New Yorkers know devastation. When the Twin Towers collapsed nine years ago they saw that the blood supplies that might have been desperately needed could dry up in such a calamity. And then there are the disasters outside the five boroughs. When an earthquake rocked Haiti earlier this year, killing hundreds of thousands of people, the Haitian community was struck, too, and New Yorkers lined up to give blood so they could do their share.
Giving blood is one of those selfless acts without which our medical response capabilities would be greatly crippled. In short, it is a public service by citizens. It also is something denied specifically to any man who has had sex with another man.
In the early days of the AIDS epidemic, the federal Food and Drug Administration instituted a ban on gay men with multiple sexual partners donating blood. The agency later expanded that to any male who had slept with a man since 1977.
This federal policy has held fast in the face of changes in our understanding of HIV/AIDS and ability to screen blood. Now, however, movement is building to change the policy.
Put simply, the Food and Drug Administration instituted the ban when knowledge of how HIV/AIDS was communicated was not well known, and AIDS was considered predominantly a "gay" disease.
"It's a broad over-classification and an exclusion of an entire group of people," said Nathan Schaefer, the director of public policy for the Gay Men's Health Crisis, a New York City-based organization providing prevention and care services for people affected by HIV/AIDS. "This is really problematic because the nation's blood supply experiences shortages."
While he did not know of any current blood shortage in the city, Schaefer believes New York is vulnerable. The city faced a blood supply drought in 2007 and could encounter a particularly critical situation in the event of another terrorist attack. Given the many gay people in New York, the national policy of not accepting their blood has a disproportionate effect on the country's biggest city.
Earlier this month, the Health and Human Services Advisory Committee on Blood Safety and Availability voted against changing the policy after hearing lengthy testimony on the issue. The panel reportedly said that current research did not yet justify the lifting of the ban. The Red Cross, which runs blood banks, and other group administering donor programs have suggested men wait a year after having sex with another man to donate blood.
Federal policy on giving blood has evolved over the years. In 1990, for example, the Food and Drug Administration banned all Haitians from giving blood on the grounds that because many Haitian transmitted AIDS through heterosexual intercourse, it was more difficult to determine which Haitian were at high risk for AIDS. A few months later, in the wake of protests by Haitian-Americans, the government reversed the policy.
While he doesn't see a change this year, Schaefer believes the push to alter the policy is greater than it has ever been and is bolstered by the fact that, from a cold medical perspective, screening blood donors through a questioning process has become unnecessary.
"The advancement that we've seen in HIV screening and testing technology has been profound," Schaefer said. "They are able to detect HIV in donations of blood within several days."
The Red Cross uses a dozen tests to determine the donor's blood type and to screen for infectious diseases, including AIDS. "Today's technology makes it almost impossible for HIV to slip through, and the total ban puts a huge burden on blood agencies and the blood supply," said Mark Wainberg, author of a study of the policy, in a prepared statement.
A report by Gay Men's Health Crisis issued this year noted that several countries including France, Argentina, Italy and Japan have reversed similar policies and outlines the shortcomings of the current rules.
"Although the current policy purports to be based upon 'behavior-based' deferrals, the questionnaire [given to prospective donors] does not ask particular questions about an individual's sexual or medical history that would be directly relevant in assessing one's risk of being HIV positive. For example, the policy currently fails to take into account the varying level of risk of HIV infection posed by different sexual practices and does not inquire about the nature of a potential donor's prior practices," the report said.
"Similarly, the current questionnaire does not address a potential donor's consistent and proper condom use, universally agreed to be highly effective in preventing HIV transmission through all types of sexual activity, number of sexual partners or frequency of sexual contact with anonymous partners. This means that gay men who always practice safer sex, or who are in monogamous relationships with partners who are HIV negative, are permanently excluded from eligibility to donate bloodm" the report continues.
Barring gay men from giving blood has a measurable effet on the nation's blood supply,according to a recent report by the Williams Institute for Sexual Orientation Law and Public Policy at UCLA School of Law. The study restimated that the policy bans almost 7 million American men from gving blood and that removing it could add 219,000 pints of blood a year, an increase of about 1.4 percent. Restricing donations only from men who have sex with men within the past year would add 90,000 pints.
But the current ban also has broader social consequencesm according to Schaefer.
For one, it stigmatizes gay sex. Think of this way, Schaefer said: A heterosexual man arrives at a blood donation station. Before being hooked up, a screener asks a few questions, including whether he has ever had intercourse with another man. Because a medical professional has inquired about homosexual activity, this man could walk away with the impression that homosexuality should be considered a public health threat.
Schaefer believes New York’s gay community should get actively involved in this issue. “There would be an opportunity for New York to be very helpful here, investment by the gay and lesbian community to really partner with policymakers in the federal government,” he said.
The movement for change has the support of Christine Quinn, the openly gay City Council speaker, as well as U.S. Reps. Jerrold Nadler and Anthony Weiner.
Aside from the message the ban sends and and the fact that excluding gay men -- or even a man who has simply had one sexual encounter with another man since 1977 -- significantly reduces number of potential donors, the issue often comes down to fairness, as gay men believe it robs them of the right to contribute to society like everyone else.
Schaefer said that anger about the current policy has led to straight people on college campuses boycotting blood drives in solidarity with the gay and lesbian community. "This is really problematic, because what this then means is that not only are the gay and bisexual people not donating blood but a number of eligible young people are not donating blood," he said.
Natalie Hunnicutt’s first assignment as a pest control aide for the city, was, she recalls, also her most memorable: crashing a party of dozens of rodents at a Queens supermarket.
“There were rats scurrying left and right and I just thought â€Oh my goodness,’” the Brooklyn resident said. The pests were leaping over her feet and into a mountain of trash, the result of people using the store’s parking lot as a garbage dump. By the end of the day, Hunnicutt said she and seven of her colleagues removed about 400 bags of garbage from the site.
Hunnicutt continued to clean private and public properties with rodent problems for a little more than two years until the city laid her off in May.
“It hurt,” the 28-year-old said about the pink slip. In her job, she said she was “cleaning up communities and making a difference. I was keeping New York City clean.”
The Department of Health and Mental Hygiene, where Pest Control Services resides, laid off Hunnicutt and 48 of her coworkers. That will save $1.5 million, according to the department. It will leave the department with 41 workers.
Beyond saving money, however, the city says the layoffs are part of a plan to restructure the bureau’s rodent control program. Rather then cleaning lots in response to complaints, the health department has a new project called rodent indexing, which, it says, can control the rat population with fewer workers. Union leaders and some City Council members, though, remain skeptical and warn about a potential vermin crisis in New York.
Rodents are preponderant, albeit unwelcome, residents of the city. New York has consistently been named the city most at risk for rodent infestation, according to several reports released over the years by d-Con. The two research scientists who coauthored the 2009 Rodent Risk Report said with New York’s aging infrastructure and high population density, it is no surprise rodents run rampant here.
“The average person does not see much of the infrastructure, some of which are underground,” Bruce Colvin, a rat expert and one of the report’s authors, said. “But rats see it and use that for travel and movement, such as sewers.”
Earlier this week, the health department released a study showing rats either currently infest or could easily inhabit half of the city’s subway lines. As many as 150 rats can live in the walls of a single station’s refuse room, the study found.
