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.
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:
“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.
Here is our op-ed on the Medicaid Redesign Team that ran in today’s Albany Times Union. Comments most welcome!
By Nisha Agarwal and Shena Elrington
Gov. Andrew Cuomo‘s Medicaid Redesign Team was handpicked by him and elected by no one. Though touted as a collection of health care “experts,” the majority of the team’s members have strong ties to special interests in the health care industry.
Not surprisingly, its proposals for cuts reflect the vested interests of its members.
Proposal 67 calls for the closing or downsizing of safety net hospitals that provide health care services in medically under-served areas. We need more health services in these communities, not less, particularly since these communities have been ravaged by hospital closures in recent years.
Central Brooklyn, with its extremely low-income and 90 percent black and Latino population, has lost two hospitals, OB-GYN and prenatal services at two other local hospitals, 13 outpatient clinics, a federally funded health center and at least two women, infants and children program centers that provide nutrition education and assistance in recent years, despite having some of the worst health outcomes in the city.
The infant mortality rate in the Brownsville section of central Brooklyn is nearly five times that of Manhattan’s Upper East Side.
Do we really need more hospitals in areas like central Brooklyn to close?
When safety net hospitals close, people are forced to travel farther to see care at the few institutions that remain open — usually elite private academic teaching centers. These are the very same institutions to which many of the Medicaid team’s members have strong connections, raising questions about the appropriateness of using the regulatory process to funnel business to special-interest groups.
What is more, proposals that would actually support safety net institutions and use public dollars in an accountable and transparent way never made it into the final Medicaid reform package.
Proposal 66, for example, would have recalibrated charity care and Medicaid dollars so that the distribution of that funding would be based on the actual Medicaid and uninsured losses. Hospitals in New York now receive “indigent care” funding regardless of the volume of care they actually provide to Medicaid and uninsured patients. So, hospitals that provide very little care to low-income New Yorkers often get more money from the indigent care pool than they deserve, while safety net institutions, which provide a lot of care to Medicaid and uninsured patients, do not get their fair share.
Recalibrating the way this funding is distributed would not only make sense and bolster the financial stability of critical safety net institutions. It also is required under federal health reform and was very favorably ranked through the Medicaid Redesign Team’s own scoring process. Yet, the proposal never made it into the team’s final recommendations.
New York is in the midst of an epic budget crisis. Medicaid is seen as the linchpin to solving that crisis. But its redesign should not be done in such a way as to threaten the very institutions that serve as a safety net for our state’s most vulnerable residents. The erosion of our health care safety net threatens the stability of the system for all of us.
This post is by Rylee Sommers-Flanagan, a summer intern with the Health Justice Program and a student at Emory University in Atlanta, GA.
Recently, news sources and blog sites released a flurry of commentary and news articles on the results of a study by the New York State Health Department that indicate unusually high mortality rates for pregnant women in New York, particularly New York City. While the report declined to make a causal link, the article published in the New York Times mentioned not only that “death rates were highest in the Bronx and Brooklyn,” but that black women were “seven times as likely to die in pregnancy as white women.”
Unfortunately, these numbers don’t surprise us. Due to entrenched racial inequalities, health disparities between whites and people of color are visible in both treatment and outcomes. Care is often segregated and sometimes it is simply nonexistent.
Take, for example, Central Brooklyn, where 92% of the population is of color. Since 2003, three major medical providers – Caledonia Hospital, St. Mary’s Hospital and the Lyndon B. Johnson Health Center – have all closed. Also in the last seven years, Central Brooklyn has lost OB/GYN and NICU services at the Interfaith Medical Center, prenatal services at the Kingsbrook Jewish Medical Center, as well as two WIC centers and four primary clinics, all now closed.
Losing these services won’t improve the disparate health fates of residents in Central Brooklyn. Predictably, the most dramatically medically underserved are also victims of the highest rates of maternal mortality and similarly elevated infant mortality rates – in Central Brooklyn, 8.75 infants die per 1000 live births compared to 2.1 deaths per 1000 in the Upper East Side.
Maternal and infant mortality are enough cause for concern, but decreased medical services have many more consequences. Another telling example is the remarkable gap in both rates and results of diabetes in Central Brooklyn as compared with the same in New York City as a whole. In 2008, 68% more people died from diabetes in Central Brooklyn than did in the rest of New York City. The story repeats itself to the tune of a variety of medical conditions. Hope seems foolhardy in this climate of hospital bankruptcies, pared budgets, and continuously diminished access to care.
But improvement is not impossible. One approach, embodied in the Infant Mortality Reduction Initiative (IMRI) has been successful in reducing infant mortality and increasing the number of women who receive pre- and post-natal care. By networking with existing programs and creating community partnerships, IMRI is generating progress. Yet, even as the report on maternal mortality illuminated the distance stretching ahead, the city has moved to severely reduce funding for IMRI and consequently participating organization like the Brooklyn Perinatal Network. There are few groups currently filling the gaping fissure left by multiple hospital closures and decreased services in the medically underserved regions of New York City. We need them all to be secure.
New York City is not the only player to blame in this game. According to The Lancet, 23 countries are on course for reducing maternal mortality as outlined in Millennium Development Goal 5, that’s 75% by 2015. The United States is not among them. A surprising set of countries – China, Egypt, Ecuador and Bolivia – are ahead of schedule.
Ultimately, policy is about priority; why aren’t mothers, infants and health a priority? Well, that’s our question for the City of New York, as well as the rest of these United States.