End of Year Celebrations & Reflections

Before the tragic events of last week, there were several major pieces of health news. Each gave us cause for a moment of celebration and a moment of reflection.

Childhood Obesity Decreasing for the First Time in Several Cities

First, the New York Times reported last Monday that several large cities, including New York City (NYC), have seen declines in childhood obesity rates for the first time. Before this, obesity rates were going up every year. NYC first celebrated this tide change one year ago. However, the Times article was a nice reminder that we are not alone. Philadelphia, Los Angeles, and El Paso also achieved some level of success with obesity prevention programs.

This is some of the first good news in the obesity epidemic, but it but it also reminds us how much work is left to be done.  Declines were relatively small, just 3%-5%. We still have a lot of overweight and obese children who are likely to develop health problems over the course of their life.  Also, in NYC, obesity rates among white children declined much more than blacks (13% versus 2%). That means we have lots of work to do to ensure that health programs and their benefits reach ALL of our children. Luckily Philadelphia shows us that this is not an impossible dream. Even with higher rates of poverty, their obesity rates dropped the most among minority children.

New Yorkers are Living Longer

Last Tuesday, Mayor Bloomberg announced that life expectancy in NYC hit a record high. Babies born in NYC in 2010 can expect to live on average two years longer than babies born in other parts of the country. The NY Post suggested that the city has become a “fountain of youth”. NYC Health Commissioner Thomas Farley credited the city’s efforts to reduce infant mortality, detect and treat HIV, and address heart disease and cancer through improved health care and anti-smoking efforts for the city’s success.

While we agree that increased rates of life expectancy are good news, a closer look at the data shows that not all New Yorkers benefited equally. While Hispanics can expect to live to be 81.9 years old, non-Hispanic Whites live 6 months less on average. Life expectancy for non-Hispanic Blacks is only 77.4, a difference of more than four years. Over ten years the gaps between groups shrunk somewhat. However, similar to our work around childhood obesity, we clearly have a lot more work to do to make health equity a reality.

Life Expectancy Improving Faster in Other Countries

Finally, last week the news media widely covered a report about life expectancy worldwide. Across the globe, many more people reach old age as compared to 20 years ago. Life expectancy is increasing, because deaths from malnutrition and infectious disease are significantly down. As a result, infant mortality has also been cut in half.

While celebrating these improvements, we noted two important facts. First, as fewer people die of hunger and infectious diseases, more people have chronic diseases such as obesity, heart disease, and diabetes. More and more, we are not alone in addressing these problems and the related health disparities. Second, life expectancy in the U.S. went up over twenty years, but not as much as in other places. Countries including Cyprus and Canada saw greater improvements than we did.  As we develop new programs, we should consider what we can learn from other countries. 

Learn More

For the most part, media coverage of these stories reported the numbers without digging very deeply into what they really mean. For more insight, we recommend a story published last summer in the Lancet, a highly respected British medical journal. The article describes disparities in life expectancy in NYC, how they stack up globally and historically, as well as what’s being done about it in the Bronx.

As always, we invite you to visit the Bronx Health REACH website to learn more about what we are doing to make health equality a reality.

Churches – still a beacon of hope as communities undergo changes both good and bad.

In an open letter from President Obama addressed to African American families in the November 2012 issue of Ebony magazine, the President begins thus, “ As a young man , I got my first start working with a group of churches on the South Side of Chicago, helping families who had no place to turn when the local steel plants shut down.  I worked with local leaders to rebuild neighborhoods, improve schools and, most of all, to broaden opportunities for people who felt like it was slipping away.”  In reading this I was reminded of the fact that time and time again it is the churches in so many hard hit communities that are the mainstay of those communities.  They stock and staff the food pantries that feed the hungry. They educate the children of the poor or at least supplement the diabolically inferior education provided by many of the local public schools (read any of Jonathan Kozol’s seminal works such as Savage Inequalities to get a first-hand description).  They rehabilitate neighborhoods that more look like the bombed out neighborhoods of Beirut than cities which are part of the greatest city in the world – New York.  It is ironic that it was the churches in New York through such efforts as the Nehemiah low cost housing program that kept many of those neighborhoods now being transformed by gentrification sufficiently intact to be now so desirable that they are the site of a feeding frenzy by vulture real estate developers. Many of these same vulture developers had bought buildings and boarded them up for decades, not caring how much it decimated the lives and real estate value of those who couldn’t flee and who clung to their American dream of home ownership. And, it was churches that operated the front lines in the battles against the scourge of crack/cocaine in those neighborhoods.

The church as an engine of change or, at least, a bulwark against the bleak social and economic forces that attempt to disembowel many of our neighborhoods is one we know well in Bronx Health REACH.  Within our community coalition we have a group of 47 churches of different denominations and sizes.  It is these churches that have been the mainstay of our efforts as we grapple with 18% of south Bronx residents diagnosed with diabetes. Many more are at risk for diabetes with the obesity prevalence rate at 31%.  Bronx Health REACH is founded on the partnerships that its parent organization, the Institute for Family Health, built with churches (as well as other community based organizations) to establish health centers in the south Bronx at a time when Medicaid Mills were the main access to health care ( I use ‘healthcare’ very, very loosely here).

Over the last decade, church leaders working with Bronx Health REACH have sought to embed health ministries in their churches.  They have either incorporated these ministries into such existing ministries as their men’s ministry, women’s ministry, youth ministry, nurses’ ministry, or have created new ministries with a singular focus on health.   A few weeks ago in San Francisco at the annual American Public Health Association (APHA) conference we presented on some of our faith based initiatives that have had demonstrable impact on some of the bleak statistics I cited earlier.

During the past year we have had visitors from the University of New Mexico, the UK and even from the Netherlands who wanted to come hear and see for themselves the work that the churches are doing in community health development.  They have explicitly remarked on the leadership role of the churches not only in the work they are doing in their respective congregations but in strongly advocating for systemic changes, most notably in ending segregated care based on health insurance status in academic medical institutions.

When the day arrives that the Bronx Health REACH slogan, “Making Health Equality a Reality’ is a fact of life it will in no small part be because of the movement that the churches in the Bronx led, and because they taught and fought to hold on to the promise of possibilities even when everything seems to point to away from that.  Their faith will have made us whole.

Charmaine Ruddock, Project Director of Bronx Health REACH

This post was previously posted on HealthCetera, the Center for Health Media & Policy at Hunter College's Blog, on November 27, 2012.

Healthy Holiday Meals – A New Tradition for Bronx Families

Turkey…mac and cheese…collard greens…cranberry sauce… sweet potato pie. Who’s excited for Thanksgiving and the holiday season?!  In three days, family, friends, and neighbors will come together for a wonderful day of amazing food, family stories, and football. After Hurricane Sandy, this holiday full of warmth and good food is definitely welcomed.

 

However, maintaining our weight and keeping our blood sugar down is not easy over the holiday season. For those of us who have diabetes, it is even more challenging. I discovered that the average American gains 3-5 pounds during the holidays. With over 11 percent of adults in the Bronx being diabetic, we cannot afford the extra weight.