Despite that, health department senior research scientist Robert Corrigan told the Board of Health, subways are not the city’s most rodent-infested places. Parks, vacant lots and construction sites are also havens for the pests, he said.
Over the years, experts have offered widely ranging estimates of the number of rats in the city. While some have put the number at one rat per person -- for a total of about 8 million -- others figure there could be as many as almost 100 million rats. Robert Sullivan, the author of Rats: Observations on the History & Habitat of the City's Most Unwanted Inhabitants, has put the figure far lower.
Whatever the count, most New Yorkers would probably agree that there are too many rats living in their midst. In recent years, the city has tried to stem the number by responding to complaints, often made through the 311 non-emergency hotline. When a rat report is received, Pest Control Services would send out pest-control aides. If they found a problem, property owners could let the aides take care of it for a fee -- shared by the city and the owner.
With rat indexing, however, the health department says it targets rat infestations before a complaint is even made. During an 18-month period in the Bronx – from December 2007 to July 2009 – Pest Control Services inspected 30,000 properties in the borough three times. Combing through neighborhoods block by block, they used hand-held computers and mapping technology to find potential rodent issues.
When they detected a problem, workers gave recommendations to property owners to improve conditions, such as clearing clutter and debris or removing rat enticing garbage. The agency subsequently sent notices to those property owners. If they failed to comply, the agency issued a notice of violation and corrected the issue at the property owner’s expense.
Comparing numbers from the inspectors’ second and third visits, the department said infestations declined in every neighborhood. According to health department numbers, the indexing approach led to an 83 percent decrease in the number of properties with rodents during the Bronx pilot.
Citing its success, the city expanded rodent indexing into Manhattan in January. The health department said further expansion will depend partly on the project’s outcome in Manhattan. The department also said the results of the Bronx pilot program, indicate that the cutbacks in Pest Control Service would not lead to more rat infestations.
Fitz Reid, president of Local 768, a union of health workers, questions that reasoning. He said rat indexing is not proactive, as the city describes it, but “a passive thing [that] does not respond to the people.” He said with fewer workers less attention would be paid to services such as baiting and cleaning.
The department contends it will continue to answer complaints about rats, conduct inspections, perform exterminations and issue violations.
City Council members also have their doubts. Although he commended the department for being proactive with the indexing program, Councilmember James Vacca said he is not convinced the program will work since the health department has yet to give council members information on the impact of laying off pest control workers. Knowing New York’s history with rodents, “I don’t want to cut programs that keep [rats] at bay,” Vacca said.
Councilmember Peter Vallone said even in lean times, services such as pest control should not experience cutbacks.
“I’m glad [the health department is] using technology against an age-old problem, and perhaps that will allow for things to be done more efficiently in the future,” Vallone said. But he wants the health department to remember that “pest control is one of the things government needs to do that the citizens can’t do for themselves. That’s a quality of life issue that we need to provide necessary funding for.”
In theory, said Colvin, proactive approaches such as indexing are the most effective means to control rat infestations. But, he said, other cities that tried such preventative measures find it difficult to secure funds to sustain the effort.
That, he said, is because attention to pest control increases when there is a visible problem. That attention translates to political, and therefore, financial, support for extermination and prevention projects. In New York for example, it took rats overrunning a Taco Bell in Greenwich Village to lead to stricter restaurant inspections.
“There’s a myth that if we’re seeing rats, we don’t have to invest in rat control programs,” Colvin said, “That’s a fallacy that’s gotten cities into trouble. … Rat populations can rebound quickly within six months if risk factors are not continually targeted.”
If Colvin’s reasoning applies here, the health department could find it difficult to get steady funding for rodent indexing in the future. The department said it did not have the cost of the rat indexing program available.
From her experiences as a pest control aide, Hunnicutt said she also is skeptical about how well rat indexing will do.
"It's a given," she said, that reducing the workforce will make the siutation worse "because there's not an efficient amount of workers to get the job done. The work will always grow."
Hunnicutt said she has kept in contact with some of the other laid-off workers. Some of them have moved on, she said, while others are still coping with the job loss. But she said she rebounded pretty quickly. She applied for, and was offered and accepted, a janitorial position at the department of health.
Her first day, June 14, went well, she said, adding “I don’t have to deal with rats!”
With almost every city agency, the key word this spring has been "cut." Mayor Michael Bloomberg's executive budget calls for operational cuts and layoffs across the board to deal with the yawning budget gap, and the reductions could get worse depending on what kind of budget the state adopts.
One of the very few to see a substantial increase is the Health and Hospitals Corp. In announcing the massive cuts throughout the city on May 5, Bloomberg said he would give the HHC $350 million in order to help it close its $1 billion shortfall. The budget also includes $310 million in capital spending for the agency.
Yet , despite this increase for next fiscal year, the HHC has instituted $300-million budget containment plan for the next four years. Explaining the seeming paradox in a briefing on May 11, HHC President Alan D. Aviles said, "The protracted economic downturn, a substantial loss of federal funding, increasing numbers of uninsured patients, sky-rocketing fringe benefit costs and $240 million in cuts to our Medicaid reimbursements, have created a perfect storm that has saddled HHC with a projected $1.2 billion budget shortfall."
Aviles promised that the four-year downsizing plan was intended to cause the least pain possible. No hospital would be closed, and job cuts would focus on people with administrative titles rather than on caregivers. Some 3,700 jobs will be cut through a mixture of layoffs and attrition.
But Judy Wessler, the director of the Commission on the Public's Health system, a labor-community health advocacy group, said that there will be pain for the public, especially under a plan to close five child health clinics and one dental clinic.
"We are adamantly opposed to that," she said, even though HHC said it selected facilities that are under-utilized. "Any community-based primary care or dental care service are needed and should not be cut."
Shuttering these sites, the HHC said, would save $39 million over four years.
The HHC has a total budget of about $6.7 billion and operates a number of health facilities, including 11 hospitals and more than 80 community clinics.
The reorganization, Wessler noted, calls for contracting out some of the agency's management operations to private, which some might say makes more sense for a quasi-government operation like HHC than a mayoral agency.
But Wessler said that many city plans for privatization have been costly and ineffective. IN particular, she cites the CityTime palm scan time-keeping system for city workers, where consultants have charged the city hundreds of thousands of dollars each, helping to send costs to 10 times the original projections.
"Number one, there's not a cost savings and number two, it doesn't do what it's supposed to do," she said. "I think that as a rule privatization does not work."
The HHC, however, said it would save $141 million over four years.
The realignment plan may not mean the end of the HHC cuts. Should the state adopt a budget incorporating many of the cuts proposed by Gov. David Paterson, "it could still be very bad," Wessler said.
And then there's the federal government's commitments, such as the medical assistance payments many low-income people may receive through Supplemental Security Income.
"If, for any reason, these additional supplemental federal Medicaid funds do not materialize, we would be left with a deficit amounting to several hundred million dollars and that would lead to further, deeper and much more devastating cuts," Aviles said.
He recalled that the last time the system was in such straits 15 years ago public hospitals were up for sale. The courts blocked that action but it served as the impetus for an overall revamp of the system, which Aviles said has been largely positive.
