OUR HEALTH PLATFORM

POLICY CONTRIBUTORS, WRITERS, & EDITORS

POLICY CONTRIBUTORS

  • Medha Ghosh, Coalition for Asian American Children
    and Families (CACF)
  • Anthony Feliciano, Commission on the Public’s Health
    System (CPHS)
  • Anita Gundanna, Coalition for Asian American Children
    and Families (CACF)
  • Hallie Yee, (formerly) Coalition for Asian American
    Children and Families (CACF)
  • Juan Pinzon, Community Service Society (CSS)
  • Max Hadler, New York Immigration Coalition (NYIC)
  • Seongeun Chun, New York Immigration Coalition
    (NYIC)

WRITERS

  • Alan Abraham
  • Jennifer Qu
  • Natasha Jaffar
  • Iman Ansari
  • Ilana Novick
  • Josie Steuer Ingall
  • Shubh Thakkar
  • Dalal Shalash
  • Elijah Rockhold
  • Annie Benjamin
  • Virginia Hart

EDITORS

  • Alan Abraham
  • Zara Nasir
  • Elijah Rockhold
  • Ilana Novick
  • Lynn Esa
  • Virginia Hart
  • Medha Ghosh
A VISION FORWARD

Every New Yorker deserves access to culturally and language affirming affordable health care. The pandemic made broadly visible our city’s unjust and inequitable health system and the ways in which it disproportionately impacts Black, Indigenous, people of color (BIPOC); immigrant communities; low-income communities; under- or unemployed New Yorkers; people with disabilities; those who are unhoused; and essential workers. The challenges elevated in the COVID-19 pandemic—systemic racism in health care and other systems that are meant to take care of people, and their subsequent and intersecting impacts— are not new. They surface for a broader swath of the community the fractured health, mental health, and political systems that have long needed change. Comprehensive health care is the result of access, quality, services, fairness, and community. The City should center these elements and communities that have been historically marginalized from health care policy.

POLICY RECOMMENDATIONS

1) Advance equitable Covid-19 responses

The year of 2020 made broadly visible our city’s unjust and inequitable health system and the ways in which it disproportionately impacts Black, Indigenous, People of color (BIPOC); immigrant communities; low-income communities; those who are unemployed; people with disabilities; those who are unhoused; and those who are on the front lines serving as essential workers during COVID-19. Throughout the decades and the COVID-19 pandemic, the levels upon levels of persistent and new injustices, community base building partners have persisted through navigating environmental and human-made disasters and constructing responses of mutual aid and solidarity in a time of extreme need in our city’s most impacted and disinvested communities.

1A. Ensure equitable vaccine distribution to disproportionately affected communities

Problem:  According to the City’s Department of Health and Mental Hygiene (DOHMH), low-income communities of color in eastern Brooklyn, eastern and south eastern Queens, and the Bronx were most affected by the COVID-19 virus. The City has developed an Equity Action Plan (EAP) to advance equitable policies and practices in the City’s COVID-19 response. However, given the legacy of health disparities in communities of color, and barriers around language, transportation, and public health education, the City must make a concerted effort to offer vaccinations and boosters to historically marginalized communities. 

Recommendation: The City must prioritize early rounds of the shots and second doses for communities disproportionately affected by the disease.  Most importantly, the City must remove barriers and bureaucracy for the mechanisms through which people are able to access at home and on-site testing, and vaccination and booster appointments.  Race is an extremely critical priority but in these early planning stages, essential worker employment like health care workers including service and hospitality workers, data like death and infection rates, along with housing status, age, economic stability, health care coverage and ethnic backgrounds could all play a role in who might be among the first groups to get vaccinated and/or boostered. The City must ensure that people administering the vaccine are representative of the community, understand cultural differences, and speak local languages. There must be an informational campaign to reach out to people who may not have enough information on logistics or who may be hesitant to take the shot.

Office: Mayor

Mechanism: Budget, Mayoral and/or Agency Policy

1B. Improve disaggregated data on infection rates, hospitalizations, and deaths

Problem: Because of medical, environmental, and structural racism and resulting health disparities, marginalized communities of color have a higher risk for poorer health and health outcomes. These communities also have a higher prevalence of underlying health conditions that exacerbated COVID-19 related morbidity and mortality.  BIPOC; immigrant communities; low-income communities; those who are unemployed; people with disabilities; those who are unhoused; and those who are on the front lines serving as essential workers during COVID-19 are particularly vulnerable. 

 Recommendation: ​​The City must improve on specific and granular disaggregated data on infection rates, hospitalizations, and deaths, and disaggregate existing data collection around race/ethnicity, sex, and age.  The City Council should require the city to expand data and improve interoperability of data systems to include collecting information on primary written and spoken language, disability status, sexual orientation, gender identity, and socioeconomic status of participants. Data collection should also be carried out in nursing homes, residential facilities, homeless shelters, and detention centers.  Deaths at home or in the streets must be counted.

