Bronx Breastfeeding Reconvening 2023 - Strengthening the Community for a Successful Breastfeeding Journey

 

On May 19th, Bronx Healthy Start Partnership along with Morrisania Diagnostic & Treatment Center WIC Program (Morrisania WIC), Bronx Health REACH and other Bronx-based supporters hosted the Second Annual Virtual Bronx Breastfeeding Reconvening 2023. Approximately one hundred participants including mothers, healthcare professionals, and community leaders, came together to promote and advocate for breastfeeding within the Bronx community.

The Breastfeeding Reconvening serves as a forum for open dialogue and collaboration, with mothers at the center of the conversation, providing their firsthand experiences, challenges, and successes to inform the direction of the initiative, and most important, to normalize breastfeeding in the Bronx.  Presenters at this year’s Reconvening included breastfeeding advocates; Karla Lewis, BA, IBCLC; Allison Walsh, IBCLC, LCCE, FACCE, LLLL; Dianne Cassidy, MA, IBCLC-RLC, ALC; Katie Kelter MD, IBCLC; Chelsea Thompson, JD among others from across the borough. 

The morning began with a warm welcome and overview of the day from Alma Idehen of Bronx Healthy Start Partnership. Bronx Healthy Start is a collaboration led by Albert Einstein College of Medicine that works towards reducing infant mortality and improving women's health among women and mothers through outreach and enrollment in health insurance coverage under the  Patient Protection and Affordable Care Act (ACA) and connects families to medical homes.

Carla Lewis, facilitator of the Morrisania WIC Baby Café, kicked off the event with a conversation with Bronx mothers about their breastfeeding experiences including their challenges, successes, and needs. Carla asked each of the moms participating in the panel the following: ”What did you wish you had before and throughout your time breastfeeding” Three breastfeeding mothers shared that having a support system made a difference in their breastfeeding journey. It was an open and heartfelt conversation that allowed other mothers  to connect and share their own individual breastfeeding experiences. 

Dianne Cassidy, a lactation consultant, discussed research on how increased support for a breastfeeding mother leads to a longer duration of breastfeeding. Participants were asked to share positive ways someone can support a breastfeeding mother including family support, work accommodations, and high quality services from the prenatal period up to and beyond birth. A list was generated for supporters to use with their clients in the future. Allison Walsh’s presentation discussed communication to help families succeed during the lactation period. This included addressing conflicting information that hospitals, obstetrics, clinics, pediatricians, social workers, other Community Based Organizations and family members may provide, and how to communicate different norms, culture, and supports. The ultimate goal is to create a common language around breastfeeding that everyone can use to best support lactating mothers. Katie Kelter, MD, IBCLC discussed from a medical perspective how she is advocating for breastfeeding in the community. She provided recommendations such as starting breastfeeding education early by including it in K-12 school curriculums, providing more resources to families and supporters, increasing trainings for healthcare providers, offering more education on New York State Labor Laws in the workforce, and expanding funding for breastfeeding services. 

Chelsea Thompson from A Better Balance presented on back to work readiness for nursing mothers in NYC. She discussed the various work leaves for pregnant and lactating women and non-birthing partners such as the provisions of the Pump Act, the pending passage of the Pregnant Workers Fairness Act (PWFA), and the effect they will have on families. The PWFA requires covered employers to provide “reasonable accommodations” to a worker’s known limitations related to pregnancy, childbirth, or related medical conditions, unless the accommodation will cause the employer an "undue hardship."

