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World Trade Center Health Registry

The city's health department has announced plans for what could become the largest public-health investigation ever: a comprehensive survey to follow the health of those people most directly exposed to 9/11's World Trade Center collapse and the subsequent clean-up efforts. 

The launching of the World Trade Center Health Registry was announced at a September 5 press conference by the city's Health and Mental Hygiene Commissioner, Thomas R. Frieden, MD, and Dr. Henry Falk, Associate Administrator for the Agency for Toxic Substances and Disease Registry and the director of the federal Centers for Disease Control's National Center for Environmental Health.

"The effects of 9/11 are still being felt today by all New Yorkers, and all Americans. Hundreds of thousands of people from all walks of life were in the vicinity of the twin towers when they collapsed, and were exposed to a combination of smoke, dust, and debris.  We need to study the health of these people in order to understand the possible health consequences related to 9/11," said Dr. Frieden. "If you were there on 9/11, you are strongly encouraged to sign up for the WTC Health Registry."

Dr. Falk said, "The World Trade Center Health Registry will do what no other health survey is doing. It will record and measure the health impact of 9/11 in the broadest possible terms.  The Registry is a tool for giving us health data that could guide how we respond to this kind of disaster for generations to come.  The more people enroll - even if they feel perfectly healthy - the better our chances will be of understanding any health effects from this tragic event."

People in any one or more of the following categories are eligible to enroll in the registry, regardless of whether they have experienced any health problems:  

· People who were in a building, on the street, or on the subway south of Chambers Street on 9/11/01;
· Workers involved in the rescue attempts, recovery, or clean-up work at the World Trade Center site, and/or the associated recovery operations on Staten Island, at any time between 9/11/01 and 6/30/02;
· Students and staff at schools (pre-K to 12) or daycare centers south of Canal Street on 9/11/01; and
· People living south of Canal Street on 9/11/01.

If enough people enroll, city and federal health officials said, the registry could result in an investigation as much as five times the size of the one following the 1979 Three-Mile Island nuclear accident in Pennsylvania. That study tracked 38,000 people. Falk noted that the report based on the Three-Mile Island registry, which was issued last year and stated that people who lived near the nuclear plant showed no significant increase in cancer deaths, probably served to calm a population nervous about the unknown long-term health effects of the accident.

"I plan to enroll in the World Trade Center Health Registry, and I encourage all Battery Park City residents and workers who were here on 9/11 to step forward and enroll too," said Timothy S. Carey, CEO and president of the Battery Park City Authority, who was also present at the press conference.

To advertise the registry, which is being funded with $20 million in federal funds, the city health department says it will put posters in subways and commuter trains that read, "I was there September 11th." It will also use billboards, direct-mail solicitations, Internet ads, and brochures to urge people to step forward and enroll.

Officials stressed that all medical information collected from individuals will be kept strictly private and confidential, and that no medical examinations or tests will be required for participation.  People can drop out of the registry at any time.

Those who enroll in the registry will be asked to answer a 30-minute telephone survey of where they were on 9/11, how long they were in areas afflicted by smoke and fumes, and whether they have had any health problems since.  Registrants will be periodically contacted to report any health changes.  This information will then be compared with that of the general population, in order to identify any health problems possibly linked to 9/11.  Ultimately, findings drawn from the health registry should be able to allow researchers to observe patterns that may be invisible to individual physicians.

The announcement of the survey follows closely on recent revelations that the Environmental Protection Agency gave New Yorkers false assurances about air quality in the days after the terrorist attack.  But city health officials say that the registry was not launched in response to the recent accusations. Plans for the registry were first announced last year. The health registry's goal is to follow up with hundreds of thousands of people who were directly exposed to the aftermath of the twin towers' collapse, which produced choking clouds of dust, asbestos, smoke, and fire. It will re-contact registrants periodically over the next 20 years to track any changes in their physical or mental health. People exposed to the WTC aftermath have already reported symptoms of asthma, persistent cough, burning eyes, and other ailments presumably caused by the airborne contaminants that so thickly pervaded the downtown area in the days following 9/11/2001.

Officials said the registry will issue quarterly reports to inform the public about what it learns from the project. The reports will be posted online  www.wtcregistry.org. The first report is expected this fall.

The registry is a jointly funded effort of the New York City Department of Health and Mental Hygiene, the Agency for Toxic Substances and Disease Registry, and the Federal Emergency Management Agency (FEMA).  RTI International, a nonprofit research firm, will conduct the interviews. 

To find out more about the WTC Health Registry and the enrollment process, you can visit www.wtcregistry.org or call 311 or toll-free to 1-866-NYC-WTCR (1-866-692-9827).

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.



According to an alarming study released last month by the city's health department and Department of Education, almost half (43 percent) of the children in New York City's public elementary schools are overweight to some extent, and a quarter qualify as obese. Hispanic children had nearly double the obesity rates of white and Asian children (31 percent versus 16 and 14 percent, respectively). African-American children fell in the middle, with a 23 percent obesity rate.

The city's 24 percent obesity rate among children in kindergarten through fifth grade is significantly higher than the national rate, which in 2000 was 15 percent. City health officials say that some, though not all, of that difference can be attributed to New York's high proportion of Hispanic and African-American children. (The study also did not include children in the city's private schools, about one-quarter of local schoolchildren. Since obesity correlates with low income, including these relatively privileged children would almost certainly have lowered the proportion of the total found to be overweight.)

In many ways, the statistics on excess weight among New York's schoolchildren mirror those of their elders. A 2002 health department survey of nearly 10,000 adult New Yorkers found that 53 percent are overweight, with 18 percent qualifying as obese. Poorer and heavily minority communities have higher rates of obesity - in neighborhoods like Central and East Harlem, the South Bronx, East New York, Flatbush, Canarsie-Flatlands, Bedford Stuyvesant, Crown Heights, Williamsburg, and Bushwick, as many as one in four adults are obese. Poor diet and lack of exercise are contributing factors. In some of these neighborhoods, almost 15 percent of the population has diabetes, a weight-related disease that can have severe complications and shorten lives. (see previous health topic page update on this subject.) In the case of Hispanic adults and children, who suffer from significantly higher rates of overweight and obesity than whites, researchers think a combination of physiological vulnerabilities, diet, cultural factors, and possibly lack of exercise may be responsible. (In a study published in the Archives of Internal Medicine, 65 percent of Mexican American men and 74 percent of Mexican American women reported that they participated in little or no leisure-time physical activity.)

Still, New York's adults are doing no worse than the average American. It's no secret that Americans have been growing steadily fatter over the past decades; and today nearly two-thirds of all American adults are overweight, with nearly one-third ranking as obese. (Both New York City surveys and the national one all use the Body Mass Index, or BMI, method of categorizing people as "healthy weight," "overweight," or "obese.")

It is disturbing, though, to find significant weight problems starting so very young, among so many of the smallest New Yorkers. The health and education departments' report on children showed that obesity was already common among kindergarteners, with 21 percent qualifying; by the first grade, obesity levels had already topped out at one in four.

Obesity in childhood is associated with serious long-term health consequences, including diabetes, heart disease, asthma, depression, high blood pressure, and some cancers. Obese children frequently grow into obese adults, and a RAND study done last year found that obesity raises a person's healthcare costs by 36 percent and medication costs by 77 percent - much more than do, say, smoking and problem drinking.

"I am deeply concerned about the troubling childhood obesity figures found in the survey," said Schools Chancellor Joel I. Klein.