Office: City Council

Mechanism: City Legislation

1C. Build community-based health safety-nets

Problem: Mayor Bill de Blasio announced that the city will invest $20 million to create the Pandemic Response Institute to focus on development of new technologies and systems that detect, track and monitor health issues, especially those that signal vulnerabilities to disease outbreaks. The City has given no detail on how they will use these emerging technologies to focus on local populations across the City, or how to use them to address hyper-specific community spread, language, culture, and infrastructure barriers. To house such an investment in the Alexandria Center for Life Sciences on the East Side of Manhattan also indicates privatization of resources and unnecessary level of burden on the community to engages with another institution, especially communities that are traditionally excluded from healthcare and other support systems, and not covered by any current or existing labor protections (i.e., sick leave).  This investment could be better focused on ensuring the City’s Health Department is better resourced to address this under their responsibility for the health of city residents and their community-based engagement. 

Recommendation: If this Institute is developed, then the city must have a transparent process in selecting an operator with deep roots in community partnerships and community led decision-making. In this project, and all others, the City must invest directly in localized partnership with community organizations on the front lines to protect those hardest hits by pandemic from barriers to accessing health and violations of rights to healthcare; to help navigate ways to ease financial costs of care; to support public health efforts to trace/quarantine/isolate; and to address the stigma and fears around testing, treatment, and tracing efforts.  Communities that are traditionally excluded from healthcare and other support systems, and not covered by any current or existing labor protections (i.e., sick leave) must be centered in this approach. The New York City Economic Development Corporporation’s (EDC) initiative to finance projects in public health and the life sciences must include an equitable assessment and evaluation of what public health projects truly address community needs. The City Council should explore legislation on EDC’s assessment and evaluation of public health projects.

Office: Mayor, City Council
Mechanism: Budget, Mayoral and/or Agency Policy, City Legislation

1D. Fund public health education for diabetics and those at high-risk of COVID-19

Problem: New York City has some 1 million residents with diabetes, a condition that disproportionately affects Black, Hispanic, and low-income communities. New Yorkers with diabetes need to know about the decisive role of excess blood sugar in severe COVID illness; and be encouraged and empowered by understanding that every step they take to reduce their blood sugar will help them.  New York City’s staggering 256% increase in deaths of people with diabetes during the first wave of COVID— the largest increase in the nation— underscores New York City’s longstanding and equally staggering failure to address chronic disease using proven strategies.. The city must provide at-risk New Yorkers with free and accessible tools and education. 

Recommendation: The City must pay for the community delivered self-management courses that best “reach and teach” diabetics at high risk for COVID accompanied with a public health and information campaign. Self-management courses provided by locally trained peer educators and peer coaches; and a group course called the National Diabetes Prevention program (NDPP) helps people with pre-diabetes (high blood sugar) improve their “lifestyle” and reduce by 60 percent the risk that they will proceed to develop outright diabetes. The city must invest in free and accessible forms of public health education to assist diabetic New Yorkers and help keep them safe during the COVID-19 pandemic. Individuals must also know how this affects their risk of contracting COVID-19 and other dangerous ailments. Diabetic individuals must have access to their medication, their primary care physician, and any other tools and resources needed to treat and manage their diabetes, all with remote access. 

Office: Mayor, City Council
Mechanism: Budget, Mayoral and/or Agency Policy

2) Foster better health navigation and access to care

The global pandemic highlights the detrimental and devastating effects of a poorly organized profit-oriented healthcare system. The communities that know this devastation most are the most vulnerable and marginalized in the City. BIPOC; immigrant communities; low-income communities; those who are unemployed; people with disabilities; those who are unhoused; and those who are on the front lines serving as essential workers during the pandemic often do not have access to adequate healthcare. It is imperative that the City funds, enforces, and delivers quality health care for all New Yorkers, including and especially people who are undocumented, people who are incarcerated, people experiencing houselessness, and low-income communities. This will happen with the proper funding and enforcement of executive orders, expanding educational efforts, and localized strategies to best support the City’s residents.

2A. Expand the reach and funding for NYC Care to serve more New Yorkers

Problem: NYC Care is a city-level program to address the high numbers of uninsured New Yorkers, especially in the immigrant community. There are at least 400,000 individuals who still do not have health insurance in the state of New York. As more and more people’s access to adequate and stable healthcare is threatened as they become under- and unemployed due to the economic effects of the pandemic.  Despite the important coverage that NYC Care provides, funding is still a limitation on how impactful the program could be. Currently, the rollout of NYC Care has utilized the expertise of trusted and culturally competent community-based organizations by offering funding through an RFP process to assist in the outreach and enrollment into NYC Care. But the current budget for NYC Care is not enough for Federally Qualified Health Centers, which exist to serve those who have limited access to healthcare. More CBO’s would have also taken advantage of the RFP, if the amount of the grant were higher.  

Recommendation:  The next administration of city elected officials must recommit to this program by investing more than what has been currently budgeted for. Community-based organizations are vital partners, and the roll-out is strengthened by included Federally Qualified Health Centers as partners. The budget and reach of NYC Care must be increased, and areas where additional health care providers need to be located should also be evaluated by assessing the needs of individuals living in those areas. Plans to expand community-based provider services must be developed with community residents and providers. Part of the planning needs to ensure that the uninsured can access services without regard to immigration status or the ability to pay.