Bronx Health REACH’s Rachel Ingram led the final session of the day by highlighting resources that would be beneficial to families and new mothers. Bronx Health REACH (BHR) provides trainings to help worksites and community spaces become breastfeeding friendly spaces. BHR also provides funding for two baby cafes in the Bronx: Morrisania WIC Baby Café and Bronx Healthy Start’s Breastfeeding Support Group. The Chocolate Milk Café is a national network developed by Black breastfeeding advocates and professionals to provide culturally congruent care to families of the African diaspora through peer-led lactation support and professional development programming. Professional support mentioned included WIC Peer Counselors and Doulas. WIC Peer Counselors are mothers in the community with personal breastfeeding experience who are trained to provide support to new mothers/parents. Doulas are trained to advise, inform, and offer emotional and physical comfort to parents, before, during, and after childbirth. Finally, there is virtual support available through NYC Warmline and the Compass App. The NYC Breastfeeding Warmline provides FREE virtual breastfeeding support from a Certified Lactation Consultant. Compass is a new app that supports parents from pregnancy through postpartum. The Reconvening wrapped up with participants joining breakout rooms to discuss ways in which the resources could be used in promoting breastfeeding and for community members and families to access and use. 

Closing remarks were made by Theresa Landau, MS, RDN, CDN, Program Director for Morrisania WIC, who thanked everyone for their input and attendance and encouraged all to join the next Bronx Breastfeeding Coalition meeting to continue the conversation. A Lactation Resource Guide with contact information and types of services offered was shared with participants and is listed below.

We look forward to seeing breastfeeding work in action at next year’s Reconvening!

LACTATION RESOURCES:

Bronx Healthy Start Go To Lactation Resource Guide

Breastfeeding Disparities Qualitative Research Study

Paying it Forward – Dianne Cassidy, MA, IBCLC,-RLC, ALC

NYC Department of Health and Mental Hygiene Doula Care

Bronx Doula Access Project

REACH June Coalition Meeting Celebrates 20 Years of REACH

Bronx Health REACH presented awards to Sue Kaplan and Joyce Davis for their work with Bronx Health REACH. (Left to right): Maxine Golub, Charmaine Ruddock, Sue Kaplan, Dr. Neil Calman and Joyce Davis.

This year marks the 20th anniversary of the Center for Disease Control's (CDC) Racial and Ethnic Approaches to Community Health (REACH) program. And, as one of the grantees funded since the inception of REACH, it also is Bronx Health REACH's (BHR) 20th anniversary as well. At the June 7th Coalition meeting, a panel of some of the founding members looked back at the past 20 years. The panelists included: Dr. Neil S. Calman, President and Chief Executive Officer of the Institute for Family Health; Maxine Golub, Senior Vice President of Program Development at the Institute for Family Health; Joyce Davis of Joyce Davis Consultants and Walker Memorial Baptist Church; and Sue Kaplan from NYU School of Medicine, Department of Population Health. The panelists discussed how it all began for BHR in 1999, what was the motivation, the vision, the mission.

"You had to go out into the community and do something, so I thought that applying for the Centers for Disease Control and Prevention's (CDC) very first REACH grant was the perfect opportunity for us to build on the work inside our organization and to do something outside the walls of our community health centers about bringing the issue of race to the forefront. We were not thinking about the social determinants at the time, but we felt that we had to address the inequities in the health care system," said Dr. Calman.

Maxine added, "At the time I did not think we had the expertise but we wrote the grant and the CDC gave us a year to plan. We held focus groups and we learned to ask, rather than, to tell the participants, and used their feedback to write a community action plan with input from the community."

"One Pastor at a Bronx church told us that he had young people in his congregation with toes cut off due to health ailments and something had to be done to address these issues," said Joyce. It was an open and engaging panel where all agreed that despite the many accomplishments of BHR, there is still much work to be done to eliminate health disparities.

Prior to the panel discussion, both Joyce Davis and Sue Kaplan were presented with awards. Joyce's award was for her exceptional leadership, vision and commitment to Bronx Health REACH and Sue's award was for her exceptional partnership and commitment. Sue in accepting her award noted, "Bronx Health REACH is not a project, it is a commitment."