In June, the Department of Education announced plans to remove soda, candy, snack cakes, and other junk food from the thousands of vending machines in New York City schools and replace the sugar- and fat-laden offerings with snacks that meet nutritional standards the department specifies. One hundred percent fruit juice will replace sugary fruit drinks, and Twinkies will give way to energy bars. Schools will also have to use a Department of Education central contract to supply and fill their vending machines according to department nutritional standards; rather than individual schools and districts contracting with a hodgepodge of different vending machine companies, as is currently the case.

More ambitiously, the education department plans sweeping changes, aimed at making them more nutritious and less fattening, in the more than 800,000 breakfasts and lunches that city public schools serve each day. Working with the Department of Health and Mental Hygiene, the Department of Education came up with a set of nutritional standards for school meals that will take three to five years to fully implement.

Children returning to school in September will find that cafeterias have already retooled some of their most popular items, such as Jamaican beef patties, chicken fingers, and cheese pizza, to cut back on fat, sugar, and salt. Rich foods will be served in smaller portions. Some items that resist "lightening" may disappear from school menus altogether, among them lunch classics like macaroni and cheese and various mayonnaise-based dishes such as potato salad. Federal guidelines recommend that the percentage of calories in school lunches coming from fat should not exceed 30 percent, averaged over a five-day period. The city Department of Education says it plans to meet that 30 percent goal each and every day.

Some onlookers, however, feel that the city's emphasis on cutting fat from school meals and replacing vending-machine sodas with juice won't help kids lose weight. Alice Lichtenstein, a professor at the Friedman School of Nutrition Science and Policy at Tufts University, said that the key to losing weight is cutting back on total calories, not cutting out fat per se; and she noted that 100 percent apple juice has as many calories, ounce for ounce, as a Coca-Cola. "Kids are eating too many calories and not getting enough exercise to burn them off," she said. "You have to focus on reducing calories, not fat or the tiny nutritional difference between sweetened and unsweetened apple juice."

Lichtenstein does approve of some of the city's other planned menu changes, including smaller portions for snack foods, more fresh vegetables ("They're calorically less dense than most other foods"), and substitution of more whole-wheat bread for white ("Whole grains increase your sense of fullness, so you eat less").

The Department of Education also plans to serve fresh fruit five days per week rather than the current three days per week, serve more fish and plant-based products, cut the number of mayonnaise-based salads offered daily from three to one and replace the jettisoned ones with fresh vegetables, and serve fewer highly processed foods.

Recent research on Americans' eating habits, obesity rates, and "environmental" food factors like portion size and ready availability suggests that these measures should, in fact, be helpful to some extent. For example, studies have shown that people, including children, do eat more, sometimes much more, when served larger portions, and don't tend to eat less at later meals to compensate. And the visibility and ease of access of tempting (i.e., fat-laden and sugary) snack foods in people's everyday environments have much to do with whether people eat these foods or not.

And then there's the exercise factor. Although the state Education Department requires children in kindergarten through third grade to have gym every day, in grades 4-6 at least three times a week, and in grades 7-12 at least twice a week, breaches of this rule are common and seldom investigated, according to a report in the New York Daily News. Some New York City public schools don't hold physical education classes at all, the Daily News reported, because they don't have room - gyms may have been turned into classrooms long ago due to overcrowding, and outdoor play areas may be nonexistent or unusable because of repairs or the danger of falling debris from crumbling school buildings. Some schools have no physical education instructors on staff.

Schools Chancellor Klein said the city is taking steps to try to make sure public schoolchildren get a chance to exercise. "We have selected a central Director of Physical Education to coordinate the efforts of the city's twelve hundred schools to promote fitness among our children and teach youngsters the vital significance of physical exercise," he said.

Addressing parents, the health department recommends that they try the following to help keep their children at a healthy weight:

Increase their activity by:
• Reducing television-viewing hours;
• Walking with the children when possible;
• Encouraging active play-time; and

Cut calories by:
• Reducing soft-drink consumption;
• Eating less fast food and serving more meals at home;
• Having healthy snack foods such as fruits and vegetables available; and
• Replacing whole milk with low-fat or skim milk for children over two years old.

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.

Court Overturns Current Lead-Paint Law

In the wake of the state Court of Appeals' unanimous decision on July 1 to strike down the city's lead-paint law, there is much celebrating by advocates for the health of New York City's children (especially its children of color and disadvantaged background) and tenant and environmental groups.

"It's a victory for the children of this city," said City Councilmember Bill Perkins, who introduced a new, more stringent lead-paint bill to the Council more than a year ago, only to have it languish without a hearing until only nine days before the Court of Appeal's decision. "The law was a law that was ineffective. The court's ruling is also good because it means we have overcome the hurdles to focus on our bill, which will effectively address the city's lead-poisoning issues."

It has long been known that lead is toxic and can cause retardation and a variety of other lifelong impairments, especially in young children. In its 1991 report "Preventing Lead Poisoning In Young Children," for example, the U.S. Centers for Disease Control and Prevention noted that even very low levels of blood lead in children have been linked to diminished intelligence, decreased stature or growth, and loss of hearing. (Children are especially vulnerable because of their small size, the fact that they are still developing mentally and physically, and their tendency to use their hands and mouths on available surfaces and to eat things adults would avoid.)

As Gotham Gazette wrote in an Issue of the Week, when a divided City Council passed the 1999 lead-paint law, known as Local Law 38, it replaced a 1982 lead-paint law that required that all lead paint be removed from the city's older buildings. Landlords complained that that 1982 law had been onerous and unrealistic.

The Court of Appeals has now ruled that when the City Council passed Local Law 38, it violated state environmental law by failing to adequately study or explain the new law's environmental or public-health impact.

With Local Law 38 struck down, the city reverts to the 1982 law. The Court of Appeals, however, found that that law, while much more comprehensive than its replacement, also "is not a viable or realistic approach to protecting the city's population, particularly its young children, from lead exposure." The court therefore urged the various interest groups – landlord groups, tenant advocates, the current mayoral administration – to negotiate in good faith, and urged the City Council to develop a new lead-paint law without delay. Perkins agrees. " Every day of delay is a day when children are being poisoned," he said.

He acknowledges, however, that a fight still lies ahead to get his stricter bill passed, and in a form that retains teeth. "To me, this is a marathon -- the last three miles are the toughest," he said. "The landlords can be relentless in avoiding their responsibility. Our biggest problem will be that there may be others who may try to recast this bill to turn it back into Local Law 38 in another guise.

" We realize we have to fight even harder now. This victory is not a reason to relax and stop fighting."

The Bloomberg administration has opposed the bill Perkins is championing, known as Local Law 101A. Michael A. Cardozo, Corporation Counsel for the city, issued a statement about the court's ruling that said, in part, "We are disappointed by [the] court's decision. The city felt that Local Law 38 provided a comprehensive, safe, workable approach to the control of lead-based paint hazards.... In our view, the court's decision gave inadequate weight to the council's extensive consideration of potential environmental impacts."

" That said, the City Council must now act promptly to rectify the situation," he wrote.

Opponents of the change in the law point to the fact that for years there has been a sharp and steady decline in the number of the city's children identified as having elevated lead levels.

The city's Department of Health and Mental Hygiene, which tracks new cases of elevated lead levels in children, had in fact issued a press release on June 11 that headlined a 79 percent reduction in new cases from 1995 to 2002, when there were 3,985 new cases reported.

"Four thousand new cases last year is nothing to brag about," Perkins countered.

Interestingly, the department press release was subtitled, "Parents with Small Children Should Insist that Landlords Fix Peeling Paint, It's the Law" – highlighting the fact that Local Law 38 put the onus squarely on parents to know their rights under the law, know about and recognize lead-paint hazards to their young children, report violations in writing to their landlords, and make sure the landlords addressed the problem properly. It also limited tenants' ability to sue their landlords.

