Wednesday, February 17, 2016

Institute for Family Health’s Maxine Golub Honored by ECHO Free Clinic

Maxine Golub is second from the left, Bronx Health REACH's Charmaine Ruddock is second from the right along with other Institute for Family Health employees.

On Thursday, February 11, 2016, Maxine Golub, the Institute for Family Health’s SVP for Planning and Development was honored by the ECHO Free Clinic, for her years of service and support with the Walton Family Health Center. Bronx Health REACH Director, Charmaine Ruddock attended the event and stated, "It was an amazing speech to those new doctors in various stages of their residency. Maxine spoke to them of their work in the Free Clinic in the Bronx in the context of the challenges working in a borough ranked 62 out of the 62 counties in New York State per the Robert Wood Johnson Foundation county health rankings report, and in a country struggling with racism and socio-economic factors as health determinants. But she told them that even in this context, there are many reasons to be hopeful, and told them why. And then, she challenged them. It was one of the best speeches I have heard in a very long time."

Below is Maxine's speech.

Good evening. Welcome, and thank you to all of you for being here. Many of you have been far more instrumental to the success of the ECHO Free Clinic than I have been, so I’d like to offer a special welcome to Neil Calman, Amarilys Cortijo, and Sarah Nosal from the Institute, and Hal Strelnick and Ira Sussman from Einstein, as well as other members of the department of family medicine. I also want to take a moment to thank the folks at the Robin Hood Foundation, who have supported this work since 2009, and to my colleagues and friends at the Institute who came tonight to show their support.

I am truly humbled to have been invited to be your honoree and keynote speaker this evening.  And I am deeply appreciative of your recognition of my work to support the ECHO Free Clinic, and to promote health and health care in the Bronx.

As Marika said, I was among the early supporters of ECHO, working alongside Drs. Calman, Cortijo, Nosal, Strelnick, Little, and many others to make this project a reality. Most of my work has been behind the scenes – administrative stuff like communications and fundraising.  In my opinion, the real credit for this work goes to the student leaders who had the vision to start the clinic, and who have, over the years, insisted on its importance to both the patients and the students.

The Institute has supported the Free Clinic for two important reasons. The first is the recognition that even though our health centers provide free care to all, many uninsured patients don’t come because they’re afraid of getting a bill. This is particularly unsettling for those who are undocumented.

But an equally important reason we do this is because of the students. It’s so important to us, and to our mission to serve the underserved, that each of you has this opportunity to learn what it means to be indigent and have limited access to care.  To meet, face to face, with patients who have not been to the doctor in years, or who have not taken much-needed medication because they couldn’t afford it. We hope that this experience will make each of you a better doctor, wherever you go, whatever you do.

The Institute for Family Health has worked in the Bronx since the early 1980’s.  We have built and operated several health centers, created a residency-training program, now operated by Bronx –Lebanon, and led Bronx Health REACH, a community based participatory project designed to eliminate racial and ethnic health disparities, since 1999, led by Charmaine Ruddock, who is here this evening.  And we’re not alone… Montefiore, Morris Heights, Bronx-Lebanon, St. Barnabas – all of have worked to expand access to primary care and related services.

And yet, where are we now?  According to the Robert Wood Johnson Foundation, the Bronx is  #62 out of 62 New York State counties. For those of you not familiar, the RWJ system is based on a tally of 35 criteria rolled up into 5 categories. Sadly, the Bronx ranks 62nd on health outcome, 62nd on social determinants, 61st on clinical care, 52nd on health behavior, and 33rd on physical environment.

So in spite of all the work that all of us have done for the past 35 years, all the new practices we have opened, the thousands of patients we care for, the hundreds of medical students and residents we have trained, we are still at the bottom of the state-wide barrel.

It’s depressing, isn’t it?

And if you want, you can also be depressed about what’s going on nationally. Politicians on the right promoting bigotry and hatred. Kids in Michigan getting lead poisoned from municipal water supplies. Countless unnecessary deaths at the hands of the police.

It is depressing. But I am not depressed, and I hope you won’t be either.  Because more than any time in my work for the past 35 years, I see major changes happening all around us…

First, there is the Affordable Care Act.  More people than ever before have health insurance in this country. I grant you there’s a long way to go, but it is a huge step in the right direction.   Nationally, nearly 18 million people have gotten insurance, with 2.1 million in NYS, and over one million here in NYC.

