Category Archives: health disparities

Improving Access to Physical Education for All New York City Students

By Sascha Murillo, Community Organizer – Health Justice Program

New York State requires that all schools provide students in all grades with physical education (PE). However, in New York City, the majority of schools are failing to meet the state PE mandate. Several reports demonstrate the breadth of the problem. A New York Times article found that about 1 in 5 NYC high school students reports having no gym class in an average week. An audit conducted by former Comptroller Liu reported that none of the 31 NYC elementary schools visited was meeting the New York State PE mandate.

While the problem affects nearly all NYC schools, schools in neighborhoods that are predominantly low-income and Black or Latino are even more unlikely to provide adequate PE. The disproportionate lack of access to PE for low-income students of color only exacerbates existing racial disparities and inequities in child obesity and academic achievement.

Ensuring access to PE for all students in NYC could go a long way to addressing these health and educational inequities. There is a plethora of evidence demonstrating that PE improves student health, reduces child obesity, and improves academic performance, including test scores. Yet with all that said, why are schools failing to provide their students with adequate PE instruction?

The cause of the problem is manifold. Many schools are simply unaware of the requirements. The PE standards as laid out by the state require that students in grades K through 6 receive 120 minutes of PE per week. The students in grades 7 and 8 should receive at least 90 minutes of PE per week and all students in grades 7-12 should have at least three gym classes per week in one semester and two classes per week in the other semester. Recess cannot be counted toward meeting these minimum time standards.

Yet even when schools have knowledge of the requirements, many struggle to meet them. Some schools utilize non-certified instructors for PE, which may prevent students from receiving quality physical education instruction. And space limitations due to co-location of multiple schools in buildings with one gymnasium also impede a school’s ability to provide all students with adequate PE time.

So what can be done? With a new mayoral administration bent on tackling the city’s widening inequities, education and health advocates alike are coming together to raise the importance of providing quality and comprehensive PE to all of NYC’s students. New York Lawyers for the Public Interest has teamed up with a wide variety of stakeholders, including Bronx Health REACH, to advocate for improved access to PE in all NYC public schools.

The NYC Department of Education (NYC DOE) has the opportunity to reverse the trend in PE and work to support and ensure compliance with the state PE mandate. The NYC DOE should provide schools with resources on the PE requirement by posting information on their website and sharing best practices across the five boroughs, including examples of co-located schools that have coordinated schedules to meet the PE time requirements. The NYC DOE should also document and regularly report schools’ compliance.

The NYC DOE should also adequately staff the department with professionals who can provide schools with support and technical assistance with offering a comprehensive PE curriculum. The NYC DOE could work toward these goals within the Office of School Wellness, which it jointly oversees with the Department of Health and Mental Hygiene.

The new mayoral administration is in charge of one of the largest public school systems in the nation, with one of the most diverse student populations. We hope that the new mayoral administration will improve the physical and academic well-being of millions of students and take a step to advance health and educational justice by making improved access to quality physical education a priority.

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Reopen Labor and Delivery at North Central Bronx Hospital!

by Sascha Murillo, Community Organizer – Health Justice Program

Sharifa Kamga is 32 weeks pregnant with her second child. Until recently, Ms. Kamga was planning to deliver her baby at North Central Bronx Hospital (NCBH). In 2012, she delivered her first child at NCBH and was delighted by the care she received from the midwives there.  But due to the recent suspension of Labor and Delivery services at NCBH, Ms. Kamga now must change her birth plan for her second child.  After receiving a call in August informing her she would have to deliver at Jacobi Medical Center, Ms. Kamga will be forced to travel farther to get the care she needs.

Concerned about inadequate staffing and patient safety at Jacobi, the Health and Hospital Corporation (HHC) decided to suspend Labor and Delivery (L&D) services at NCBH and transfer all L&D staff to Jacobi, leaving Ms. Kamga—and many women like her—distressed and fearful.

Eileen Markey from Community Power North Bronx speaking to a group of moms about the closure of L&D at NCBH.

Eileen Markey from Community Power North Bronx speaking to a group of moms about the closure of L&D at NCBH.

Several aspects about the decision are troubling. Patients and NCBH staff were only given three days’ notice of the change. Additionally, many advocates are concerned that Jacobi does not have the capacity to serve the influx of new patients previously served by NCBH; in 2011, NCBH delivered 1,647 babies, which is quite the patient caseload to add to Jacobi’s 2,072 deliveries in the same year. Even with the added staff from NCBH, Jacobi will struggle to accommodate the increased patient volume.