The new bill before the council, among other increases in stringency, shifts the burden of inspecting for lead-paint hazards from the tenant to the landlord, imposes penalties on landlords for noncompliance (according to the New York City Coalition to End Lead Poisoning, Local Law 38 provided "no penalties whatsoever for noncompliance"), includes lead dust (a known hazard to small children) among the problems that landlords must inspect for and correct, lowers the age of protected children from 6 to 5, and applies to day-care centers and schools as well as homes.

According to the city health department’s 2001 report on lead poisoning in the city, nearly 95 percent of children identified as suffering from lead poisoning were black, Hispanic, or Asian. "There is a stubborn tendency for children of color to be the ones who are affected," said Perkins.

The 3,985 new cases in 2002 also followed a well-established pattern of occurring disproportionately in poor neighborhoods, such as low-income pockets of the Bronx, Harlem, Queens, and areas like East New York and Flatbush in Brooklyn.

"The constituency that is most victimized is the least politically powerful," said Perkins, who represents parts of Harlem, Morningside Heights, and the Upper West Side. "That's why the council has to be the champion of the victims of lead poisoning. We failed at that in 1999, but I think we now have a chance to redeem ourselves.

"We need a transitional plan, so says the court. Well, we've put together an alternative law and had it before the council for a year. So we're way ahead of the game. Now, we need to start immediately to meet with the mayor, landlord bodies, and other members of the council, and to get this thing moving."

Some of the bill's supporters, who now include 37 of the City Council's 51 members, have accused Council Speaker Gifford Miller of stalling the progress of 101A, which he does not support.

"The support of the Speaker would obviously be very helpful at this point," Perkins said. "He needs to stop dragging his feet, to say the least."

In covering the Court of Appeals decision, the New York Daily News reported that Miller received $35,950 in campaign contributions from real-estate groups. Miller told the News that the money had not influenced his stance on the bill.

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.

How the 2004 Budget Is Shaking Out for Health Care

The 2004 state and city budgets look significantly less dire than they did only a few short weeks ago in terms of their impact on New York City's health care. But they are far from ideal, with several important public-health programs slated to be cut or even eliminated.

One much-needed break came courtesy of the state legislature, which in mid-May, simply defied Governor George Pataki's draconian proposed budget and passed its own, which featured an extra $2 billion (for a total of $92.8 billion). In particular, the legislature restored more than $750 million from roughly $1.4 billion Pataki had wanted to strip from the health care industry.

Hints of the legislature's intent had emerged before the actual voting. Kevin S. Parker, the State Senator from the 21st District in Brooklyn, speaking at a May 9 conference on discrimination in health care, called Pataki's budget "the worst I've ever seen." He added, "I've got two theories about the governor's budget: Either he fell down and suffered a severe head injury and has just been kind of wandering around in a daze, or he's been kidnapped by aliens and replaced by a pod person."

As reported here earlier, Pataki had proposed changing the state's Medicaid program so that the state would absorb all of the local costs for Medicaid prescription drug coverage, while the localities would increase their share of hospital and clinic costs from 25 percent to 37.5 percent. Although this swap would have benefited every other county in the state, New York City stood to lose some $140 million, according to the Independent Budget Office, because 35 percent of Medicaid payments here go to cover inpatient hospital costs and only 15 percent go for drugs (in-hospital care in New York is particularly expensive).

But the legislature rejected this "swap," meaning that the city will avoid the extra cost.

Governor Pataki had also proposed a variety of measures to contain the cost of Medicaid by lowering reimbursement rates, "taxing" providers, and limiting eligibility for Family Health Plus and children's Medicaid. These changes would have had a major impact on the city's Health and Hospitals Corporation, which, as a Medicaid provider, was projected to lose $200 million through lower reimbursements and increased assessments.

But the legislature rejected these changes as well. James R. Tallon, president of the United Hospital Fund, says, "Because the legislature largely rejected the proposed cuts, the outcome is that New York City hospitals have sidestepped -- for now -- the greatest level of negative impact of the governor's plans for Medicaid."

Handily, New York will also receive a Medicaid boon from Washington under the recent federal changes in the tax law. The city could receive as much as $290 million in new Medicaid funding over 15 months.

Yet another set of health care changes proposed by the governor would have reduced state matching funds for local public-health programs. The city's Department of Health and Mental Hygiene had estimated that this proposal would have reduced support for these programs in the city by $50 million. The legislature rejected most of the changes sought by the governor, although the city will still see an estimated reduction of $20 million in public-health matching funds. Because these are matching funds, however, this change will only affect the city's budget gap if the city chooses to replace the lost state funds.

Bloomberg Adds Back $90.2 Million in Services

The city's new fiscal year begins on July 1, and for the last few months, Mayor Michael R. Bloomberg and the City Council have been haggling back and forth, trying to close a $3.8 billion budget gap.

But on June 4 -- the day before Mayor Bloomberg's and the City Council's initial budget deadline -- Bloomberg unexpectedly restored $90.2 million for services that his executive budget plan had proposed cutting; including, according to the Associated Press, $5 million worth of health department funding. He gave as a reason the fact that the state will now be giving much more budget relief to New York City than the city had previously believed. According to the city's Independent Budget Office, Albany is now offering the city a total gap-closing package worth roughly $2.3 billion: $1.3 billion in new tax revenue that the city will be allowed to raise, and $1.0 billion in other assistance. This, the Independent Budget Office says, may be as much as $210 million more help in closing the 2004 budget gap than the mayor's initial executive budget had taken into account.

Among the health care restorations the mayor has promised are continued funding for an asthma control initiative (a recent study showed that an astonishing 25 percent of children in Harlem suffer from asthma) and a program to combat lead poisoning. He also backed off from an earlier budget proposal to outsource case management jobs at the city's HIV/AIDS Services Administration and to seek other changes to the 1997 legislation governing this agency -- moves that AIDS advocacy groups protested vigorously as ploys to weaken the agency.

As of this writing, the mayor and the Council continue to haggle over its details. According to the New York Times, the Council has a "wish list" of another $260 million in services it wants to preserve. Among health care measures, City Council Speaker Gifford Miller has vowed, the Council will fight to keep open 12 child health clinics still slated to be closed. (There are 31 child health clinics in the city, but the dozen targeted for closing are disproportionately located in disadvantaged neighborhoods -- four in Harlem, four in Brooklyn, and two in the Bronx -- according to Judy Wessler, director of The Commission on the Public's Health System, a local public-health advocacy group.)

Miller and the Council's Deputy Majority Leader, Bill Perkins, are also calling for the restoration of $5 million to continue funding an initiative to combat infant mortality, particularly among infants of color, whose mortality rate, Perkins says, is 70 percent higher than the city average. "Five million dollars is not that much money," Perkins says. "But it's a statement of a commitment."

Other important public-health programs in the city have also had their funding yanked or slashed in the mayor's budget, and not yet restored. The Commission on the Public's Health System cites four such:

- five school-based health clinics, one in each borough, which could close for lack of $419,000 in funding
- waivers of medication fees for uninsured and poor patients who lack money to fill their prescriptions at public health and hospitals facilities; their funding has been slashed.
- mental health and substance abuse programs in six Health and Hospitals Corporation, to be cutback; and
- a hepatitis-B school immunization program that will be eliminated, and 100 public health assistants terminated, because its $1.6 million in funds were cut.

Says Judy Wessler, "We believe that the public health infrastructure is critical, and the loss of these programs would be a very bad thing. Remember, public health is a 'first responder' for public safety, too, just like firemen or the police. It prevents epidemics, it can prevent people from getting very sick."

