Tag Archives: health disparities

It’s Time to Transform NYC’s Trash

Check out the guest blog below from our colleagues in the Environmental Justice program here at New York Lawyers for the Public Interest and from the Alliance for a Greater New York (ALIGN).  Low-income communities and communities of color disproportionately bear the burden of environmentally hazardous industries and exposure. Environmental discrimination has broad implications for the health of these communities, as evidenced by high rates of asthma in heavily polluted areas such as the South Bronx. The piece below looks at the issue of waste management in New York City and calls for a policy change that would make NYC communities cleaner and healthier.

By Justin Wood and Maya Pinto of the Transform Don’t Trash NY Coalition

Thanks to new programs from New York City’s Department of Sanitation, many New Yorkers are beginning to recycle and compost more of the trash we generate in our homes and apartments.

But have you ever wondered what happens to the trash you throw out at work, or what happens to food scraps every time you eat a meal at a restaurant?  NYC businesses generate a staggering 5.5 million tons of garbage per year – and almost 75% of it ends up buried in landfills or burned in incinerators.[1]

Not only do these outmoded disposal practices contribute significantly to greenhouse gas emissions; our giant, chaotic, and inefficient private-sector waste system also contributes to chronic health crises for thousands of New Yorkers.

1)  Inefficient collection means thousands of unnecessary trucks on our streets and pollution in our communities.

Our commercial and restaurant waste is picked up by any of over 230 private haulers, which operate more than 4,000 trucks in NYC.  Because these companies constantly compete for customers, they operate inefficient, overlapping truck routes and send unnecessary diesel emissions into our air – releasing dozens of nasty pollutants linked to premature deaths, heart attacks, asthma, and other serious ailments.  Commercial garbage truck drivers face pressure to complete their collection routes each night as quickly as possible – leading many to engage in speeding, illegal turns, and reverse moves on one-way streets, endangering pedestrians and cyclists.[2]  In fact, better regulation of commercial waste trucks may be essential to achieving the safe streets called for in the mayor’s new Vision Zero plan: studies have found that, per mile, commercial garbage trucks cause more cyclist fatalities than any other vehicle.

2)  Our waste is disproportionately handled in low-income communities and communities of color. 

The vast majority of NYC waste is carted by heavy collection trucks to transfer stations before ultimately being hauled away from the transfer stations in still more trucks.  The majority of these transfer facilities are located in just three outer-borough neighborhoods – the South Bronx, North Brooklyn, and Jamaica, Queens – which are home to more than half a million people, most of whom are low-income and of color, and many of whom suffer from elevated rates of asthma and other chronic health problems.

“Waste-to-Energy” Incinerators also emit greenhouse gases and toxins such as dioxin and mercury, which are associated with cancer and other health impacts common to overburdened communities.  Hundreds of thousands of tons of NYC waste are trucked to an incineration plant in Newark’s Ironbound neighborhood, which is burdened by  a high rate of childhood asthma.

3)  Workers Face Serious Health Hazards   

The solid waste industry is among the deadliest in the nation for workers, and waste workers face daily hazards like exposure to poisons, toxins, rodents, infectious diseases, and diesel fumes.

While collecting garbage is inherently difficult, dirty work, not all workers are treated equally.  City workers collecting waste from residences have good health benefits, union representation, and pension plans.  In contrast, private hauler workers who collect waste from offices, restaurants, and other businesses suffer from an under-regulated “race to the bottom” in which wage and safety standards are sacrificed for the bottom line.  Moreover, commercial waste workers are disproportionately people of color who earn significantly less than their white counterparts.[3]

The Solution:  Transform Don’t Trash NYC!

Thankfully, our city has the opportunity to set policies that solve these problems.  The City can enact high-road labor and environmental standards and establish accountability mechanisms in the commercial waste industry by adopting an approach to solid waste management that is increasingly being used in cities across the country.

Cities including Los Angeles, San Jose, and Seattle have adopted innovative approaches to waste management in which haulers submit bids for the exclusive right to collect waste in geographic zones designated by the city.  Haulers are selected based on factors such as fair prices for customers, the hauler’s ability to meet city recycling goals, and commitment to fair wages and health benefits for workers.

The results are promising: San Jose has seen its business recycling and composting rates jump rapidly from 23% to 71% after choosing an innovative hauling company to collect all commercial waste.  Los Angeles just adopted similar legislation and anticipates that its new system will greatly boost recycling and composting rates while reducing inefficient truck routes throughout the city.