Office: Mayor, Council

Mechanism: Budget, Mayoral and/or Agency Policy

2B. Enforce language access local laws for health care organizations

Problem: A large number of New Yorkers have limited English proficiency, posing a significant challenge when they interact with government services. The Mayoral Executive Order established policies and standards for translation and interpretation services for City agencies that have direct interaction with New Yorkers. Agencies must provide services in the top 10 languages in New York, including Spanish, Chinese, Russian, Korean, Italian, and French Creole, as dictated by the City of New York. Health care institutions have not been abiding by these mandates to ensure inclusivity and equitable access to health care. According to a report by Make the Road NY, many immigrant New Yorkers are unable to communicate with their doctor, did not receive informational materials from their doctor in a language they could understand, and have never been informed of their right to receive free translation services. 

Recommendation: The city should ensure and enforce that our health care institutions are abiding by the Mayoral Executive Order 120 and Local Law 30. These citywide policies on language access are meant to ensure the effective delivery of City services. The City’s Human Rights Commission should review language access plans and conduct “secret shopper” efforts. “Secret Shopper” scores provide feedback on the quality of language access services provided, which will help inform policy and operational recommendations. In doing so, this policy helps hold health care institutions accountable to providing adequate language services. The law should also expand the number of languages that are considered in the Order, as many communities are left out when only six languages are represented.

Office: Mayor, City Council 

Mechanism: Budget, Mayoral and/or Agency Policy

2C. Pass Intro 1674 and create an Office of the Patient Advocate

Problem: New Yorkers need a centralized place to report problems with medical care; communities need a watchdog to identify trends and gaps in health services across the city. When there are hospital closures or a new facility is to be sited, the current process does not welcome community involvement or input. Although New Yorkers can report issues involving hospitals, primary-care clinics and some types of medical centers through the New York State Department of Health, the health care system is incredibly complex and the burden should not be on New Yorkers to navigate its bureaucracy. 

Recommendation: The City Council should pass Intro 1674, which calls for the creation of an Office of Patient Advocate in New York City. A dedicated office whose responsibility it is to assist and engage members of the community in crucial health decisions affecting New Yorkers will aid in the City’s approach to healthcare being more humane and participatory. The Office should assist in receiving, tracking, and analyzing patterns of patient complaints about problems navigating both public and private health systems in New York City and in getting timely, appropriate, and non-discriminatory care. The same city office should monitor the filing of Certificate of Need (CON) applications from NYC-based health providers, alerting community boards to the applications, gathering public comments, and then submitting comments to state CON regulators about how proposed transactions would serve to improve access to care for New York City residents.

Office: City Council

Mechanism: Budget, City Legislation

2D. Fund health initiatives serving BIPOC and low-income, immigrant communities

Problem: Research shows that immigrant families often forgo needed health care and social services because they fear interactions with public agencies. Overall, immigrant New Yorkers have lower rates of health insurance, use less health care and receive lower quality of care than U.S.-born populations. Further, the neighborhoods that experience the highest disease burdens are populated mainly by people who are Black, Latinx, and low income. In order to continue operating and serving BIPOC and low-income, immigrant communities, the city budget must contain health initiatives to serve these communities. 

Recommendation: Existing health initiatives such as Access Health NYC and the Managed Care Consumer Assistance Program (MCCAP) should continue to be funded in the 2022 fiscal year. Programs like these are vital for addressing access to care issues, education, and outreach too hard to reach marginalized and sometimes insular communities.  Low-income New Yorkers continue to benefit from ensuring it has capacity to work with underserved populations, to do outreach and public education about health care coverage, care, and rights. Access Health NYC also provides added value to the Health + Hospitals NYC Care program.  

Office: City Council

Mechanism: Budget

According to the Community Service Society, Black and Latinx New Yorkers are twice as likely as white New Yorkers to die from the COVID-19, exposing the deep health disparities resulting from structural racism present in our healthcare and health affirming systems. Quality care remains out of reach for members of marginalized communities because of economic factors and health care bias, both of which contribute to disparate health care outcomes. The City must improve access to healthcare through adequate funding for public hospitals and Federally Qualified Health Centers that serve uninsured New Yorkers. Additionally, the city must improve care by investing more to train health care providers to address implicit bias.

3A. Defend, protect, and fully fund the public hospital system

Problem: The New York City Health and Hospitals (NYC H+H) system holds the key to lessen health disparities in this city. It has been and will continue to be in the epicenter of the fight to protect the public’s health. The New York City Health + Hospitals system (NYC H+H) provides public healthcare for 1.3 million New Yorkers. Public hospitals, where people without insurance can access healthcare, are overburdened because of an overall shortage of hospital beds,

 contributing to disparities in health outcomes in marginalized communities. H+H helps all who need help regardless of ability to pay, including immigrant New Yorkers. According to the Queens Chronicle, much of the NY State Indigent Care Pool (ICP) Funds, public money earmarked for caring for low-income New Yorkers, is misdirected to hospitals that do not primarily serve low-income patients. The Independent Budget Office reports that the city has allocated just $2.6 billion to NYC H+H for 2022, even though hospital expenditures are expected to top $11 billion. 