But what is most troubling is that this closure is part of a larger pattern in New York City of cutting health care services in underserved communities. Until recently, Interfaith Medical Center and Long Island College Hospital, two financially struggling hospitals that serve predominantly low-income and immigrant communities of color in Brooklyn, were slated to close. Throughout the city, it is not uncommon for health services to be concentrated in wealthier neighborhoods, and for service providers in low-income areas to face financial hardship or closure.

Accordingly, people of color overwhelmingly make up NCBH’s patient population, and a significant proportion of that population speaks a language other than English at home (in 2012 alone, NCBH provided nearly 30,000 interpreter sessions in 72 languages). The closure of L&D services at NCBH, then, would adversely impact a community that already faces disproportionate rates of pre- and post-natal complications: Bronx communities have poorer maternal and infant health outcomes than the rest of NYC, and a report from the Bronx Health Link documents disparities in infant mortality, maternal illness and mortality, and access to prenatal care.

Advocates and hospital watchdogs have reason to be alarmed, pointing to the impact of previous cuts to care services in the North Bronx. In 2009, NCBH suffered a dramatic loss in services and midwives, which undermined the award-winning midwifery practice at NCBH.  Having had the lowest rates of cesarean sections in the city in 2008, the North Bronx has since seen C-section rates skyrocket by 90%.

“These are families,” says Ms. Kamga. “This is not about numbers. You are actually displacing families whose lives will be affected by this one decision. It’s a big deal.” Further cutting services at NCBH will disproportionately harm women and infants in the North Bronx and only exacerbate existing disparities in both access to care and overall health. It is imperative that the L&D services at NCBH remain open and accessible to North Bronx residents. To voice opposition to the closure of L&D services at NCBH, moms in the community, health advocates, and health providers will be rallying in front of North Central Bronx Hospital this Friday, September 20, at 11 AM. Please join us to demand that HHC reopen L&D at NCBH. You can also sign our petition here.

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1963 March on Washington 50th Anniversary Reflection

by Jennifer Swayne, Staff Attorney- Health Justice Program

MLK Monument Pic 2Today marks the 50th Anniversary of the 1963 March on Washington.  This March took place during a time of great upheaval and racial tension and represented a growing swell of actions highlighting the injustices that permeated American society.  Marchers traveled from near and far to call for equality in civil, political, economic, and human rights.  On this anniversary, individuals are once again convening on the Washington Mall.  This time, the purpose is to not only commemorate the historical March of 1963, but to also take stock of where we have yet to go as a nation.

Today, we no longer face water hoses, attacks by police dogs, “whites only” signs, and literacy and jelly bean tests for voting.  Instead, we face systemic inequality.  Instead of “whites only” signs, we continue to face the pervasive notion that people of color do not belong in certain spaces, as evidenced by the murder of Trayvon Martin, or that they pose a threat, as demonstrated by the illegal use of “stop and frisk.”  Instead of jelly bean tests that disenfranchise black voters, Justice Antonin Scalia labeled the Voting Rights Act a “racial entitlement” before the Supreme Court obliterated the Act.

The healthcare setting is another sphere where systemic inequality remains.  Low-income communities of color face unequal access to healthcare and bear a disproportionate burden of poor health outcomes. One example is the continued loss of healthcare services in medically underserved neighborhoods.  In New York City, we are in the midst of a crisis where institutions such as Interfaith Medical Center in Brooklyn, Holliswood Hospital in Queens, and two Immunization Clinics in the Bronx and Queens will be closed.  The barriers to healthcare that medically underserved communities face fit hand in hand with the other forms of inequality mentioned above—they reflect a perverse disregard for people of color and low-income communities and demonstrate that we still have much further to go to realize the dream of full equality.

While we have moved forward from some of our darkest moments in 1963, many challenges lie ahead. Yet today’s gathering in Washington reminds us that we can work together to make positive changes for all communities.  In addition to Dr. Martin Luther King’s “Dream,” we should also heed his words that “[t]his is no time to engage in the luxury of cooling off or to take the tranquilizing drug of gradualism. Now is the time to make real the promises of democracy.”

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OPINION: Address community needs before closing hospitals

Check out the opinion piece written for the Brooklyn Daily Eagle by HJ team members Shena and Jenn about hopsital closures in low-income communities of color in Brooklyn and what they mean for access to care. You can read the piece here.

 

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New Report on Health Needs, Gaps and Barriers to Care in North and Central Brooklyn Released in Conjunction with Proposed Redesign of Brooklyn’s Health Care System

See below—and congratulations to Shena, Jenn, and Alyssa for their hard work!