 

In honor of Diabetes Awareness Month, I am taking up the challenge to prepare favorite family holiday recipes with healthier ingredients and to eat smaller portions during the holiday season. I hope my fellow Bronxites will take up the challenge as well. I know it is hard, but I believe it is possible. Many of us have been preparing healthier meals and reducing the amount we eat each meal for the last few years – and that’s great! But the holiday season does not mean it is time to go back to old habits.

 

Below are some healthy cooking and eating tips and healthy, diabetic-friendly holiday recipes that the Bronx Health REACH team has gathered over the years to help us create a meal plan for ourselves and our family and friends.

 

Healthy Cooking Tips

• Make eggnog with low-fat milk.
• Instead of using butter, lard or salt to give flavor to meat and vegetables, use canola or olive oil, lemon and orange juice, lemon peel, and herbs such as rosemary, basil and tarragon.
• Bake turkey breasts instead of the whole turkey. Remove the skin and fat from the turkey when eating.
• Try making lighter gravy using the turkey broth and herbs.
• Serve a salad with low-fat salad dressing as a first course.
• Serve 100% whole grain pasta, bread, brown rice and crackers.
• Serve cut up vegetables as a snack before dinner with low-fat ranch dressing or dips with low-fat sour cream.
• Make stuffing healthy by adding more vegetables like celery, peppers, and onions. Leave out the sausage.
• Make sweet potatoes without marshmallows. Sprinkle on extra cinnamon instead for flavor.
• Use non-fat milk, chicken or vegetable broth in mashed potatoes instead of butter or cream. Add garlic for flavor.
• Serve collard greens or spinach with very little or no oil. Use lemon juice instead of salt.
• Serve fresh fruit salad or low-sugar gelatin before serving pies and cakes.
• Arrange a buffet table so that the vegetables, fruits and whole grains are first.

 

Healthy Eating Tips

• Eat lunch. Have a small sandwich, fruit or crackers and lots of water before leaving home so as not to be tempted to eat three servings of your Grandma’s mac and cheese!
• Fill up on lots of vegetables and salad, but avoid large amounts of salad dressing, especially if it’s not low-fat! Filling up with vegetables will reduce the amount of meat, stuffing, and other high-calorie foods.
• Control the amount of each type of food you eat. By making healthy choices, we reduce our risk of diabetes and heart disease. For diabetics, healthy eating will help control blood sugar level.
• Drink water with a touch of lemon or seltzer instead of soda and fruit juice. High calorie sodas and sweet drinks can add hundreds of calories to the meal. If I must have a soda, I will drink diet soda.
• Don’t eat to make someone else happy. If someone offers more sweet potatoes with marshmallows or asks, “Did you taste my pie?” I plan to politely say, “I’m sure it’s delicious but I’m already full!” or only have one small taste.

 

Healthy and Diabetic-Friendly Recipes

 

Mac and Cheese Lite
Courtesy of Now Eat This! By Rocco DiSpirito

 

Ingredients

Nonstick cooking spray

Salt

4 ounces whole wheat macaroni

1/2 cup onion-garlic puree

1/2 teaspoon dry mustard

Pinch cayenne pepper

1 cup shredded 50 percent reduced-fat cheddar

1/3 cup nonfat Greek yogurt

1/4 cup whole wheat panko bread crumbs

1/4 cup grated Parmesan

 

Directions

Preheat the oven to 425 degrees. Mist an 8-by-8-inch baking dish with cooking spray; set it aside. Bring a large pot of salted water to a boil. Add macaroni and cook according to package directions, drain. Meanwhile, bring onion-garlic puree, mustard, and cayenne to a simmer in a small saucepan over medium heat, stirring often. Whisk in cheddar until melted. Remove from heat and whisk in yogurt. In a medium bowl, toss the macaroni with the cheese sauce. Season with salt to taste. Pour the mixture into the prepared baking dish and sprinkle panko over the top. Top with Parmesan. Bake until Parmesan is melted and macaroni is hot throughout, about 10 minutes.

 

Serves: 4

Serving Size: 2/3 cup

Per serving: 237 calories, 17g protein, 31g carbohydrate, 7g fat (4g saturated), 3g fiber

 

Cranberry Sauce with Splenda

Courtesy of www.diabetesdaily.com

 

Ingredients

1 teaspoon cornstarch

1 cup Splenda

1/2 cup water

3 cups fresh or frozen cranberries

1 Tbs orange peel

1 tsp fresh grated ginger

 

Directions

Combine cornstarch, Splenda and water in a medium saucepan, stirring until Splenda and cornstarch dissolve. Stir in cranberries, ginger and orange peel; bring mixture to a boil, stirring constantly, over medium-high heat. Reduce heat, and simmer, stirring often, for 5 minutes or until cranberry skins begin to pop and mixture begins to thicken. Set aside to cool. Cover and chill at least 3 hours.

 

Serving Size: 1/4 cup cranberry sauce

Serves: 6

Carbohydrates per serving: 14g

 

Lite Pecan Pie

Courtesy of www.diabetes.org

 

Ingredients

 

Crust:

1 1/4 cups of graham crackers, crushed

1 tablespoon light margarine

1 tablespoon cold water

 

Filling:

3/4 cup egg substitute, such as Egg Beaters (or 3 eggs)

1 cup sugar substitute for baking, such as Splenda

1/2 cup light margarine, melted

1 teaspoon vanilla

2 cups pecan pieces

 

Directions

Pre-heat oven to 350 degrees. To prepare crust, combine crushed graham crackers, margarine, and water and press into bottom and sides of a 9-inch pie plate. Bake crust for 5 minutes, remove from oven and set aside. To prepare filling, mix egg substitute, sugar substitute and melted margarine and vanilla. Add pecan pieces and mix. Pour filling into crust and bake for 35 minutes. Let cool and serve at room temperature.

 

Serves: 8

Per serving: 297 calories; 20g carbohydrates; 23 fat

 

We would love to add more healthy recipes to our list!  Please send your favorite healthy holiday dishes to erodgers@institute2000.org or post them on the Bronx Health REACH Facebook page  www.facebook.com/BronxHealthREACH.

 

Have a healthy and safe Thanksgiving!

 

For more information about diabetes, please visit our website.

Healthy Living in the Bronx -- A Call to Action from the Notorious PhD

On September 22nd, community residents and organizations from across the Bronx participated in the “Just in the Bronx – Our Voice, Our Choice” summit at the Bronx Museum. The day was a testimony to famous anthropologist, Margaret Mead’s belief, “that a small group of thoughtful, committed citizens can change the world.” We heard from community residents, students, teachers, faith based groups, food advocates, elected officials, and Department of Health officials talk about the myriad of exciting projects they are involved in to make the Bronx a place where people are creating opportunities to eat healthier and be more physically active. The event reminded us that while there is a lot of work that still needs to be done; we’ve come a long way as a borough in improving the health of the Bronx. From Play Streets to growing healthy food in classrooms and in community gardens and window sills to community-led fitness groups, Bronxites can hold their heads up high; amazing work is being done across the borough and things are moving in the right direction. During the Action Forum community residents shared their views and indicated their willingness to continue creating this healthier Bronx that we all want.