Unlike the operational reductions on tap for other city agencies, the hospitals corporation's cost-containment plan is set for four years. Outside factors could improve the situation by then.
Part of what is draining HHC resources is the cost of uninsured patients entering and receiving care in the system. According to the agency, it serves 450,000 uninsured New Yorkers a year, The overhaul of the health-care system that President Barack Obama signed this year, which will provide millions of uninsured Americans health coverage, could very well ease that burden.
Others see possible hope in Paterson's proposed tax on soda and other sugary beverages. Wessler and Barry Liebowitz, president of the Doctors Council, which represents HHC doctors, think such a tax would not only push New Yorkers toward healthier eating and drinking habits but also would provide another revenue stream for public health.
The proposal though, has run into stiff opposition from the beverage industry, from The The Teamsters, which represents workers in the beverage industry, and from United Food and Commercial Workers Local 1500, which charges it would place a burden on poorer, urban consumers.
The proposed cuts come at a particularly critical times for the city's public hospitals and clinics. The backdrop for all of this is the closing of St. Vincent’s Hospital. "With the closure of St. Vincent's Hospital, the last vestige of a formerly vast Catholic healthcare system in the city, the viability of our public system, as the primary healthcare safety net for the most vulnerable among us, is all the more critical," Aviles said.
As a Catholic hospital, St. Vincent's turned away no one, making it more like public facility. Because of that, the HHC will have to pick up more of the slack in lower Manhattan than private hospitals. "The private sector has been less than good about taking care of people who are uninsured," Wessler said. "The public hospitals are going to have to continue their very important role."
Further, she noted, plans for Lenox Hill to operate a facility in lower Manhattan offered little consolation. "Lenox Hill has their own financial problems," she said.
Wessler said she heard reports that emergency rooms at Beth Israel and Bellevue have begun to overflow as a result of the closing, which many people in lower Manhattan feared would happen. But Patrick Bahnken, who as president of District Council 37 Local 2507represents city paramedics and emergency medical technicians, said that the 13 Fire Department ambulance tours that replaced the St. Vincent's tours, have not been overburdened yet.
"They're doing a hell of a job," he said of his members.
Javier Espinosa had not visited a doctor in 13 years. After crossing U.S.-Mexico border illegally desperate to find work to support his family in Hidalgo, Mexico, Espinosa has held numerous jobs such as bus boy, dishwasher, and deliveryman. But he has never had any medical insurance and could not afford any visit to a doctor’s office.
Having not seen his family for 14 years and struggling to make ends meet in a recession, Espinosa had a panic attack last year and rushed to the emergency room at Elmhurst Hospital in Queens.
"Usually when I get sick, I would just get some medicine from the pharmacy. But this time I thought I was about to have a heart attack,” said Espinosa, now a resident of Jackson Heights and a furniture finisher in a factory in Flushing. "I stayed overnight in the hospital and the bill was over $3,000."
Espinosa is one of the estimated 12 million undocumented immigrants in the United States who are not covered by employer-sponsored medical insurance or eligible for government-supported Medicaid. He hoped that, after months of heated national debate, people like him would finally be covered by the new national healthcare system. But Espinosa's hope was dashed on March 23, 2010 when the House of Representative, by a 219 to 212 vote, passed a healthcare bill with a provision to exclude anyone without papers.
The bill, known as the Patient Protection and Affordable Care Act, aims to expand healthcare coverage to 32 million Americans who are uninsured. The new law also will expand coverage for the poor, impose new taxes on the wealthy and bar insurance companies that refuse to cover people with pre-existing medical conditions. In 2014, it will create an insurance exchange to people who do not have insurance to shop for an affordable health plan subsidized by the taxpayers.
The new law, however, will not make undocumented immigrants eligible for publicly supported Medicaid, and it will not allow them to purchase insurance in the insurance exchange -- even if they pay full price with their own money.
Some believe that, just like access to abortion, coverage for undocumented immigrants were sacrificed in the negotiation over the legislation.
"The bill was passed virtually without any Republican support. So they had to get enough Democratic support to make it happen," said Mark Scherzer, legislative counsel of New Yorkers for Accessible Health Coverage. "So conservative Democrats, particularly from Southern and Southwestern states dictated a lot of the terms. That's why we saw not only the immigration provisions but also the abortion restrictions."
New York, long considered a progressive state when it comes to public policy regarding immigrants, is one of a handful states that still provide funding for Medicaid to undocumented immigrants.
In order to educate immigrant New Yorkers about healthcare access, The Center for Immigrant Health at New York University's School of Medicine has issued a brochure detailing the medical resources available to immigrant New Yorkers, documented or undocumented. They include Emergency Medicaid, Prenatal Care Assistance Program, AIDS Drugs Assistance Program, Child Health Plus B and treatment at all facilities under New York City Health and Hospitals Corp.
According to the Health and Hospitals Corp., New York City public hospitals and clinics annually serve 1.3 million predominately low-income New Yorkers, including nearly 450,000 patients who are uninsured. An executive order signed by Mayor Michael Bloomberg in 2003 protects immigrants' confidentiality when they go for medical treatment or seek help fro other city agencies such as the police.
But will the new law curtail these benefits?
"One of the wonderful things about the federal reform is that a lot more people are going to get coverage," said Scherzer. "But one of the hard things for a state like New York is that we have been offering extended coverage for a long time, and this new law is going to pull us back closer to the national standard. Some of our progress may be at risk. We are going to have to fight to make sure that we don’t get pulled back."
Back in Jackson Heights, Espinosa decided to come clean with the hospital about his status and sought help. After meeting with a social worker, he received a temporary Medicaid card.
"They asked me where I live, who I live with, who supports me and who pays the rent," said Espinosa. "I had no job and no money at the time, and they decided that I needed temporary Medicaid."
He was told to see a psychiatrist and given some medicine.
"They treated me well," said Espinosa. "The only problem is that it takes too long to get an appointment." Espinosa quit after three sessions of treatment for his panic attacks. In the meantime, he had developed some problems with his eyes and had to wait for two month to get an appointment.
"I thought I was going to be blind by the time I get to see the doctor," said Espinosa. Luckily, the problems went away before his appointment.
Unlike Espinosa, many undocumented immigrants take the issue of healthcare into their own hands and look for resources inside their own communities.
Evelyn Lim (not her real name), a native of Ipoh, Malaysia who now lives in Elmhurst, Queens, overstayed her tourist visa, which expired in 2003. She found a Chinese doctor in her neighborhood in a small private clinic that charges her $50 per visit. In her case, the $50 goes a long way because it covers her annual physical, which can cost up to several hundred dollars.
"I just walked into the clinic and asked them," said Lim. "They do blood test, urine test … everything for $50. He is doing the community a service."
While paying out of pocket to see a doctor is common in ethnic neighborhoods, Lim said sometimes there are "traveling doctors" who carry medicine in suitcases and go into communities to give away medicine. But Lim said she would not take anything from them because they might not be licensed.
Immigrants who are here legally also have concerns about the new healthcare law. In 1996 during the conservative anti-immigrant crackdown, the federal government established a five-year waiting period for new documented immigrants to access Medicaid. In the new law, that provision remains as an obstacle for new arrivals.
