Category Archives: people of color

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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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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Suffolk County Language Access Executive Order Signed!

by Lindsey Hennawi, Program Assistant

Great news! On November 14th, 2012, Suffolk County Executive Steve Ballone signed an executive order requiring county government agencies to translate vital public documents into the top six languages spoken by limited English proficient (LEP) residents of Suffolk County and to provide interpretation services for all LEP residents as well.

Twenty percent of Suffolk County’s 1.5 million residents are LEP. Now, residents whose primary languages are Italian, Mandarin, Spanish, Polish, French Creole, and Portuguese will be able to access local government offices and communicate with officials. This means victims of domestic violence and hate crimes can access police protection. Residents affected by Superstorm Sandy can receive much needed information about recovery efforts. Support services such as unemployment insurance and public benefits are now also accessible to LEP residents. Thanks to this executive order, an individual’s language will no longer be a barrier to participation in government services or access to important resources.

The order is descended from similar legislation, including President Clinton’s 2000 executive order that mandated all agencies receiving federal funding develop language access plans in order to comply with the 1964 Civil Rights Act’s prohibition of discrimination based on national origin; Mayor Bloomberg’s Executive Order 120, signed in 2008, that bans city agencies from discriminating against residents based on their primary language or national origin; and Governor Cuomo’s 2011 Executive Order 26 that does the same for executive state agencies.

One of the first of its kind in a suburban county in the United States, Mr. Ballone’s executive order comes on the heels of the previous Suffolk County executive, Steve Levy, who in his tenure utilized county police as immigration agents, criminalized Latino day laborers, and marginalized Latino-majority neighborhoods, earning the county a reputation for anti-immigrant resentment and violence.

Suffolk County’s executive order is a result of the advocacy of the organizations with which NYLPI partnered on this campaign, including the Long Island Civic Engagement Table, the Long Island Language Advocates Coalition, Make the Road New York, the Center for Popular Democracy, and other groups that have tirelessly promoted immigrants’ rights in Suffolk County for years. Since 2009, NYLPI has advocated for language access orders on the city, state, and county level, and is currently working to develop materials to help other advocates replicate these efforts.

We are thrilled Suffolk County has taken this critical step toward advancing the civil rights of LEP individuals and making New York a more inclusive home for all its diverse residents. Congratulations to all of the advocates involved and thank you, Steve Ballone, for your work toward equality and justice on behalf of LEP residents! May yours be one of many county orders to come.

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A Community Mobilizes to End Medical Apartheid

Hello readers, we are pleased to announce that the peer-reviewed journal, Progress in Community Health Partnerships, has published a piece about our campaign with Bronx Health REACH to end segregation in the delivery of health care services by teaching hospitals in New York. You can download a copy of the piece here. Feedback welcome! We are using every avenue at our disposal to get the word out about this urgent issue, including the very types of publications that health care providers and policy decision-makers are likely to peruse.

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Acknowledging Difference, not Defeat: A Racial Justice Perspective on the Medicaid Debate

This post, by Health Justice Director Nisha Agarwal and Staff Attorney Shena Elrington, also appears on the Race-Talk blog, Huffington Post, and Alternet.

The federal Medicaid program has become something of a policy piñata in the national discourse. Over the course of the past year conservatives have been asking, “is Medicaid real health insurance?” The public insurance program for low-income individuals has been criticized for not providing sufficient access to physicians, long wait times to see a physician when one can be accessed, and poorer quality of care once patients get in the door – all of which conservatives argue are reasons to dismantle the program altogether. If being on Medicaid isn’t much better than being uninsured, why bother spending tax dollars on it?

Meanwhile, a recent editorial in the New York Times offered unequivocal praise for the Medicaid program, pointing to a study conducted in Oregon that allowed researchers to compare the experiences of people who received Medicaid coverage to those who did not. According to the study, Medicaid recipients reported better health than the uninsured recipients  and were less likely to have medical bills sent to  collection agencies or forgo other obligations in order to pay for their medical care. Supporters of the public health insurance plan were therefore able to hit back against conservative naysayers and argue that Medicaid truly is a program worth preserving and expanding.