Mt. Hope Staff Makes the Mt. Hope Health Center a Healthy Beverage Zone

When you enter the Institute for Family Health's Mt. Hope Family Practice you can now quench your thirst with a cup of delicious, fruit infused water as the Mt. Hope Family Practice is part of the Bronx Healthy Beverage Zone. The fruit infused water came about after the staff expressed an interest in changing their eating habits.

"We invited Bronx Health REACH staff member Kelly Moltzen and Cornell University Cooperative Extension-NYC to the Health Center to show us how we could manage our sugar intake," says Tanya Baker, staff administrator at Mt. Hope. "During this meeting they provided examples of various sugary beverages and under each container they placed a plastic pouch showing exactly how much sugar each one contained. We were shocked by the unhealthy amounts of sugar in each beverage. During this education session they taught us how to read the nutrition labels. With this newly acquired knowledge we decided to sign the pledge to stay away from sugary drinks."

Kelly, who also co-chairs the Bronx Healthy Beverage Zone initiative, provided Mt. Hope with a fruit-infusion water dispenser as part of the Creating Healthy Schools & Communities program's worksite wellness initiative. Mt. Hope introduced the fruit infused water to staff members and patients with the goal to decrease their sugar intake.

"The dispenser is put out every day in the patient waiting area for everyone to enjoy," adds Tanya. "Myself and the Medical Director are committed to drinking at least 64 ounces of water every day, and other staff members and patients have increased their consumption as well. We have patients and Mt. Hope staff filling their water bottles when they arrive and as they leave. The pineapple flavored fruit infused water seems to be the most popular as patients and staff always request it."

Staff share their enthusiasm about the fruit infused water:

“The infused water is so refreshing and in such a perfect location, patients and staff love it” - Krystina Baez, MOA

“Nothing better than walking in to the Mt. Hope Health Center on a hot summer day and seeing ice cold, refreshing fruit infused water. The staff and patients love it.” -Christina Burgos, MOA

“The infused water is amazing, especially the pineapple. It’s refreshing and quenches our thirst.” - Montrecia Frazier, MOA

“Ms. Baker, let’s keep this water going. The patients love it when they walk in thirsty from the outside.” - Karen Gil, MOA

“I am really enjoying the refreshing water they provide. I love it so much that it has encouraged me to do it at home as well.” - Affya Thompson, LPN

“Having the infused water here at Mt. Hope exposes patients to a great way of living.” - Dr. Amarilys Cortijo, Medical Director.

“It is exciting to see staff taking control of their health...Mount Hope is serving as a great example for what other worksites and health clinics can accomplish.”  - Kelly Moltzen, MPH, RD

Tanya Baker and Kelly Moltzen contributed to this article.

Symposium Provides Forum for Community Based Organizations to Showcase Their Work

On September 27th Bronx Health REACH, along with the Center for the Study of Asian American Health at NYU School of Medicine’s Department of Population Health, and Bronx Community Health Network, all grantees of the Centers for Disease Control and Prevention’s (CDC) Racial and Ethnic Approaches to Community Health (REACH) grant; and the NYC Department of Health & Mental Hygiene, a CDC Partnership to Improve Community Health (PICH) grantee hosted a symposium, “Community Transformation through Partnerships.” Over 150 people attended the forum that provided community based organizations such as Transportation Alternatives, Casita Maria and others to share strategies and initiatives designed and implemented to create opportunities for healthy living in communities with significant rates of racial and ethnic health disparities.

Dr. Ruth Petersen, Director for the Division of Nutrition, Physical Activity, 

and Obesity at the Centers for Disease Control and Prevention.

Opening the symposium was Dr. Ruth Petersen, Director for the Division of Nutrition, Physical Activity, and Obesity at the Centers for Disease Control and Prevention. Dr. Petersen spoke about the REACH program improving the health of many Americans by providing 2 million people greater opportunities for choosing healthy foods and beverages, and 600,000 people with increased opportunities to be physically active as a result of environmental and policy improvements. Richard Hamburg from Trust for America’s Health and Dr. Susan Beane from Healthfirst were keynote speakers. Mr. Hamburg noted that the best long term investment is increasing CDC funding to programs such as REACH as doing so has been shown to improve the health and well-being of many communities. Dr. Beane discussed Healthfirst's efforts to merge health and social services to create and support a "Healthy Village" system of healthcare.