"Whether you move to a new place, the first few years you are acclimating, it is probably the toughest time," said Noilyn Abesamis-Mendoza, health policy manager of the Coalition for Asian American Children and Families. "A lot of people come here for other opportunities, to reunite with their family or economic opportunities, they are really here to make a better living for themselves. I think healthcare is probably very low in their priorities as far as why they come to New York.
"When you don’t give people things like healthcare access, they have to make tough decisions. Especially we are in a recession so when they think about it, sometimes their health takes very low priority,” said Abesamis-Mendoza. “If they don't have access to preventive healthcare, they won't be able to get better and help the economy come back up or just be productive residents of New York State, we lose out on that."
Experts on the bill point out that the proposed insurance exchange would be the solution for immigrants, since there will be no waiting period for that.
"Anyone who might have wanted to get Medicaid will be able to get in through an exchange and get decent coverage, at no cost if they are below poverty level," said John McDonough, a fellow in public health at Hunter College. "There will in fact be an affordable coverage option available for legal immigrants without the five-year wait through the exchange."
Calling this "an enormous breakthrough," McDonough said, "It is probably the best healthcare legislation for legal immigrants in the United States ever."
In the new bill, a new community health center trust fund will provide additional federal funds of $11 billion for the expansion of community health center programs. According to McDonough, this will make the new healthcare system marginally better for undocumented people than what exists now.
"For the most part, there are very, very few folks in the undocumented community who are going to buy their own coverage unsubsidized. … It's so expensive, they don't have the money to do it," he said. "But the law does make a very large infusion of dollars into federally-qualified health centers, which is a very important point of caring service for the undocumented folks."
The best solution for the undocumented, of course, would be legal status. But Espinosa, for one, remains pessimistic.
"To tell you the truth, I don’t see any hope," he said Espinosa. "I am waiting for Obama to do something. I am giving myself two years. If nothing happens, I will go back to Mexico."
Larry Tung is a Brooklyn-based journalist and media artist.
State trooper Paul Richter was lying on the ground, looking up at the man who had just shot him. Death seemed all but certain. The Queens-born Richter had been shot in the leg, arm and neck while checking out a vehicle that had been used in the robbery of a sporting goods store, and the shooter seemed ready to finish him off.
"Nah, he's dead," the shooter's accomplice said, giving Richter a reprieve. But the 1973 encounter in Lake Placid left Richter paralyzed for months. Eventually he was able to regain some function of his legs and can walk with the assistance of a cane.
Since then Richter has dedicated himself to helping people paralyzed by spinal cord injuries. "I've never got a penny for doing this. I can't golf anymore, so I spend my time and money this way," he joked.
Now, though, the program that Richter created -- the Spinal Cord Injury Research Board -- is slated to fall victim to the state's fiscal crisis. The board is scheduled to be phased out under Gov. David Paterson's 2010-2011 budget proposals. Supporters of the program say losing it will do immeasurable damage, not only to the field of spinal cord injury research but to the state's overall economy as well.
In 1998, with the help of friends and influential people like Christopher Reeve, Richter got the state to create the Spinal Cord Injury Research Board, which distributes research grants to facilities all across the state. To fund it, the state placed a surcharge on fines for moving traffic violation.
"It’s a self-sustaining program,” Richter explained. “It was an idea I had to try to raise money, and most spinal cord injuries result from automobile and motorcycle accidents."
Representatives of the budget office say the board is an unfortunate casualty of the state's dire financial situation. Facing a deficit of as much as $9.2 billion the administration says it needs to keep money from the surcharges in the general fund. The budget would cut $6.7 million scheduled to go to the board and instead keep it in the general fund.
Supporters of the board, such as Terry O'Neill, a friend of Richter's who helped get the bill that established the board enacted, say the state cannot do that.
"The statute is written very specifically, saying that the funds must be used for spinal injury research," said O'Neill. "Someone would have to rewrite the law, and I would like to know who that is, and I would go and confront them."
But Jessica Basset, a spokeswoman for the State Division of the Budget, contradicts that notion. "The money moves through the general fund first, and the law says a certain amount may be transferred into the (spinal cord) fund--up to $8.4 million. It provides a limit but does not provide a floor," she said.
According to Basset, the state intends to honor over 40 existing contracts that total over $25 million but will not be making any new grants.
Some advocates of the program say they have heard that the health commissioner Richard Daines does not think the program has produced clinical results that are immediately improving lives. Advocates admit they have not heard this directly from the commissioner but the notion is out there. Daines could not be reached for comment.
Jeffrey Hammond a spokesman for the State Department of Health, said that "some tough decisions had to be made during this difficult time." He said the program is being phased out but current contracts will be honored through 2014.
O'Neil has not heard anything specifically from Daines and suggests the cut may be symptomatic of how the budget process works. "I think if it worked as the process usually does the agencies were told to come up with things to cut, and someone just put it on the list to see if anyone protests," he said.
So now the supporters are protesting and publicizing how much they think the program has done in the area of spinal cord injury research. On Wednesday a group including O'Neill, Richter, Ratan and other experts in the field met with legislators to convince them to spare the program. Their final meeting was with representatives of Assembly Speaker Sheldon Silver's office. Silver has been an outspoken supporter of stem cell research. The staffers assured the group that they are looking at the value of each program slated to be cut in Paterson's budget but no guarantees were made to save the program. Sen. Neil Breslin who met with the group earlier in the day said it made no sense to cut a self sustaining program that is attracting more money to the state. He said he had written a letter to Sen. Tom Duane chair of the Senate Health Committee. The board, O'Neill said, "picked a very distinct problem -- nerves don't regenerate--and we've funded different ways of attacking that problem: pharmaceutical, physical therapy, robotics, cell transportation."
For Nancy Lieberman the benefits of the program are immeasurable.
A ski accident in 2007 left Lieberman a quadriplegic, unable to accomplish some of the simplest tasks, like brushing her teeth. As a powerful Manhattan corporate lawyer Lieberman was used to being in total control, but her accident left her at the mercy of others. Thanks to physical therapy involving the use of robotics, therapy she receives at a clinic partly funded by the state through the spinal cord injury board, Lieberman has been able to regain the use of her hands.
"Because of this therapy I can work. I can turn the pages of a book. You tell me how important that is to a lawyer. How do you quantify that? For the first time I can lie in bed and read the New York Times. How do you quantity being a mother with a 10-year-old son and being able to feed him breakfast?" Lieberman said.
Lieberman receives therapy at the Burke/Cornell Medical Research Institute. The process involves strapping her arm into the "wrist machine," as she calls it. Lieberman looks into a screen and is prompted to make certain motions. Repeating the motions builds strength where once she had none.
Usually, Lieberman said people with spinal cord injuries do not continue to improve three years after their accident, as she has. "The further out you go, what you have is what you get, but the opposite is true for me" she said, Because of the strength I have from the therapy at Burke I can now pull a door open. You tell me if that's worth funding."
"The weight the robots put on the nervous system allow the brain and spinal cord to repair and increase function,” said Dr. Rajiv Ratan, director of the institute.
Ratan said the program would not exist if it were not for the funding. He says the state provides a little over 10 percent of funding for his program but because of the state money his program was able to leverage grants from a bevy of other sources. He said the state funding led to his recruitment at Burke and has helped establish a network of researchers across the state who share data on what works.