Brooklyn, NY (April 10, 2013)—In conjunction with the proposed redesign of Brooklyn’s Health Care System the Community Health Planning Workgroup (CPHW), a consortium of community stakeholders, healthcare providers and community health planners, today released The Need for Caring in North and Central Brooklyn, A Community Health Needs Assessment, sponsored by The Brooklyn Hospital Center, the I M Foundation, and the New York State Department of Health. The Community Health Needs Assessment, conducted by the Brooklyn Perinatal Network, the Commission on the Public’s Health System, and New York Lawyers for the Public Interest, sheds additional light on North and Central Brooklyn residents’ perception of the needs, gaps and barriers to care in their communities.

The report covers 15 zip codes, including Bedford Stuyvesant, Bushwick, Brownsville, Crown Heights, Cypresss Hills, East Flatbush, East New York, Flatbush, Fort Greene, Prospect Heights, Williamsburg, Downtown Brooklyn, Gowanus and Greenpoint, and addresses key findings, focus group results, and recommendations.

Field surveys and focus groups were used to capture the voices of the community. Community residents completed over 600 surveys, and 79 residents participated in nine focus groups targeting groups underrepresented in the survey sample, including teens; individuals with disabilities; Spanish speakers receiving mental health services; immigrants; men aged 18-35 and 45-55; senior citizens; pregnant women; and LGBTQ individuals.

Following the completion of the Community Health Needs Assessment, listening sessions were held to solicit community input and feedback concerning the findings.

Among the key findings:

  • The report found the most common illnesses/health conditions among residents surveyed were high blood pressure/hypertension (24.8%), followed by asthma (19.9%); diabetes (15.7%); and hearing or vision problems (15.2%).
  • 85% of respondents said that it would be most convenient to receive care in their neighborhood; almost 20% of the sample (18.7%) received none of their care in their community.
  • 50% of residents surveyed said they or members of their household had visited an emergency room in the past two years.
  • When asked which healthcare services households had difficulty accessing in their neighborhood, 100% of respondents said a dentist.
  • Half of respondents had a limited ability to secure health care services. When asked why, 48% said barriers to health care included quality of care, culture and language differences, hours of service and attitudes of providers; 19.8% said insurance issues or lack of insurance; 23.1% said long waits for or at appointments; and 9.1% said cost of care.

“We are really pleased to have had the opportunity to ensure that the community’s voice is a driving factor in how healthcare is delivered and look forward to the healthcare planning developments that come from the CHNA process. We are hopeful that our process will serve as a model way to meet the needs of communities being served,” said Shena Elrington of New York Lawyers for the Public Interest who served as co-lead partner in the development of the report.

The report concluded with approximately 15 critical recommendations to improve healthcare in Brooklyn. These included addressing accessibility; improving screening, outreach, cultural and linguistic competency, patient-centered care, and customer service training; providing extended hours for primary care; increasing awareness and access to low-cost health services/insurance; providing financial support of efforts by grassroots community-based organizations (CBOs) to promote community resources; coordinating a network of health care and social service providers; engaging community residents; targeting services to focus on particular illnesses and communities; increasing access to specific health care services; working with Access-A-Ride to address transportation issues; increasing the number of providers who accept public health insurance; and increasing availability and access to mental health services.

To read the full report, click here. To read a summary of the report, click here.

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Mental Illness – Fighting Stigma and Improving Access to Care

by Jennifer Swayne, Staff Attorney – Health Justice Program

On Friday, December 14, 2012, we once again faced unspeakable tragedy as a gunman broke into Sandy Hook Elementary School in Newtown, CT and opened fire, killing a total of 28 people—20 of whom were children. While many of the initial conversations surrounding this horrible tragedy focused on the ongoing debate about gun control, very few of those conversations focused on mental illness, the stigma surrounding it, and access to mental health care services. Some news sources have reported that the gunman faced mental illness, though it is not clear what, if any, mental health services he and his family may have sought in the past.  However, what is certain is that we need to engage in dialogue on mental illness, as there are many individuals who face significant stigma and who are not able to access critical mental health services consistently.

Mental illness knows no race, culture, ethnicity, language, socioeconomic status, age, gender, or religion, yet there is stigma and overwhelming silence surrounding its impact.  Many have probably encountered someone with mental illness without even realizing it, especially since about 1 in 4 adults age 18 and over, and about 1 in 5 children age birth to 18 suffer from a diagnosable mental illness at some point in their lives.  Because of the stigma surrounding mental illness, however, we continue to miss opportunities to help others get the support and assistance they need, especially when those who exhibit signs of mental illness are simply labeled and dismissed as “crazy.”  Instead, we are relegated to hindsight assessment when it is much too late to take action.