If New York City follows suit, we could eliminate over 5 million diesel truck miles every year on our streets, improve the health and wellness of our most vulnerable residents, prevent 2.5 million tons of waste per year from being landfilled or incinerated, and create over 15,000 quality local jobs by recycling our commercial waste into useful products.

You can show your support for a healthier, cleaner, and greener NYC by joining our online campaign today!


[1]Recent data from an unpublished study commissioned by DSNY (acquired by TDTNY through a FOIL request) show that our commercial waste problem is worse than previously understood.  NYC previously estimated commercial waste generation at 3 million tons per year with a 31% recycling/diversion rate.  New estimates are 5.1 million TPY with only a 26% diversion rate.  Source:  Halcrow Engineers, “New York City Comprehensive Commercial Waste System Analysis and Study,” submitted August, 2012.

[2] After directly observing more than 125 different NYC blocks at night, DSNY’s consultants find that these illegal time-saving maneuvers were common.  Source:  “New York City Comprehensive Commercial Waste System Analysis and Study,” p. 3-15.

[3] EEO tabulations of Census data analyzed by ALIGN show that while 12% of white workers in the waste industry earn less than $35,000/year, a majority of Latino workers and 75% of non-citizen workers earn less than $35,000/year. See Transform Don’t Trash NYC p. 12.

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Health Justice and the Government Shutdown

by Lindsey Hennawi, Program Assistant

The United States Congress regularly votes to pass appropriations bills to fund federal operations. Lately, however, the Republican-controlled House of Representatives and Democratic-controlled Senate have been unable to agree on these bills, so they instead pass a series of temporary “continuing resolutions” to keep the government funded. The last of these resolutions expired on September 30th. Since Congress was unable to pass another, a government shutdown process has begun, and will continue until a budget is agreed upon.

The appropriations bills keep failing due to Republican provisions to defund or delay implementation of the Affordable Care Act, which went into effect on October 1st. This has been the major sticking point between the Senate and the House and thus the main reason for the shutdown.

What does a shutdown entail, exactly? Furloughed from their jobs, more than two million federal employees will have their paychecks delayed; many may never get backpay once they do go back to work. Not all government function will cease, but many of the agencies impacted are ones most crucial to protecting marginalized people. The Social Security Administration has halted acceptance of new applications for disability pay. If the shutdown lasts for more than a week, funding will run out for the Women, Infants and Children (WIC) program, which provides health and nutrition resources to nine million new and expectant moms. If it exceeds two weeks, millions of vets will be cut off from benefits. By the end of the month, funding for food stamp aid for 47 million Americans will be drained as well. Head Start programs will close, starting with 20 this week, leaving thousands of parents without affordable options for pre-K or childcare for their children. New clinical trials, vaccination programs, and certain food safety procedures are all on hold. And so on.

This scenario is basically the conservative utopic vision of government. The state security apparatus—military, law enforcement, prisons, the NSA—is still intact (considered “essential,” they remain open), whereas social welfare programs face de facto suspension. So, programs that incarcerate and oppress poor communities of color: unaffected. Programs that feed and care for them: shut down.

How could this happen? In short, the House is really set on gutting the ACA, while the Senate wants to protect it. The driving force behind the shutdown, an extremist conservative faction, insists that the rest of Congress must be willing to compromise. But many feel those conservatives had their chance to challenge the ACA—and boy, did they try—and now must accept it as law.

So let’s be clear about exactly what’s going on here, then. Far right-wing conservatives are essentially holding the government hostage to prevent the implementation of a Supreme Court-upheld law that would provide comprehensive health care to millions of people who traditionally could not afford it: poor folks, people of color, immigrants, LGBTQ folks, people with disabilities, and youth, to name just a few groups who have received expanded protections and access to care under the ACA. But the chances of actually successfully overturning the ACA are slim to none, because, well, that’s not how laws work.

In other words: they’re strangling the democratic process, risking the lives and livelihoods of millions of working and struggling people in so doing, to deny working and struggling people access to affordable, comprehensive health care—you know, the kind of care those extremists, as mainly rich white men, have been able to access their whole lives.  And even though they have virtually no chance of succeeding in this endeavor, they’re doing it anyway, because that’s how little they value the rest of us.

This is what makes calls for compromise so insidious. Any middle-ground under these circumstances means letting a bunch of over-privileged elites throw the legal equivalent of a temper tantrum in order to perpetuate endemic health disparities, a dwindling safety net, discriminatory barriers to care, and social and economic inequality that disproportionately harm poor people of color.

