The New York City health department has announced the most detailed
and comprehensive health policy ever developed for the city. Called "Take
Care New York," the ambitious, four-year plan sets goals and
activities in 10 health areas the department believes will have the most
impact on improving the health of New Yorkers. The 10 areas were chosen
because they address the leading causes of illness and death in the city
considered preventable (such as heart disease, smoking, excessive drinking,
and cancer) - what city health commissioner Dr. Thomas R. Frieden called
"our most important and winnable health battles."
The city claims that successful implementation of the new policy will save
thousands of New Yorkers' lives and prevent hundreds of thousands of
illnesses each year.
The program makes 10 top recommendations to New Yorkers to improve their
1. Have a regular doctor or other health care provider
2. Be tobacco-free
3. Keep your heart healthy
4. Know your HIV status
5. Get help for depression
6. Live free of dependence on alcohol and drugs
7. Get checked for cancer
8. Get the immunizations you need
9. Make your home safe and healthy
10. Have a healthy baby
Some of the targets for 2008 the city says it plans to hit include:
â€˘ Reducing the number of adult smokers by 240,000, preventing 80,000
â€˘ Decreasing the number of HIV/AIDS-related deaths by 42 percent, preventing more
than 700 deaths every year;
â€˘ Increasing by 200,000 the number of New Yorkers 50 and older who are
screened for colon cancer, preventing at least 200 colon cancer deaths per
â€˘ increasing the percentage of women 40 and older who receive regular
mammograms from 77 percent to 85 percent;
â€˘ A two-thirds decrease in the number of children under six with potentially
dangerous blood-lead levels caused by environmental lead hazards; and
â€˘ Increasing by 150,000 the number of New Yorkers 65 and older who get an
annual flu shot, resulting in 1,000 fewer deaths during flu season each
There will obviously be price tags for many of the plans mentioned, such as
the city's printing and distributing many more informational brochures and
expanding or creating programs such as testing for AIDS, giving away
condoms, creating an Internet registry of children's immunization histories,
and providing smokers with free nicotine patches to help them quit. The city
has not yet given out an estimate of the total cost of the program or
details on how it will be funded.
This huge public health undertaking is the most ambitious that New
York, even with its long history of pioneering public health programs, has
ever attempted, and a broader and more aggressive program than any other
city's in America.
One can view a booklet
laying out the basics of the recommendations in at the city
health department's web site; or download
as a PDF file. Those interested in the health department's formal,
64-page policy paper, which sets forth the goals, recommendations,
benchmarks, rationales for focusing on the areas it does, current leading
causes of preventable deaths and illnesses among New Yorkers, and funding
and progress-evaluation issues, can alsodownload it as a
PDF file from the department's web site.)
Increases in Syphilis and Tuberculosis
Both syphilis and tuberculosis, infectious diseases against
which the city had made great headway in past decades, are on the rise.
Although curable with antibiotics, both diseases are quite dangerous if left
untreated; and both are contagious, although infection is preventable.
New York seemed to be achieving a clear victory over the
sexually-transmitted disease syphilis in the late 1980's and the 1990's,
with cases dropping from a high of 5,000 cases in 1988 to just 82 in 1998. A
bacterial rather than a viral infection, syphilis can, after all, be cured
with a single shot of penicillin if caught in its early stages. However, an
alarming resurgence of the disease has taken place in New York in the past
few years. Shockingly, there was a nearly threefold increase in cases just
between 2000 and 2002. The figures for 2003 show the increase has continued,
although at a slightly slower pace: a 22 percent increase between 2002 and 2003.
New York City's total rate of the disease in 2002 was 5.4 cases per 100,000
persons, or more than twice the national rate.
This disparity may well be because the new epidemic is primarily affecting
gay and bisexual men (and white men living in Manhattan). More than 95 percent of
reported cases in recent years have been among men; in a 2002 study, 80 percent of
them reported male sex partners.