One of the highlights of the summit was Professor Mark Naison’s keynote address which challenged us to look and understand many of the systemic causes of the unhealthy nature of our Bronx community. Professor Naison is a Professor of African-American Studies and History at Fordham University, Director of Fordham's Urban Studies Program, a community activist and remarkable rapper. Below is his speech. We hope that you enjoy it as much as we did.

Thank you to all of our community partners for making the summit a huge success. To get more involved, please check out the Call to Action from the day on the event’s Wikispace page. You may also be interested in learning more about the organizations that participated in the Action Forum, which you can do with the Action Forum Directory.

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Keynote Address – Professor Mark Naison

Since everybody in the Bronx knows me as Notorious PhD, I have to begin my speech with a line from one of the Bronx’s greatest rappers, Big Pun, whose life and early passing symbolizes the issues we are confronting here today. The line--”Iverson crossover, cheese doodles, grape soda” is one part of a litany of cultural practices which Pun found on the streets of the Bronx, some of which condemned people to an early death. This is certainly true of eating practices in Bronx neighborhoods, many of them places where it is almost impossible to find fresh fruits and vegetables, and where residents would have difficulty affording them even if they could find them. The Bronx is not only the poorest of New York’s 62 counties, it has been rated the unhealthiest, and has the highest rates of both hunger and obesity among New York’s five boroughs. Despite all the heroic efforts of people in this room, and throughout the borough, to bring healthier food to the people of the Bronx, and promote healthier lifestyles, the forces activists are up against, some of them political, some of them market driven, are making that task extremely difficult. In the remarks that follow, I will argue that the health problems of the Bronx are not primarily a result of poor choices on the part of its residents, but of policies which accentuate the poverty of Bronx residents and make their lives more difficult and stressful. And while I fully support community based health programming, I also urge people to turn their attention to policies shaped by powerful forces outside the borough which undermine the health of Bronx residents.

There are three different dynamics currently affecting the health status of Bronx residents in a negative way, each of which is rarely discussed in the medical literature—gentrification, housing and urban planning policies which promote hyper-segregation; and test driven education policies which undermine health and fitness of public school students. I will discuss how each of these shape life in Bronx neighborhoods, and intensify health problems that were serious even before their effects became visible.

First, let us look at Gentrification. The Bronx has been the site of a demographic revolution in the last 20 years, with people from West Africa, the Dominican Republic, and Mexico moving to the borough in large numbers. But this has not been an entirely voluntary migration. According to Greg Jost, Deputy Director of the University Neighborhood Housing Program, “New York’s poorest renters are being priced out of other boroughs and are moving to the West Bronx one of the last bastions of affordable housing in the borough.” When in the Bronx, Jost adds, many of these new residents are paying over half their income in rent, putting a huge dents into funds available for things like health care, food and recreation. And that is not all. According to community activists I have spoken to, the exodus from gentrifying neighborhoods like Harlem, Washington Heights, the Lower East Side and Williamsburg, has resulted in immense housing overcrowding in many sections of the Bronx, with families doubling and tripling up in apartments, people renting out rooms, and even couches to boarders, and spanking new townhouses being subdivided into illegal rooming houses where immigrants can rent rooms with communal bathrooms and kitchens at prices they can afford. These crowded conditions accentuate the risk of fires and communicable diseases, while the income pressures inhibit families abilities to purchase health food. You cannot realistically address healthy conditions in the Bronx, in my judgment, without looking at housing overcrowding, and housing affordability; both of which are at crisis levels in the Bronx The second factor is housing and planning policies which promote hyper-segregation and accentuate the concentration effects of poverty.

During the last ten years, almost every vacant lot in the South Bronx has been the site of new housing construction, some of it in the form of town houses, some of it in the form of large apartment complexes. This has definitely increased the supply of affordable housing in the borough, not enough to offset the impact of gentrification related migration, but still an impressive contribution. But while all of this new housing has gone up, it has not been accompanied by the construction of new youth or recreation centers, raising the question, where are the young people living in these new buildings going to go to get exercise or supervised recreation? If the local public schools were open to the community for this purpose, that would be different, but because of budget cuts, some of them stemming back to the fiscal crisis of the 70’s some of them more recent; those gymnasiums are almost entirely unused in after school hours. And the result is a recreation crisis- felt most acutely by youth= fostered by planners who concentrate affordable housing in already poor-segregated neighborhoods without providing the new recreation resources these residents will need. Most Bronx neighborhoods are not only FOOD DESERTS, they are RECREATION and EXERCSE DESERTS. The dangers of the double whammy should be apparent to everyone in this room. And they can only be corrected by changes in city policy regarding the relationship between housing and recreation space in all new development.

The final force, shaped by political interests outside the borough, negatively affecting the health of Bronx residents, is school policies shaped at the City, State and National level which rate teacher performance, and the fate of entire schools, on the basis of student results on standardized tests. In New York City today, both as a result of Bloomberg Administration policy, and as a condition of accepting Race to the Top Money, schools who do not meet certain performance targets on standardized tests must be closed and half of their teaching staffs removed. More than 144 such school closing have taken place already, many of them in the Bronx, despite the protests of students, parents and community members, with more slated for the future. Along with this, new procedures have been approved at the state level requiring public ratings of teachers, 40 percent of which is based on students test scores, with several years of bad ratings requiring that the teacher be removed. These two policies have created an atmosphere of near panic in the schools of the Bronx, where many of the students are children of immigrants, and a high portion have special needs. And the results have been devastating for the physical and emotional health of these students. To make sure students test well, many schools have taken time once used for gym or recess and use them for test prep; while converting after school recreation programs into study halls.

The result is that already recreation starved youngsters in the Bronx get almost no physical activity in their schools and sit at their desks all day. This in my judgment is a public health disaster, but you cannot address it without reducing the impact of high stakes testing on the careers of Bronx educators. It is a policy problem that has to be addressed at its source, City Hall, the State Capital in Albany, and the US Department of Education.

I am not pointing out these larger forces to undermine the valuable work everyone here is doing to improve health opportunities and health choices for Bronx residents. Everything you are doing builds communities and saves lives. But we also have to try to change policies at the city and national level which make this work more difficult- and build the kind of alliances necessary to do that. The people of the Bronx did not create the conditions they live in; and while they can organize to make their lives better it they will need help from both markets and government who thus far have done more to accentuate their hardships than relieve them.

The Fitness Divas Transforming Their Community One Park at a Time

Darlisa Evans, Betty Robertson and Wendy Williams are community residents who participated in exercise classes offered this past spring by Bronx Health REACH and the Institute for Family Health, and who achieved significant improvements in their health, stronger friendships and a new passion for healthy living. They remained so committed to healthy living that this summer they formed their own group – the “Fitness Divas.” In addition, to regularly providing exercise classes for their friends and neighbors in nearby parks and a local housing complex, they’ve become amazing public health and parks advocates in their own community.

