Building Healthy Communities: Farms at NYCHA
High levels of poverty, segregation, and public disinvestment create neighborhood inequality. In 2016 the de Blasio administration launched the Building Healthy Communities (BHC) initiative to improve health outcomes in 12 chronically underserved neighborhoods across NYC by increasing access to fresh food, providing opportunities for physical activity, and promoting safe and vibrant public spaces. Farms at NYCHA (New York City Housing Authority) is a component of BHC where young public housing residents build and maintain urban farms, which help expand healthy food access, provide workforce and leadership development, and build stronger communities. Through initiatives to date, more than 32,000 pounds of free, organic produce were grown and distributed to NYCHA residents, more than 3,100 pounds of food scraps were diverted from landfills, more than 90 young people were prepared for jobs and college, and vibrant green communal spaces emerged to improve the quality of life for residents.
Active Design in NYC
The environments where people live, learn, work, and play impact their ability to stay healthy, affecting their diets and physical activity. Active Design Guidelines offer evidence-based strategies to design and adapt buildings, streets, and urban spaces to increase opportunities for physical activity. FPHNYC secured more than $250,000 in grants to support the work of the NYC Health Department, which partnered with government agencies, professional organizations, and other institutions to develop and disseminate these strategies. Since being published in 2010, the guidelines have won multiple awards and more than 2,000 architects, planners, designers, developers, building owners, and community leaders around the country have been trained to use them.
A Bold Plan to Get Students Moving
To tackle limited physical activity among NYC’s students, FPHNYC secured funding from the Centers for Disease Control and Prevention (CDC) and partnered with both the NYC Department of Health and Department of Education, along with the Citizens Committee of NYC, to enhance school spaces and encourage physical activity. Over the course of three years, more than 60 projects used strategies highlighted in the Active Design Toolkit for Schools. Changes such as improved gardens, stairwell murals, and space enhancement led to increased physical activity opportunities for more than 40,000 students across all five boroughs.
Breastfeeding Empowerment Zones
Despite the benefits of breastfeeding many mothers don’t breastfeed, often due to lack of support. The Breastfeeding Empowerment Zone (BFEZ) is a neighborhood initiative based at the Center for Health Equity’s Brownsville Neighborhood Health Action Center. The program trains and empowers community members to support breastfeeding parents and their families, provides workforce development opportunities, and engages community stakeholders in neighborhood health planning. The program has been in place since 2014, and in 2017 the initiative helped establish more than 110 breastfeeding-friendly spaces in Bedford-Stuyvesant and Brownsville, trained male peer educators to support new fathers, and encouraged local businesses to pledge designated nursing spaces.
Preventing Teen Pregnancy Across NYC
Unintended teen pregnancy and early parenthood can have long term consequences for teens and their children. The South Bronx has one of the highest rates of unintended teen pregnancy, poverty, and student dropout. To address this challenge, FPHNYC secured $7.5 million in CDC funding for five years to start an innovative teen pregnancy prevention initiative called the Bronx Teens Connection. Involving multiple city agencies and emphasizing community engagement, the program aimed to improve sexual and reproductive health while reducing unintended teen pregnancy rates. More than 6,100 teens in the South Bronx have received pregnancy prevention education in 21 partnering schools, community clinics provided more than 760 referrals for reproductive healthcare, and the rate of long-acting reversible contraceptive use increased by 41 percent. The program was so effective that the Fund obtained a new five-year federal grant in 2015 to expand the model citywide, with the goal of reaching 15,000 youth annually.
Creating a New Vision to Solve Poor Academic Performance
There is a strong link between poor vision and poor performance in school—an estimated 25 percent of school-age youth in the U.S. need glasses to read the blackboard. FPHNYC was able to secure a two-year grant to pilot and evaluate a vendor-based vision care model to determine whether it could reach more students at a lower cost. The pilot targeted 11,000 students and contracted with an external vendor to provide eye exams and glasses. The program offered valuable insight into how the City could move forward and be most effective with its vision screening programs and was a source of important information in Mayor de Blasio’s 2015 initiative with the eyewear firm Warby Parker. Mayor de Blasio recently announced that all kindergarteners and first graders who need them will get free eyeglasses in the 2019 school year.
Decreasing Salt Consumption to Address Heart Disease
Diets high in salt increase blood pressure, which leads to a greater risk for heart disease and stroke. More than 75 percent of the sodium we eat comes from processed food. In its commitment to cutting excessive sodium intake for New Yorkers, who consume on average 40 percent more sodium than the recommended daily limit, the NYC Health Department leads the National Salt Reduction Initiative, which has been underwritten by extensive private and public financial support secured by FPHNYC and aims to reduce sodium intake by 20 percent. By setting sodium reduction targets for packaged and restaurant foods and by encouraging companies to commit to those targets, the initiative resulted in 28 companies reducing sodium levels in their products. In 2015, NYC became the first city to require chain restaurants with 15 or more locations nationwide to post warning labels next to items with high levels of sodium. In 2016, the FDA released voluntary sodium reduction targets of its own, scaling a model started here.