"The state funds are a magnet for money into the state," said Ratan, adding that the state grants not only lead to grants from the federal and private sectors but also to the creation of more medical facilities and the recruitment of students into the field. "So it makes no sense on a moral level or on a strictly financial level" to cut the program, he said.
Ratan describes a 21-year-old who jumped into the shallow end of a pool and became paralyzed seven years ago. "Seven years later he has regained muscle function. We were able to restore function in ways that are really unheard of," he said.
Richter and his associates have been lobbying legislators on the effectiveness of their program. They point to research the Spinal Cord Injury Research Board funds at Columbia University, the University of Rochester and the University at Albany-- all programs that have demonstrated real results.
Stem cell biologist Sally Temple, whose research at the New York Neural Stem Cell Institute receives about 20 percent of its funding from the state program, won the 2008 MacArthur "Genius" award for her research into treating spinal cord injuries. She says losing funding could lead to layoffs of her staff. She said a number of her colleagues who were considering moving their labs to the region are now looking elsewhere because the program is in jeopardy. The state has built a reputation as a bastion for this kind of research since the program was formed in 1998 and now the network of researchers and the reputation hangs in the balance.
O'Neill and Lieberman both say the state should not cut back on funding for this kind of research at a time when so many veterans from Iraq and Afghanistan have suffered head, neck and spinal injuries. "How are we going to tell veterans that we can't fund this research?" asked Lieberman. "They are coming home from Iraq and Afghanistan paralyzed. Do we tell them that they have to live like that?"
Treating people so they can return to work also will save the state money in the long run, Lieberman notes. "They say Medicaid costs are killing the state," she said. "Well, I agree. So they should use the money and put people on these machines. Fund the research that has let me go back to work. I couldn't do anything, but now I'm back at work as a lawyer."
Ratan said the machines cost anywhere from $12,000 to $75,000 to purchase. His main concern is testing the machines to find out exactly which kind of spinal cord injuries the machines benefit and how long therapy should be used. He said plans were underway to start a study of robot therapy on 500 patients. Ratan said the study will not likely take place if the state funding program is canceled.
Lieberman says she knows it will take collaboration and work on a number of different therapies just to help her improve. "There is no silver bullet," she said. "Spinal cord injury is very complicated. No one is going to inject me one day and I will be able to walk the next day. My muscles are atrophied. I would need all sorts of therapy to get that back. It might not be stem cells; maybe robotics, all sorts of electronic stimulation to solve the problem."
But she has made real progress. She can now lift a toothbrush -- an electronic one at that -- to brush her own teeth. When her van is in the shop she now feels capable enough to take the bus home by herself. And she credits all that improvement to the therapy she receives at Burke. She just hopes more people will get the same chance she had.
"I met a man who said the state pays $300,000 a year for his care. Why can't we take that money and put people on these robots?" asked Lieberman. "Think of the money. You can't quantify that -- giving someone back the ability to support themselves."
New York City, you have a problem.
Yes, like the thousands of shopaholics or compulsive credit card users, you have racked up some serious debt. And now some advocates want to cut you off.
During the first two terms of the Bloomberg administration, the city's capital budget ballooned from about $24.8 billion to $45.5 billion -- an increase of more than 83 percent. In that same time period the amount of money the city paid in debt service every year increased from $2.4 billion to $5.4 billion. In the mayor's $63.6 billion budget proposal for fiscal year 2011, nearly 9 percent is dedicated to paying off the city's capital debt.
And it doesn't stop there. By fiscal year 2014, the city could be paying about $6.9 billion in debt service.
For years, Mayor Michael Bloomberg has bragged of his commitment to capital investment. He has said he would not abandon the city's infrastructure -- in fact, he would make its renewal one of his top priorities.
Now that those investments have been made, budget experts wonder whether they were the right decisions. The size of this plan has some of them worried.
"What you see in 2010 is record high commitments," said Maria Doulis, a senior research associate at the Citizens Budget Commission, who has called for the mayor to cut back on the capital budget. "They should figure out what their priorities are and adjust accordingly."
The Bloomberg administration has made some strides in the last several years to get its debt service under control -- such as paying off debt with surplus dollars and stretching out the capital budget from four to five years.
But experts wonder whether these actions are enough.
Last week, Marc LaVorgna, a Bloomberg spokesperson, said the administration would not turn its back on economic growth. In a struggling economy, city-fueled development helps create jobs. The administration, he added, will not make the same mistakes of the 1970s era New York City -- when streets and economic development deteriorated.
Nonetheless, some members of the administration acknowledge that there is a problem and it needs to be addressed.
On Thursday at the start of the City Council's hearings on the preliminary budget, Councilmember Domenic Recchia, the council's new finance committee chairman, wondered just how big that problem really is.
"Are you requesting we reduce it more, cut the capital plan in half?" asked Recchia.
The city's Budget Director Mark Page responded: He'd take a rain check.
"As a practical matter, I think it's too much to deal with in the next few months," Page said of the city's rising debt. "In the long run, I think the long term cost of debt service as a fixed cost in New York City is a serious problem for us."
The current fiscal year has the largest proposed capital budget commitments in all of Bloomberg's tenure -- projected to top more than $14 billion. Funding is going to resurface 3,700 miles of roadway, at the cost of $689 million, more than $11.2 billion will go to school facilities construction and $646 million for the Newtown Creek Wastewater Treatment Plant.
While debt service is often referred to by the administration as an "uncontrollable cost," it is linked entirely to the size of the capital budget, said Page. If the city cuts the capital budget, then its debt service obligations will also go down.
The record high commitment this year comes despite stretching the budget from four years to five and cutting 27 percent from projects funded with New York City General Obligation and New York City Transitional Finance Authority bonds last year.
While some of the overall increase during the Bloomberg administration has to do with the mayor's priorities and his commitment to updating the city's infrastructure, some of the rise originated outside of City Hall. When the state started matching the city's allocation for school construction, the department's capital allocation effectively doubled, said Doulis. The building boom also caused construction costs to spike, increasing the cost for the city's projects, Doulis added.
Beyond that, she said, the administration substantially increased funding for capital projects for parks, public buildings, hospitals and environmental protection even when adjusted for construction cost increases.
Doulis would like to see the city cut back on capital spending, though she would not detail a specific target.
Those in the construction industry, however, side with Bloomberg.
"Our infrastructure is the circulatory system of what keeps our economy moving and growing and thriving," said Felice Farber, the director for external affairs at the General Contractors Association of New York. "If we're not building it or maintaining it, it's going to cost us more in the long run."
Farber suggested the city commit to completing projects on time instead of cut capital spending. The longer a project is delayed, the more likely the cost of construction could increase, making the entire project more expensive. Nearly two years ago the city and the association agreed to a pilot program that would penalize the city if it were at fault for delaying a project. The city already penalizes contractors if they are at fault for delays.
That program, which was set back when the capital budget was cut last year, just got started in January and covers $5 billion worth of projects, according to the administration. But Farber thinks it will help keep projects on time and on budget.
More than half of the construction trade in the city is supported by city funds right now, Page said last week. With the recession, it's hard to imagine what would happen if the city started cutting capital too.