What is most alarming is that having syphilis increases the chances that one
will get HIV -- by up to five-fold, according to Dr. Susan Blank, the city's
Assistant Commissioner for Sexually
Transmitted Disease Control. Meanwhile, syphilis also makes a person
with HIV much more infectious to their sexual partner(s), presumably because
in its early stages syphilis often causes painless open sores, mainly on or
in the genitalia or anus, but also known to occur on the lips, inside the
mouth, as a rash on the hands, or indeed on any skin exposed during sex.
Their painlessness may cause them to go unnoticed by the infected person.
Having HIV also makes it more likely that one will get syphilis. According
to Blank, when the city conducted interviews of syphilis patients at city
STD (sexually transmitted disease) clinics, the men with syphilis who also knew their HIV status reported a
more than 50 percent rate of HIV. Indeed, a 2002 study conducted by the health
department along with the U.S. Centers for
Disease Control and another research group found that having HIV was the
number one risk factor for getting syphilis.
To try to break this deadly, spiraling dance between the two diseases, the
city has extended the hours of its 10 free,
confidential STD clinics, which are located in all five boroughs. (Click
on the link for clinic locations, hours, and other information). Even aside
from the grim HIV-syphilis synergy, it is crucial that those who have
syphilis learn that they are infected, because the disease is easy to treat
in early stages with antibiotics, but if left untreated can gradually play
havoc with various organ systems, including the brain, cause serious health
damage, and end in death. Many times syphilis presents few symptoms, at
least initially, so a blood test is a good idea.
The city and gay men's health groups are continuing educational outreach
efforts to the male gay and bisexual population. The health department is
also developing programs to further educate health-care providers about the
Syphilis can be spread by vaginal, anal, or oral sex, or by kissing if there
are sores in the mouth.
Meanwhile, the city also released preliminary data in March that cases of tuberculosis
in New York had increased five percent from 2002 to 2003. While not large, it is the
first increase in a decade mostly marked by reliable decreases in the TB
rates. (New York City's TB rate remains three times higher than the national
According to city health commissioner Dr. Thomas R. Frieden, the increase
part of the current global TB epidemic. Sixty-seven percent of diagnosed
cases were among foreign-born New Yorkers, whom city officials say might
well have been infected in other countries. Another 8 percent were among homeless
Frieden urged New Yorkers to get screenings and treatment at city hospitals
and clinics. The city provides free, confidential treatment for TB at its 11 "chest centers"
around the five boroughs.
Left untreated, TB can ravage a patient's lungs and other organs.
On a more optimistic note, the cases of tuberculosis resistant to treatment
with multiple drugs continued a decade of decrease. There were 21 in 2003
compared to 27 in 2002, contributing to a total decrease of more than 95 percent
since 1992. These multi-drug-resistant cases of TB can take three to four
times as long to treat as conventional TB. The rest of the world apparently
has not been so lucky; a recent New York Times
article cited a World Health Organization survey estimating there may be
as many as 300,000 new cases of drug-resistant tuberculosis a year in the
world, particularly in underdeveloped countries. The Times article noted
that drug-resistant cases are more common in moderately poor countries where
patients receive inadequate treatment (a course of treatment for TB in the
U.S. is lengthy, with patients required to take various pills for six months
or more, often under direct supervision to make sure they don't stop too
soon or skip days, which might allow the growth of drug-resistant bacteria).
One can acquire tuberculosis by breathing in bacteria in air that is contaminated by
someone with active, untreated tuberculosis in the lungs. Luckily, it is rather hard
to catch, requiring "prolonged, direct contact" with an infected person,
according to the health department. It cannot be spread by sharing utensils,
or casual contact.
Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF
The comments section is provided as a free service to our readers. Gotham Gazette's editors reserve the right to delete any comments. Some reasons why comments might get deleted: inappropriate or offensive content, off-topic remarks or spam.