It doesn't necessarily look good for these programs. City Council leaders have told the press that high among its remaining priorities are reopening the six firehouses Bloomberg closed at the beginning of the month, and saving zoos in Brooklyn and Queens. Meanwhile, a poll of city residents taken by the New York Times on June 6-10 indicated that their top priority among services is also preserving firehouses, followed by maintaining classroom aides in public schools.

Whether anyone will champion the public health programs still on the chopping block hard enough to save them remains an open question. The Council has re-scheduled its budget vote, though the process could drag on for the rest of the month. Stay tuned.

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.





















School Buses Can Be Dangerous to Kids' Health

The children are there on West 26th Street every morning, waiting to board the yellow school bus. They say their quick good-byes to parents and caregivers, and the adults rush off to jobs or daily chores, completely unsuspecting of any danger. And why should they worry? A Transportation Research Board report (in pdf format) found that kids are much safer traveling on school buses than by foot, on bicycle, or in private vehicles. But in fact, there is danger awaiting these children that perhaps their parents and caregivers, and even the Transportation Board, overlooked.

A majority of the school buses serving New York City children use diesel fuel, and while the dangerous effects from exposure to diesel exhaust are fairly well known -- cancer, for example, and respiratory ailments, including asthma, which is on the increase in alarming proportions among children -- who knew that diesel emissions were actually greater ON the school bus than in the outside air?

According to "No Breathing in the Aisles," a report (in pdf format) conducted by the Natural Resources Defense Council, the Clean Air Coalition, and the University of California at Berkeley, the average child riding a school bus is exposed to levels of diesel pollution that are up to four times greater than those measured in a passenger car directly in front of the bus, and up to eight times greater than the average diesel exhaust levels in outside air.

The combustion of diesel fuel creates particulate matter, the majority of which are fine particles, less than one micron in diameter. "The fine particles are particularly harmful, especially to children," explained Craig Wilson, associate director of environmental health at the American Lung Association of New York State. "They penetrate deep into the lungs and interfere with the development of lung tissue. They also contribute to asthma, exacerbate allergies, decrease lung function, and have been linked to lung cancer and premature mortality."

The New York Power Authority agreed to pick up the tab to retrofit 1000 city school buses with diesel particulate filters which would reduce emissions significantly. The initiative focuses on school buses in all boroughs except Manhattan. After a year and a half, however, not one school bus company has taken advantage of the deal.

Diesel particulate filters trap exhaust particles and, combined with an engine adjustment and the switch to using ultra-low sulfur diesel fuel (with all related costs covered by the power authority), emissions on the school buses are reduced by 90 percent.

Bus engines built before 1995 are not able to accept this particular retrofit (and 3200 buses in the fleet of 5000 that serve New York City school children presently have pre-1995 engines), but the New York Power Authority also agreed to cover installation costs for diesel oxidation catalysts that would reduce pollution on the older school buses by approximately 20 percent to 30 percent. To date, 10 buses have had oxidation catalysts installed, and 30 more will be completed in July. An additional 200 older buses are in the pipeline, according to the authority, awaiting completion of the agency’s bidding and selection process for vendors to service the installations. All 10 of the older buses that have been equipped with oxidation catalysts, and those in line to receive them, are from one company, Atlantic Express in the Bronx. None of the other 64 bus companies serving the school system have requested installation of the catalysts on their older buses.

Even more disturbing, not one bus company has agreed to install diesel particulate filters on their newer buses and switch to using ultra-low sulfur diesel fuel, the combination that achieves the greatest reduction in emissions. "Our goal is not a 20 percent reduction," said Wilson of the American Lung Association. "It is to get in excess of a 90 percent reduction."

In a recent article in the New York Times, bus company officials blamed the technology for the delay, and expressed fears regarding engine damage or manufacturer warranties not being honored, as well as the suspicion that switching to low sulfur diesel fuel -- a necessity with the diesel particulate filters -- would eventually mean higher costs.

The New York Power Authority has done everything it can to allay these fears, according to New York Power Authority spokesperson, Connie Cullen. "We’ve been talking with the bus operators, answering their questions and concerns. We independently contacted every school bus engine manufacturer and were able to get letters of verification that the warranties on the engines will remain intact when this equipment is installed. This is in addition to already existing warranties that come with the filters and catalysts. We’ve shared all these letters with the bus operators.

"Initially we offered to pay the difference in cost between the regular onroad diesel and the ultra-low sulfur diesel (a differential that fluctuates between 10 and 18 cents a gallon in New York), and then we decided not only to pay the differential, but the whole cost. None have agreed to use the ultra-low sulfur diesel."

In 2006, all bus and truck operators will be required by federal Environmental Protection Agency regulations to use ultra-low sulfur diesel fuel (15 parts per million sulfur as opposed to 500 parts per million sulfur in onroad diesel). The New York Power Authority initiative covers the cost of purchasing the cleaner fuel for the three years prior to the mandate.

"All New York City transit buses and sanitation trucks are already using ultra-low sulfur diesel fuel," added Ms. Cullen.

It takes the same amount of time to install the diesel particulate filter (or the diesel oxidation catalyst) as it does to replace a muffler on the vehicle, between two to eight hours. The New York Power Authority also offered to accommodate the schedule of the bus operators, to do the work on weekends or school holidays, and to pay overtime for the maintenance workers involved.

Apparently, these efforts have not swayed NYC school bus operators. And it is a voluntary program. The Department of Education has yet to require the retrofits as a condition for doing business with the city.

Some school bus associations, citing other public health studies, dismiss the Natural Resources Defense Council report as unscientific and even play down the danger to children outlined in it.

"People call anything ‘unscientific’ when what they really mean is that they didn’t like the results," said Gina Solomon, Senior Scientist at NRDC, and one of the authors of the report. "The study was scientifically designed in collaboration with well-respected researchers from the University of California at Berkeley, and was peer-reviewed. In addition, scientists from Yale University repeated our study in Connecticut and found the same results."

In the Yale study, released last year by Environment and Human Health, Inc., measurements of fine particulate matter were five to 15 times higher on the school buses than in the average outside air. Monitoring equipment was not only located on the bus, as in the NRDC study, but on the children themselves as they went through their school day. Levels spiked every time the children were on the buses, or even when they approached them. A moving bus once again produced the highest levels in the back of the bus and with the windows closed. But levels were even higher inside an idling bus that was loading and unloading students, and highest when idling with the windows open, particularly if more than one school bus was lined up, allowing exhaust from one bus to enter another.

In both studies, emission levels varied by bus, and none of the buses tested had any pollution control devices and/or used ultra-low sulfur (or "green") diesel.

Advocates of the retrofit program in New York City are frustrated by the delay. "We know other school districts have done it, one in Connecticut, and one in Boston," said Craig Wilson of the American Lung Association. "There are some technical challenges, but there is no reason why it can’t be done."

"They will be legally required to use low sulfur diesel fuel in three years anyway," noted Ms. Solomon of NRDC, "so it’s hard to argue against it now. Some people are just resistant to anything new."

Do parents need to take their children off school buses? According to Natural Resources Defense Council recommendations, if a child has asthma, the parent should observe whether the condition worsens as a result of riding on the bus and, if so, consult a pediatrician and consider alternate transportation. All other school children should be instructed not to sit in the back of the bus, particularly for long trips. Harmful effects accumulate over years, so it is important to contact school districts and local politicians, appealing to them to reduce diesel emissions on school buses immediately through retrofits and the use of ultra-low sulfur diesel, prohibiting bus idling, and the purchase of alternatively fueled buses.