In the lobby of the Service Employees International Union Local 32BJ’s lower Manhattan headquarters on Feb. 10, senior citizens with oxygen masks who might lose their closest hospital gathered with paramedics, nurses and doctors who might lose their jobs. They came to hear the city’s highest elected officials -- everyone with the notable exception of Mayor Michael Bloomberg -- express their outrage over the imminent closing of St. Vincent’s Hospital in Greenwich Village, their shouting often competing with the voices of parents of various ethnicities trying to sooth their coughing children with winter colds.
New Yorkers are used to hearing doomsday calls and cries that the closing of this or that institution will cause irreparable harm to the city, and the cynical newsreader often walks away unimpressed, sure that at the end of the day it will be no big deal. But community activists, health care experts and many local officials said, to put it bluntly, that the closing of the St. Vincent’s Hospital is a big deal, and a sign of an intensifying contraction of the already overburdened health-care apparatus in the five boroughs. This, they fear, will lead to chaos, a spike in avoidable fatalities and an inadequate response to a future disaster, natural or otherwise.
Start with the immediate impact. Assuming St Vincent's does close, if you live, work, or spend significant time in the West Village, Chelsea or Soho and you have a heart attack or any other kind of serious medical emergency, an ambulance would have to take you across town to Bellevue, a public hospital, or Beth Israel. Alternatively, the emergency medical technicians could head south to New York Downtown, which is also a long trip. Medical responders note that all of these facilities are already overburdened with patients, meaning that, if they have to take on more, ambulance response capability and quality of emergency care in the entirety of lower Manhattan could plummet.
Residents of the East Side are worried, said Jo Hamilton, chair of Community Board 2, which represents Greenwich Village, noting that her constituents have the support of Community Board 6, which represents part of the East Side. "They're very, very concerned about what the impact of this closing is going to have on their hospitals, which already filled to the brim," she said. "So where are those 60,000 emergency visits that St. Vincent's has every year, who's going to absorb those?"
Stopping short of invoking 9/11, Hamilton noted that St. Vincent's is a Level 1 trauma center, meaning it is equipped to handle the highest level of care to trauma patients, who often require a number of different types of treatments. "God forbid any kind of a disaster be it natural, or another -- I don’t even want to say it. If anything major happens, this is the place that is actually equipped to service those kinds of emergencies," she said.
Manhattan Borough President Scott Stringer, speaking at the 32BJ event, said, "This is the hospital that was ready to roll during the terrorist attack, and every day is ready to help if you have a heart attack."
St. Vincent's is a Catholic institution that turns away no one. The hospital incurs the cost of treating uninsured patients every day, resulting in a massive financial loss that has reached a breaking point.
In short, St. Vincent's is a victim of the bigger problem of the American privatized health-care system. Two hospitals in Queens -- St. John's and Mary Immaculate -- closed a year ago after falling into bankruptcy. According to Patrick Bahnken, who as president of District Council 37 Local 2507, which represents Fire Department paramedics, this has put a strain on both the 911 system and the other medical centers in the borough. Specific numbers are unavailable, but the Mayor's Management Report released last week found that citywide "ambulance response time to life-threatening medical emergencies increased three seconds to six minutes 39 seconds, while fire unit response to these emergencies remained the same at four minutes 14 seconds."
St. Vincent’s, like the two Queens hospitals, cannot reconcile the goal of serving the public good with staying in the black, and its closing would cause similar problems beyond its immediate surroundings. The lack of long-term thinking on how to keep the hospital alive only highlights just how broken the entire health-care system is. Gov. David Paterson has established bridge loans to the hospital, which, if we're lucky, will have kept the place running as you read this article. In the meantime, he's meeting with unions, creditors and other stakeholders.
On Friday, the hospital began laying off some 300 employees, including managers, unionized workers and medical residents. The hospital has also instituted a temporary 20 to 25 percent pay cut for non-union workers, and it proposed a temporary 15-percent pay cut for 1199/SEIU members, which the union is considering if it can stave off closure.
The hospital could switch hands, meaning that it would no longer be a Catholic hospital, but could still provide care to the surrounding community. One group has already pulled away from doing this, but even if that deal had gone through the hospital would have been converted to an outpatient facility, resulting in the same strain on the emergency response grid.
The hospital, in conjunction with Rudin Management Co., proposed leveling the hospital's signature O'Toole building to build a new medical center and condominium. The deal could provide the hospital with much-needed revenue, and Hamilton expects to hear about the approval in the spring. But in the meantime, it has become irrelevant. "This is completely on the back burner,” she said. “It’s more important at this point to save the hospital."
The plan was controversial. "From the beginning, critics have assailed the mass and height of the proposed towers and their impact on the historic neighborhood, while the hospital’s supporters underscored the need to upgrade St. Vincent’s," the New York Times observed.
After much controversy and some modifications, the Landmark's Preservation Commission endorsed the plan, but it still needs approval from the City Council.
Bloomberg's absence from the discussions involving St. Vincent's future has disappointed community groups and unions (3,500 workers would lose their jobs). Stringer, along with Comptroller John Liu and Public Advocate Bill de Blasio -- all of whom are seen as likely mayoral candidates in 2013 -- won applause at the 32BJ meeting by pointing the finger at City Hall, accusing it of inaction.
"I'm tired of people telling me every time there's a recession or a budget cut that the most vulnerable will have to pay this price," Stringer shouted.
De Blasio said the city and state should "help us put together the building blocks to save this hospital. Because if you don’t, we’ll look back for decades and say, 'How did this happen on our watch?'"
With the crowd on their side, the officials pleaded for the city to do something.
What? No one knows, and if three mayoral hopefuls cannot offer an alternative to the mayor’s silence, Bloomberg probably cannot do much either. He has already proposed cuts in city services, so a city bailout at this point seems unlikely at best. The reality is that the closing of two hospitals in Queens and the fate of St. Vincent's are not isolated incidents but part of a system failure. All the city’s private hospitals could be threatened by the American notion that health care must generate revenue. That is something a Community Board chair or even a mayor who has made public health one of his top priorities cannot change.
Ari Paul is a reporter for The Chief-Leader, a weekly newspaper covering city government and the civil service, and a correspondent for Free Speech Radio News.City health officials have now rolled out a voluntary program to reduce the salt in foods. This follows the ban on transfats, the requirement that many menus include calorie postings and the removal of junk food and soda from schools. All of these efforts are geared to steering consumers toward healthier choices. But questions remain about how much effect these measures can have on public health problems like obesity and diabetes that are related to the food that people eat.
For example, though preliminary surveys show some people make healthier choices based on calorie postings the findings are inconclusive, and an October 2009 study published in the journal Health Affairs found many fast food restaurant and frozen foods processors underestimate in their posted calories counts. Unhealthy choices -- usually foods that are sweet, salty and relatively cheap – are pervasive, especially in wide swaths of the city known as "food deserts," where fast food prevails, while access to fresh fruits and vegetables is limited. These areas have the highest levels of obesity, diabetes and other food-related diseases, and they tend to be low-income and minority neighborhoods.
To address this, many cities are moving aggressively to shape broad policies on food systems. They are using land use regulations to restrict junk food outlets, and to promote urban agriculture and community gardening. Since access to healthy food varies greatly by neighborhood, many cities are working with the most affected communities on plans and strategies for change. New York City is not there yet. So far, it has not yet expanded its focus to go beyond consumer choice and include access.
