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.