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Health
Internet resources for what you need to know about NYC Health
Five Favorite Sites For Beginners

The Topic
"Health" refers to the health issues facing the city, touching on everything from the mayor to Medicaid to managed care to mosquitoes.
The Context
New York City is one of the biggest public health challenges in the world. With 7 million residents--over 1 million of whom are uninsured--the city has the largest number of HIV cases and the largest number of intravenous drug users in the U.S. Efforts to contain a tuberculosis outbreak that threatened the city in the 1990's have been a major success--between 1992 and 1998, the deadly multi-drug resistant cases of TB declined by over 90 percent.

New York City has 20 public hospitals which served 1.5 million people in 1998 alone. Run by New York City's public Health and Hospitals Corporation, the hospital system now has a surplus of $21 million, following years of deficits and cutbacks.

The Reporter
Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.

by Maia Szalavitz

AIDS; Ambulances; and Summer Sunblock (to avoid aging and skin cancer)

(July '01) World AIDS

In June, the first-ever United Nations special session on a health crisis gave overdue attention to the devastating pandemic of AIDS. While U.N. officials argued over policies and displayed a giant red AIDS ribbon on the side of their headquarters, demonstrators marched, shouting "greed costs lives, pills cost pennies." Worldwide, 22 million people have died of AIDS, 13 million children are orphaned and 36 million are living with HIV, according to U.N. Secretary General Kofi Annan. Every day, it is estimated that 15,000 people become infected.

The Organization of Islamic countries forced the Declaration of Commitment, a consensus statement on dealing with the disease, to drop all references to measures to reduce risk amongst prostitutes, homosexuals and intravenous drug users, but nonetheless the document included numerous specific targets and timetables. One main goal was to reduce HIV infection rates by 25 percent amongst young people by 2005. Others include freeing the world blood supply of HIV and reaching 90 percent of teens with prevention programs by 2005 and having an infrastructure in place to provide treatment with anti-HIV drugs within two years.

One jarring absence was the lack of participation by South African President Thabo Mbeki, whose country has the dubious distinction of having the highest rate of HIV infection in the world. Most other African countries were represented by their presidents or prime ministers. Mbeki has said that he is not sure whether HIV causes AIDS, and his representative reiterated his stance. South Africa's refusal to provide drugs to infected mothers to prevent transmission to their children has provoked worldwide outrage. Mbeki's avoidance of the session was even more glaring since he was visiting President Bush in the U.S. at the time.

Debates over the world AIDS fund, how it will be administered and what it will pay for-- how much treatment and prevention, how much infrastructure-- continue.

Following a speech by Secretary of State Colin Powell, Congress introduced measures to increase the American contribution from $200 million to over $1 billion. The American contribution had been only double that of one citizen (Bill Gates) -- and the much smaller UK had pledged as much.

Perhaps most hopefully, the Statement of Commitment included strong language on improving the rights of women, calling on all countries to, by 2005, "promote the advancement of women and women's full enjoyment of all human rights; promote shared responsibility of men and women to ensure safe sex; empower women to have control and decide freely and responsibly on matters related to their sexuality to increase their ability to protect themselves from HIV infection."

City Ambulances

If a private ambulance responds to your emergency call, you are ten times more likely to end up at the hospital that sponsors the ambulance than you would be had a city ambulance answered, even if a city hospital is closer, according to a report issued recently by City Comptroller Alan Hevesi. And if you have health insurance, your odds of going to the sponsoring hospital are even greater, the report concluded.

The study looked at 300,000 ambulance transports in 1999-- but it was criticized by Mayor Giuliani as politically biased because it didn't ask whether patients had directed the ambulances to go to a private hospital, or whether the ambulance team had made the choice.

The issue affects both patient care and hospital finances, because if only poor patients use city hospitals, their budgets suffer. And in an emergency where seconds count, going to a more distant hospital could cost lives.

The Greater New York Hospital Association, which represents both city and private not-for-profit hospitals (it includes most major New York hospitals) released a statement expressing concern about the findings. It said, "According to 911 protocols, when patients are transported by 911 ambulances, there are many contributing factors that determine patient destination, including patient choice, patient condition and the need for specialty care." The organization said that it would review the report, in conjunction with the Fire Department (which runs the ambulance system) and other appropriate agencies, to determine whether change is needed.