However, Mayor Michael Bloomberg has hired a food policy czar and formed a Food Policy Task Force. And City Council Speaker Christine Quinn has said she will roll out a policy agenda for food this spring that will address the question of access in a more comprehensive way. The question now is how far these efforts will take the city toward a more holistic food policy.
City food policy has yet to focus on the supply side of the equation -- improving access to healthier foods, especially in the food deserts but also in areas where good choices are available but not affordable.
This theme emerged from the recent New York City Food and Climate Summit, sponsored by Manhattan Borough President Scott Stringer and an array of non-profit healthy food groups. The conclave, which drew hundreds of people from throughout the city, followed an earlier Stringer report on food policy and his 10-point NYC Food Charter: 10 Principles for a Sustainable Food System.
The city already has some of the building blocks in place to expand the supply of healthy foods. The Council on the Environment sponsors 51 green markets, but they tend to be located in areas that already have good access to fresh food. In addition, many are open only once a week, most are seasonal and not all accept food stamps, which 1.1 million New Yorkers rely on to buy food.
The city's http://www.greenthumbnyc.org/Green Thumb program supports over 600 community gardens throughout the city, and many of them supply produce to gardeners. The city’s health department launched healthy bodega and green carts initiatives in neighborhoods where access to healthy foods is particularly limited, but these are limited in scale and have produced mixed results. And the city’s botanic gardens help train people to do their own composting, which can create soil for local gardens.
So far, however, city has not connected the dots to both increase the supply of healthy food and focus on food deserts. In the policy arena, food was noticeably absent from Mayor Michael Bloomberg’s long-term sustainability plan, PlaNYC2030, released on Earth Day 2007.
Meanwhile, the city’s ongoing development efforts have undermined access to better food. For example, the city has been shutting down the Depression-era city markets that were mostly located in working class neighborhoods and could have filled the gap in the food supply. For example, the Bronx Terminal Market was recently converted to a shopping mall and the city has not been able to make places like La Marqueta in East Harlem or the Essex Market on the Lower East Side into major centers for low-cost healthy food let alone multiply that model throughout the city.
While many European cities have preserved their neighborhood public markets, New York has let them slide into disuse and instead encourages large supermarket chains. One of the most dramatic recent examples of the city’s developer-driven policies is the ill-fated city proposal to turn the Kingsbridge Armory in the Bronx into a suburban-style shopping mall with a supermarket that would have driven out of business many well-established local markets.
On the surface, it might appear that the city is moving in the right direction with its recent initiative offering tax and zoning incentives to supermarkets that locate in food deserts and older manufacturing areas. But this effort may do more to help supermarket giants find cheap land than it does to improve access to healthy food, as I have previously suggested.
The problems with this initiative are emblematic of the upside-down land use policy regarding food access. The new initiative can pave the way for giant retailers to move into low-income areas that are in transition to upper income communities, helping to push out the very people that are most in need of access, and thus not solving the problem of access. The 100 rezonings completed by the administration, fueled by the real estate bubble, helped pave the way for these changes.
The city’s supermarket program can also push out smaller local retailers, destroying the bodegas instead of helping them to offer healthy food and to become examples of healthy local entrepreneurship. And the zoning changes have made it easier for supermarkets to move into industrial zones, pushing out active industries because they escalate rent levels and cause traffic problems. The supermarkets are allowed to have ample parking, encouraging more driving and energy use at a time the city claims it wants to reduce traffic.
While the chain supermarkets do tend to carry fresh produce, there is nothing in the law that will prevent them the stores from stocking almost all of their shelves with industrially processed food with lots of sugar, salt and other mysterious ingredients. The program offers no incentives or subsidies for green markets, community gardens, consumer cooperatives or other media for healthy food. And it does nothing to expand the production of food in the city.
At first sight, the idea of growing food in New York City might seem absurd. The island of Manhattan is densely populated. Much of the soil throughout the city is contaminated. And even though there were working farms in all five boroughs only a century ago, few New Yorkers have practiced farming.
Yet urban farming occurs throughout the world in cities as densely populated as New York, and it is growing in places where governments help out. According to City Farmer, 40 percent of the population in Vancouver, Canada, a city of 1.6 million, grow food. Vancouver also has 1,000 community gardens and a food policy that encourages the production and distribution of local food, which also reduces transportation and energy costs.
New York City has 52,000 acres of backyard space in New York City that could together provide vegetables for 700,000 people, New School Professor Nevin Cohen, a leading expert on urban agriculture, said at the Food and Climate Summit. There are no city programs to help cultivate them or to systematically promote community efforts.
Just Food, a local non-profit, helps create Community-Supported Agriculture groups that buy directly from local food producers in the region. The city’s zoning regulations are fairly open, permitting agriculture in most residential districts.
While proposals for vertical farming on Manhattan-sized skyscrapers may be literally "pie-in-the-sky," no one in government seems to be looking at the more possible alternatives of farming in the outer boroughs, where some 30 percent of land is public right-of-way, much of it unused or underutilized, and much of it in food deserts. Throughout the city, many parks, schools and other community facilities could host urban farms and composting operations, train a new generation of urban farmers, make healthy food more accessible, and expand the choices for the majority of the population.
In urban Milwaukee, Will Allen created an urban farm that does all of these things and has become a national model. We need to learn from these experiences and then do it here on a large enough scale to make a difference.
This article originally cited the number of neighborhoods where the Green Carts and Healthy Bodega programs exist. That information has now been corrected.
Tom Angotti is Professor of Urban Affairs and Planning at Hunter College, City University of NY, editor of Progressive Planning Magazine, and a member of the Task Force on Community-based Planning.
(Earlier this month, the Bloomberg administration announced a new initiative aimed at encouraging food processors and restaurants in New York and across the country to cut back on salt in the foods they sell. This one of two commentaries on the move. The other, in support of the plan, appears here.)
Mayor Michael Bloomberg is at it again with his "big government knows better than you and your doctor" attitude. He crusaded to ban smoking in New York City restaurants and bars, forced restaurants into posting calorie counts and promoted high-powered advertising campaigns against sugary drinks. Now, the mayor and his health department czar are demanding 25 percent reductions in the amount of salt in manufactured foods sold in New York City -- even hysterically comparing the popular seasoning with rooting out "deadly asbestos in the classroom."
Since manufacturers would have to change their entire food product line for New York City because of this aggressive assault against salt, Bloomberg's zealous effort will affect food policy for the entire country. Although claiming this is a "voluntary" anti-sodium campaign, his vicious and untrue comparison of salt to deadly asbestos is especially a stab in the back to the city's ethnic cuisine. It will soon affect millions of resident diners as well as tourists who visit New York City for its excellent food offerings.
"Say it's not our business?" the mayor grumped at a news conference. "I don't think so," he declared.
In recent years the U.S. Department of Health and Human Services has been asked to run a large-scale trial to determine the impact of salt reduction in the diet upon health outcomes in the general population. Yet this has never occurred. And since there has never been a conclusive scientific trial, what Bloomberg is "making his own business" is essentially his own egomaniacal experiment. He is placing New York City's population into the largest clinical trial ever, using its residents as guinea pigs without their consent.