And with the ACA came the Teaching Health Center Program -- creating a new funding stream to train 500 primary care providers to work in high need communities. Sure, it has its problems, but it is indeed another huge step in toward recognizing the importance of community-based primary care.

Second, there is wide spread recognition that social determinants of health – education, housing, income, nutrition, opportunities for exercise, safety, stress - make a greater difference in health outcomes than anything we do as individual providers. If you need a primer on this, I refer you to the work of Sir Michael Marmot, the president of the World Medical Association.

This recognition is so widespread that the national center for Medicaid and Medicare has recently issued a request for proposals designed to foster collaboration between health care providers and community service organization to address social determinants. The Institute has recently piloted a survey about social determinants in one of our Bronx sites, and found that 20 percent of those asked report at least one significant problem related to food security, safety, finances or housing.

Third, people are talking about race and racism in every walk of life – and the fact that race impacts health outcome is no longer a debatable question. The impact of race and racism is being discussed in campuses across the country. The NYC Health Department and the City University of New York have new departments focused on equity.  It’s in the news, in our political campaigns, and in best selling books.  This week, the entire NY Times education section is devoted to race. Our presidential candidates have met with Black Lives Matter, and acknowledged the racism in the poisoned water of Flint, Michigan. We have a long way to go to eliminate the impact of racism in our country, but these are critical milestones in bringing this issue to light.

Fourth, groups are acknowledging the need to work together to address health and health related concerns comprehensively. Locally, Bronx Health REACH, the Institute’s CDC project to address racial disparities in health, is working with bodegas, churches, schools, hospitals, health centers, health departments, elected officials and more to address health disparities. Together with folks from the Borough President’s office, Montefiore, and the NYC DOH, we have started a campaign called #NOT 62: The Campaign for a Healthy Bronx. And in spite of spending the past five years at the bottom of the list, RWJ recognized the power of the campaign and gave the Bronx one of eight “Culture of Health” awards nationally for this effort.

And finally, there are all of you. I have watched for the past 15 years as the students, with support from their very dedicated faculty, have built this clinic from nothing… from an idea someone had, to getting support from the college, to finding the Institute to be your clinical sponsor, to opening up, to seeing roughly 1,000 patients who make approximately 1,400 visits per year.  

I have heard stories of patients who have not seen a doctor in years, often leaving chronic illnesses untreated. You have diagnosed patients with out-of-control diabetes, PTSD and other mental health problems, even cancer. You have provided physical exams to young people eager to find work.  And in many of these instances, you were true heroes, battling the system to make sure that the patient got the care that he or she needed.  Sometimes you even brought them there yourselves.  And while I hope for a day when everyone has access to health care, and we can retire the free clinics entirely, you deserve tremendous appreciation for the work that you do. You have changed lives.

You, like your predecessors, are smart, hard-working, deeply committed students.  I have great faith in your abilities, and deep confidence in you -- as the next generation of leaders in health care, in public health, and in civic life.

So if you’ll permit me, I’d like to end with a few reminders – for all us, really, since we all need them, but especially for those of you who will be graduating this spring.

These are the things that keep me from being depressed at the enormity of the challenges we face in our work.  I hope they’ll work for you too.

1) Remember the ECHO Free Clinic. It’s a great example of what is right. For those of you leaving school, please don’t tuck it away as something you did in medical school that has no relevance to your “real” life. No matter where you choose to practice, there will always be folks who need a little more help, folks whose life experience has made it difficult for them to get basic care, folks who are afraid, folks who can’t pay. Be there for them – just as you are now.

2) Appreciate your colleagues, reach out across disciplines, and across institutions.  Talk to nurses, social workers, community organizers, faith-based leaders, community members, even administrators! Healthcare is complicated, and growing more so. And addressing the social determinants of health will be even harder. We must work together to address the big challenges – to solve clinical problems, social problems, and financial problems. We may each see things a little differently, but we need each other.