Gail Heidel, Associate Director of Creative Arts Programs at Casita Maria.

Bronx Health REACH partners were featured on two panels. On the Community Leadership and Engagement panel Erwin Figueroa, Bronx organizer for Transportation Alternatives spoke about the work of transforming the Grand Concourse into a Complete Street. And, on the Evaluation and Storytelling panel, Gail Heidel, Associate Director of Creative Arts Programs at Casita Maria, gave an overview of their projects painting murals on playgrounds in the South Bronx to encourage more outdoor physical activity. She also spoke about engaging residents to be active participants in the Bronx campaign to become ‘The World’s Strongest Borough’ utilizing the ‘Mobile Pull-Up Bar of Power.’

Charmaine Ruddock, (left) Project Director at Bronx Health REACH.

The final panel of the day was a unique conversation with funders and grantees discussing, from their respective perspectives, the expectations and efforts of each when trying to effect long term sustainable changes in communities disproportionately experiencing racial and ethnic health disparities. The panelists were Max Winer from New York University, Sarah Oltmans from Robin Hood Foundation, Nupur Chaudhury from the New York State Health Foundation, Linda Lee from Korean Community Services and Bronx Health REACH's Charmaine Ruddock. Charmaine focused her remarks on the importance of getting buy in from the community. "You can't have folks helicopter into the community and helicopter out; there has to be a commitment to the community."

Healthy Beverage Zone Launches in the Bronx

On Tuesday, April 18th Bronx Health REACH/The Institute for Family Health, and Union Community Health Center officially launched the Healthy Beverage Zone initiative, a borough-wide movement promoting healthy beverage consumption among individuals who work and/or live in the Bronx. The event, held at Hostos Community College, a partner in the initiative, included Bronx Health REACH's Kelly Moltzen, Bronx Borough President Ruben Diaz Jr., New York State Senator Gustavo Rivera, Assemblyman Victor Pichardo, and Dr. Vanessa Salcedo from Union Community Health Center. The speakers encouraged Bronx residents to take the pledge to make their workplace, school, place of worship and home a healthy beverage zone free of sugar sweetened drinks.

The Institute for Family Health's Mount Hope, Stevenson and Walton health centers will soon become Healthy Beverage zones. The Bronx, selected as one of 50 finalists in the Healthiest Cities & Counties Challenge, has received a $10,000 community award to support the Bronx Healthy Beverage Zone. At the end of the Healthiest Cities & Counties Challenge, the programs that show measurable change may be eligible for prize awards of up to $500,000.

You can read more about the Healthy Beverage Zone by visiting the website. 

Bicycle and Soccer Program Comes to Claremont Village

Bronx Lebanon Hospital, a partner with Bronx Health REACH, is creating a bike and soccer program for residents of the Claremont Village community. The goal of the bicycle program is to  provide exercise and, very importantly, to establish bike lanes for the Claremont Village neighborhood connecting Mott Haven, Hunts Point and Claremont, with safe bike routes.

The bicycle program offers, every Saturday from 10 a.m. to 12 p.m. the Claremont in Motion Bike Ride Program  free, learn to ride classes and group rides  open to anyone ten years and older. Held at the Claremont Neighborhood Center, participants are first evaluated on their biking abilities, and if needed, offered riding lessons. Participants also take a road safety course before heading out for a group ride. Group rides have consisted of trips to the Bronx Zoo, the Bronx Botanical Garden, Crotona Park, and Randalls Island. Bike New York assists in the riding lessons and group rides. Another aspect of the bicycle program is working with Recycle a Bicycle to refurbish old bicycles, which will provide participants in the program with an opportunity to learn basic bicycle mechanics.