Amid news of an unprecedented rise in asthma for New York City children, a new grassroots group, the Asthma Free School Zone, is gearing up for community action in the next school year. Director and founder, Rebecca Kalin, has a 6-point agenda for the Asthma Free School Zone, and the first two items on the list involve diesel emissions: prohibiting idling within a school zone, and insisting on clean fuel technology on school buses.

Kalin related a story about a public school on East 12th Street where the yellow school bus is no longer a welcome sight. "One teacher I know runs to the windows and slams them shut every day when the school bus appears," she said. "He doesn’t want his kids to have to breathe the smelly fumes." Kalin hopes the community will come together on this issue so that teachers can keep their classroom windows open, and students can breath safely.

Various funding options exist for school bus operators in New York, in addition to the $6 million available through the New York Power Authority initiative. The New York State Clean Air School Bus Program has allocated $5 million for awards up to 100 percent of school bus retrofits or replacement costs. Another $5 million is available for upgrading buses built before 1990, as well as other funding incentives for retrofits, through EPA’s Clean School Bus Program. And $20 million is available from the EPA to retrofit school bus diesel engines, as part of a consent decree with Toyota stemming from emission violations.

























Survey of Emotional Distress

More than six percent of New Yorkers report suffering from "severe emotional distress," with Hispanics and the poor among the most likely to suffer such distress, according to a citywide survey released on April 30.

The city's Department of Health and Mental Hygiene surveyed 10,000 residents from 33 New York City communities in 2002. This Community Health Survey asked New Yorkers about the extent to which they had recently experienced conditions such as feelings of sadness and anxiety. Those who reported high levels of these feelings were classified as experiencing significant emotional distress: 6.4 percent of New Yorkers overall reported such distress.

According to Lloyd I. Sederer, M.D., Executive Deputy Commissioner of the Department's Division of Mental Hygiene, this is the first time the survey has been done, so it is not clear if the reported rates of severe distress have increased (for example, in response to the economic doldrums or threats of terrorism), decreased, or stayed the same over time. Sederer said the agency plans to repeat the survey in June in order to see if there have been any changes.

Sederer said the New York survey was unusual in its "snapshot" approach, asking how respondents had been feeling over the past 30 days. "That does make it hard to say how the rates would compare to the rest of the country," he said. A large national study done by the U.S. government in 1991, the National Comorbidity Survey, asked about feelings of depression and anxiety in the past year and over the respondents' lifetimes; it found that 10 percent of Americans had suffered from major depression and 17 percent from an anxiety disorder in the past year, and 17 percent from depression and 25 percent from an anxiety disorder over the course of their life to date.

One finding of the survey was a strong correlation between poor emotional health and poor physical health. Those who said they suffered significant emotional distress also reported being in poor physical health three times more often than New Yorkers who said they were not significantly distressed. Among those with significant distress, 54 percent said they were also in poor or merely fair physical health, versus 17 percent of those who felt better emotionally. Those who reported significant emotional distress generally had higher rates of chronic health conditions such as high cholesterol, high blood pressure, obesity, asthma, and diabetes.

Sederer acknowledged that it is not always clear whether emotional distress was leading to poor health or vice-versa, but he did note that those who reported more emotional distress tended to follow less healthy lifestyles, including less exercise, more binge drinking, greater likelihood of tobacco use, and poor diet. "If you're depressed or anxious, the likelihood is that you'll be at a much greater risk for so-called habit-related disorders -- those that result from drinking too much, smoking, and not taking care of yourself," he said. "But poor physical health can also definitely lead to emotional distress. In the elderly, for example, those who have chronic physical illnesses have much higher rates of depression than those who are physically healthy. It's important to be aware of that in order to screen for depression those who are at the higher risk."

Other survey findings included:

" Hispanics reported nearly twice the rate of severe distress as other New Yorkers (11.9 percent, versus 4 percent for Asians, 4.6 percent for blacks, and 4.9 percent for non-Hispanic whites). Sederer said that the reasons for this were not clear. "Is it a cultural issue, a greater willingness to talk about the problem, a problem with access to or seeking of care? The reasons haven't yet been well studied," he said.

" Neighborhoods with the lowest incomes tended to report the highest rates of significant emotional distress.

" Only 36 percent of New Yorkers who reported significant emotional distress were employed, compared with 60 percent of other New Yorkers.

" 55 percent of New Yorkers who reported significant emotional distress had annual household incomes of less than $25,000.

" Significant emotional distress was more frequently reported among people 45 and older.

" Significant emotional distress was more frequently reported among those who are divorced, separated, or widowed (9.6 percent) than those who are married or partnered (5.5 percent) or never married (6.6 percent).

"As with all of these studies, these are correlations, not analyses of which causes which," Sederer said. "But with the next survey, in June, we hope to refine the questions to tease out some of those issues."

The report noted that effective treatments exist for emotional problems, and it recommended that New Yorkers experiencing persistent symptoms of emotional distress seek help from their physician or a mental health counselor. 1-800-LIFENET, the city's free information and referral hotline for mental health and alcohol/substance abuse services, is available 24 hours a day, seven days a week. LIFENET can be reached at the following numbers:

English: 1-800-LIFENET (1-800-543-3638) OR 311
Spanish: 1-877-AYĂšDESE (1-877-298-3373)
Chinese: Asian Lifenet (1-877-990-8585)
Other languages: 1-800-LIFENET
TTY (hearing impaired): 212-982-5284

The study also recommended some simple steps for better mental health that New Yorkers could take on their own: exercise regularly, eat a healthy diet, and refrain from abusing alcohol or drugs or smoking.

Meanwhile, the state legislature continues to battle to pass a state budget that would restore huge sums of money that Governor Pataki has proposed cutting from health care, including mental health care. The legislature passed an appropriation bill for health and mental hygiene that would restore $1.1 billion of $1.25 billion Pataki had proposed cutting, The New York Times reported on May 2. The Times quoted Richard N. Gottfried, a Democratic assemblyman from Manhattan and the chairman of the Health Committee, as saying that several hundred million dollars in federal Medicaid money would also return to New York under the legislative proposal.

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.

Recruiting Foster Parents


A Harlem Hospital study is producing an alarming finding: as many as one in four children in Harlem have asthma. Only halfway through an ambitious effort to test every child within a 24-block area, doctors expected to find rates higher than the national average of 6 percent, perhaps even percentages approaching the high teens, but nothing reaching these heights.

A studyof Philadelphia school children actually produced similar numbers a few years ago, but the children were never examined by doctors. Instead, over 5000 5th and 6th graders were shown a video that dramatized various asthma symptoms and they were asked if they had ever experienced these symptoms or had been told they had asthma: 25 percent said they had, but it was never documented.

Indications were present here in New York that the situation was bad even a decade ago when hospitalization discharge records for children treated for asthma were four times higher than the national average.

But the Asthma Initiative is the first documented study in the nation to get such high results. Many of the children tested, and their parents, were not even aware that they had the disease, a dangerous situation because asthma symptoms tend to get worse if left untreated.

Triggers for asthma include exposure to smoking, cockroaches, dust mites, mold, and dampness. Deteriorating building stock, diesel fumes, as well as cheap home heating oils that contain a high sulfur content are among other factors suspected of contributing to the problem.

The Asthma Initiative is a collaboration between Harlem Hospital's Department of Pediatrics, the Harlem Children's Zone, Columbia University's Harlem Health Promotion Center, Touchpoints and the New York City Department of Health and Mental Hygiene.


New Yorkers recently discoveredthat they have a higher life expectancy than the rest of the country, and that includes a 9 percent decline in infant mortality rates, from 6.7 to 6.1 deaths for every 1000 babies born. This number has been declining for years: in 1984, 13.6 children out of every 1000 born had died before the age of one. New York's infant mortality rate is now lower than the national average of 6.9, and compared to other cities for the same period, the rate of 6.1 is less than Cleveland at 9.7, Chicago at 7.5, or Dallas-Ft. Worth at 6.9, but higher than Los Angeles at 5.4 and San Francisco's 4.3.