Recommendation: All the public hospital facilities cannot afford to lose any funding. Equity in the distribution of resources would ensure that these neighborhoods have adequate and responsive resources to respond to this virus and the disparities in health outcomes in marginalized communities. Eleven public hospitals provide for Medicaid patients, and serve nearly half a million patients who lack insurance. The City should increase the annual unrestricted subsidy in the city budget. However, much of the public hospital system in the city is reliant on the State of New York. Public hospitals must receive their fair share of the New York State Indigent Care Pool funds; local elected officials should call on state legislators and the governor to sign bills A6883 and S5954 to better target support to safety net hospitals which provide services to persons who are uninsured or insured by Medicaid. 

Office: Mayor, City Council
Mechanism: Advocacy for State Reform, Budget

3B. Fully fund Federally Qualified Health Centers, the Health Department, and Health+Hospitals

Problem: According to the Health Resources and Services Administration, Federally Qualified Health Centers (FQHCs) are community-based organizations that provide comprehensive, culturally competent, patient-centered health care services to underserved populations including people experiencing homelessness, residents of public housing, and veterans. They are required to provide services on a sliding fee scale. Even low fees, however, can place health care out of reach for those without insurance. 

Recommendation: The City must fully fund FQHCs across the five boroughs. The City should create a special fund to completely finance access for people who are uninsured at FQHCs. Current tax levy funding should be reserved for the health centers operated by the New York City Department of Health and Mental Hygiene (DOHMH) and NYC H+H.

Office: Mayor, City Council
Mechanism: Budget

3C. Train students, interns, and residents on equity around race, gender, and sexuality

Problem: Systemic racism is one of the most potent structural determinants of health and is reflected in the disproportionate burden of poor health outcomes in Black and Latinx communities in New York City. According to Health Affairs Journal, Black people and people of color are subjected to disparate treatment at the hands of clinicians, which manifests in inadequate treatment for pain, less accurate diagnoses, and grievous disparities in maternal and child health.  Most LGBT people experience some form of healthcare discrimination and more than one-quarter of trans and gender nonconforming people have delayed getting necessary care due to discrimination and disrespect, according to Lighthouse. While there are significant external factors that affect health, like environmental and socio-economic circumstances, implicit bias, by contrast, must be addressed by the health care providers. While it stands to say that our public hospitals may have more physicians and health workers of color than perhaps the private facilities, racial equity training is still of benefit. According to Health Catalyst, providing data about health outcomes helped clinicians to understand the value of addressing implicit biases to improve patient care.

Recommendation:  To teach medical students, interns, and residents to become culturally responsive and antiracist providers, racial equity training that includes the impact of systemic racism on health care for all students, interns, and residents at H+H should be part of their medical education. The City must provide additional funding for the Health Department’s Race to Justice initiative and expand its toolkit and training efforts to address bias against LGBTQ+ people.  Racial equity trainings should be carried out by individuals and/or community-based groups with appropriate expertise and are from marginalized communities.  H+H should be making the trainings mandatory for all H+H staff including management as a priority while exploring any ways of reducing resistance to it being perceived as force on but more as moral and professional growth.  There should have regular refresher courses or workshops to ensure continued development of anti-racist competencies. Racial equity trainings, while necessary, is “not sufficient” to mitigate such bias; therefore, the City needs to foster engagement of H+H student, interns, and residents with BIPOC through workshops, chats, visits, and other activities. 

Office: Mayor, Council
Mechanism: Budget, Mayoral and/or Agency Policy

4) Build a comprehensive citywide mental health continuum

The most vulnerable New Yorkers, including Black, Asian American and/or Pacific Islander (AAPI), Latinx, LGBT, immigrant, disabled, low-income, and housing insecure New Yorkers, are the ones that continue to be neglected by the minimal mental health care resources of the City. Often, forms of violence, coercion, and violation like criminalization, institutionalization, and incarceration are used to handle these New Yorkers, rather than providing real, culturally responsive mental health care and solutions. The City must invest in community-led and based responses, and reallocate ThriveNYC funds to meet these needs.

4A. Invest in community-led and community-based accessible mental health resources

Problem: White New Yorkers are more than 20 percent more likely to report being connected to mental healthcare than their Black, AAPI, and Latinx counterparts, according to data from ThriveNYC. Although 1 in 5 New Yorkers will experience mental illness in a given year, hundreds of thousands remain unable to access high-quality, culturally responsive care. Black, Latinx, LGBTQ+, immigrant, disabled, and low-income New Yorkers of colorare more likely to face involuntary hospitalization, removal from school or workplace communities, or incarceration because the system fails to meet their mental health needs. According to The City,18 people experiencing mental health crises have died during confrontations with police since 2015.

Recommendation: The City of New York should invest in community-led and community-based accessible mental health resources. There is an opportunity to address any shortcoming of the City’s Thrive program by improving its function and services that include funding community based emotional distress response and services, respite programs and place where they can find respite such as holistic, safe, and widely accepted community practices like healing circles and community-health worker programs. The City should shift ThriveNYC monies towards more robust, culturally responsive and community-based mental healthcare and expand partnerships with community-based organizations and service providers, according to City and State. The City must invest in community-based health centers, expanding their mental health services and delivery infrastructure and providing the financial and logistical support necessary for these centers to expand free-of-charge peer support offerings, respite centers, school-based programming, and mobile crisis intervention. As mentioned in the anti-criminalization section of The People’s Plan, the City should provide crisis intervention that does not rely on the police as many police encounters with people who are in crisis or experiencing emotional distress end in arrest, violence, or death.