 

Last Thursday, the Fitness Divas joined Bronx Health REACH for a meeting with the NYC Department of Parks & Recreation to discuss the poor conditions of the parks in the Bronx and how community residents and organizations can partner with the NYC Parks & Recreation Department to make improvements to Bronx parks. Attending the meeting from the Bronx Office of the NYC Department of Parks and Recreation were Robert Wright, Chief of Recreation and Deputy Chiefs of Recreation Neil Harmon and Pete Jones. During the meeting, Darlisa, Betty and Wendy discussed the poor condition of Galileo Park, where they exercise. They pointed to the fact that the park is dirty, the equipment is old and poorly maintained, the benches are waterlogged and that there is a sinkhole. Beyond the unappealing state of the park, they talked about their concern for the lack of park space for children with disabilities, especially in Plimpton Park, which is right across from a school for children with special needs. In the grand scheme of things, the Fitness Divas pointed out that the parks should not only be seen as places for physical activity but for healthy eating as well. Ideas were shared about placing Green Carts in the parks and encouraging bodegas neighboring the parks to set up outdoor stands offering water and fruits.

 

The Parks Department staff agreed that there are a number of challenges to using parks in the Bronx, especially in Community Board 5, which has the least amount of green space in the Bronx and does not even have a recreation center. However, they discussed and emphasized the important role of community members in reporting these concerns and getting involved in their local park to improve its conditions. Deputy Chief Harmon recommended a number of activities that people can to do improve the conditions of their parks:

• Contact your local Community Board and/or call 311 to make complaints. When you call 311, the claim goes directly to the Parks Manager and then he/she has 48 hours to fix the problem in the park. Also, make sure to request a meeting with the Parks Manager to meet you at the park to review the problem and see how it was fixed.
• Work with the Partnership for Parks to create a “Friends of Group” for parks that don’t have them. “Friends of” groups become part of a citywide network of people connected with and interested in improving their local parks. Anthony Martinez is the coordinator for the Bronx.
• Join the Parks Committee of your local Community Board.
• Work with your Community Board to get the Community Affairs Department of the nearby precinct to increase police patrolling near the parks.
• Set up a meeting with your local City Council member to discuss the capital funds for your local parks and increasing the number of Park Enforcement Patrol officers.
• Attend the Parks Department budget consultation/“scopes” meeting to voice concerns about local parks. Anyone from the community can attend.

In addition to this invaluable information from the Parks Department, one of the major takeaways from this meeting was the importance of community involvement in all work that we do. In order to make significant, sustainable improvements to our parks in the Bronx, community residents must be at the forefront of all activities and discussions, because they know their community best -- they know the people, the concerns, and the solutions better than anyone else. For these reasons, we strongly encourage our partners and colleagues to make sure that community residents are sitting front and center when developing and implementing programs and policies that aim to improve the health of the Bronx and reduce health disparities.

 

We can’t thank Darlisa, Betty, and Wendy enough for their energy, enthusiasm, hard work, and commitment to the health of the Bronx and our parks. There is no doubt in our mind that there will be major improvements in the parks in the Bronx in the near future because of these amazing women and others like them!

 

For more information about how you can get involved in your Community Board, click here.

 

For more information about how you can create a “Friends of Parks” group at your park, click here.

 

 

 

 

The New Parks in Hunts Point Are Great…If You Can Find Them

The POINT Community Development Corporation's Summer Youth Employment Program highlights opportunities and challenges for physical activity in Hunts Point

This summer, Bronx Health REACH and the Partnership for a Healthier New York City partnered with the POINT Community Development Corporation’s Summer Youth Employment (SYEP) A.C.T.I.O.N. program to better understand the opportunities and concerns around physical activity in the Bronx.

In early July, Candida Bido from the Bronx District Public Health Office and Paula Park presented to the youth about major health issues in the Bronx, physical activity programs, and parks usage. Most of the youth use the parks 2-3 times a week primarily for exercise/hanging out with friends, including playing basketball and bike riding; their parents do not use the parks for exercise, but they attend BBQs in the park and bring their younger children.

In late July, Elizabeth Hambley from Boogie Down Rides conducted a training and visioning session about improving opportunities for biking in Hunts Point, including working with the youth to design their ideal bike environment. Also, Juan Camilo conducted a geographic information system (GIS) mapping workshop with the youth to develop a map of assets and barriers to physical activity in Hunts Point.

In addition to meeting with community organizations to learn more about health and physical activity in the Bronx, the youth surveyed Hunts Point residents about the parks. Most of the adults surveyed knew about Barretto Point Park and Riverside Park in Hunts Point and felt safe at the local parks. About half of those surveyed thought the parks were clean. Finally, the survey asked what activities residents would like to have in the parks. The following activities were mentioned: BBQs, salsera, carnival, teen events, music/performances, block party, movie night, and swimming.

For their end of summer event, the youth led a bike tour of the parks and green spaces in Hunts Point on August 16th. “Pedal the Point” aimed to raise awareness about the opportunities for physical activity and recreation in the community and draw attention to some of the inconveniences of getting to the parks, including dangerous traffic and awful smells coming from the market. The bike route included: Riverside Park, Drake Park, Hunts Point Landing, Barretto Point Park and the Hunts Point Recreation Center. Twenty-five people attended the bike ride, including 15 youth, Assemblyman Marcos Crespo, and Sustainable South Bronx. Click here for photos!

Thank you to the POINT and this amazing group of youth for an eye opening bike ride and fantastic summer! The bike tour really showcased that while there are some opportunities for physical activity in Hunts Point, it’s very hard to find the parks and very dangerous to get to them. It is critical that we make it easier to get to these parks if we hope to improve the health of Bronx residents. Possible solutions include extending the bus service to Barretto Point Park in the fall and spring and creating bike paths to Hunts Point Landing once it opens. We look forward to partnering with the POINT, Assemblyman Crespo and these amazing youth on this initiative over the next year.

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After a competitive process, Bronx Health REACH, a program of the Institute for Family Health, was selected as the Borough Lead Organization (BLO) for the Bronx by the Partnership for a Healthier New York City (Partnership). The Partnership is a newly formed nonprofit funded through a Centers for Disease Control and Prevention Community Transformation Grant (CTG) received by the New York City Health Department. CTG supports community-level efforts to reduce chronic diseases such as heart disease, cancer, stroke, and diabetes by promoting healthy lifestyles, especially among population groups experiencing the greatest burden of chronic disease. As the BLO, Bronx Health REACH is organizing and leading a borough-wide coalition of community partners that will work with the Partnership to impact positive change in health behaviors related to healthy eating, active living, tobacco-free living and reduced excessive and underage alcohol consumption in the Bronx.

To learn more about the POINT and the SYEP A.C.T.I.O.N. program, please visit http://thepoint.org/ and http://thepointcdc.tumblr.com

To learn more about Bronx Health REACH’s work as a Borough Lead, or to join our coalition, please contact Emma Rodgers at (212) 633-0800 x1249 or erodgers@institute2000.org

For more information about the Partnership for a Healthier NYC, please call (646) 619-6499.

