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.