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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

The New Health Commissioner

Advocates on health issues have been pleasantly surprised so far by Mayor Bloomberg's appointments to top positions. But they remain skeptical about the merger between the health and mental health departments, which was approved by voters in a ballot question on charter revision last November.

On December 27, Mayor Bloomberg announced that Thomas R. Frieden would be the commissioner for the newly merged health department. Frieden served previously as Deputy Health Commissioner under Mayor Dinkins, and was responsible for the implementation of a tuberculosis (TB) control program that is widely viewed as a public health triumph. More recently, Frieden worked for the World Health Organization, as a medical officer in charge of tuberculosis control in India.

Between 1978 and 1992, the number of tuberculosis cases in New York City almost tripled-- and the number of tuberculosis cases which involved infections resistant to drug treatment doubled. Frieden instituted a program called Directly Observed Treatment Short-course (DOTS) which involves having health care workers watch patients take their medications, to ensure that they don't forget or stop taking the drugs before the infection has been contained.

Under the new program, tuberculosis cases dropped 65 percent between 1992 and 2000-- to the lowest number ever recorded for New York City.

"I think it's a very positive statement that the commissioner of public health has a background in public health. It's quite an upward movement," " says Judy Wessler, Director of the Commission on the Public's Health System.

The previous health commissioner, Dr. Neil Cohen, was a psychiatrist. This gave him a great background for dealing with mental health issues and for ensuring that they weren't neglected if the mental health and public health agenices merged. But he was not as familiar with infectious disease control as a public health specialist would be.

Cohen was widely praised by the mental health community, however. Evelyn Roberts, Executive Director of the NYC-Metro chapter of the National Alliance for the Mentally Ill, says, "We had a good working relationship with him and some of us were hoping that he would stay on. Our concern when the referendum [merging the agencies] passed was, 'Well, it's OK so long as Neil Cohen is there, but what will happen if the agency is run by someone who isn't a mental health person?'"

"What we're looking to see is who will be appointed as deputy commissioner for mental health -- and whether that person has strong credentials in mental health and is a strong advocate." she adds.

Wessler's concern about the merger had been that public health rather than mental health might get shorted-- so advocates on both sides were wary that the consolidation would just be used to cut costs and services all around.

The ballot proposal on the issue received almost no publicity in the wake of September 11th-- and advocates say that the advertising campaign that did reach some was improper and possibly even illegal. Mayor Giuliani sent postcards to voters with a picture of firefighters on the front -- urging support for the iniative.

AIDS activists -- who had a difficult and often litigious relationship with the Giuliani administration-- are unusually positive about the appointment of Frieden to the new agency. "I have a wait-and-see attitude," said Terri Smith-Caronia of Housing Works, "However, I've heard nothing but good things about him in the HIV community nationwide. I've heard he's brilliant, doesn't suffer fools well and is very open to working with the public. My most immediate concern is how well does he deal with urban issues."

Smith-Caronia also praised the appointment of Verna Eggleston to head the Human Resources Administration because that agency's welfare decisions can affect access to health care through Medicaid. Eggleston previously served as the head of the Hetrick Martin Institute, which helps gay and lesbian youth and has always aimed to attract the dispossessed, not add barriers to care.

During the campaign, Bloomberg promised to end the practice of cutting people from Medicaid automatically when welfare benefits end, pointing out that this simply shifts the costs of their healthcare to city hospitals. Fifty percent of Medicaid funding comes from the federal government; 25 percent comes from the state and the rest from the city. The city pays 100 percent for emergency care of the uninsured, however.

The new commissioner will have an unusually knowledgeable and supportive mayor to work with. Bloomberg has been Chairman of the Board of Trustees of Johns Hopkins University for six years and the school was so impressed with his support and fund-raising prowess that its School of Public Health is now named for him.

During his mayoral campaign, Bloomberg promised to work to increase access to health care and fund basic public health measures that are often the first to be cut in budget crises. When these programs are working, their results are invisible. For example, if rat control is effective, no rats are seen and if tuberculosis control is working, the disease becomes rare.

However, now that the budgetary situation has gone from feast to famine, it remains to be seen whether he can keep these pledges and shield the health department from drastic cuts while not raising taxes. Frieden has a tough road ahead.

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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