While the national debate lurches back and forth, we find a more complicated reality on the ground, in the low-income communities of color where we work to eliminate race- and class-based biases in the health care system. The uncomfortable truth is that Medicaid beneficiaries do often receive poorer quality of health care, particularly when it comes to accessing specialists. But to see this you have to look at how Medicaid beneficiaries fare vis-à-vis privately insured individuals, not the uninsured, which has been the focus of current debates.

For example, in  our work with Bronx Health REACH, a faith-based community coalition in the Bronx, we have seen how Medicaid patients seeking specialty services at major New York City hospitals are seen in separate—effectively segregated—facilities from their privately-insured peers, with longer wait times, less experienced doctors, and much less continuity and coordination of care. (You can read more about these problems in this monograph published by the Bronx Health REACH coalition and in this complaint we filed with the New York State Attorney General.)

Working with low-income parents, we have also seen how children with Medicaid have to wait for grotesquely long periods of time before they can get mental health treatment and special education evaluations, if they are able to access these services at all, and how elite institutions providing such services refuse to serve publicly insured populations despite the significant shortage of pediatric mental health providers in New York City.

Our experience thus seems to support conservative arguments to some extent: Medicaid beneficiaries do not have sufficient access to physicians, experience long wait times to see a physician when one can be accessed, and suffer from poor quality of care once they get in the doctor’s door, at least when compared with those patients who are privately insured.

Undoubtedly the current climate surrounding Medicaid makes it difficult for advocates to point out the lower quality of care Medicaid beneficiaries receive, for fear that any criticism of the program will serve as powerful ammunition for the other side to use. But acknowledging certain aspects of the conservative argument need not mean that advocates have to accept the entirety of their conclusions. Something else we’ve learned through our work is that Medicaid isn’t “bad” insurance per se. Rather, healthcare providers and institutions choose to treat Medicaid beneficiaries badly by discriminating against them with respect to the quality of care provided. Consider the Bronx example. Hospitals in New York City (and elsewhere) are not only reimbursed by Medicaid for providing patient care, they also receive over $1 billion through the Medicaid program for non-patient purposes such as resident doctor training – a funding stream so substantial that the New York hospital industry is fighting tooth and nail to keep it safe from federal budget cuts. Medicaid seems to pay hospitals very well, and yet these same hospitals choose to provide segregated and unequal care to Medicaid beneficiaries. Why?

As with many things, these bizarre dynamics cannot be understood without accounting for race, and for the fact that the vast majority of publicly insured individuals in New York City are black and brown. We have heard how top-flight specialists want to be able to choose the patients that they treat, which is invariably code for avoiding people of color who are perceived to be more “complicated” and “non-compliant.” Elite NYC hospitals eager to attract these specialists happily comply to doctors’ demands by giving them fancy facilities to see their preferred patients, while the Medicaid patients are separated out into “clinics”, where they are treated by a rotating band of doctors-in-training.

In addition to wanting to attract renowned specialists, the hospitals want to attract the “right” kind of patients – that is, wealthy, white, suburban patients. Behind closed doors administrators will openly argue that their “‘paying’ patients will not want to sit in the same waiting room as people on Medicaid,” so it is simply better for the hospital to segregate the two groups.

Worse still, these biases become a part of the culture of how medicine is taught, with students and residents working with Medicaid patients in the clinics learning very early on that some patients—the kinds of patients they get to practice on, the poor patients of color—are less worthy than others. Indeed, research has suggested that by the end of their medical education, student doctors actually become more biased than they were when they began medical school. These biases, whether conscious or not, permeate the medical system at both an individual and systemic level, affecting the quality of care that Medicaid beneficiaries receive.

From our perspective, the debate about Medicaid is less about left-and-right and more about black and white. The conservatives’ sleight of hand is to point to quality of care problems for Medicaid beneficiaries and to jump from there to the conclusion that the Medicaid program is to blame, which obscures the mediating role that institutional racism plays in ensuring poor outcomes for Medicaid patients. Meanwhile, supporters of Medicaid effectively erase race from the debate as well by closing their eyes to the many challenges Medicaid beneficiaries face in accessing high-quality health care, despite the fact that they are walking in the door with an insurance that research shows is pretty good. A more nuanced position would acknowledge differences in care without accepting defeat. It is not the Medicaid program that must be dismantled, but the biased attitudes and policies that lead Medicaid patients to get inferior quality of care.

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