Street Soccer USA, and Bronx Lebanon Hospital, with support from Bronx Health REACH, is partnering on a  soccer program. On Saturday, September 10th a “Back to School” event was held at CS 55, with soccer training workshops being held for youths aged 5 to 18. The main attraction of the event, the Street Soccer USA Stadium, is where youth participating in the event can play short, 15 minute games during the day. The goal of the soccer program is to establish an after school program at CS 55 starting in October, and eventually build a soccer court within Claremont Village using  an underutilized space on the property.

Assemblyman Victor M. Pichardo - Making Government a Force for Good

Bronx Health REACH continues its series on individuals who have made a significant contribution to not only the Institute for Family Health, but to the African-American, Black and Latino communities in the Bronx where they have been strong activists for needed change. A notable member of this group of change agents is New York Assemblymember Victor M. Pichardo, representing the 86th New York State Assembly District, which includes the University and Morris Heights, Mount Eden, Kingsbridge, Tremont, and Fordham sections of the Bronx.

Assemblyman Victor M. Pichardo became interested in public service following a family tragedy fifteen years ago. The Asemblyman’s cousin, who had been working as a livery cab driver, accidently bumped a motorcycle and the motorcyclist ended up stabbing his cousin to death. The suspect fled to the Dominican Republic. “It seemed like the case to get the guy that killed my cousin had stopped, so Senator Charles Schumer took an interest in the case and flew down to meet the President of the Dominican Republic to request extradition. Unfortunately word got around and the suspect then fled to Belgium. With the assistance of Senator Schumer, Interpol tracked down the suspect and he was later brought back to face justice. From that point on, I understood that government is, and should always be, a force for good.”

Assemblymember Pichardo's start in public service began as an intern for Senator Schumer, and eventually became the Community Outreach Coordinator/Latino Liaison. After taking a position at Mercy College, Pichardo discovered that public service was a better fit, and took a job as the Director of Community Affairs for New York State Senator Gustavo Rivera. In this position he saw the severity of health disparities faced by Bronx residents. “I have heard residents tell me, ‘My daughter is suffering from asthma, and I still have to wait three months to get an appointment,’ while others have confided that they are unable to get affordable cancer screenings and the only time they can get them is when a community health fair has them for free. But now with the Affordable Healthcare Act in place, health care must be provided to communities of all sizes, regardless of geographic and socio economic status, and individuals should receive the same equity of care in a timely matter.”

With the Bronx being ranked 62 out of 62 counties by the Robert Wood Johnson Foundation County Health Rankings & Roadmaps, Assemblyman Pichardo would like to turn around the negative stereotypes most people have about the Bronx. “It should not matter which zip code you were born in, you should be given and afforded the same resources and opportunities as anybody else in terms of jobs, housing, and education. Take the recent incidents of police brutality, which I feel has spiked in the last few years. Government has a responsibility to make sure that a young man of color, regardless of the neighborhood he lives in, be it the Bronx, Staten Island, Louisiana, or Minnesota, should be able to safely walk in his community, and not lose his life for an unfathomable reason.”

He adds, “People who feel more job and housing secure tend to be healthier overall, and their health outcomes tend to be better. We need to create sustainable safe communities with residents having gainful employment and affordable/stable housing. When that happens your mind is focused on taking care of your health, and the health of your family. The flipside is that being stressed out on things like a paycheck that won’t pay the rent and buy sufficient food, much less healthy food negatively affects ones health.”

Last April, when Bronx Health REACH held the #Not62 – The Campaign for A Healthy Bronx! Town Hall, the Assemblyman spoke to attendees after having spent an all-night legislative session in Albany to finalize the budget. He shared with the audience what he and the other Assembly members had been fighting for - a $15 minimum wage in New York State. “That $15 minimum wage means there is more money in the community for residents to purchase healthy fruits and vegetables, which means healthier outcomes, and that would be one of the first steps we can take to move from worst to the best, so the Bronx is no longer 62 out of 62.”