Bloomberg and his health czar are again pushing a "one size fits all" model for New York City, ignoring that salt has important properties that preserve and stabilize food and, of course, often makes it taste better. Sodium cannot be manufactured in the human body, so all humans need some measure of salt. Isn't it better for Americans to be free to consult their own doctors about their salt intake r than have politicians and nanny state bureaucrats setting arbitrary government rules? What's next in Bloomberg's radical book of "health regulations"? A "bedtime" rule stipulating how long people should get their nightly rest?
By the way, one can conduct an intellectually honest debate over the pros and cons of Bloomberg's health crusades, but there's no argument that the mayor is a hypocrite for often openly indulging in junk food while at the same time attacking everything ranging from salt to sugary drinks. New York Times reporter Michael Barbaro recently listed the mayor's admitted "weaknesses," including burnt bacon, hot dogs, Big Macs, fried chicken, wine, pizza, coffee and his favorite snack of all, Cheez-It's. Think of all the sodium in all that!
New York Magazine's Chris Rovzar has mused that, because of the mayor's love of junk food and awareness of how hard it is to resist, hizzoner likes to set up "hurdles" like calorie counts and trans-fat bans for people who are subject to temptation.
Whatever the mayor's motivation, restaurant owners, chefs and their customers know that salt obviously makes certain foods taste better. Chef David Chang, owner of the Momofuku Noodle Bar, notes that cooks have been using varying degrees of salt with food almost as long as they have been using fire. "You need salt to draw flavor out of food," Chang says. "It is a skill that you teach cooks. For that to be regulated by the government is stupid and foolish."
Noma Dumich, former owner of the Manhattan French restaurant Sel Et Poivre ("Salt and Pepper"), which is now owned by her daughter and son in-law, further underscores that the city government is pursuing a restaurant-killing and job-killing strategy. "I'm very worried about what Bloomberg's campaign will mean to my family and other city restaurants," she says.
Research shows that over the past 30 years the only country that has ever reduced its salt consumption is Finland. Interestingly, though, when comparing cardiovascular performance and increases in longevity in Finland over the last 30 years with the rates in neighboring countries and the U.S., none of which lowered salt consumption, Finland's has had the worst performance of all. Could one therefore conclude that salt reduction doesn't provide any significant health benefits, and may actually lead to diminishing the health of a population?
That's one more reason why the My Food My Choice grassroots organization has emerged to join a growing number of New York City consumers, restaurant owners and food manufacturers in opposing Bloomberg's nutritional fascism. The group is calling for peoples' freedom of health choices, as well as asking the mayor to not treat his constituents as guinea pigs. Bloomberg ought to mull that over while munching on his Cheez-Its.
Orit Sklar is the national spokeswoman of the coalition My Food My Choice, a grassroots coalition of consumers and businesses that promotes the advancement of consumer choice in the marketplace and an environment of economic vitality.
(Earlier this month, the Bloomberg administration announced a new initiative aimed at encouraging food processors and restaurants in New York and across the country to cut back on salt in the foods they sell. This is the first of two commentaries on the move. Another, opposing the plan, appears here..)
The National Salt Reduction Initiative, a New York City-led partnership of cities, states and national health organizations, has announced its proposed targets for a voluntary reduction of salt (sodium) levels in packaged and restaurant foods. The goal of the initiative is to reduce the salt in packaged and restaurant foods by 25 percent over five years -- an achievement that would reduce the nation’s salt intake by 20 percent and prevent many thousands of premature deaths as well as countless hospitalizations for people with heart and kidney disease. Success would translate into major public health benefits in the U.S.
The sodium in salt is a major contributor to high blood pressure, which causes heart attacks and strokes, the leading causes of preventable death in the U.S. and, arguably, the world. Every year, heart attacks and strokes cause an estimated 23,000 deaths in New York City, more than 800,000 deaths nationwide, and cost Americans billions in health care expenses.
Using data derived from the 1988-91 National Health and Nutrition Examination Survey, the average dietary sodium intake for adults in the U.S. is estimated at 3,400 milligrams per day, with similar amounts for all races and ethnic groups. This estimated average, however, does not include discretionary sodium use, such as using salt when cooking or at the table. This discretionary sodium use is estimated to increase the average daily intake by about 15 percent. This means that the average American adult ingests almost 4,000 milligrams of sodium daily, a level that is way above the recommendation of the National Research Council that the average adult American consume no more than 2,400 milligrams of sodium per day.
A study using data from over 9,000 overweight American adults in the National Health and Nutrition Survey Epidemiologic Follow-up Study has shown that an increase in daily dietary sodium intake by 2,300 milligrams results in a 32 percent increase in risk for stroke, an 89 percent increase in death from stroke, a 44 present increase in death from coronary heart disease, a 61 percent increase in deaths from all cardiovascular diseases, and a 39 percent increase in death from all causes.
This study did not find a significant association between dietary sodium intake and risk of cardiovascular disease in people who were not overweight . However, since approximately 70 percent of U.S. adults are either overweight or obese -- with that proportion increasing steadily -- the data on risks for overweight people are very relevant to our population.
The statistics bear out what we know medically. High sodium intake increases blood pressure and that in turn increases risk for these blood vessel diseases. Importantly, the large INTERSALT study has shown that lowering sodium intake by 2,300 milligrams a day, from about 3,800 milligrams to about 1,500 milligrams correlates with a 3 to 6 mm Hg reduction in systolic blood pressure. Even a 3 mm Hg reduction for the general U.S. population should result in 11 percent fewer strokes, 7 percent fewer coronary events and 5 percent fewer deaths, reducing the number of heart attacks and strokes by approximately 126,000 a year and deaths by 44,000.
A 1999 statement by the National High Blood Pressure Education Program of the National Heart, Lung, and Blood Institute concluded that a clear causal link between dietary sodium intake and blood pressure exists. The group of scientists also stated that the evidence for this relationship is sufficiently strong to warrant a specific recommendation about reducing dietary salt intake. The American Heart Association and American Medical Association have also called for reducing salt intake.
As with transfats, which New York City banned in restaurants in 2006, people do not go to restaurants with the express purpose of eating more salt. In the vast majority of cases, most people will not even miss the extra salt.
Millions of Americans live with congestive heart failure and kidney insufficiency. For them, excess sodium intake can result in life-threatening and costly hospitalizations. Despite this, food processors and cooks continue to add unnecessary salt to food, making it more and more difficult to obtain a low-salt meal at most restaurants without considerable effort. Many people with heart or kidney problems cannot experience the enjoyment of eating out because of the relatively high salt content of many restaurant foods.
The New York City-based initiative to reduce salt consumption by working with the food and restaurant industry warrants implementation immediately. Just as restrictions on smoking in public places have led to major health benefits, this initiative should have a similar impact on health without detrimental impacts on the food economy or on the delight people take gain from eating at their favorite restaurants. This is also a very cost-effective approach that is consistent with current efforts taken in Washington and individual states to improve the nation’s health without increasing our national debt.
Robert C. Block, MD, MPH, is a member of the Department of Community and Preventive Medicine and the Department of Medicine, Cardiology Division at the University of Rochester. John Bisognano, MD, PhD, is with the Division of Cardiology, Department of Medicine at the University of Rochester and president of the New York chapter of the American College of Cardiology.