Creating a sustainable exercise program in the Bronx

This spring, Bronx Health REACH and the Institute for Family Health began offering a regular exercise group for community members from the University Heights area of the Bronx. Every Monday to Thursday morning the group met at PS 204 and engaged in a different set of exercises depending on the day of the week. On Mondays and Wednesdays, the group walked from PS 204 to Roberto Clemente State Park, then walked within the park, and finally back to the school for a total of almost three miles. On Tuesdays, the group participated in a Zumba class and on Thursdays, a stretch band and muscle training class.

Initially, many of the exercise group participants found it difficult to complete a full exercise routine or to complete the three mile walk without taking frequent breaks. However, over the last five months, the members have reported significant improved health outcomes, including lower blood pressure, weight loss, lower glucose levels for those with diabetes, and a general feeling of being more in control of their health. In addition, this exceptional group of women have made friendships and formed bonds with each other- exemplified by the giant water fight had on one particularly hot summer morning. The small and intimate classes offered them a way to be physically active without feeling judged and they say that this makes all the difference.

Most importantly, the women have pledged to continue exercising together even after the Bronx Health REACH HealthCorps members for 2011-2012 complete their terms and will no longer be able to lead the groups. To ensure they continue to get their daily exercise, the group has reserved a community room in the apartment building where some of the members live to hold a Zumba class every Tuesday and Thursday. It will be led by Darlisa Evans, a member from the exercise group, who initially had a very difficult time completing an entire 45 minute routine. Darlisa has an exceptional weight loss story of her own and is dedicated to helping other women and men realize that they too can lead healthier lives and lose weight. On Wednesdays another member, Wendy Williams, will be leading a yoga class, and on Mondays and Fridays, Betty Robertson, also a group member, will be leading a stretch band group and a walking group in the neighborhood park. By working together these women have turned a program led by Bronx Health REACH into a sustainable exercise program run by the participants.

Bronx Health REACH is very proud of all of these women for their commitment in creating a sustainable and long-running program without outside intervention. With their dedication, the residents of the University Heights community will have access to free exercise classes led by their own neighbors.

Is Physical Inactivity as Bad as Smoking?

Last month, researchers from the World Health Organization and the London School of Hygiene and Tropical Medicine reported that the total weight of human beings on Earth is 287 million tons. Of that, 3.5 million tons is due to obesity and North America alone counts for a third of that even though we are only 6 percent of the world’s population. A lot has been written about the causes of obesity and obesity-related diseases such as heart disease and diabetes, but a set of new reports suggest that voluntary physical inactivity, basically being a couch potato, is increasing worldwide and contributing to these global gains.

An article in the NY Times last week summed up some of these latest figures and they show widespread physical inactivity in all corners of the world. In the past, sedentary lifestyles were seen as a luxury of rich countries, but poor countries are not nearly as active as they used to be. For example, while 43.3% of Americans and 34.8% of Europeans don’t meet the minimum recommendations for physical activity, more than 30% of Middle Easterners and 27% of Africans live sedentary lifestyles. These are large numbers and they lead to major health crises. In the U.S., almost 11% of all premature deaths are related to too little exercise and the World Health Organization estimates that more people die from diseases linked to physical activity each year than from smoking.

In prior blog posts, we have written about Bronx Health REACH’s efforts to increase access to parks in the Bronx and fight childhood obesity – both of which involve increasing physical activity. These efforts are working, but they are met with constant barriers, not least of which is a perception that if you look healthy you are healthy – even if you’re not exercising. As this new data shows, the global population is quickly becoming inactive and without targeted intervention, these numbers will only increase. To combat this, Bronx Health REACH is working on a number of initiatives with the Partnership for a Healthier NYC to increase utilization of city parks and to promote opportunities for free and low-cost physical activity (which can be found on the BeFitNYC website). We may lead the world in physical inactivity, but it only takes a 20-30 minute walk a day to reverse this trend. Visit your local parks or see what free or low-cost activities are happening in your neighborhood –  it’s time to get off the couch and get moving!

Check out these websites to get started!

BeFitNYC: http://www.nycgovparks.org/befitnyc/

Girls on the Run: http://www.girlsontherun.org/

Shape Up NYC: http://www.nycgovparks.org/programs/recreation/shape-up-nyc

A Guide to Fitness and Nutrition Programs in the South Bronx: http://www.nyc.gov/html/doh/downloads/pdf/cdp/cdp-resource-sobronx.pdf

Does being near a park mean that people use it?

The Bronx has over 7,000 acres of park space - more than any other borough in New York City. Yet, the borough’s health outcomes are the worst in the state and data from the NYC Department of Health shows a dearth of physical activity by Bronx residents. In a recent survey, close to 30% of Bronx residents reported engaging in no physical activity in the last 30 days.

Though some studies have shown proximity to a park does increase physical activity in urban areas, it’s not a cure-all. Concerns about park access, park safety, and park sanitation are frequently cited by Bronx residents when asked about their park usage. A recent journal article in Health Affairs by a primary care physician who used to practice in the South Bronx chronicled the story of one of his patients who had gained weight and developed back problems in a relatively short span of time. For years the man had played soccer at Macombs Dam Park, but when the Yankees built their new stadium right next to it, the parkland had become a construction site. Though the city replaced the park five years later with plenty of places to exercise including handball courts, basketball courts, baseball diamonds, and a running track, there is very little green open space. An artificial turf field was built on top of a parking garage but the doctor found that it was used primarily by youth sports leagues. The pickup adult soccer games had stopped.

As the doctor learned and as Bronx Health REACH has heard again and again, just living near a park doesn’t mean that people are going to use it. Bronx Health REACH has two National Parks Service Community HealthCorps members working in the borough to increase utilization of the parks. They have started walking groups in nearby parks and worked with youth to use the park for outdoor activities. While these programs have been successful, there have been many roadblocks. For one, many people living near these parks didn’t even know they existed. Or if they did, they didn’t feel welcome to use them because of perceptions that the parks administrators had made it difficult to get permits or refused to work with community groups trying to hold programming. Recently, Bronx Health REACH heard from one of its partner schools, Sheridan Academy for Young Leaders (PS 457), that it had been denied a permit for a field day at Macombs Dam Park on the grounds that schools (and the kids that come with them) damage the parks. What good is a public park if children can’t play in it?

Bronx Health REACH will continue its efforts to address residents’ concerts around park access, safety, and sanitation. We have met with park officials about easing restrictions on permits and increasing their visibility in the neighborhood. We are also starting conversations with local police precincts and the parks service to increase patrols in Bronx parks where residents have told us they feel unsafe. These are not insurmountable obstacles, but they are real ones and until they are addressed it’s unrealistic to think that just having a park will result in increased physical activity. Bronx Health REACH has seen that facilitating exercise in outdoor spaces does result in weight loss, but until community residents utilize these spaces on their own, the programs will be hard to sustain. We hope that by addressing Bronx residents concerns and making the parks more welcoming to their neighbors, more people will take that first step into a healthier lifestyle.

