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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

In The News: The State of New York City's Health Care System

(july '00)Though Mayor Giuliani has decided to keep future information about his prostate cancer treatment private, his bout with the disease has already had a huge impact on healthcare in New York. Perhaps recognizing what it is like to be vulnerable (or perhaps recognizing the political potency of the issue), the Mayor recently chose to focus on health issues. He's gotten the governor's attention as well. Suddenly, the state's top Republicans sound like Democrats -- calling for increased health coverage and higher spending. The state of the city's health system is receiving increased attention. Here's a rundown of what's being going on:

  • Almost immediately after his cancer diagnosis and his withdrawal from the Senate race, the Mayor reversed his policy of discouraging Medicaid applications, which was part of his welfare reform program. In fact, he is now actively encouraging Medicaid enrollment. His new program, Health Stat, based on the computerized policing program, CompStat, will seek out "hotspots" of uninsured people and reach out to them. The Mayor hopes to enroll 900,000 currently uninsured New Yorkers.

  • Also, the Governor didn't cut Medicaid in this year's budget as he had done each previous year. He supported a plan to bolster New York's teaching hospitals. Both the Mayor and the Governor now support health insurance for all children and raising the income limit for Medicaid so that the working poor can get health coverage.

  • Another important health issue facing the city this year is the return of West Nile virus -- a mosquito-borne illness affecting mostly the old and immuno-compromised which was seen for the first time in the region last summer. Sentinel chickens have been set out to alert epidemiologists of the presence of the virus; if they get bitten by a mosquito which tests positive, pesticide spraying may be ordered. This year, the city will not use Malathion, which the EPA has now labeled a potential carcinogen.

  • The city continues its battles against the HIV and Hepatitis C epidemics as well. While the number of deaths from HIV dropped 72% between 1995-98, about 8,000 new infections are reported each year and the city estimates that there are 44,000 people currently living with HIV. The city is also currently experiencing a rise in the number of asthma cases, particularly amongst poor children. Though the reasons for the asthma epidemic are unknown, many suspect air pollution or other environmental toxins which are more common in poorer neighborhoods.

  • Efforts to privatize city hospitals have failed -- forcing the Mayor to abandon, at least for now, the notion of selling them. Another managed care failure was an attempt to switch care for the tens of thousands of prisoners who pass through Riker's Island to a system in which the provider is paid per inmate, rather than per condition treated. St. Barnabas Hospital, which had taken over health care for the facility, had been plagued by lawsuits related to inmate and even guard deaths. Now bidding is taking place for a new provider who will not have the incentives to cut care for profit that St. Barnabas did. Riker's Island healthcare is of concern to the whole city because prisoners are amongst the sickest populations here. An epidemic unchecked in Riker's could spread throughout the city as inmates are released and returned to their neighborhoods.

Maia Sounds Off:

While the economic boom has allowed the city's health system to take a break from seemingly endless cutbacks, it is still precariously balanced. The uninsured still get too much of their healthcare too late -- at expensive emergency rooms. The Mayor's continuing efforts to move all Medicaid recipients into managed care have lead to serious and sometimes potentially life-threatening delays and obstacles to care.

Many HMO's, having recognized the difference between serving healthy middle class populations and sicker, poorer ones, are pulling out of the program, threatening the entire strategy. People with HIV and with mental illness, who are supposed to be exempt from the current plan, often have difficulty extricating themselves from it.

With the Mayor's new interest in healthcare and the optimism of a continued boom economy, New York has a rare opportunity, however. By spending wisely now, it could put a strong system in place which would have the efficiency to weather worse times. One option: cancel Medicaid managed care efforts entirely. Managed care will ultimately end up increasing costs for poor and sick populations because it adds a layer of expensive bureaucrats to oversee doctors, push cutbacks and justify its own existence. Instead, the city should work with doctors themselves to keep costs down and consider paying their salaries rather than paying per patient or per-procedure done or not done. Other innovative ideas are needed soon. Let's not let a unique chance to improve health care slip away.

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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