Office: Mayor, City Council

Mechanism: Budget, Mayoral and/or Agency Policy

4B. Provide real options for New Yorkers who have serious mental health conditions

Problem: New Yorkers with severe mental illnesses have even less humane, safe, and non-coercive resources to turn to, especially in preventative settings or before crisis situations arise. Individuals experiencing significant mental health challenges are often coerced into treatment through involuntary institutionalization and medication, criminalized for the symptoms of unmet care needs, and removed from their communities and meaningful systems of support. Although the City has expanded its mobile crisis intervention programming, options remain limited for the highest-need populations, especially people experiencing homelessness and those who suffer from psychosis.  According to Mental Illness Policy, 4 percent of adults have serious mental illness and are most urgently in need of services. However the three NYCThrive programs designed to serve this population — NYC SAFE, Mental Health Service Corps, and Diversion Centers — do not focus on or are ineffective in addressing this issue.

Recommendation: Instead of jailing or institutionalizing those with serious mental health conditions, the City should provide resources and stipends for continued attendance at treatment programs, and move away from punishment-models of treatment and care, similar to the Crisis Intervention Team model and mental health courts. There should also be assisted outpatient treatment based in community health centers and peer support teams, rather than at hospitals. Interventions should be voluntary and based on the consent of the person affected. Ultimately, care offerings must be tailored to the unique needs of marginalized populations in neighborhoods that have experienced systemic disinvestment.  The City must provide real options for folks who have serious underlying mental health conditions and trauma and prevent mental illness and address toxic stressors. New Yorkers who are in need of housing and economic resources should be offered such resources at treatment and respite sites. As mentioned in the anti-criminalization section of The People’s Plan, the City should expand Mobile Crisis Teams and provide crisis intervention that does not rely on the police as many police encounters with people who are in crisis or experiencing emotional distress end in arrest, violence, or death.

Office: Mayor, City Council

Mechanism: Budget, Mayoral and/or Agency Policy

5) Support maternal and infant health and wellbeing

Infant and maternal healthcare should last before and after pregnancy and birth. The Center for Disease Control reports that for every maternal death, there are up to 100 more outcomes during labor that can have a negative long-term impact on the mother’s health. New York City faces significant disparities in maternal health for low-income mothers and Black and Brown communities as demonstrated by NYS Health Foundation. The City must aid the health of the community by investing in doula programs, midwifery care, and systems that coordinate community-based support for pregnant women.

5A. Establish citywide doula and midwifery care accessible to all pregnant people

Problem: Maternal mortality rates in New York City are unacceptably high; and as in other locales, disproportionately impact women and pregnant people of color. According to the NYC Department of Health, Black non-Latinx women are eight times more likely to die of pregnancy-related complications than White women. In addition, neighborhoods with predominantly Black and Hispanic populations, and where many residents live in poverty – such as East Flatbush and Brownsville in Brooklyn, Williamsbridge and Mott Haven in the Bronx, and Jamaica in Queens – have some of the highest rates of infant mortality and severe maternal morbidity in the city, according to the NYC Department of Health and Mental Hygiene. In addition, the rates for severe maternal morbidity in certain NYC communities are also high and most often impact women and people of color. The most recent data is for 2014, when 3,138 pregnant women and/or people in NYC experienced life-threatening complications during pregnancy and/or childbirth.

Recommendation: The City must establish a larger investment and creation of policies for a citywide doula and midwifery care that is fully accessible to all pregnant people, especially Black and Brown families. Funding free doula services before and after pregnancy, and a basic income stipend before and after birth will strengthen maternal health for all City pregnant people, especially Black and Brown women.  The City can funnel most doula and midwifery care by expanding its Healthy Women, Healthy Futures doula initiative. This citywide program aims to promote the health of women, children and families throughout NYC and provides free birth and postpartum doulas to New York City women. Early NYC Department of Health evidence suggests that clients in these programs are less likely to have a preterm or low birth weight baby. Funding free doula services must be an accessible resource for NYC Black and Brown communities who are particularly vulnerable to maternal mortality. The City should also ensure that doula services are accessible and affirming to pregnant non-binary and trans people. 

Office: Mayor, City Council

Mechanism: Budget, Mayoral and/or Agency Policy

5B. Improve coordination between hospital and community-based services for pregnant people

Problem: Meeting the needs of pregnant people requires collaboration between conventional hospital-based services and community-based services, such as prenatal case management services and comprehensive doula support programs. In spite of this, the reception of community-based interventions, like doula care, vary from hospital to hospital.  According to the New York City Department of Health and Mental Hygiene, receptivity of hospital staff to the doula impacts pregnant womens’ and people’s access to doula care.  If healthcare professionals do not receive a doula’s work positively, this poses a challenge to coordinating hospital-based and community-based services.