High Cigarette Taxes Are a Start But Not the Whole Solution

High cigarette taxes are starting to have the impact that anti-smoking proponents have been hoping for. The latest National Survey on Drug Use and Health reported that 15.8% of young adults between the ages of 18 and 25 are daily smokers, down from 20.4% in 2004. The agency stated that substantial increases in cigarette taxes combined with increased education and enforcement efforts targeting younger smokers contributed to the decline. New York State has the highest state tax in the nation at $4.35. New York City tacks on an additional $1.50 tax making a pack of cigarettes almost $6 more than in other parts of the country. The high cost of cigarettes is a deterrent, but there’s still plenty of work that needs to be done to prevent our kids from becoming the next generation of smokers.

Among adults, the Bronx has one of the highest rates of smoking in NYC. Despite a 30% decline since 2002, southeast Bronx residents are nearly 40% more likely to be current smokers than NYC residents overall and other neighborhoods such as Fordham and Kingsbridge count almost a quarter of their residents as smokers. The danger smoking poses to Bronx youth is particularly worrisome. Research shows that 90% of all adult smokers begin before the age of 18. Although the Bronx has one of the lowest youth smoking rates in the city, 3,000 public high school students in the Bronx are regular smokers with data trends showing that 1/3 of these students will die prematurely because of the habit. These are 1,000 unnecessary and preventable deaths in a borough that already has too many of them.

Bronx Health REACH has been partnering with the Bronx Smoke-Free Partnership for the last few years on a number of campaigns to further lower youth smoking rates in the Bronx. One campaign explores the impact of tobacco marketing in stores on youth. Bodegas, pharmacies and other tobacco retailers are some of the last places in the United States where Big Tobacco can market its deadly products to our youth. The Partnership found that of the 11,500 tobacco retailers in NYC, 75% are located within 1000 feet of a school. A recent study suggests that the more tobacco products kids see, the more likely they are to smoke. The “point of sale” campaign aims to educate community leaders and local tobacco retailers about tobacco marketing and youth smoking and develop policies that promote healthier environments. With over two thirds of teens shopping in bodegas at least once per week, it is vital that we focus our efforts on this important issue. 

 On May 31^st, Bronx Health REACH joined the Bronx Smoke-Free Partnership, the NYC Coalition for a Smoke-Free City and youth from across the five boroughs in Washington Square Park for World No Tobacco Day to educate community leaders across the city about the importance of reducing youth exposure to tobacco marketing in stores. This event built upon the success of the “Take a Walk in Our Shoes” tobacco marketing tours held last October. In the Bronx, students from PS73 led Senator Gustavo Rivera and other community leaders on a walking tour of tobacco marketing inside and outside of the bodegas on Ogden Avenue in Highbridge to show them what they see on their walk to school (watch “Take a Walk in Our Shoes” here).

Going forward, Bronx Health REACH plans to work directly with bodegas, Merchant Associations, Business Improvement Districts, and Community Boards throughout the borough to gain a better understanding of the challenges store owners face around this issue and develop programs that benefit the health of our youth and businesses. Also, we hope to provide workshops for faith-based leaders, community-based organizations and other community leaders throughout the summer. We must continue to listen to and collaborate with these groups and individuals if we hope to create long-term, sustainable changes that better the health of Bronx communities.

Op-Ed: Bronx Residents Celebrate 1 Year Anniversary of Smoke-Free Parks and Beaches!

By Suneet Goraya

Bronx Health REACH

New York City was one of the first cities in the world to prohibit smoking in parks and on beaches. May 23rd marked the one-year anniversary of this historic policy that made it illegal to smoke anywhere in a city park, beach or pedestrian plaza, including Orchard Beach and Van Cortlandt Park! As a National Parks Service HealthCorps member for Bronx Health REACH, I am thrilled about this policy, because participants in our adult walking groups, girls running program, and zumba classes are no longer exposed to toxic secondhand smoke while exercising in the parks. With over 7,000 acres of parks space in the Bronx alone, smoke-free parks and beaches are vital for the health of Bronx residents and the maintenance of our beautiful parks and beaches. Many Bronx residents have noted that smoking in parks and on beaches has been a large deterrent from going to the parks and beaches to exercise and enjoy the outdoors.

While the Bronx is home to the largest amount of parks land in the city, it also fares the worst in health outcomes. According to the New York City Department of Health and Mental Hygiene, over 30 percent of children in Head Start programs and 40 percent of adults in the South Bronx are obese. Currently, 4 in 10 adults in the South Bronx report not exercising at all. In addition, Bronx County has one of the highest rates of asthma in the United States. In some areas of the Bronx, it is estimated that 1 in 5 children have asthma. Health experts have determined that there is no safe level of secondhand smoke exposure. Just 30 minutes of exposure to secondhand smoke can increase asthma attacks in asthmatic children. Prohibiting smoking at parks and beaches encourages Bronx residents to utilize the plentiful park space for physical activity and recreation, without inhaling secondhand smoke or increasing their risk of an asthma attack. 

Building healthier environments for Bronx residents is of great importance to Bronx Health REACH and our community partners. Thank you to our community leaders for supporting this important policy to improve the health of Bronx residents. This smoke free policy is a significant stride in reducing health disparities in the borough. It was a great first smoke-free year and we look forward to hosting Zumba, walking, running, and other activities this summer in smoke-free parks and beaches across the borough.

Supporters Pack Public Hearing to Demand Health Equity

For the past decade, Bronx Health REACH and its parent organization, the Institute for Family Health, have been battling the segregated system of care that persists in New York academic medical centers. In this two-tiered system, patients with Medicaid or no insurance are sent to outpatient clinics when seeking specialty care, while privately insured patients are sent to faculty practices. Bronx Health REACH has long argued that these systems are separate and unequal for a number of reasons, including poor continuity of care and afterhours access in the clinics. Our efforts have led to a civil rights complaint filed by New York Lawyers for the Public Interest with the Attorney General in 2008 and legislation introduced in the NYS legislature by Assemblyman Nelson Castro and Senator Gustavo Rivera. The most recent step forward was an especially exciting one. On May 10^th, Assemblyman Richard Gottfried held a public hearing on the Health Equity Bill (A07699) and invited people to testify in support or in opposition. In an inspiring vindication of the coalition’s work for so many years, the legislators heard over and over again just how much this legislation was needed.

The hearing room at 250 Broadway in downtown Manhattan was packed with supporters of the bill, health care advocates, and Bronx Health REACH coalition members, who wore stickers proclaiming “Make Health Equality a Reality”. Out of the 21 people who testified, only one person, representing the Greater New York Hospital Association, spoke in opposition to the bill. (To hear more about the testimonies, read our press release about the hearing.) The testimonies were well-informed and moving. Physicians spoke about the importance of care continuity and the feasibility of integrating practices so that all patients are seen in the same time and in the same place. Lawyers testified on the legal implications of separating patients based on insurance and how this separation violated civil rights laws. Pastors spoke about ministering to their ever sicker congregations and their frequent hospital visits to visit infirm congregants. And in perhaps one of the most dramatic moments of the day, one Bronx resident speaking about his personal experience accessing health care with Medicaid, gestured behind him to 15 members of his church who rose to stand with him and demand equal access. The testimonies and stories were diverse, but they had a common theme: all people should receive the same quality health care.