However, if you look inside the average to its highs and lows, it becomes clear that not every New York family is benefiting from decreased infant mortalities. If you live in Kips Bay in Manhattan or Red Hook, Brooklyn, infant deaths are the lowest in the city: 1.4 to 2.2 per 1000 births, respectively. If you happen to give birth to a child in Central Harlem, however, the death rate more than doubles from the city average to 13.1 babies dying for every 1000 born. In Bedford, Brooklyn, 10 out of every 1000 infants die, and in Flatbush, 7.4. In Manhattan as a whole, the rates actually rose by 6 percent. The New York City Department of Health and Mental Hygiene provides a table (pdf) that breaks down infant mortality rates by neighborhood throughout the city.

Thomas Frieden, commissioner of the Department of Health and Mental Hygiene, acknowledged this disparity in a recent Letter to New Yorkers. "Babies born in poor neighborhoods are 10 times more likely to die than babies born in the most economically advantaged neighborhoods," wrote Frieden, promising to "prioritize public health efforts to communities that need them the most."

The most common causes of infant deaths are premature births/low birth weight, birth defects, and Sudden Infant Death Syndrome.


"Federal Agencies could play a stronger role in helping states to reduce the number of children placed solely to obtain mental health services". An April 2003 reportfrom the General Accounting Office estimates that the families of at least 12,700 children across the country were driven to give up their kids to child welfare agencies or juvenile justice systems because they knew of no other way to obtain mental health services for them. The report suggests that a reduction in costs for mental health services, as well as improved access to these services, could change this situation.


Foster parents wanted. Mayor Bloomberg and the Administration for Children's Services (ACS) are kicking off a massive campaign to recruit foster parents. There are currently 25,400 children in foster care in the city. In a press conference with the mayor, William Bell, commissioner of the Administration for Children's services, said they are particularly in pursuit of people willing to parent siblings, teenagers, and mentally fragile children. The agency is hoping to attract a foster parent pool from Bedford-Stuyvesant, Jamaica, Queens, Central Harlem, and Concourse/Highbridge in the Bronx, neighborhoods where many of the children come from, so that the children can remain within their own communities.

Severe Acute Respiratory Syndrome

If it weren't for the daily drama of the televised war in Iraq, the mysterious flulike illness from Asia known as SARS, for Severe Acute Respiratory Syndrome, would probably be capturing more local interest.

But, aside from a flurry of rumor-fueled panic in Chinatown, which has experienced a dropoff in tourism due to fears about SARS, New Yorkers seem phlegmatic about the risk posed by the new disease. "It sounds like the flu," said Katherine Bruni, 35. "You know, it'll kill the people the flu kills... the very old, the very young, people with compromised immune systems... I'm not that worried about it, personally."

SARS, may, in fact, be worse than the flu - although there have been no deaths among the 148 suspected SARS cases spread over 30 states in the U.S., SARS has so far shown a mortality rate of about four percent elsewhere in the world, as compared to about one percent for common influenza.

According to the World Health Organization, there were 2,671 suspected SARS cases in 19 countries as of April 8, and 103 people have died. China, where the illness emerged about three weeks ago in Guandong Province, has been hardest hit, with 1259 cases and 53 deaths, according to the health organization. Other countries in Southeast Asia, including Hong Kong, Vietnam and Singapore, are also experiencing substantial outbreaks. On March 15, the World Health Organization issued a global travel alert, cautioning that travel to Vietnam or Hong Kong might pose a health risk. It was the first time the U.N. agency had ever issued such a global alert. The U.S. Centers for Disease Control and Prevention have also issued a travel advisory urging people to avoid discretionary visits to Hong Kong, Singapore, Vietnam, and mainland China.

Seven New York City residents have contracted the disease, all while traveling in Asia recently, city health officials report. Ranging from a one-year-old boy to a 91-year-old woman, they all had mild cases and are recovering. So far, there have been no cases of SARS spreading from person to person in New York City.

Rumors of His Death Exaggerated

Chivy Ngo, owner of the Bo Ky restaurant on Bayard St. in Chinatown, notes that he is very much alive and well, despite rumors last week that he and several workers at his restaurant had died of SARS after Ngo supposedly traveled to Asia. Ngo's "death" was falsely reported last week in a mass-circulated e-mail, and business at his restaurant dropped off to nearly nothing for several days, though it has rebounded since the hoax was exposed, according to Robert Weber, a spokesman for the group Asian Americans for Equality. Weber adds that while tourists and visitors appeared to avoid Chinatown out of fear of SARS last week, leading to empty restaurants and deserted street markets, trade seems to be returning to the area now. "But, business-wise, Chinatown really didn't need a SARS scare. After September 11, that was like having a root canal after a heart attack," Weber says. "No one here is spreading SARS. People should come eat here and enjoy what we have to offer."

U.S. Senator Hilary Rodham Clinton, New York City Health Commissioner Thomas Frieden, and New York City Councilmember John Liu held a joint press conference to discuss how $16 million that Senator Clinton secured on behalf of the Centers for Disease Control to help combat SARS will be used. The conference attendees ate at a Chinatown restaurant.

What Is SARS?

The U.S. Centers for Disease Control has said the cause of the disease appears to be a new mutation of the coronavirus, a member of a virus family which also causes some forms of the common cold. Symptoms of the illness include a high fever (over 104 degrees Fahrenheit), cough, and shortness of breath.

There is no cure for SARS at this time, although the CDC is working on an antiviral agent, a vaccine, and a diagnostic test for the illness.

While the disease is clearly contagious, it is not clear exactly how it is spread -- whether it requires personal contact, or can be spread through the air, as through droplets from a sneeze. It is also not clear whether people can be carriers but not show signs of infection themselves.

"Most of what everyone is saying is based on sketchy data, so it's going to be a while before we know what's going on with this disease," says Arthur Rheingold, head of the Division of Epidemiology at U.C.-Berkeley's School of Public Health. "We don't know the primary routes of transmission yet. We don't understand whether people can be carriers without showing symptoms. Investigators are frantically trying to find these things out."

Don't Panic

Jerry Hauer, acting assistant secretary for public health preparedness at the U.S. Department of Health and Human Services, told the Associated Press on April 7 that health officials are baffled as to why U.S. patients have become less sick than those in, say, neighboring Canada, where SARS has killed 10 people and forced thousands of people in Toronto to be quarantined.

"It might be that some of these folks in Canada just got more of the virus, were in closer contact," Hauer told the AP. "Any theory I give you at this point in time would just be a theory."

Hauer also said the spread of the illness may be slowing. ``I think we've started to stabilize in the number of cases. We're not seeing these large jumps every day,'' he said. But "[w]e don't know yet whether ... we're through act one of a two-act play or whether we're just four lines into a three-act play."

President Bush signed an executive order adding SARS to a short list of diseases requiring mandatory quarantine under the Public Health Service Act. But no one in the United States has been quarantined for the illness, and there are no plans to do so at this time, experts testified before a Senate committee on April 7. Although some experts warn that SARS could yet turn out to be a deadly global pandemic, Berkeley's Rheingold says he doubts it could have the kind of lethal potential as, say, the deadly Spanish flu epidemic of 1918, which killed tens of millions worldwide.

"We have better medical care these days, antibiotics for treating secondary infections, better public health systems in place," Rheingold says. "I would expect that even if we find we have an organism of comparable lethality on our hands, we would do much better, mortality-wise."