Recommendation: Maternal workers, like doulas and other community support mechanisms, should be part of the health team. Health systems should combat current obstacles that inhibit access for all women and pregnant people in New York, especially women/people of color and women/people with disabilities. Hospitals and other health institutions in the City must identify additional resources to improve hospital environments for doulas, in turn fostering collaboration between evidence-based community services and hospital services. These resources can include increased funding for doula care and support tools to uncover the barriers that doulas face in hospitals. 

Office: Mayor, City Council

Mechanism: Budget, Mayoral and/or Agency Policy

5C. Increase funding and improve the quality of prenatal care and postpartum services

Problem: According to the New York City Department of Health, evidence-based intervention programs, such as doula support programs, have led to better birthing and labor experiences. However, funding remains a barrier for these interventions.  Private insurance is not required to cover these support programs, leaving many people to pay out of pocket for services. Financial barriers to doula care widen across racial lines in NYC; according to the NYC Department of Health and Mental Hygiene, Black women are eight times more likely to die during childbirth than white women.  Doula care is an important tool in bridging these disparities, but they are often financially inaccessible for BIPOC people. There have been moments in the city where funding has been shifted and/or reduced to combat maternal and infant mortality because the rate went down without understanding the complexities and its impact on reversing gains and successes. 

Recommendation: The City provide an increased stream of funding for evidenced based interventions that will improve the quality of prenatal care and postpartum services for high-risk women and pregnant people, such as comprehensive doula care.  These would-be perinatal case management services, comprehensive doula support programs and centering pregnancy programs. Many free and low-cost doulas are funded by the City or through grants, and funding must increase to subsidize doula services for those who cannot afford them. Several local doula groups have established programs to provide doula support to communities who have historically struggled to access doula care. However, many of these programs are on a volunteer basis. The City must fund these programs to bridge the disparity in maternal mortality rates between racial groups in the city.

Office: Mayor, City Council

Mechanism: Budget, Mayoral and/or Agency Policy

6) Resource community health care and sovereignty

Health sovereignty refers to the ability of people to choose health care options that are socioculturally relevant and ecologically possible, according to Kassam, Karamkhudoeva, Ruelle, & Baumflek. All New York City residents should have a voice in their healthcare infrastructure, especially those historically left out of health affirming resources and decision making. The City can create more opportunities for representation and access by increasing funding to programming that serves marginalized New Yorkers, modifying existing laws to improve health planning, and using land use policy to increase health care access and participatory decision making.

6A. Fund trusted reproductive healthcare providers serving LGBTQ+ people

Problem: LGBTQIA+ individuals, as well as those who are seeking reproductive care, often experience hostility when seeking care, and many health professionals are not aware of the unique health issues unique to LGBTQIA+ populations.  According to the Public Advocate for the City of New York, “a growing body of evidence shows that LGBT individuals…do not receive the same quality of services as the general population with regard to a variety of health issues, including treatment of cancer, mental health and substance abuse treatment, violence prevention, and health insurance.” Additionally, the Public Advocate assessed that LGBTQIA+ individuals are less likely to seek out vital healthcare treatment because of extremely negative experience with homophobic or transphobic healthcare providers. 

Recommendation:The New York City Health and Hospitals Corporation operates five LGBTQIA+ affirming clinics throughout the city, but these clinics both in number and in scale are not resourced to meet the needs of LGBTQIA+ New Yorkers seeking care. The City of New York must allocate additional funding to trusted healthcare providers that serve LGBTQIA+ communities throughout the city and reproductive care providers. Funded healthcare providers should provide staff with in-house training on LGBTQIA+ issues including health care disparities unique to LGBTQIA+ communities. The City should also further fund initiatives to increase LGBTQIA+ affirming healthcare in all NYC H+H sites and public hospitals. 

Office: Mayor, City Council

Mechanism: Budget, Mayoral and/or Agency Policy

6B. Modify Intro 973/Local Law 6 for a more impactful Interagency Council on Comprehensive Community Health Planning

Problem: Local community health planning should make healthcare systems more accessible and accountable to New Yorkers, and help assess the infrastructure and resources needed to increase healthcare access. In 2017, the City Council passed a bill to address this: Intro 973/Local Law 6, which established a Committee on City Healthcare Services and draws upon the City’s land-use process to support an improved health care infrastructure. The Committee on City Healthcare Services is charged with issuing a biennial report that includes, among other things, recommendations for how to most effectively utilize City resources to provide healthcare services and improve coordination among agencies in providing services. However, this bill should be revisited and modified to ensure a greater number of local residents serve and have a voice in health care planning, and that the findings of the committee are implemented to actually increase neighborhood health care access. 

Recommendation: The Committee on City Healthcare Services’ decision-making process can no longer remain the exclusive prerogative of corporate executives and state bureaucrats. The policy rationale for this is that of bringing private interests in healthcare delivery into better alignment with public interests. But community health planning should make the healthcare system more accountable to average residents in their communities by having actual representatives of the local community, BIPOC health centers, and other stakeholders representing marginalized New Yorkers. Additionally, provisions in the bill focused on developing community health impact assessments by this body, but the bill did not articulate mechanisms for these assessments to be addressed by the City’s DOHMH or H+H systems. The city may not be able to address all these inequities, have powers over private/voluntary hospitals and over hospital consolidations, mergers, and closings, but a modified Intro 973 can provide opportunities for communities to address the unbalanced power dynamics and critically contribute to the solution by adding more teeth to the Committee’s assessments and recommendations.