Dr. Eric Gayle – A Commitment and Passion for Providing Underserved Communities with High Quality Medical Care

Bronx Health REACH continues its series on individuals who have made a significant contribution to not only the Institute for Family Health, but to the African-American, Black and Latino communities in the Bronx where they have been strong activists for needed change. A notable member of this group of change agents is Dr. Eric Gayle, Vice President, Medical Services and Regional Medical Director, in New York City for the Institute for Family Health. Dr. Gayle also mentors minority students who are interested in careers in medicine, and leads the Institute’s credentialing committee.

Growing up in Kingston, Jamaica Dr. Eric Gayle quickly learned that a community lacking robust healthcare means having to wake up at 4:30 in the morning to stand in line for hours to be seen by a doctor. To Dr. Gayle, this did not seem right, and those experiences influenced him to become a doctor. The path to becoming a doctor began following his arrival in New York with his mother after completing high school in Jamaica. Dr. Gayle found having to navigate getting into college and medical school in the United States had its challenges. One was the few financial resources available to him; the other was improving his language skills since his spoken language was his native Jamaican patois. He found that he had to work hard to enhance his own standing in the eyes of others for them to give him access to opportunities. After determining the best avenue for getting into medical school, Dr. Gayle enrolled at the Sophie Davis Biomedical Education/CUNY School of Medicine, beginning his path to a career in medicine.

One class he took opened his eyes to the poor health services many New Yorkers received. Dr. Gayle had to review health services offered to the Harlem community and in doing so he was shocked to learn that Harlem residents received the same poor health services as Dr. Gayle experienced growing up in Jamaica. As a Bronx resident Dr. Gayle also observed that his neighbors in the community were not getting what they needed to become healthy. After completing his B.S. from the Sophie Davis Biomedical Education/CUNY School of Medicine, Dr. Gayle transferred to the Mount Sinai School of Medicine to complete his medical degree. He then did his residency in family medicine at Beth Israel Hospital, and upon completion of his residency in 1998, went to work at one of the Institute for Family Health’s (IFH), clinics in the Bronx.

His current responsibilities relate to the overall operations of the IFH New York City clinical centers. Dr. Gayle is responsible for ensuring that there is enough provider staff at all IFH centers, and that providers meet expectations on the quality of care for patients. "We are here for the patients, to improve their health and to serve the community. My principal responsibility is to give all health centers everything they need to be successful and meet that objective. Even though practicing in underserved communities is not easy, I can impact someone’s health by prescribing medication or offering them advice. It is hard to impact some of the social determinants of their health. Those are outside my control," says Dr. Gayle.

From his days growing up in Jamaica, Dr. Gayle knows what his patients are experiencing when it comes to accessing healthcare in underserved communities. "I know what it means to be in poverty and have social determinants impact your health. When my mother and I arrived in New York we did not have health insurance so I understand what my patients are going through and I have an understanding of what it takes to get them through these challenges," says Dr. Gayle. Addressing the current state of health disparities, Dr. Gayle believes there is more work to be done. "I don’t think we have impacted social determinants of health. I see there is dialogue and research but nothing has been done to improve income equality or housing, as many are still dealing with the same issues that were there 20 years ago. People are struggling to find food. Why does that continue to be a problem? It would take commitment and resources such as money to revamp the whole system," says Dr. Gayle.


A commitment to providing underserved communities with high quality medical care is what has been a guiding passion throughout Dr. Gayle’s career. So what advice would he give to those graduating medical school seeking a similar career but who are graduating with $200,000-$300,000 in student debt? “Though, this may be seen as a significant barrier I tell students not to be discouraged. If you have the passion, and really want to do this work, you can be successful," says Dr. Gayle.