Reducing Asthma Triggers in Low-Income Homes
The homes of low-income New Yorkers have significantly more allergens and asthma triggers like cockroaches and mice. This contributes to major disparities in asthma hospitalizations and emergency department visits, with the highest rates occurring in high-poverty neighborhoods. FPHNYC raised and managed more than $1.1 million in grants from the Robin Hood Foundation and the New York State Health Foundation to examine the low-cost Integrated Pest Management (IPM) approach, which aimed to reduce asthma triggers in low-income homes with children who had severe asthma. This evaluation is providing valuable information to the NYC Health Department, allowing them to analyze potential costs and savings of implementing IPM, as well as days of school and work missed for children or their caregivers. The study found that the intervention reduced children’s asthma symptoms, though there were no changes in asthma-related health care use. The findings from this initiative confirm that reducing triggers through programs like IPM can serve as an impactful component of comprehensive asthma interventions, though additional interventions would be needed to impact care use and long term cost effectiveness.
Deploying New Technology to Measure Population Health
Measuring the health of the city’s population is critical to identifying health disparities, new threats, and the impact of change. Although the NYC Health and Nutrition Survey (NYC HANES) is the gold standard for measuring the health of New Yorkers, it is costly and time consuming to implement routinely. The Fund raised $1.7 million in grants to explore a faster, more cost effective way to measure the health of the city’s residents and their communities. During the three-year project, the NYC Health Department compared data collected from NYC HANES to the NYC Macroscope, which uses data from Electronic Health Records. The project determined that tracking health trends with the Macroscope method is an accurate, faster, and less expensive way to collect some health data.
Improving Foodborne Outbreak Detection with Social Media
A grant secured by FPHNYC from The Alfred P. Sloan Foundation supported a collaborative project between the NYC Health Department and Columbia University to evaluate the use of social media data to detect foodborne outbreaks not identified through traditional complaint systems such as 3-1-1. Computer scientists at Columbia University have developed and continue to improve a system that follows a machine learning approach to identify Yelp reviews and tweets that indicate a foodborne illness at a dining establishment. The NYC Health Department has integrated the results of this system into its outbreak detection and investigation efforts to decrease the significant health and financial impact of foodborne illness.
Enhancing a Nationally Accredited Program for New NYC Parents
First-time, low-income mothers often need extra support to ensure healthy outcomes for their babies and themselves. The NYC Nurse-Family Partnership provides that support. Specially trained nurses visit a client’s home throughout her pregnancy and until her child is two years old. Provided at no cost, program services have resulted in improvements in education and economic self-sufficiency and lead to improved health outcomes for moms and babies. Grants secured by the Fund have contributed to a number of enhancements to the national, evidence-based program, including resources to support education and training for the mothers and specialized support for higher risk families of women in the foster care system or recently incarcerated. The NYC Nurse-Family Partnership has become one of the first in the country to employ its own mental health providers.
Promoting High Quality Primary Care for Patients across NYC
Many New Yorkers experience significant challenges to receiving coordinated health care that addresses their specific needs. The NYC Health Department’s award-winning Primary Care Information Project (PCIP) promotes the use of health information technology that helps providers improve the delivery of primary care, especially to underserved residents. FPHNYC secured several grants to create the NYC Regional Electronic Adoption Center for Health (NYC REACH) to supply technical assistance services to more than 18,000 health care providers. NYC REACH served as the foundation for PCIP’s current efforts to facilitate practice change and increase the delivery of preventive care as part of federal and state payment reforms.
Testing a New Care Model for Patients with Hepatitis C
The Centers for Medicare and Medicaid Services awarded a grant to enable the NYC Health Department to implement Project INSPIRE, an innovative program designed to improve health outcomes, increase cure rates, and reduce hospitalizations for high needs patients with Hepatitis C. The comprehensive care coordination effort united a number of health care approaches and professionals to provide integrated and interdisciplinary care to address medical and psychosocial factors relevant to each patient. These included medical and behavioral assessments, specialist referrals, telemedicine consults, provider training, coordination among care team members, patient navigation through the care process, and coaching on self-sufficiency skills.
Innovative Alternatives to Hospitalization for Psychiatric Distress
Emergency care and hospitalization for severe psychiatric distress is costly. Parachute NYC provides alternative care and treatment through home-based and respite center services and confidential peer support. By the end of the project’s three-year funding period, it had become the first large-scale implementation of mobile teams and respite centers in the world for people experiencing emotional crises. It offers community-based options that focus on overall wellness, recovery, and hope. During the three years’ funding, Parachute NYC launched four Need Adapted Mobile Crisis Teams and four Crisis Respite Centers each in Manhattan, Queens, Brooklyn, and the Bronx. The project also established a citywide, 24-hour peer support line. Watch the Parachute NYC video to learn more.
Launching the NYC Population Health Improvement Program
In 2015, FPHNYC joined in partnership with the New York City Department of Health and Mental Hygiene, the United Hospital Fund, and The New York Academy of Medicine to launch the New York City Population Health Improvement Program (PHIP). The PHIP encompasses a collection of workgroups promoting health equity, better care, lower costs, and improved health outcomes for New Yorkers by engaging community leaders to transform the health system. Goals of the project include supporting community-driven health initiatives through Neighborhood Health Workgroups, strengthening connections between health care providers and community organizations, establishing screening and referral partnerships to address socioeconomic needs of patients, and raising awareness of the many drivers of health equity.