing a Pilot Project Citywide

In the middle of a New York City Housing Authority (NYCHA) complex, where there was once an empty lot, there is now a farm teeming with purple eggplants, rainbow chard, and okra. At six sites in four boroughs, Farms at NYCHA combines youth workforce development, healthy food access, community engagement, and sustainable open space activation. FPHNYC played a critical role in this multi-faceted project.

Farms at NYCHA is a Building Healthy Communities initiative, aligned with FPHNYC’s mission to support the health and wellbeing of all New Yorkers. Neighborhoods for farm development were chosen based on a historic lack of investment in open spaces, and limited access to healthy, affordable food. Most of the neighborhoods also have a disproportionally high burden of chronic disease and poor health, including high rates of obesity, diabetes, and asthma. In 2017, over 230 residents participated in over 70 community events, 19,800 lbs. of free organic produce were distributed, and over 340 students were engaged in farm-based learning programs.

In support of program partners Green City Force (GCF) and NYCHA, FPHNYC collaborated with the Mayor’s Office of Strategic Partnerships to bring in private investment and served as fiscal manager, advisor, and partner convener. This initiative, launched in 2013 expanded with funding from the Laurie M. Tisch Illumination Fund, now has support from a diverse variety of funders including the Merck Family Fund, New York Community Trust, Scherman Foundation, The Staten Island Foundation, Brooklyn Community Foundation, Unilever, Target, and the City Council.

“We value the leadership and support that the Fund for Public Health in New York City contributed to the Farms at NYCHA partnership since its launch in 2016. Thanks to their stewardship the farms have grown into sustainable community spaces, sources for fresh local produce, volunteer sites, and training grounds for NYCHA resident AmeriCorps Members that will be maintained for seasons to come,” said Lisbeth Shepherd, Founder and Executive Director of Green City Force.

FPHNYC is proud to have helped grow this project from a one-site pilot to an award-winning program with sites in Manhattan, Brooklyn, the Bronx, and Staten Island. After 3.5 years, as the program transitions from start-up to full-scale implementation and sustainability, FPHNYC is pleased to pass the fundraising and fiscal management responsibilities to Green City Force and the Mayor’s Fund to Advance New York City. Farms at NYCHA will continue to advance with GCF as the backbone citywide partner, NYCHA as the lead agency partner and with critical leadership and support from the Mayor’s Office of Criminal Justice.

The Farms at NYCHA program is an example of the FPHNYC model in action; since 2002, we’ve raised close to $400 million to support hundreds of programs to improve health in NYC. We’ve mobilized funding, accelerated implementation, and created and nurtured public-private partnerships to improve the health of individuals, families, and communities across NYC. Many of our programs were initiated as pilots. Learn more about how we impact public health here.

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.