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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

Extreme Weather And Your Health

This year, winter did not seem to arrive until early spring -- and then temperatures bounced from shivery to steamy. Drought (the city is still in a Stage One Drought Emergency) cut water reserves, but now some areas are flooded. Dress without checking the forecast these days and you risk freezing or frying; but even today's sophisticated computer models seem increasingly to make unreliable predictions.

This crazy weather adds to post-9/11 unease. But is it, too, affecting our mental and physical health? And what can we expect next?

Everyone talks about the weather-and unfortunately, now it looks like we have done something about it. Scientists no longer doubt that global warming is taking place, nor do they question that the burning of fossil fuels has helped cause the changes.

"No one event makes us think global warming is occurring," says Dr. Paul Epstein, associate director of the Center for Health and the Global Environment at Harvard Medical School. "But the pattern we are seeing of increased anomalies and variability in weather is consistent with climate change and with the analysis of the Intergovernmental Panel on Climate Change of the UN which concluded last year that extreme weather is increasing in intensity everywhere and is projected to increase in frequency as well. What we see is entirely consistent with the consensus of the entire scientific community."

This scares Epstein, who has analyzed how extreme weather affects human health. "After a drought, heavy rains can drive infectious organisms into the water supply like cryptosporidium (which can kill children, the elderly and people with compromised immune systems) and E. coli (which causes food poisoning and can be serious amongst the very young and those with immune problems)," he says.

Indeed, on May 31, in upstate Rockland County officials announced that there was an outbreak of E. coli affecting 15 children in the county, although it has not been linked with any particular water source or cause yet.

In 1999, heavy rains following a dry period drove E. Coli into the water supply of a county fair in upstate New York; several children died and hundreds became ill. An even worse event followed flooding in Milwaukee in 1993. Over 400,000 people were sickened by cryptosporidiosis and at least 100 died.

"Unstable weather can give rise to a population explosion of nuisance organisms," says Epstein. For example, with mosquitoes, droughts kill off many of their predators and then flooding provides food and breeding sites. Warm weather allows more to survive the winter than would ordinarily do so. Disease-carrying rodents like rats and mice also benefit. Warm weather makes for a longer breeding season.

West Nile virus, which was first found in New York in 1999, infected dozens and killed seven people that year and two the following year. It could increase with larger populations of mosquitoes; the first case of an infected bird (the source of the virus) this year was reported May 16 by the state health department.

New York allergy sufferers have already probably noticed that this year has been unusually difficult. This is another way global warming can affect human health. When the percent of carbon dioxide in the air increases, plants release more pollen. Trees drop more seeds and cones. One study found that when carbon dioxide doubled, ragweed pollen increased 60 percent.

The carbon dioxide levels in the air were typically 280 parts-per-million in 1840; now they are 370 and are projected to double within the next several decades if current emission levels continue.

Asthma will also worsen; reported cases doubled in the last 20 years and the problem shows no signs of letting up. The reasons for this are unclear, but may have to do with air pollution, pollen levels and increased levels of nuisance organisms like cockroaches.

Extreme heat itself is also a danger to the lungs. Says Epstein, "Ozone is formed faster on warm days. It can block your lungs, harm your lung sacs-it can make you dizzy." The heat itself, of course, can kill elderly people and people on certain medications which reduce the body's ability to deal with high temperatures.

Not to mention sunburn and increased risk of skin cancer related to another ozone problem: there's less of it now in the upper atmosphere to protect us from radiation. Ozone may be harmful to breathe on the ground, but in the upper atmosphere which is now thinning, it acts to reduce the level of radiation from the sun that reaches the ground.

Wild weather variability -- and even particular conditions -- may also cause or exacerbate heart problems, though the data here is less clear. One study found that heart patients were more likely to die following surgery if they were in a dark, rather than a sunny, hospital room.

The effects of climate change on mental health are also hard to predict. "It has the potential for disturbing mental health," says Epstein. "It's unsettling and makes us aware that the pattern is changing and this is disturbing emotionally."

Since we now know that humans have seasonal variations in neurochemicals, which can cause depression and possibly other problems when out of balance, changes in factors like the degree of cloud cover and level of rainfall could also physically affect our brains.

Dr. Michael Terman is director of the Winter Depression Program at Columbia-Presbyterian Medical Center. He studies Seasonal Affective Disorder, which is a type of depression that is at its worst when the days are shortest and sunlight exposure is lowest. In affected people, he says, "It can start as early as October and end as late as April but the peak months are January and February. There can also be seasonal exacerbations that reside on top of chronic depression."

Even people who don't suffer depression are affected by changes in light levels. A recent study by the National Institute on Mental Health had normal people lie in a completely dark sleep lab for 14 hours each day, starting in the late afternoon. Their brain's secretion of melatonin, a hormone believed to help regulate the body's clock in relation to light exposure, changed as the experiment progressed.

"This indicates that there is an inherent biological susceptibility to seasonal changes," says Terman. "It's in our genes."

Another factor potentially affected by climate change that can alter mood is the level of negative ions in the atmosphere. Terman originally studied negative ion treatment (using a machine which generates these charged particles) as a control condition to compare to light therapy. He used two controls, one with a high level of negative ions, one with a low level. He found that both the light therapy and therapy using high levels of negative ions produced significant improvement in mood.

Levels of negative ions are lowered in urban atmospheres, in air-conditioning and in heated rooms. These levels are high where there are significant numbers of trees and other vegetation.

Perhaps the most frightening aspect of global climate change is its unpredictability. Researchers know that small events can cause huge weather changes in unpredictable ways; large events are even less predictable. Scientists can't tell now whether the world is headed for a meltdown or a new Ice Age because the variables in the climate's balance are so complex.

So what can New Yorkers do to protect their health? Terman has an on-line "morningness/eveningness" questionnaire which can help you determine which levels of light and timing of light exposure best suit you; he's also seeking subjects for studies on both seasonal and non-seasonal depression. Negative ion machines can also be purchased.

But coping with climate change needs to be done on a social and political level, not just by individuals. Epstein suggests contacting the International Council for Local Environmental Initiatives to learn more and consider getting involved. And of course, wear sunscreen!

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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