The mass shooting that happened in Newtown is an extreme, and there is nothing that excuses the actions of the gunman.  However, mental illness is much more complex than this extreme case of violence we have witnessed suggests. For instance, people with mental illness face greater risk of becoming the victim of crime rather than being the perpetrator.  Therefore, we must be careful not to let a single person’s actions symbolize our collective understanding of how mental illness manifests and operates.

Further, we have a health care system where mental health parity has been lacking, and sadly, quality mental health services remain a luxury reserved for those who have the ability to pay in cash for those services.  The result is that those who have no insurance, those who rely on private insurance with limited mental health benefits, and those who rely on public insurance often go without needed mental health services that can help them live full and productive lives. Untreated mental illness can result in homelessness, incarceration, victimization, high burden placed on families and caretakers, and productivity loss, not to mention the financial costs of healthcare expenditures resulting directly from failure to treat mental illness sooner rather than later.

New York State is in the process of redesigning its system of behavioral health services for some of the most vulnerable people in our society—low-income children from birth to age 21 who use public insurance.  This is a group that has suffered immensely from lack of adequate mental health services. Under Medicaid, the system of mental health care for children has been overwhelmingly underfunded and the New York State systems that serve children—Department of Health (DOH), Office of Mental Health (OMH), Office of Children and Family Services (OCFS), Office of Alcoholism and Substance Abuse Services (OASAS), Department of Education (DOE)—and other agencies at the local level, have not coordinated their efforts to serve children, leading to a disjointed system.

It is promising that New York State is engaging in a process to revamp the system of care for our children, but we have to make sure that it is a system that will actually work and result in real change or else children will continue to face dire consequences and suffer from the stigma of mental illness well into adulthood.  Children with mental health problems have lower educational achievement, greater involvement with the criminal justice system and fewer stable and long-term placements in the child welfare system than their peers.  In attempts to access mental health services, publicly insured children are also more likely to rely on restrictive or costly services such as juvenile detention, residential treatment, emergency rooms, and are more likely to be placed out of their homes in order to obtain critical services, as opposed to being able to readily access outpatient services, especially if they are children of color.

On December 14, NYLPI and the Children’s Defense Fund submitted joint comments (which you can access here) regarding the critical mental health services that children need to New York’s OMH, OASAS, and OCFS.  In our comments we:

(1) address the health disparities that impact receipt of mental health care;

(2) list the services that children should receive and who should provide those services;

(3) highlight the importance of cultural and linguistic competency;

(4) discuss the need for early identification and prevention measures such as behavioral health screening; and

(5) stress the need for training and funding so that providers are able to actually provide the appropriate services.

As we can see, mental illness is complex and it is not going away.  We must proactively engage in creating a better system of care rather than responding in the aftermath of tragedy. It is vital that we have honest and ongoing conversations about the state of our society, mental illness, stigma, and access to appropriate mental health care services.

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Segregated Health Care & the Latino Communitiy

Last week, we met with the New York State Assembly/Senate Puerto Rican and Hispanic Task Force to discuss the issue of segregated care in New York private teaching hospitals and our Health Equity Bill (A07699/S5785).

We brought a small but mighty group of advocates, doctors, and community residents to present before the Task Force on this important issue. According to 2009 United Hospital Fund data, 61.2% of Latinos in New York are on Medicaid or uninsured – meaning that the steering of patients based on insurance type has a particularly strong impact on the Latino community. Access to quality-health care is already difficult for Latinos – language/cultural barriers, above-average poverty rates, restrictions on health care for immigrants, etc. – so the addition of unfair hospital policies, like segregated health care, which have no medical, financial, or moral grounds should not be allowed to continue in New York.

Our bill will make it illegal to separate patients based on insurance type so that all patients are treated with the same care, in the same setting, and with the same respect once they enter a hospital.

Special thanks to our partners, Bronx Health REACH, and bill sponsors, Assemblymember Nelson Castro and Senator Gustavo Rivera for joining us at the Task Force meeting.

Below, you can watch our presentation:

NYS Assembly/Senate Puerto Rican & Hispanic Task Force Meeting 02.29.12 from Somos New York

To view our powerpoint presentation from the Task Force meeting, click here.

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March 6, 2012 · 5:56 pm