To avoid contracting SARS, he says, "Don't travel to Asia unless you have to." Otherwise, he says, take the same precautions as you would to avoid the common cold: "Wash your hands a lot." The average person, he believes, has a "vanishingly small risk of catching SARS on the street."

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.


Diabetes rates have doubled in adults in New York City in the last eight years, according to a recent report from the Department of Health (pdf file), which says the disease is now "epidemic" in people of all ages. Eight percent of the population now suffers the condition, which is the sixth leading cause of death in the city. Amongst children, however, the rate may have risen even more sharply, according to physicians who treat the condition in the community.

"The increase has been dramatic," says Dr. Yolaine St. Louis, chief of pediatric endocrinology at Bronx-Lebanon Hospital and a spokesperson for the American Diabetes Association. Nationwide estimates put the rise at between four and tenfold amongst kids.

Diabetes is a condition in which the body stops responding to insulin, a hormone produced by the pancreas which tells cells to remove sugar from the blood for use as energy and for storage. Two forms are most common: type I, which is a genetic condition in which the immune system kills off insulin-producing cells and type II, which is associated with obesity. In type II diabetes, cells become unable to properly respond to insulin. Type II accounts for up to 90 percent of all cases — and is the form that has been increasing.

In fact, type I is also called juvenile diabetes, because it was once believed that Type II never, or only rarely, affected children. Recently, however, the proportion of children with Type II diabetes has skyrocketed.

Says St. Louis, "I have been working in this area for fourteen years. When I first started, about two to ten percent of cases amongst children were type II, now it's 30 to 35 percent."

The epidemic has hit hardest people of color, and those who are poor — populations which greatly overlap in New York. There seem to be both cultural and genetic reasons why African Americans and Latinos are at higher risk for both obesity and diabetes, and there are environmental reasons why in developed countries, the poor are vulnerable.

"I see a population in Nassau County as well as in the Bronx," says St. Louis. "Even amongst the kids who are more well-to-do, those with an [African American or Latino] background still have more obesity and diabetes." This could be due to a "thrifty" gene, which tells the body to store large amounts of fat in case of famine. In the past, this gene would have given people a survival advantage because people with the gene could store more food from times of plenty for times of scarcity. Now, of course, it can harm.

Cultural factors — such as a common belief amongst Hispanics that thin children are unhealthy — could also play a part. "Black and Hispanic people don't want to be thin like models and it's positive not to worship thinness, but there's also a healthy limit. We cannot as a community be getting this overweight. It has serious health consequences."

The highest diabetes rate in the city is in East Harlem, where 14.9 percent of adults are affected. The hardest hit ethnic group is Hispanics; 12.2 percent of Latino adults have the condition.

Rising rates amongst children foretell an even greater epidemic in the future, if steps are not taken to fight it. St. Louis says that when she first started practicing in the Bronx, it was rare for her to see a child who weighed 250 pounds. These days, she sees such a new patient monthly, sometimes weekly. "You have to be close to 500 pounds to impress me now," she says, sadly.

So what has changed recently to spur such a shocking increase in obesity and its consequences? Genetics, of course, and many cultural practices, do not change rapidly. But recent research has shown that food portion sizes have grown tremendously in the last decade and that people are becoming less and less active.

Lack of safe streets and play areas reduce opportunities for poor kids to exercise even further. Budget cuts now mean that in many city schools, kids have gym class just once a week. "One kid told me that in his school, some grades have no gym. Grades 3, 5 and 7 have gym-but 2, 4 and 6 don't," says St. Louis, who adds, "If gym class is over-filled, the teacher is probably not making sure that the fat kid in the back is participating."

School lunches, however, are not a big culprit. St. Louis says, "No one is getting fat on school lunch. They all hate it." Also, though the food tends to be fatty, the portion sizes are not overly large and schools have recently added things like skim milk, which help.

"After school, they do all this academic stuff," says St. Louis, "And that's great but there is very little physical activity." St. Louis says that while there are organizations like the Police Athletic League and the Boys and Girls' Club in the Bronx, many parents don't know how to get their children involved and need to be given more information.

For adults, making major lifestyle changes in diet and exercise is difficult. For poor children, there are even more barriers. Fast food is cheap and readily available, while fresh fruit and vegetables are more expensive and harder to find in poor neighborhoods.

Fortunately, with diabetes, small changes can make a big difference, and that is how St. Louis is able to help her patients. "A lot of parents don't realize that going from 300 pounds to 280, that's a big deal. It may make the difference between taking one medication or two and the difference between eye disease later in life or none."

St. Louis doesn't tell a patient, for example, that he has to lose 100 pounds or start exercising every day. Research finds that people told to make such huge changes are usually too daunted to start, and get discouraged. Instead, she praises kids for small steps — walking home from school once a week, losing one pound, or even just stabilizing and not gaining.

Since it is hard to get kids to worry about future consequences, which with diabetes are particularly dire and can include blindness, limb amputation and shortened lifespan, St. Louis focuses on teaching them about how diabetes could hurt them in the near term. If it is not properly controlled, diabetes in children can lead to lifelong short stature, because it hinders development. Also, the disease can dramatically affect school performance because blood sugar problems can cause headaches and difficulty concentrating.

St. Louis runs a support group called Sugar Babes, for kids with diabetes and their families. In it, participants discuss how to make small, manageable changes and what to do when kids are resistant. She mentions making more such groups available, getting more fresh fruits and vegetables into schools and poor communities, improving public safety so that kids can play outside, more gym classes as important steps to fight the epidemic. "All of these are issues that as a city we need to address," she says.

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.

Health Risks Near Ground Zero?

A number of articles and stories suggest that some people who lived or worked near Ground Zero after the September 11 attacks have developed health problems.


Air Quality At Ground Zero
Gotham Gazette - May 2, 2002
Eric Goldstein, Gotham Gazette's Environment columnist, takes a look at the Environmental Protection Agency's reversal of policy this week concerning indoor cleaning and testing for air quality. Is it too little, too late? Or a triumph for New Yorkers?

Breathing the Air Downtown
New York Times - Feb 22, 2002
In this editorial, the Times criticizes the government's failure to provide leadership concerning the issue of air quality and its health effects downtown. In particular, it cites worries about the air quality of indoor environments.

Give Us Back Our Neighborhood
Gotham Gazette - December 10, 2001
Madelyn Wils, the only member of the Lower Manhattan Redevelopment Corporation who actually lives in Lower Manhattan, blasts the city for its inaction in helping the residents living near Ground Zero.

Environmental Aftermath
Gotham Gazette - October 22, 2001
The hundreds of government scientists who have been testing the air in lower Manhattan have reported that there is little to worry about. Yet in the last two weeks it has become increasingly apparent, Michael Burger charges, that the scientists are not looking for precisely the right thing -- or, if they are, they are not releasing that information to the public.

More Resources

Government Information

EPA Response to September 11

Lower Manhattan air monitoring news
http://www.nyc.gov /html/dep/html/airmonit.html

NYC Department of Environmental Protection
http://www.nyc.gov/html/dep /home.html

NYC Health Department Responds to Concerns About Air Quality in Lower Manhattan

OSHA Map of Asbestos Sample Data for Lower Manhattan
http://osha.gov/nyc- disaster/map.html


The Environmental Impacts of the World Trade Center Attacks
The National Resources Defense Council's new report lays out the facts about the environmental concerns downtown and analyzes the government's response.

St. Louis Post-Dispatch on Federal Withholding of Air Quality Test Results
This article from the St. Louis Post-Dispatch broke news that results from tests conducted by the U.S. Geological Survey that revealed the dust around the World Trade Center to be as "caustic as liquid drain cleaner" were never released to the public.