For a community-based coalition such as Bronx Health REACH the hearing held particular importance. The opportunity to stand up and demand change from legislators is an empowering one and Bronx Health REACH was especially grateful to be able to share that experience with its partners and coalition members. Though the coalition is ever moving forward, it’s important to stop and celebrate victories, of whatever size, when they occur and we’re glad that we are able to celebrate this one.

Doctors learning how to wield the knife, but not for surgery

The connection between healthy eating and good health is no longer surprising news for most Americans and their physicians. However, even though doctors treat patients struggling with obesity, diabetes, and heart disease, many of them pass through medical school with little knowledge of nutrition. And while your doctor may not be cooking you dinner every night, research has shown that physicians who engage in healthful behaviors are more likely to advise their patients to do the same. In other words, the more your doctor knows about healthy eating and cooking, the better he/she will be prepared to give you advice on how to avoid chronic diseases that are linked with unhealthy food choices such as obesity and diabetes. This idea is catching on. A recent article published in The New York Times chronicles some physicians’ commitment to healthy food and how they use that knowledge to better treat their patients.

Healthy Kitchens, Healthy Lives was founded eight years ago by Dr. David Eisenberg, an associate professor at Harvard Medical School and the Harvard School of Public Health, as a collaboration between the university and The Culinary Institute of America to teach medical professionals how to select, purchase, and prepare healthy foods. The goal is to learn about healthy foods that can reduce disease risk and replace unhealthy habits. Or as one physician attendee of a recent conference said, “I’d love to be put out of work.” Dr. Eisenberg would like to see teaching kitchens in medical schools and hospitals and some physicians are following his lead. One doctor interviewed in the article holds a culinary boot camp in the 2,400 square food kitchen and lecture room built below his medical office. Another physician bought a farm and often runs into her patients when selling eggs at the local farmers’ market.

These efforts are inspiring and depict a shift in the traditional model of how doctors usually treat their patients, i.e. “a pill for every ill” as one doctor put it. But we are still a long way from doctors’ offices being equipped with teaching kitchens or from doctors regularly prescribing healthy food as a way to avoid or manage chronic conditions. Bronx Health REACH has stressed the importance of nutrition and healthy food choices in much of its programming, including the Culinary Initiative in churches and its partnership with New York City public schools, such as the Seeds in the Middle program at P.S. 221 in Crown Heights, Brooklyn and the food access and sustainability curriculum at M.S. 328 in Washington Heights, Manhattan. The Institute for Family Health, Bronx Health REACH’s parent organization, provides WIC (Women, Infant, and Child) services to its patients, which is a special nutrition education service that provides healthy food to mothers and young children. The Institute also employs a number of case workers that seek to coordinate care for the patients and provide them with services outside of the patient-provider relationship. There is a movement underway to integrate nutrition with traditional treatment regimens and it will continue to grow. If that’s the case, we hopefully will see more doctors wielding knives to teach their patients how to chop vegetables rather than using them to conduct surgery.

New York City’s FreshDirect Deal

On February 7^th, Mayor Michael Bloomberg, Governor Andrew Cuomo, and Bronx Borough President Ruben Diaz, Jr. announced a deal that provides FreshDirect with $127.8 million in taxpayer money to subsidize a relocation of FreshDirect’s headquarters from Long Island City to the Harlem Rail Yard on the South Bronx waterfront.  Two days later, the NYC Industrial Development Agency held a hearing on the FreshDirect deal to provide community members with an opportunity to voice their opinions before the deal was voted on. The concerns were many. South Bronx residents raised concerns about the impact on the environment, promised job creation, living wages, acceptance of EBT (food stamps), and the inaccessibility of FreshDirect services to South Bronx residents. A group called ‘South Bronx Unite: Stop FreshDirect’ was formed to speak out against the deal. South Bronx Unite members have created social media outlets (blog, Facebook and Twitter) to get the word out and have started a Change.org petition to stop FreshDirect from building its new headquarters in the South Bronx, and another petition encouraging a boycott of the company.

Many of the concerns that South Bronx Unite has raised include the environmental impact of bringing FreshDirect to the neighborhood, as well as how it will affect residents in the South Bronx. They have asked for an environmental impact statement for the site, noting that bringing FreshDirect to the area would add another 130 trucks per day to the South Bronx (already home to some of the highest asthma rates in the country). The group also says there is no written guarantee that FreshDirect will bring jobs to the area, though the company has said that 30% of the estimated 1000 jobs created in the next 10 years will go to community residents. However, even if the jobs materialize, community residents have argued that the wages are low and the workers will be exempt from any local living wage mandate adopted by the city (nearly 40% of current FreshDirect employees makes less than $25,000 per year). Other concerns center on the clientele that FreshDirect services. Currently, FreshDirect does not deliver to the South Bronx and does not accept food stamps. While the Bronx Borough President put together a Memorandum of Understanding to try and address these concerns, South Bronx Unite has protested that it does not adequately address the issues.  

But concerned residents and community groups are not just protesting, they’re also developing different solutions that would make efficient use of the nearly 100 acres of public waterfront land that FreshDirect will be leasing. Part of this effort entails having the city call for a moratorium on all new development at Harlem River Yards until a new Environmental Impact Assessment is conducted. The city could also consider funding new, innovative projects that make fresh, affordable, healthy food available to New York City residents in a way that provides living wages to its workers and does not add to the environmental burden of the Bronx. 

One such idea is that of landlord and developer Steve Smith, who has crafted a vision for a regional food campus at Oak Point in the South Bronx. This would provide access to “locally grown, locally raised, locally made” food for South Bronx residents and the larger NYC area.  Paul Lipson, consultant to the project, presented at Bronx Health REACH’s February 2012 Nutrition and Fitness Workgroup meeting about the proposed 130,000 sq ft regional food hub. It would house GrowNYC’s Wholesale Farmers Market and provide the opportunity for store owners and community members to access produce directly. Plans include a kitchen on the second floor and a “wash and chop” facility which would allow everyone – from bodegas to institutions such as the NYC Department of Education Office of SchoolFood – to make more direct use of local produce. Other proposed ideas for the site include having a rooftop hydroponic greenhouse operation serving grocery delivery chains in the New York metro area; an agricultural cooperative aggregating over 60 regional growers and producers; a borough-based brewer of beers and ales (the Bronx Brewery currently brews in Connecticut); a Bronx-based caterer and institutional food service providing meals for charter schools and senior centers; and a produce distributor. South Bronx Unite says that while this whole project would be dependent on subsidies, it would be a tenth of the price of the subsidies the City is planning on giving to FreshDirect. 

Bronx Health REACH will continue to monitor and evaluate efforts to hold the city and FreshDirect accountable to the South Bronx community in which FreshDirect is looking to relocate.

Fighting Childhood Obesity

In recent years, efforts to tackle childhood obesity have engaged everyone from the First Lady of the United States to local bodega owners. The reasoning is sound: today nearly half of the children in New York City are not at a healthy weight and the dearth of healthy options in many communities leave families with few options beyond the many fast food restaurants that crowd city blocks. The bright side is that these troubling statistics have led many organizations to integrate lessons around childhood obesity into their activities, bringing a “stay healthy” message into many different forums. As a recent New York Times article highlighted, the Children’s Museum of Manhattan has taken on this issue and run with it.