Rev. Dr. J. Albert Bush – A Strong Voice for the Bronx Community and Beyond

Bronx Health REACH  will be featuring individuals that have made a significant contribution to not only the Institute for Family Health's Bronx Health REACH, but have been strong activists for needed change in the Black and Latino communities in the Bronx as well as elsewhere. A notable member of this group of change agents is the Rev. Dr. J. Albert Bush, Sr. pastor of Walker Memorial Church in the Bronx. Rev. Bush is a 1983 graduate of the Lutheran Theological Southern Seminary in Columbia, South Carolina where he earned a Master of Divinity degree, and later earned a Doctor of Ministry Degree from the Drew University Theological Seminary in New Jersey. 2016 marks his 34th Pastoral Anniversary at Walker Memorial Church.

Growing up in South Carolina as the second of nine children, Rev. Dr. J. Albert Bush was the first in his family to graduate from college. Adopting a liberationist approach to theology, Rev. Bush started to see and understand how God could use poor people as an instrument to make change in their community.

Answering the call to serve at Walker Memorial Church in 1982 provided a wake-up call for him. Walker Memorial Church had been at 116th Street in Harlem, and moved to the Bronx prior to his arrival. “The Bronx at the time had no housing, no industry, just burned out buildings and depression all around. Many of the people in the congregation saw my arrival as a ticket back to Harlem,” says Rev. Bush. Believing that his time in the Bronx would only be two years, Rev. Bush found himself asking God, “Why did you send me here? Do I belong here?”

Out of his quest he discovered that Walker Memorial Church did not need to return to Harlem. He could learn to love and care for the people of this community and lead them so that they could take responsibility for the change that needed to come. Looking back Rev. Bush admits that was a painful decision, but is convinced that it was the right one at the time. “God was making plans for me to do something, and when I embraced that concept, I led my congregation to become involved in the renewal and rebuilding of this community,” says Rev. Bush.

That renewal and rebuilding has included the Grand Concourse Academy Charter School. “We purchased the empty lot next door twelve years ago and built Grand Concourse Academy Charter School without any federal, state, or grant money. The school was built with all the financial support coming from members of Walker Memorial Church,” says Rev. Bush.

Rev. Bush has also been a long time member of the Bronx Health REACH Coalition where he provides Walker Memorial Church as the meeting place of the Faith Based Outreach workgroup and the quarterly Coalition meetings. He has seen the damage health disparities has done to the community. “This community unfortunately has some of the highest breast cancer rates, highest heart disease rates, and highest amputation rates from diabetes. The thing that surprised me most was the lack of awareness in the community itself. People did not know they were unhealthy,” says Rev. Bush

He believes that healthcare should be more affordable, and more accessible. “You are talking to a man that was once paying $2,500 a month for health insurance over four years to cover his family. That is crazy! One needs a full time job just to pay for health care and that is senseless. It seems that we are comfortable in America keeping and maintaining an underclass,” says Rev. Bush. Rev. Bush adds, “I have experienced a great deal of what the people I seek to help have experienced. I was born in poverty, raised in poverty, and knows what it is like to not have health insurance. I feel every American should have the same level of healthcare that every Senator and Congressman receive. If we can grant it to them, they can return the favor.”

One thing Rev. Bush would change to make health care more equitable would be the elimination of the two class system where those with insurance can see anyone faster than those without insurance that have limited options. “I know of people that have died in the emergency room that had been waiting up to fourteen hours to be seen by a doctor, but people with same problem that have health insurance, they can be seen by someone lickety-split,” says Rev. Bush.

Rev. Bush still continues his work assisting those that have been displaced by disasters in places such as Mississippi and Georgetown, South Carolina. “I am the lead for our denomination (National Baptist Convention) for the disaster response team to any man-made and natural disasters. I have fifteen men on the ground in Mississippi providing relief to those affected by the tornadoes. I have thirty-seven men in Georgetown, South Carolina who are working in partnership with the American Red Cross, FEMA, and other disaster relief agencies, as well as congregations, to aid and assist the people of South Carolina with emergency supplies, such as food, water, and clothing, helping people rebuild homes damaged by the floods,” says Rev. Bush. Currently Rev. Bush is working with officials in Flint, Michigan trying to resolve the man-made disaster of poisoned water.