It seems ironic today in light of what’s going on in Flint, but my very first job in health care was at Montefiore’s lead poisoning prevention program. It was there that I realized that the incredibly dedicated doctors I worked with could treat children, but could not prevent the problem. To do that, we needed housing organizers, tenants associations, lawyers, public health professionals, scientists and politicians.  In 1981, led by a committed city council member, NYC passed one of the toughest lead laws in the country, requiring landlords to eliminate lead hazards before a child got poisoned. In 1984, a group sued the City to strengthen its enforcement. But as we all well know, this problem hasn’t gone away…

3) Which leads me to my last and most important point -- Stay in it for the long haul. Change is a long-term proposition. Don’t give up – the world needs you. Hold on to the determination that has brought you here, and keep finding ways to make things better. None of us can do it all, but each of us can do something.

And for those of you who are physicians: you have earned authority and respect. That’s powerful. I hope you will use that power to be a force for change and a voice for the underserved.

It has been my great pleasure to watch the unfolding and blossoming of the ECHO Free Clinic, and the look-alike clinics it has nurtured in NYC and across the country.

To be honest, in our first meetings 15 years ago, it never occurred to me that it would become such a fantastic program, caring for thousands of patients, and training hundreds of doctors. Or that students al

Wednesday, February 10, 2016

New York City Council Provides Funding to Support Program for Immigrant Health



Photo: Michael Fleshman via Flickr


As part of a $1.5 million Immigrant health initiative, the New York City Council has allocated $450,000 to the Institute for Family Health, Bronx Health REACH, New York Lawyers for the Public Interest (NYLPI), and Academy of Medical & Public Health Services. The program, UndocuCare enables undocumented immigrants without health insurance in New York City access to health treatment and services through Medicaid. UndocuCare has been operating as a pilot program over the past year and the New York City Council funding will go towards expanding community partnerships for outreach and awareness with the New York City immigrant population.

This outreach and awareness is vital since many undocumented immigrants living in the city are unaware that they may be eligible for Medicaid. Those who maybe eligible for Medicaid must have one of the following: a pending application for an immigration benefit, a life-threatening illness, or be a young person who received permission to stay in the United States through the Deferred Action for Childhood Arrivals (DACA) policy. The New York Daily News wrote about one undocumented immigrant, Alberto Lopez needing a kidney transplant. Mr. Lopez believed that as an undocumented immigrant he would not be able to receive medical treatment. A nun at his church connected Mr. Lopez to NYLPI, (a Bronx Health REACH partner) who enrolled him in UndocuCare. As a result, Mr. Lopez was able to receive treatment. Laura Redman, who runs the health justice program at NYLPI pointed out that, “NYLPI believes that close to 45% of the state’s 250,000 undocumented immigrants may be eligible for Medicaid.”

El Diario Features Healthy Bodegas

Photo: Gerard Romo/El Diario

Hylonkys LaChapelle, owner of Gerard Minimarket is participating in the Healthy Bodega Initiative.

The January 30, 2016 issue of El Diario featured an article about the Healthy Bodega Initiative, a partnership between Bronx Health REACH, The Bodega Association of the United States (ASOBEU), and the Hispanic Information and Telecommunications Network, Inc. (HITN). The article featured the owner of Gerard Minimarket, a bodega that participated in the August training, and featured conversations with  Bronx Borough President Ruben Diaz Jr., ASOBEU President Ramon Murphy, and Bronx Health REACH Director Charmaine Ruddock.

Hylonkys LaChapelle, the owner of Gerard Minimarket located at 740 Gerard Avenue, Bronx, New York spoke of making changes to her bodega after attending the August training. She described re-arranging and moving the best looking apples and bananas to more prominent areas of shelf space.  The result is shoppers purchasing more fruits. “Now, two boxes of bananas (approximately 30 pounds of product) is sold in a matter of a day,” said LaChapelle.

Bronx Borough President Ruben Diaz Jr. spoke about the #Not62 campaign (the Bronx is ranked as the least healthy of 62 of 62 counties in New York State) and how those healthy bodegas that participated in the August Healthy Bodega Training will now be a “part of the solution offering healthy alternatives to their customers.”

Charmaine Ruddock, Director of Bronx Health REACH provided background on how the training program emphasizes the importance of including healthy alternatives at the deli counter such as low fat cheese and low fat mayonnaise in sandwiches, and water offered rather than soda.

You can read the full article here.

The next two- day Healthy Bodega Training will be held on March 8th and March 9th from 5 to 9:30 p.m. If you know a bodega in your community that would benefit from this training, please contact Zulay at the Bodega Association at (212) 928-0252.

