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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

Abortion Training

Every now and again, activists' dreams do come true and a seemingly small effort can yield big results. Such was the case for NARAL-NY (National Abortion Rights Action League- New York), which recognized a key part of the problem of the dwindling supply of abortion providers and persuaded Mayor Bloomberg to adopt its proposed solution.

Access to training in abortion procedures for future MD's turns out to be a major reason why fewer and fewer doctors provide abortions-- and Mayor Bloomberg promised during the campaign and re-iterated recently that he plans to require that all obstetrician/gynecology residents who rotate through New York's public hospitals be trained in abortion unless they have moral or religious objections.

"We want to say how thankful we are to Mayor Bloomberg for standing up and defending this after it came out in [the press] in a very sensational way," says Kelly Conlin, Executive Director of NARAL-NY.

"I think it's terrific," said Joan Malin, CEO of Planned Parenthood-NYC, "I think it's an essential component of ensuring access to this needed medical service and is a good thing to do."

Both the Village Voice and the Daily News reported on the radical nature of the change, which reverses a trend in government efforts to sidestep the abortion issue or placate religious conservatives.

Though it seems like a small step, this change in medical training could have a major impact.

In the entire U.S., there are only approximately 2,000 doctors who perform abortions -- and more than half of them are over 50. Yet abortion is the second most common surgical procedure amongst women-- and 43 percent of women will have at least one abortion in their lifetimes.

Each year, according to NARAL, 85 abortion providers retire and are not replaced-- and the second most common reasons doctors give for not providing abortion is that they have never been trained to do it.

New York City, interestingly, is a national center for medical education. In fact about one in seven American physicians do their residency training here--about 100-150 ob/gyns in city public hospitals run by the Health and Hospitals Corporation each year.

Cristina Page, Director of the Residency Training Initiative at NARAL-NY, has been studying the abortion training problem for three years. She says that over time, it became clear to her that changing abortion training here could have not just local, but national and international effects.

New York City trains more foreign doctors than any other city-- and to pay off the costs of their medical training, many foreign doctors choose to work for five years in areas of rural America which have a physician shortage. Since 86 percent of U.S. counties have no licensed abortion provider, these doctors could fill in many gaps.

"When we figured it out, I kept having these epiphanies and running to my executive director and saying, 'We could have a real impact' if I'm reading these numbers correctly." says Page.

During the course of its work, NARAL-NY polled ob/gyn residents about their views on abortion and found that while 60 percent said they planned to offer it, over three-quarters had had no training in the latest medical procedures for conducting it.

In part, the problem of lack of training is a result of the success of legalized abortion. Twice as many doctors who came of age when abortion was illegal-- at a time when 23 percent of all pregnancy-related hospital admissions resulted from botched, illegal procedures-- currently provide abortions, compared to younger docs who never saw what could go wrong when abortion was kept underground.

Also, when abortion was first made legal in 1973, 81 percent of abortions took place in hospitals. As earlier and cheaper procedures moved abortion from hospitals to clinics, one unforeseen side effect was that residents, who rotate through hospitals, not clinics, were no longer trained to do abortions.

According to NARAL-NY, the abortions currently done in city hospitals use outdated techniques and are often subject to bureaucratic delays. Also, hospital-based abortions use expensive operating-room time -- rather than the cheaper set-up common in clinics. About 6,500 abortions are currently performed annually in Health and Hospitals Corporation hospitals, according to published data on the hospital system.

Page met regularly with a group of physicians involved in the current system for training ob/gyn's at the Health and Hospitals Corporation to determine how best to improve it. Dr. Hakim Elahi is Chief of Women's Health Services at Elmhurst Hospital in Queens.

He suggests that the corporation in charge of the city's municipal hospitals set up at least two "centers of excellence" for abortion training, one at a Queens or Brooklyn hospital and one at a Manhattan hospital.

New York's public hospitals currently lose money because they are reimbursed for expensive operating room abortions at the same rate as for cheaper outpatient procedures-- and delays mean that many patients are simply referred out to Planned Parenthood or other clinics.

"If we had a center of excellence, we could do abortions and minor surgery like tubal ligations and residents could rotate through. We would save lots of money." says Elahi. In fact, the hospital could come out ahead because it loses money and sometimes patients themselves by referring them elsewhere.

"If we say we are providing women's health care, from an ethical point of view we have an obligation to offer all services." he says.

Elahi says the first step in implementing Bloomberg's plan would be to find underutilized areas in hospitals to create the centers -- and then cut through the bureaucracy. At Planned Parenthood, a woman can have an abortion in one appointment.

"They can do it the same day, see a provider, get a physical exam and sonnogram and an abortion-- rather than see [women] three or four times the way we do," says Elahi, "We all know that when an abortion is delayed, complications increase. They come in at 8 weeks and we [do the abortion] at 11 weeks. If we get them earlier, they go home faster and have less risk of long term morbidity like ectopic pregnancies and infertility."

The Health and Hospitals Corporation bureaucracy is notoriously slow-moving, but Elahi and NARAL-NY believe that this initiative will go forward. "It will happen in stages, " he says. "But it will happen." Positive signs include Bloomberg's continued support and his appointment of Dr. Benjamin Chu, to head the Health and Hospitals Corporation.

Both NARAL-NYC and Planned Parenthood said Chu has been supportive of their agendas in the past. (The mayor's office referred calls for comment to the Health and Hospitals Corporation, which did not return calls).

Of course, one activist group's victory can be a loss for another. Lori Hougens, spokesperson for the New York State Right to Life Committee said, "This pro-abortion mayor is attempting to propel a violent procedure which has no healing benefit but rather has as the only goal the death of a member of the human family - into the mainstream of medical practice. To suggest that the fine medical art of child killing is somehow on par with medical procedures that heal human beings is revolting."

Hougens did not say whether the group is planning a lawsuit or protests but it is likely that there will be challenges from anti-abortion groups.

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.
  • - 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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