Summer Sun

As the ozone gets thinner, New Yorkers are finding that it doesn't take a trip to the beach to get a suntan-- but the same seemingly innocuous daily sun exposure from walking to and from work or running errands also causes wrinkles and can increase your risk of skin cancer. Some 1.3 million cases of skin cancer are diagnosed each year, though only 51,400 of these will be the most dangerous type, malignant melanoma.

Dr. Marsha Gordon, Assistant Clinical Professor and Vice-Chairman of the Department of Dermatology at Mount Sinai Medical Center, said, "People are under the mistaken impression that if they are not sunbathing or participating in outdoor sports, they aren't at risk, but incidental sun exposure is significant and remarkably little is needed to start the process that causes aging and can lead to skin cancer."

Gordon recommends wearing sunscreen on your face every day-- no matter what season or what the weather is like-- and wearing it on other exposed body parts when you will be outside for significant periods of time. Most people skimp on sunscreen, and this can cut its SPF in half. The average person should use one ounce of sunscreen-- enough to fill a shot glass-- to cover his or her body completely.

The type of sunscreen you choose is important. "It should have a high SPF and block both UVB [this prevents sunburn] and UVA [which is now also known to penetrate the skin and increase risk of cancer and wrinkles]. There are a number of different ingredients which do this, but my favorites are titanium dioxide, micronized zinc and Parsol 1789." says Gordon.

A new sunscreen, Mexoryl, currently used in Europe, is believed to be the best protection against certain UVA rays, but the FDA has not yet approved it here.

Gordon also suggests wearing a broad-rimmed hat for the beach or outdoor sports and when possible, scheduling outdoor activities early in the morning or late in the afternoon to avoid the peak hours for sun exposure.

Dermatologists recommend examining yourself monthly for any evidence of potential skin cancer -- and having a yearly check-up by a doctor. If a mole is enlarging, asymmetrical, has a notched or irregular border or has mottled color, see your doctor immediately as these are signs of melanoma which is curable only if caught early.

Gordon notes, "There's a misconception that if a mole is flat, it's OK. But almost all the early melanomas we catch are flat."


Maia's Favorite Five Sites For Beginners:

  • New York City Department of Health - Includes health alerts (including West Nile info), information on restaurant sanitary conditions and information on various health-promotion programs.
  • New York State Department of Health - More health data for New Yorkers including information on how to sign up for Child Health Plus and Family Health Plus-- the insurance programs for those who are presently not covered by other plans.
  • Medscape - This site, aimed at doctors, allows you to search Medline, the database of medical journals, for free. Abstracts of most journal articles are available for free as well. Once you have some basic knowledge about a condition you are researching, you can look here to get a sense of what is going on in terms of study in the area. There is a companion consumer-focused site, CBSHealthWatch, which is linked.
  • American Cancer Society - Half of all Americans will face cancer at some point in their lives-- and the New York and Washington-based American Cancer Society web site provides a wealth of information for those dealing with the disease. Includes links to other major cancer sites and resources.
  • AIDS Information - A sort of "AIDS central" for New York city with links to major HIV/AIDS organizations and information sites.


Other Recommendations:

  • Quackwatch - Debunks medical scams and inflated claims made by "alternative" medical practitioners.
  • AccentHealth.com - A consumer health information site, affiliated with CNN.
  • Citizen Action - Healthcare is one of the primary focuses of this New York advocacy group. Includes information on New York's health plans for low income people lacking insurance.
  • Oncolink - An incredible research resource for cancer patients and others concerned about this disease.
  • National Alliance for the Mentally Ill - An organization of advocates for people with mental illness which includes information on treatment and support for various disorders like depression, bipolar disease and schizophrenia.
  • Insure Kids Now - Information on New York state's insurance program for poor kids and information on other state's policies, from the federal government and the governors' association.

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Gotham Gazette is published by Citizens Union Foundation and is made possible by support from the Robert Sterling Clark Foundation, the John S. and James L. Knight Foundation, the Altman Foundation,the Fund for the City of New York and donors to Citizens Union Foundation. Please consider supporting Citizens Union Foundation's public education programs. Critical early support to Gotham Gazette was provided by the Charles H. Revson Foundation, Rockefeller Brothers Fund and the Alfred P. Sloan Foundation.

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