EatSleepPlay is a comprehensive, arts and literacy health-based project that uses creative and fun ways to engage children and their parents in the area of nutrition, sleep and active play. It includes a permanent exhibit where children can crawl through a giant digestive system and meet super-powered vegetable heroes called Super Sprowtz that explore the benefits of fruits and vegetables at a giant NYC Green Cart. The initiative reaches outside of the museum walls with an 11 week family health curriculum developed in partnership with the National Institutes of Health. The exhibit has proved popular with schoolchildren and some of the schools that Bronx Health REACH works with on an obesity prevention program have already brought their students to the museum as part of their nutrition education curriculum.

These kinds of efforts meant to engage young people in healthy activities in a somewhat non-traditional way have been sprouting up all over the city. Steve Ritz, a biology and earth science teacher formerly at Discovery High School in the Bronx, started Green Bronx Machine, a so-called “portable science lab” where students plant vertical living walls. (Watch Steve Ritz give a fantastic TEDx talk on YouTube here: http://www.youtube.com/watch?v=lcSL2yN39JM.) Other schools tout healthy bake sales and integrate physical activity into classroom work because students aren’t receiving the recommended amount of physical education. Though more traditional methods, such as organizing sports teams or incorporating nutrition education into the curriculum are critical, the ability to think outside of the box in order to address the obesity epidemic is a crucial part of this movement.

New York Hospitals' Charity Care Isn’t So Charitable

New York State’s Indigent Care Pool (ICP) exists to offset the cost of uncompensated care for uninsured and underinsured patients. Annually, nearly $1.2 billion in Medicaid funds are allocated to 201 hospitals statewide to compensate hospitals for the cost of providing care to people that cannot or will not pay their medical bills. In 2007, the state enacted the Hospital Financial Assistance Law (HFAL) to respond to concerns that hospitals were not properly notifying patients of financial assistance and lacked transparency and accountability for how they using public funds. However, a report issued this month by the Community Service Society found that an overwhelming majority of New York hospitals violate the HFAL and continue to impose barriers to financial assistance.

Bronx Health REACH is a longstanding advocate of providing equitable access to care for uninsured and underinsured patients. Part of this effort involves providing clear financial assistance policies to patients through the hospital’s website and the physician referral line. In 2011, New York State Senator Gustavo Rivera and Assemblyman Nelson Castro introduced legislation that would require patients receive information about financial assistance in these ways, as well as prohibit hospitals from steering patients into different care settings. (To read more about this legislation and segregated care, click here.) The passage of this legislation would be a step forward in ensuring that uninsured and underinsured patients receive the financial aid that they need. However, an overarching concern is that the largest amounts of money are going to the hospitals that provide the least amount of care to needy populations, while the safety net institutions shoulder an increased burden with severely limited funds.

The Community Service Society analyzed state department of health data for all New York hospitals and found that the hospitals that approved the largest amount of financial aid applications generally received a smaller amount of funding. For example, Jacobi Medical Center, a public hospital in the Bronx that treats a large proportion of uninsured patients, received $167 in 2010 for each of the 52,702 financial aid applications it approved in 2008. In comparison, Lenox Hill Hospital, a private hospital on the Upper East Side of Manhattan, approved only 130 applications that year and received $84,469 per application. In this current system, the Indigent Care Pool does not reward safety net institutions, which provide significant financial assistance to needy New Yorkers, as they generally receive a lower amount of funding. The report concludes that the extreme variability in the amount of funding received shows that there is a serious need for change in state policy, as well as increased regulation of how these payments are distributed.

The CSS report contains no end of statistics that detail the non-compliance of New York hospitals under HFAL, as well as the inequitable distribution of resources to safety net hospitals. While these reports are critical in order to shed a light on these practices, they should also be a call to action for communities, organizations, and health care advocates. Enormous amounts of money have been paid to treat indigent patients, yet it’s not reaching the people that need it most. (The New York Times wrote an article on this issue and outlined some patient stories, which you can read here.) Without pressure from the communities that these funds are meant to assist, the hospitals may continue to reap the benefits of state funding without providing the assistance it promises. The $1.2 billion per year needs to go to the people that need it most.

Schoolchildren Making a Difference in Access to Healthier Food in the South Bronx

Lack of access to healthy food is an unfortunate reality for the residents of many South Bronx communities. Fast food restaurants and bodegas make up much of the food landscape and healthy options are few and far between. To address this issue, Bronx Health REACH partnered with Citizen Schools, an after school program for low income communities across the country, to teach an 11 week apprenticeship program on food access at MS 331. 14 students from the middle school and Bronx Health REACH staff worked with West Tremont Deli Grocery Corp, a neighborhood bodega frequented by many students and teachers, to provide healthier food options. Prior to working with Bronx Health REACH and Citizen Schools, the bodega had been a participating store in the New York City Department of Health and Mental Hygiene’s Healthy Bodegas Initiative, a program focusing on increasing the availability and promotion of healthier foods in local corner stores.

The 11 week apprenticeship, called Adopt-A-Bodega, incorporated education on nutrition, healthy eating, food access, and marketing techniques with direct action. After learning about health issues, the students brainstormed about what they would like to do to change the bodega right in front of their school that serves many of them on a daily basis. As a class, they came up with four student/ teacher lunch specials that included a healthy deli sandwich (or salad) on whole wheat bread, a bottle of water, and a piece of fruit for a discounted price. Though the bodega owner was initially skeptical about the promotion, it ended up being very popular and the increase in his business made him more open to working with the students on other initiatives.

In addition to the lunch special, the students worked with the bodega owner to sell healthier snack options, such as granola bars and Baked Lays, which the students had taste tested during one of their lessons. The students also requested that the bodega stock more fruits and vegetables, but the owner initially refused as there wasn’t any room to put them. The NYC DOHMH donated a beautiful wooden produce display that was placed in the very front of the store, next to the cash register, so that customers had easy access to it. This display allowed the bodega to stock nearly double the amount of fresh fruit and also increased business because it presented the food in an appealing way. As the students learned, many successful business ventures hinge on presentation.

Throughout this apprenticeship, the students learned that supply is heavily influenced by demand. If you demand healthier food, and business owners see that they can increase sales, they will be more likely to provide the healthier food. Using this model of social change, Bronx Health REACH hopes to continue improving access to healthy foods in bodegas across the Bronx.

Efforts to increase healthy food options as a way to address the childhood obesity epidemic are receiving national attention and support. First Lady Michelle Obama’s Let’s Move! campaign includes the Healthy Food Financing Initiative, which provides financing for developing and equipping grocery stores, small retailers, corner stores, and farmers markets selling healthy food in underserved areas. Throughout the country, cities and states are working within their communities to identify food deserts and find solutions to increase healthy food options in those areas. (Read a prior blog post about food deserts here.) 

In the South Bronx, West Tremont Deli Grocery Corp has made an important contribution in making the neighborhood a healthier place to live. Bronx Health REACH and New York State Senator Gustavo Rivera hosted an event on December 21^st to honor the bodega owner on his dedication. Read more about the event and Senator Rivera’s comments here.