When Prisoners Come Home, Gotham Gazette's Social Services topic page update for January, painted a disturbing picture of how much support released prison and jail inmates need to have a chance at productive lives on the outside, and how little New York City and New York State tend to give them.
Now, several legal advocacy groups, including the New York-based Urban Justice Center and the Legal Aid Society of New York, are pointing out how the state fails one of its most vulnerable and fragile groups of newly released prisoners - those with both serious mental illness and a substance abuse problem. On October 21, the groups filed a federal lawsuit on behalf of the hundreds of seriously mentally ill New York City parolees who their advocates say are unfairly denied community-based mental health and substance abuse services each year, often remaining in jail for many additional months for no more reason than a lack of community treatment slots that they can be referred to.
The suit charges that the state is illegally discriminating against these "dual-diagnosis" parolees -- who are mentally ill as well as having substance abuse problems -- because there are many more residential treatment programs available for parolees with substance abuse problems only; and these parolees are typically released days, not many months, after state officials agree they need treatment and not more jail time.
Dually-diagnosed parolees are generally only eligible for so-called MICA (Mentally Ill, Chemically Addicted) programs, of which there are far fewer in the city. Empty beds in these programs are a rarity. One of the key aims of the lawsuit is to force the state to increase the number of, and parolees' access to, these programs.
Currently, the filers of the suit say, a typical scenario involves a mentally ill parolee returned to jail - and then warehoused there -- for minor parole violations, such as missing appointments with their parole officers. The complaint claims that these violations are typically related to, if not directly caused by, the parolees' mental illnesses and co-existing substance-abuse problems. Even when, as frequently happens, their state parole officials decide that release and treatment for these parolees' illnesses would be more appropriate and effective, as well as better serving the interests of justice, than additional jail time, the re-imprisoned parolees tend to languish in jail for months waiting, often in vain, for one of the handful of state-funded treatment beds in the community that they might qualify for.
"I've met people who've had to wait a year to get out of jail again, even after their parole officers have determined that they need community treatment, not more jail. Six to nine months' wait is typical," said Heather Barr, an attorney with the Urban Justice Center. "And often in the end they don't even get the community beds they were waiting for - they're just released - eventually -- because no beds have come open. And then they end up back in jail for more parole violations that probably would have been avoidable if they'd gotten some help out there.
"And I've seen people who actually have to be kicked out of jail in the end, because they might be getting some kind of treatment in there, maybe psychiatric medications and some observation, which is better than nothing. Have you ever been to Rikers Island? It's a horrible, horrible place, but people have so few options, and such bad options, that even a cell in Rikers seems like something. They know they need continuing and/or better treatment and support to function outside in society, and there just is no treatment for them out there. There's no bed; there's no hope of a bed."
Barr said that there are probably a couple of hundred Mentally Ill Chemically Addicted beds in the city, but almost all are full at any given time. And parolees are discriminated against for admission, either deliberately or by default, she said.
"For instance, on one day this past September, there were 18 MICA beds open," Barr said. "Now, twelve of those beds were at places that won't accept parolees - they demand on-site interviews for admission and won't allow telephone interviews, and people in jail can't get to the places to be interviewed. That leaves six beds total for all the homeless people with mental illness and substance abuse problems, people with addiction problems just discharged from the psych wards, and so on, in New York City. And there's a big focus on providing treatment beds for the homeless, which is great, except parolees usually can't qualify on those grounds -- the rules say that if you weren't homeless before going to jail, you're not considered homeless for treatment-eligibility purposes -- even though many if not most of them have no place to live anymore when they get out of jail, which is pretty typical."
As for how these extra beds are to be paid for, Barr notes that it costs $70,000 a year to keep someone locked up at Rikers Island, but only about $12,000 to provide them with a year of residential treatment at a Mentally Ill Chemically Addicted program.
She says she's optimistic the coalition will win the suit - eventually. "Some of these cases can drag on for years," she said. "But it's so clear, in this case, that the state is denying people with specific disabilities the same care as others, like people with just substance-abuse problems, that we pretty much have to win. That's illegal. It violates the Americans with Disabilities Act, among other things."
The full text of the complaint (in PDF format)is available on the Web site of the Washington, D.C.-based Bazelon Center for Mental Health Law, another of the groups that filed the suit against Governor George Pataki and other New York officials.
The complaint is being brought specifically on behalf of two incarcerated parolees, William G. and Walter W., and the class that they represent of mentally ill parolees in New York City jails waiting for community treatment. The parole officers of both the two recommended MICA treatment for their serious, long-term mental illnesses (schizophrenia and major depression, respectively) with accompanying substance abuse problems. But the two have remained at Rikers respectively for seven and nine months to date, while they wait for the elusive MICA beds to open up. For Walter W., indeed, the wait could well be too long - the state's parole hearing officer in charge of Walter's case, while he agreed back in May that such treatment is the most appropriate option for Walter, has also said that if no such bed opens up, Walter will be sentenced instead to time in a state prison.
Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.
Since this health column last reported on the plight of the millions of uninsured and under-insured people in New York and across America, the situation has, unfortunately, gotten worse.
Health care costs are soaring once again; insurance premiums are rising at double-digit rates; the economy, despite all the current administration's talk of a recovery, seemingly remains stalled in the doldrums; states are in fiscal crisis; and continuing layoffs have yanked from millions more Americans the employer-provided health insurance they once took for granted. A September 30 report from the U.S. Census Bureau revealed that, between 2001 and 2002, the number of uninsured Americans rose sharply (by 2.4 million) for the third year in a row. That means 43.6 million Americans, or more than 15 percent of the population, now lack even basic health coverage. Millions more are underinsured. In New York State, the percentage of uninsured is higher than the national average and the total well over three million people, most of them in New York City. According to the Institute of Medicine, already 18,000 Americans die every year because of inadequate insurance; as more lose their coverage, the numbers will rise.
