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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

DARE Doesn't Work

(March '01) When New York City brought the Drug Abuse Resistance Education program, or DARE, into the public schools in 1997, there had already been at least a half dozen studies showing that it did not cut teen drug use and one study had even found that kids who had gone through the DARE program used slightly more drugs than those who had not. [See Gotham Gazette article from last July]

But because DARE is run by police officers and therefore funded through the police department-- and not with scarce education monies-- Mayor Giuliani was able to place the program in the schools without a vote by the Board of Education and with virtually no public discussion.

Now, after years of denials, DARE has admitted what the research has repeatedly shown: the program doesn't work. They will now give it a complete overhaul. New York will be one of six test cities in which a new curriculum will be compared to the version already in place to see if better results can be achieved.

The program is currently presented by police officers in 17 lessons -- which aim to improve self-esteem and teach disapproval of drugs and various ways of saying no to them.

However, prevention experts are not optimistic about the chances that the new DARE will be any better than the old. Many believe that the federal government is throwing good money after bad. The one thing that DARE isn't willing to change--the fact that cops deliver the lessons-- may be the root of its problems.

Ironically, before DARE, most New York city school districts used prevention programs with curricula based on what research has found effective. They did have a program in which police officers visited schools-- but the cops only taught when partnered with prevention counselors. Still, only a minority of school districts fought to keep DARE out and retain the programs on which DARE will be basing its overhaul.

In addition, the city's public schools have long had, on top of a prevention curriculum like DARE, a full time, certified substance abuse prevention counselor in each school. Lynn Argo chairs the organization which represents the directors of each district's program and herself works as a director in School District 19 in East New York, Brooklyn.

"I did not accept DARE in my district," she says. "When you go into a classroom and discuss a sensitive topic that will hit nerves in children who may be living with it at home-- say a parent or a brother or sister is using drugs -- you need to be prepared to do follow-up and they can't. They are police officers, not counselors."

Argo adds, "The whole concept is wrong." She believes that police officers are simply not suited to delivering a prevention message-- particularly to children at risk. If someone they know is using, a police officer is "absolutely" the last person they'd want to talk to, she says.

DARE plans, in addition to making its curriculum more interactive, to move its main lessons from fifth and sixth grades to seventh and ninth. But for these kids, police officers are even less likely to be appropriate messengers -- as anyone who has ever tried to "interact" with a surly seventh grader might suspect.

Rod Skager, Professor Emeritus of Education at UCLA and an expert on drug prevention says, "DARE cannot be fixed for two reasons. First, a genuinely honest learning process appropriate for adolescents would not be acceptable to DARE or its sponsors. For example, it would be necessary to acknowledge that many people believe they have had positive experiences with marijuana in particular and yet did not become addicted or even have any disruption in their lives. If this is not done, kids recognize that they are being indoctrinated rather than educated.

"Second, genuinely interactive learning strategies are essential when working with adolescents on issues involving personal choice. This requires that kids share personal experiences around both drugs and abstinence and also participate in setting the agenda. Police could not do this."

Skager notes that in the age of the Internet, good schools must teach students how to look for biases in information sources and evaluate statistics presented in the context of proper scientific method. As a result, unless DARE is willing to entertain debates about drug policy and related propaganda about drugs and drug users-- topics Argo says she uses to encourage research projects when they come up with her students-- it will be seen as just another perspective from a group with an agenda, rather than a reliable source of information about what can be life or death decisions for teens.

Maia Sounds Off

The most recent nationwide survey on teen drug use found that over one in ten 12th graders has tried MDMA (ecstasy) and 48 percent have smoked marijuana at least once. With such a large percent of teens taking drugs, an approach like DARE is bound to fail-- not least because the stories it tells of instant addiction and drastic health consequences are mainly contrary to the teens' own experiences or to what they see happening to their families or friends.

Further, because DARE presents a view of all drugs as equally dangerous, it does nothing to help teens understand the risks they are actually taking. If you try marijuana and find that the scare stories were exaggerated, what's to stop you believing that what you've heard about heroin is equally overstated?

And worse, the abstinence-only message prevents life-saving informationfrom getting to kids. For example, MDMA can kill when the body gets over-heated and dehydrated-- but drinking too much water while on the drug can also be deadly. Users who keep cool and drink amounts of fluids appropriate to their activity level can reduce these risks. Similarly, most heroin overdoses are actually mixtures of heroin and alcohol or heroin and other "downs" like valium. Teach teens to avoid these extreme high-risk situations, and more will live long enough to overcome any drug problem they develop.

If we do not educate our youth about the real risks and dangers, these avoidable deaths will continue. Lynn Argo points out that if we really want to improve reading and math scores, we need to provide help to children at risk to stay healthy or else drug problems may overwhelm all other concerns. But could we ever dare to deal with the problem so honestly? For the sake of public health, let's hope that an honest evaluation of DARE will lead to better and more effective programs.


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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