And the relief efforts are not limited to the United States. In response to the Ebola crisis in Liberia, Rev. Bush Sent aid project through his missionary organization, So Send I You to Providence Baptist Church in Monrovia. “We have sent food relief to Liberia by shipping two ninety foot containers to Liberia with $90,000 worth of food. We also have a daycare center in South Africa in the poorest section of Soweto, and a food kitchen in Swaziland that feeds seventy-five orphan children that have lost both parents to AIDS. We are also building a church and library in South Africa,” says Rev. Bush.

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 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.

Health Care Organizations Issue Call to Action to Eliminate Health Disparity

For over a decade Bronx Health REACH has been working within underserved communities to eliminate health disparity. In that time, government agencies, hospitals, and health systems have become more willing to address health disparities and work toward solutions to achieve health equity. This partly stems from ethical obligation, but it also enhances performance and makes good financial sense. (Chronic diseases account for the largest health gap among ethnic and minority populations and are responsible for 75 cents of every dollar spent on health care in the U.S.) Even so, the Call to Action to Eliminate Health Care Disparities, issued by leading national health care organizations last week, is notable for its commitment in providing a foundation to accelerate efforts to achieve health equity.

Led by the American Hospital Association (AHA), the “Call to Action” brought together five major health care organizations, including the American Association of Medical Colleges (AAMC) and the National Association of Public Hospitals and Health Systems, to focus their efforts on eliminating health disparity. “We’re in a new era of health care,” says Dr. Maulik Joshi, senior vice president of the AHA. “Collaboration is a key part of the process.” The group will focus on three building blocks: increasing the collection and use of race, ethnicity and language data; increasing cultural competency training for all staff; and increasing diversity in leadership and governance. The organizations will pool resources and tools and have created a website (www.equityofcare.org) as a portal for information on how to implement these initiatives within hospitals.

A main impetus for joining this effort, says Dr. Marc Nivet, chief diversity officer at the AAMC, was the recognition that medical schools and teaching hospitals need to do a better job in communicating the importance of health disparity. “We’re creating future physicians and we’ve known for a long time that we’re not providing a workforce that is culturally competent,” says Dr. Nivet. “We need to have the concept and understanding of health disparity woven into the curriculum.” Collecting and sharing data is also a key component so that people understand the issues and better policy can be made. The goal, says Dr. Joshi of the AHA, is not just systematic data collection, but a better understanding of the community and how the right data can be used achieve equity of care.

The importance of integrating the entire hospital structure with the community is also a key part of this effort. “Community organizations have been in the right place for decades in terms of trying to improve health by not just paying attention to health care, but paying attention to other social determinants of health,” says Dr. Nivet. “It’s important that all of that knowledge is transferred through shared learning between major medical institutions and community groups to figure out how we can all work together more closely going forward.” Dr. Joshi agrees, saying that hospitals are often role models in the community and collecting better data allows hospitals to know their communities in a more comprehensive way. “We need to move away from this mentality that we sit in the community to that we are part of this community,” concludes Dr. Nivet.

The chasm between public health and medicine is a frequent roadblock in collaboration between community groups and hospitals, but the “Call to Action” may be the crucial opportunity needed to bridge the gap. We applaud these health care organizations for taking a decisive step forward in outlining steps to achieve health equity and providing resources so that hospitals can implement better practices. As a community-based initiative, Bronx Health REACH looks forward to increased collaboration with hospitals and hopes that this effort galvanizes hospitals across the country to heed this Call to Action and become active in the national effort to eliminate racial and ethnic health disparities.