And that’s not compromise; it’s capitulation.

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Living in Fear — Children of Undocumented Suffer Health Problems

Check out this article from New American Media on how our immigration policies negatively impact the health and well-being of children of undocumented immigrants. You can read the article 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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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.


March 6, 2012 · 5:56 pm

Bridging Theory and Practice for Language Rights

Check out a newly published article in the Journal of Health Care for the Poor and Underserved, co-authored by Health Justice Director, Nisha Agarwal, on the importance of language access in the pharmacy setting. This is an area where the evidence about the importance of providing language concordant services for patients who are limited English proficient (LEP) keeps growing and, despite all the discussion in medical circles about “evidence-based” policymaking, we continue to face resistance at state agencies charged with protecting and advancing public health. Instead of collaborative discussions about how to improve access to prescription medications for immigrant communities and reducing health disparities, we hear complaints about how language assistance services might put huge chain pharmacies out of business – immigrant scape-goating at its worst.

We’re taking our fight to the pages of research journals, as well as to the corridors of power in Albany and to the streets until we win. Join us in this effort! Send us an email and let us know that you’d like to join the coalition to ensure Safe Access for Everyone to prescription medications (SafeRx): healthjustice[at]nylpi.org.

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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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Action Alert: Email the MRT

In response to the hurried and flawed process used to develop proposals for New York Medicaid redesign, the Save Our Safety Net-Campaign asks allies to send emails to members of the Medicaid Redesign Team (MRT) expressing our distaste with their decision making process.

Sample text and email addresses of MRT members are below.


Subject: Disappointed with Medicaid Redesign Process

Sample text:

“Medicaid Redesign Team –

We are saddened and angered by the “rush to judgment” on February 24th in the vote of the Medicaid Redesign Team to approve a package of recommendations that you had in your hands for less than 24 hours.  There had been major changes in what recommendations you were being asked to vote on, yet you voted.  The information was just made available on the web site the same day as the vote.  The aborting of the time frame by five days meant the public had no opportunity to review, digest, and comment on this package – much of which will have a dramatic impact on people’s lives.

The process had so many flaws that it would be difficult to name all of them.  But while trying to appear as this was a public transparent process, in the end it was anything but open and public.  To cite just one “mistake”, Mr. Introne acknowledged publicly at the meeting on February 24th that people who had been listed in support of proposal #67, had actually spoke in opposition to this proposal.  #67, or Berger 2, would make money available to close, consolidate or merge hospitals, nursing homes, and clinics and was actively supported by Ken Raske (GNYHA) and Stephen Berger.”

Email addresses of MRT members:

Ann Monroe<amonroe@chfwcny.org>;Arlene Gonzalez-Sanchez<arlenesanchez@oasas.state.ny.us>;Joe Giglio (Assembly)<giglioj@assembly.state.ny.us>; Assemblyman Richard N. Gottfried<gottfried@assembly.state.ny.us>; Carol Raphael<craphael@vnsny.org>; DanSisto<dsisto@hanys.org>; Dennis Rivera<drseiu@aol.com>; Dr. JeffreySachs<jsachs@sachsmessage.com>; Nirav Shah<nrs02@health.state.ny.us>; Dr. William Streck<william.streck@bassett.org>; Ed Matthews<ematthews@ucpnyc.org>; Eli Feldman<efeldman@mjhs.org>; Elizabeth Swain<eswain@chcanys.org>; Frank Branchini<fbranchini@emblemhealth.com>; GeorgeGresham<georgeg@1199.org>; James Introne<James.Introne@exec.ny.gov>; Jason Helgerson<jah23@health.state.ny.us>; Karen Ballard<kballard@nyc.rr.com>; Ken Raske<raske@gnyha.org>; Lara Kassel<lkassel@cdrnys.org>; Linda Gibbs<lgibbs@cityhall.nyc.gov>; Lisa Ullman<Lisa.Ullman@exec.ny.gov>; Max Chmura<max.e.chmura@omr.state.ny.us>; MikeDowling<mdowling@nshs.edu>; Mike Hogan<cocomfh@omh.state.ny.us>; RobertMegna<Robert.Megna@budget.state.ny.us>; Kemp Hannon (Senate)<hannon@nysenate.gov>; Thomas Duane (Senate)<duane@nysenate.gov>; SteveAcquario<sacquario@nysac.org>; Steve Berger<sberger@odysseyinvestment.com>

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