Office: City Council 

Mechanism: City Legislation

6C. Use the City’s land use authority to prevent hospital closures

Problem: New York City Hospitals have been closing at an alarming rate, on average two hospitals a year over the past ten years. At present ten to twelve additional hospitals are teetering on the edge of closure or are eliminating vital health services. These closures stem from financial and political pressures often resulting in approval of the transfer of hospital property to private developers. New York City and New York State failed to replace critical life-saving services provided by these closed facilities creating health care disaster zones in low-income, immigrant communities and communities of color. The City, in addition to the Uniform Land Use Review Process, has substantial planning and review authority, precedent, and responsibility in the Department of Health & Mental Hygiene, the Board of Health, and the Mayor’s Office of Long-Range Planning and Sustainability.  However, it has largely deferred to the State, which, through its broad regulatory authority and its fragmented and generally unplanned funding of the Medicaid program, controls much of what happens in the City’s health care system.

Recommendation:  The City has substantial ability to assess and to advocate politically for broad access to health services and public health protection. The City can engage in a comprehensive health planning process to identify, on a continuing basis, the health care needs of all of the City’s communities and build support for strengthening those services where they are needed. As the health care system shifts from inpatient to outpatient and primary care services, such planning would ensure access to health care be improved. The City must review its use of the City’s land use authority (Uniform Land Use Review Process) to restrain the closing of hospitals including variances, sale or transfer of city-owned land or any other decisions) across the five boroughs. The City must also utilize and broaden the city’s current urban planning process to address closings of healthcare facilities and improve the health status and healthcare access in local neighborhoods throughout the city. 

Office: Mayor, City Council

Mechanism: Land Use Action

7) Address the health of incarcerated New Yorkers​

According to Kaba et al, significant health disparities exist for incarcerated persons of color, including the occurrence of infection, violence, and mortality. People incarcerated in New York City jails are amongst the most socially and economically marginalized New Yorkers in the city, and jailing itself is an extreme detriment to health and mental health, associated with severely poor health outcomes according to Health Affairs. Rikers has become even more dangerous during the pandemic, with fifteen deaths in the complex 2021, making this year the deadliest in New York City jails since 2016, according to the Gothamist. The City must decarcerate for public health, while also ensuring incarcerated New Yorkers currently at the complex have access to health care and are connected to a continuum of care outside the jail complex on their release.

7A. Provide adequate medical and mental health staffing and care for incarcerated New Yorkers

Problem: People being held in barges, detention centers, and jails currently have little to no access to appropriate medical and mental health care. Rikers is severely understaffed with medical professionals. The City’s Correctional Health system manages the delivery of healthcare for the city’s 12 jails and is responsible for providing quality care to approximately 55,000 people moving through the Department of Corrections’ custody each year. But the sick call system relies on correctional officers to transport incarcerated patients to the jail clinic(s), sometimes resulting in missed appointments. Missed appointments have become more common during the pandemic, due to staffing shortages and sick-outs by correctional officers, according to The City. The City reports that “city jails records show thousands of missed medical appointments each month, at a time when prompt care is especially urgent. In March 2021, one in five scheduled doctors’ visits didn’t happen — 12,914 in all.” The lack of access to physical and mental healthcare is especially severe during the pandemic; unsanitary conditions and COVID-19 have been rampant in the jail complex, reaching crisis levels according to the Queens Daily Eagle

Recommendation: As people in New York City jails are being held forcibly in the City’s custody, the City must ensure their access to medical care during their time in jail. This includes adequate health and mental health staffing, and a closer investigation into the way DOC transports patients to clinics and how there may be alternative ways to ensure transport of incarcerated New Yorkers who are in need of medical attention to Correctional Health. Additionally, solitary confinement also known as punitive segregation often lead to worse health outcomes and delays in responses to medical crisis or emergency, and should be suspended, with moves to end the practice immediately. 

Office: Mayor, City Council

Mechanism: City Legislation, Mayoral and/or Agency Policy, Oversight and/or Auditing

7B. Release New Yorkers held pretrial at Rikers to promote public health

Problem: According to the Center for Court Innovation, 75 percent of people in New York City jails are there on pretrial detention—they have not been tried or convicted of a crime. During the COVID-19 pandemic, the New York Times reported that social distancing was impossible at Rikers Island. Black and Latinx people are more likely to be detained pretrial and given higher bail amounts than white people arrested for the same offenses, according to the Vera Institute. Furthermore, people who are incarcerated in City jails are at high risk of contracting and spreading COVID-19 and other communicable diseases.  Even outside of the pandemic, public health and sanitation in jails remains dismal. But Rikers is currently facing a public health and humanitarian crisis at unprecedented levels. In September 2021, the complex’s top doctor Ross MacDonald penned a letter to elected officials recommending that all be done to release incarcerated New Yorkers from the jails for the sake of public health.