UC-Davis Report on Air Sampling Downtown
An independent study set a mile north of the World Trade Center reveals highly contaminated air downtown.

NYC Department Of Health Presents Findings From Indoor Air Sampling In Lower Manhattan
The city agency releases its initial findings from indoor tests of thirty buildings throughout the downtown area.

News Stories

Uncertainty Lingers Over 9/11 Air Pollution - Sep 7, 2003
The air in Lower Manhattan after Sept. 11 has swirled back into the news -- what people knew about it, when they knew it and what they said about it. The underlying issue, researchers, doctors and politicians say, remains just as unresolved today as it was back then in the chaotic, emotional days after the attacks: How do you communicate something about which no one has ever had any experience? Was there a standard of confidence about the environmental risks and unknowns that was scientifically or perhaps even morally appropriate under the circumstances? (New York Times)

300,000 Around WTC to be Studied for 20 Years - Sep 6, 2003
Some 300,000 people who lived, worked or were near Ground Zero after Sept. 11, 2001, are being asked to join an official registry to monitor any health effects from the World Trade Center debris plume. (New York Daily News)

EPA Assured Public Before Actual Testing - Aug 28, 2003
In the aftermath of the Sept. 11, 2001, attacks on the World Trade Center, testing to monitor levels of debris dust didn't begin for 10 days - and analysis of the findings didn't become available until October. Months later EPA scientists would conclude that the dust caused lung disease in test animals - ailments that mimicked those reported in people who lived and worked near Ground Zero. (Newsday)

Governor Wants To Know How Dangerous 9/11 Air Really Was - Aug 28, 2003
Six days after a federal report said the White House misled New Yorkers about the air around Ground Zero after Sept. 11, Gov. Pataki said yesterday he wants to know how dangerous it really was. But Pataki stopped short of criticizing President Bush, his fellow Republican, and didn't support a call from Sen. Hillary Clinton (D-N.Y.) and Rep. Jerrold Nadler (D-Manhattan) to reclean area buildings. (New York Daily News)

Residents Angry, but not Surprised at Premature E.P.A. 9/11 Air Reports - Aug 21, 2003
Downtowners expressed outrage but little surprise last week at the news that the White House allegedly influenced statements the Environmental Protection Agency made soon after the collapse of the World Trade Center about air quality in Lower Manhattan. (Downtown Express)

Downtown Moms Question W.T.C.Baby Study Findings - Aug 14, 2003
Despite research showing a possible link between trade center toxins and lower baby birth weight, several downtown mothers who participated in a recent study said last week that the preliminary results did not appear to describe them or their babies. Mount Sinai School of Medicine tracked 182 women who were pregnant and in the vicinity of the World Trade Center on Sept.11, 2001, or within three weeks thereafter. In results released last week, researchers found that women who were exposed to dust from the trade center collapse were twice as likely as a control group to have babies who were slightly small for their gestational age, or for the amount of time they spent in the womb. (Downtown Express)

WTC Health Problems Persist - Aug 11, 2003
Thousands of New Yorkers say they still suffer from the World Trade Center attacks - and they are reaching out to help hot lines in numbers greater than last year, The Post has learned. Callers are seeking assistance for health complaints - ranging from respiratory ailments and pneumonia to acid reflux - that many link to the toxic plume created when the Twin Towers fell, as well as for post-traumatic stress disorder, anxiety and depression. (New York Post)

Feds Launch Long-term WTC Health Studies - Aug 10, 2003
Long-term studies to monitor the health effects of the World Trade Center attacks on New Yorkers are getting under way. A 20-year study conducted by the city Department of Health and the federal Agency for Toxic Substances and Disease Registry will begin in September or soon after to identify patterns of physical and psychological illness attributable to 9/11. (New York Post)

Smoke and Dust at World Trade Center Is Linked to Smaller Babies - Aug 6, 2003
Scientists say they have measured a slight but significant rise in the percentage of small babies born to women who were around the World Trade Center during or after the terror attack compared with babies of a large sample of pregnant women who were elsewhere at the time. The researchers, from the Mount Sinai School of Medicine, proposed that air pollution from the pulverized, smoldering wreckage was the most likely cause of the difference. (New York Times)

Health Care Changes Could Hurt New York

So far, 2003 is proving to be a hot year for health policy developments, both locally and nationally. Here is an update:

Unfortunately, most of the dire budget predictions made here earlier are coming true. The city asked that the state pay an additional $200 million of its Medicaid costs; instead, Governor George Pataki wants the city to pay a greater share of hospital and clinic costs than it does now. In exchange, the state would provide more money for prescription drugs. This shift would benefit many upstate counties, but would hurt the city because 35 percent of city Medicaid payments go to cover inpatient hospital costs while only 15 percent go for drugs. Medicaid is the federal health insurance program that provides coverage for the poor.

The New York Times estimated that the change would cost the city an additional $140 million and wrote in an editorial that the cuts would devastate the city's teaching hospitals, which educate about 15 percent of all doctors in the United States.

The governor also wants to reduce the number of people eligible for Medicaid. He has proposed lowering the maximum income that people can have and still qualify for the program. In the past, this has proved to be counterproductive because many of those kicked off Medicaid remain uninsured. Then, when they turn up in emergency rooms needing treatment, the city is forced to cover 100 percent of the cost. If these people had stayed on Medicaid, the federal government would have paid 50 percent of their treatment costs.

The federal government also has its eye on Medicaid. States, including New York, put many people on Medicaid who do not meet all the federal rules for being in the program. In fact, one third of people currently on Medicaid in the United States fall into this category and receive a full package of benefits. But the Bush administration is proposing that this change - that people who states voluntarily add to the Medicaid program no longer get all benefits.

Under current rules, states must apply for a federal waiver to change eligibility requirements and benefit packages in many cases. With the new system, they would no longer have to do so.

Critics-including some Republicans -say that the Bush proposal looks remarkably similar to a plan vetoed by President Clinton, who said at the time that it would lead to cuts that would be "devastating" for the poor.

"I don't see how New York would benefit with this kind of arrangement," says James R. Tallon, president of the United Hospital Fund. "New York has a significant Medicaid program, therefore, one has to be skeptical about any standard federal formula. New York probably has more to lose than gain."

The National Governor's Association, which might be expected to enthusiastically support anything that offers Medicaid spending relief (since Medicaid spending makes up approximately 20 percent of most state budgets) did not endorse the proposal but simply thanked the administration for putting Medicaid spending in the spotlight.

The president has put Medicare reform on his agenda as well. During his State of the Union address last month, Bush proposed adding a prescription drug benefit to the program. But to take advantage of the benefit, the elderly would have to enroll in health maintenance organizations. The administration, through its administrator of the Center for Medicaid and Medicare Services, Tom Scully, denied that the program would "force" beneficiaries into HMOs, but few details of the plan have yet been released.

There is some unequivocal good news for Medicare patients and their doctors, however. Scully told a Senate subcommittee on January 30 that the administration did not support actually going through with the 4.4 percent cut in doctor's fees that is scheduled to go into effect on March 1. This will now be considered along with the federal budget. Experts had said that, following a 5.4 percent reduction that went into effect last year, another cut would drive even more doctors out of the program.

And Pataki had some positive news for one group of health care consumers-the seriously mentally ill. After the Times revealed that nursing homes were warehousing mentally ill patients and that many of the group homes serving them provided worse care than the mental institutions they replaced, the governor appointed a commission to look into the problem. Taking its recommendations, Pataki has proposed spending $80 million to create new housing to replace the current system. While Democrats want more, advocates for the mentally ill are pleased to get a substantial increase during a fiscal crisis.

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.

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