But advocates of a universal national health system – at least, the optimists among them -- see promise amidst the general catastrophe. They are allowing themselves to hope that the erosion of health coverage among Americans who until recently considered themselves comfortably middle-class – and thought the lack of health insurance the problem mostly of a limited subclass of the impoverished, the disadvantaged, and the marginal -- will have real political repercussions in the forthcoming presidential elections and in the halls of Congress.
Voices ranging from liberal politicians to middle-class consumer groups to physicians can now be heard saying the same thing: that after decades of misfires – most famously Bill Clinton's messy failure ten years ago to achieve his campaign promise of universal health care – America, the last holdout, may finally join all the other countries of the industrialized world in adopting some form of national health insurance.
An NBC News/Wall Street Journal poll done in July did indeed find that health care costs ranked as Americans' top economic concern, cited by 24 percent of respondents. By contrast, only 16 percent cited high taxes as their main concern. The incumbent and the other would-be candidates in the next presidential election clearly feel pressure to respond. President George W. Bush and most of the major Democratic presidential contenders have each proposed health care reforms, ranging from Bush's plan for tax credits to help the uninsured buy insurance to the Democrats' various proposals to expand health coverage by rolling back Bush's tax cuts.
But all of these plans retain the basic forms of our current health insurance system -- for-profit hospitals and HMOs; private insurance companies that reap high profits and also spend considerable amounts (subsidized by the premiums of the insured) for marketing, overhead, executive salaries, and profit-sharing with investors; and great influence wielded by the hugely powerful and profitable pharmaceutical industry.
But a group of doctors has come up with a far more sweeping and radical plan, one which calls for a true one-payer, nationalized health service that would cover everybody, and that would (theoretically at least) redirect our vast health care expenditures from corporate coffers and back into health care services.
According to one of the proposal's authors, Chicago physician Dr. Quentin Young, American doctors have traditionally been conservatives when it comes to health care reforms, and they almost reflexively tend to oppose anything that smacks of government-administered health insurance. "But now even doctors are realizing that there's something worse than the government, and that's corporations," Dr. Young said. "Even people who have insurance, so-called 'good' insurance, are now finding their charges and coverage being questioned, because the insurance companies have discovered that simply not paying out claims is the best way to maximize their profits. Doctors can't provide their patients with the care they know is needed, and they're being harassed to death to justify what they do provide."
The plan was developed by Physicians for a National Health Service (PNHP), an organization of 11,000 doctors, many of them prominent. Two former Surgeons General and a former editor of the New England Journal of Medicine lead the group, which went public with its so-called "Proposal of the Physicians' Working Group for Single-Payer National Health Insurance" at a press conference in New York in August. The next day, the proposal appeared in the Journal of the American Medical Association (JAMA 8/13/03), which some in the group see as a victory in and of itself, although a spokesman for the (generally conservative) American Medical Association said that the AMA itself still opposes a single-payer health care system. (The AMA has a long history of battling government-administered health insurance; for example, it opposed the creation of Medicaid in 1965.)
The plan, which has now been endorsed by more than 10,000 physicians, calls for a government-financed national health insurance system that would cover every American for all necessary medical care from infancy to death. (In essence, it would be like an improved, expanded version of Medicare, but available to all, not just the elderly and disabled.) Prescription drugs, mental health care, and long-term care would be covered. The government would administer the plan, but most doctors and hospitals would remain private, and patients would be free to choose any physician or hospital they wished. Health professionals would decide what services should be covered, based on the latest medical evidence. Private insurance companies would still exist, but could only provide insurance for services such as elective surgeries that would not be covered by the government plan.
The full text of the proposal, which contains further details and cost-savings analyses, can be read online here (In PDF format).
The proposal criticizes the incremental, piecemeal health reform plans offered by Bush and the main Democratic presidential hopefuls.
"Proposals that call for tax credits or that push seniors into private HMOs all retain the role of private insurers. They are doomed to failure, because they perpetuate administrative waste, and make universal coverage unaffordable," said Dr. Oliver Fein, chairman of the New York Metro Chapter of PNHP, who presented the proposal at the New York press conference.
The plan's authors claim that single-payer national health insurance, far from increasing health care costs, would save at least $200 billion each year by eliminating the high overhead, marketing, profits, and administrative costs that private, for-profit insurers divert money to (rather than spending it on actual health care services).
"We spend $1.6 trillion on health care each year, which is one-seventh of our Gross National Product. That would be a very high cost for an excellent health care system; and what we have is a rather poor one," Dr. Young said. "Compared to countries that spend far less than we do, America scores very poorly on the standard, accepted indices of public health."
But is America, the sole holdout among industrialized countries in terms of adopting a national health plan, ready for such sweeping change?
"Well, I'm old enough to remember the civil rights movement, and anybody who predicted that before it happened would have been laughed at as some utopian dreamer," said Young. "I would say that the conditions for mass social change are ripening. There's a vast discontent out there with the current system, whose weaknesses are being starkly exposed right now. It will take a monumental effort, and a change of administration, for this to happen, but I think in the end it will."
Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.
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.
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.
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.
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.
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 â€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.
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.
ASTHMA INITIATIVE
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.
INFANT MORTALITY
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.
LACK OF MENTAL HEALTH SERVICES
"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.
A CAMPAIGN TO RECRUIT FOSTER PARENTS
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.