Recommendation: In the aftermath of the COVID-19 pandemic, the City should release people being held in pretrial detention. As Ross MacDonald wrote in his letter to city officials, “decarceration efforts, which are a proven public health response to COVID-19, have not been meaningfully pursued since 2020.” As City judges can change pretrial status, district attorneys and defense lawyers should be encouraged to continue filing motions for release of this population (as they had done in unprecedented numbers early in the pandemic). In the event a person has a warrant, an agency who issued the warrant must clear it prior to release. The City should direct the NYPD to clear warrants for the purpose of releasing people held pretrial. 

Office: Mayor, City Council, Comptroller, District Attorney 

Mechanism: Advocacy for State Reform, Mayoral and/or Agency Policy, Oversight and/or Auditing

7C. Connect formerly incarcerated New Yorkers to city health systems and services

Problem: In New York City, discharge planning helps people who need mental health services receive treatment and other essential services outside of jail. It includes an individual assessment of a person’s specific needs including mental health, medications, and more. The City’s current discharge system however, does not address post-release mental health services. One of the biggest problems that contribute to rearrest among mentally ill individuals in New York City is the lack of supportive housing services upon release. This exacerbates the challenges already faced by those in need of mental health services. 

Recommendation: The City should secure the right to a proper discharge planning for incarcerated New Yorkers. Formerly incarcerated individuals should be connected to the City public hospital system and social services. The City should aid incarcerated New Yorkers in renewing Medicaid prior to discharge to ensure access to health care. increase engagement attempts during an individual’s incarceration. 

Office: Mayor, City Council

Mechanism: Mayoral and/or Agency Policy, Oversight and/or Auditing

8) Build a community-to-communal health pipeline

It has taken decades if not centuries to create the current structural health inequities and disparities that marginalized people of color in this city have faced, and it will take time to undo them. The City must have a multi-pronged approach to fight these health disparities that affect vulnerable communities of color. This includes resourcing health educators and health professionals from these same communities, and building pipelines within these communities so marginalized people of color can both access health care and health care related jobs in their neighborhoods. In addition to this, the various City agencies that exist to address these issues operate individually, but information and resources should be shared across these departments.

8A. Expand support for trusted health educators and promoters in BIPOC communities

Problem: Individuals from communities of color such as immigrant communities tend to lack health insurance due to several factors, including language and other cultural barriers, immigration status, and difficulty navigating the health care system. Not only are two out of three uninsured individuals in New York immigrants, but immigrants are much less likely to receive insurance coverage granted by their employers. More than 25% of immigrant children in New York City also lack health insurance.

Recommendation: The City should use the promotor@s model to increase health access for more New Yorkers. The model builds on a foundation of social justice for improving individual and community health and wellbeing, and there is promising evidence of health promoters and educators playing a vital role in response to the COVID-19 pandemic, according to James Woodall. There are several community-based organizations and frontline groups that have successful models that depend on local community residents who share similar characteristics as the communities they serve. The idea behind the model is to teach community members to be “promotor@s,” which are individuals who work to promote health in their respective communities. This is typically done by peer support, showing leadership, and linking others to important resources and services in each community. This helps to empower and engage community residents to improve health care systems for themselves and others.

Office: Mayor, City Council

Mechanism: Budget, Mayoral and/or Agency Policy

8B. Invest in health profession pipelines for people from marginalized communities

Problem: Medical and structural racism and classism causes BIPOC to have disproportionately worse health outcomes. There are many root causes that must be addressed to change this reality; one of them includes more BIPOC health professionals who come from marginalized communities that allow them to better relate to, sympathize, and take care of marginalized BIPOC patients. According to Wilbur et al, patients with a health care provider of the same race report greater mutual respect compared to patients with a health care provider of a different race. This kind of rapport and trust is important in healthcare settings where patients and healthcare professionals both need to disclose and discuss sensitive and private information, and cultural understanding and humility is needed to provide better care and health care decisions. 

Recommendation: Pipeline programs are proven solutions to addressing and helping to promote a culturally competent, diverse, and prepared health care and biomedical research workforce that will enhance patient care and ensure health equity. The City should invest in existing programs that have experienced reduction in federal funding such as NY Metro Area Health Education Centers (AHEC), which focus on addressing health disparities by increasing diversity in health professions. This initiative will focus on intervening in the educational pipeline to enhance opportunities for racial and ethnic minorities and disadvantaged students to enter careers in health professions and sciences. This will further help to close educational opportunity gaps and reduce health disparities within racial and ethnic minority populations.

Office: Mayor, City Council

Mechanism: Budget, Mayoral and/or Agency Policy

8C. Promote coordination and information sharing across agencies and programs

Problem: City agencies appear to operate their health and health pipeline programs in relative silos, with little opportunities for coordinating interventions across agencies or developing a learning community among agencies to share best practices and other insights from each agency’s programs. 

Reform: A system should be created to share information between agencies and programs in order for there to be an increase in coordinated activities and interventions in New York City. The CIty should make room for more coordination and information sharing across agencies and programs. Agencies appear to operate their pipeline programs in relative silos, with little opportunities for coordinating interventions across agencies or developing a learning community among agencies to share best practices and other insights from each agency’s pipeline programs. 

Office: Mayor, City Council

Mechanism: Mayoral and/or Agency Policy