High Cigarette Taxes Are a Start But Not the Whole Solution

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

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

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

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

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

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

By Suneet Goraya

Bronx Health REACH

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

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

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

Supporters Pack Public Hearing to Demand Health Equity

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

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

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

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

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

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

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