Does Soda Need a Warning Label?



Image from Public Health Advocacy website

The harmful effects of cigarettes have been well documented, requiring them to have warning labels on the package. With  recent studies revealing the harmful health effects, should soda also have a warning label? New York State Assembly Member Jeffrey Dinowitz and state Senator Gustavo Rivera believe so and have introduced legislation (Assembly Bill 2320-B& Senate Bill S 6435)  requiring that any sugar sweetened beverages sold in New York State have a warning labels.

The label would state:

SAFETY WARNING: Drinking beverages with added sugar contributes to obesity, diabetes and tooth decay.

The label would be affixed to any carbonated or noncarbonated sweetened nonalcoholic beverage that has seventy-five calories or more per every twelve fluid ounces. Warning labels would not be needed for beverages consisting of one hundred percent natural fruit juice or natural vegetable juice that does not contain caloric sweeteners. A larger sign/poster would be posted in places such as restaurants and any establishment that dispenses sodas.

California lawmakers tried to pass similar legislation (SB203) but the bill died in committee in April 2015. CalBev, the California arm of the American BeverageAssociation, argued against the California bill by stating that soft drinks are not “uniquely responsible for weight gain,” and added that affixing a warning label would not change behaviors or teach people about healthy lifestyles.

But contrary to what CalBev has stated, various studies have confirmed that a warning label for soda is warranted. The California Center for Public Health Advocacy (CCPHA) states in a factsheet“An overwhelming body of scientific research shows that liquid sugar is uniquely harmful because it gets absorbed so quickly, and much faster than solid food. When sugar floods the bloodstream, it overloads the pancreas and causes the liver to store much of the sugar as fat – which leads to fatty liver disease. Both of these conditions contribute directly to diabetes. Research shows that drinking one or two cans of a soda a day increases the risk of developing diabetes by 26 percent.”

Nutrition experts agree that sweetened beverages, such as soft drinks, energy drinks, sweet teas and sports drinks, offer little or no nutritional value, and contain large quantities of added sugars. A 20 ounce bottle of soda contains the equivalent of approximately 17 teaspoons of sugar, whereas the American HeartAssociation recommends consuming no more than five to nine teaspoons of sugar daily. 

In New York City the harmful effects of soda consumption are more acute. Providing testimony before the New York State Assembly Standing Committee on Consumer Affairs and Protection on April 13, 2015, Christine Johnson, Assistant Commissioner of the Bureau of Chronic Disease Prevention and Tobacco Control at the New York City Department of Health and Mental Hygiene stated, “In New York City, 56% of adults are overweight or obese and over 10% have diagnosed diabetes. Rates are even higher in New York City’s poorest communities, which also bear a greater burden of chronic disease. 

Nearly a quarter of adults drink at least one sugary drink per day, and consumption rates are nearly double in New York City’s lowest-income communities compared to the highest-income communities, and over 40% of New York City public high school students report drinking one or more sugary drinks daily. The proportion of New Yorkers regularly consuming sugary drinks has declined in recent years; however, these rates are still too high.”

A study funded by the Healthy Eating ResearchProgram of the Robert Wood Johnson Foundation, and conducted by University ofPennsylvania, Harvard T.H. Chan School of Public Health and the University ofWaterloo asked 2381 parents to select a beverage from a simulated vending machine containing a variety of were sweetened and unsweetened drinks. The study revealed that those drinks with warning labels were three times as effective in making parents less likely to purchase a sweetened beverage. The warning labels also were effective among parents of varying educational backgrounds revealing that not just the most educated parents read the labels, but all parents read and considered the labels.

Assembly Bill 2320-B & Senate Bill S 6435 is important. Having that warning on soda labels means that each time a consumer goes to buy or drink that soda they would know of the danger to their health and hopefully, would put that soda down.  We know, however, that getting these two bills passed will not be easy. It will draw the ire and enormous money and power of the Soda Beverage industry to defeat it. The Bronx Health REACH Coalition knows how critical it is to reduce the overweight and obese epidemic in the Bronx  where 2 in 3 adults are overweight or obese, and where 4 in 10 public school elementary students are either obese or overweight. Efforts of our policy makers to make it easy for residents to make healthy choices is extremely important.

Should warning labels be placed on soda? Join in the conversation below.


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