Tag Archives: racism

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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Knowledge is Power

This post is by Julina Guo, a Columbia University student and intern for the Health Justice program.

Disparities in health care impact thousands of lives every day.  One of the biggest challenges in the fight for equal health care is lack of awareness. We can help ourselves to become more knowledgeable and informed so that our own voices are heard in the healthcare debate. Below is a list of notable works that have highlighted pressing issues in health care equality as it relates to race, immigration, gender, and socioeconomic status. Although numerous reports and research studies have been published on the topic of health disparities, we focus in this bibliography on more journalistic works that tell a story of how health disparities impact real human lives.  We hope you find it useful!  And if, in the course of your travels through this literature, you discover other wonderful texts you’d like to share, please email us  (healthjustice@nylpi.org) and we’ll add them to this bibliography.  Thanks!

Abraham, Laurie K. 1993. Mama Might Be Better Off Dead: The Failure of Health Care in Urban America.  Chicago: University of Chicago Press.

Abraham examines the real impact of unequal health care on the Banes, a low-income African American family, in Chicago. Through stories of inadequate medical attention, visits to the emergency room, struggles to qualify for Medicaid, and other misfortunes that befell this family, Abraham depicts the need for health care reform through the eyes of the poor.

Byrd, W. Michael and Linda A. Clayton. 2001. An American Health Dilemma: Race, Medicine, and Health Care in the United States, 1900-2000. New York: Routledge.

An extensive chronicle of the African American experience within the larger context of health care in the United States and global racism in the last 2,000 years. Byrd and Clayton posit that that the denial of quality health care to African Americans originated in colonial era, a tradition that quickly transformed into a social norm to deprive African Americans of their rights.

Fadiman, Anne. 1997. The Spirit Catches You and You Fall Down:  A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus, and Giroux.

This book describes the emotional and medical tragedy of the Lee family, a refugee Hmong family from Laos, in the 1980s. When their child Lia Lee was diagnosed with severe epilepsy at an early age, the Lees tried to negotiate with doctors in a culturally mismatched setting only to find tragedy.

Hilfiker, David. 1994. Not All of Us Are Saints: A Doctor’s Journey with the Poor. New York: Ballantine Books.

Hilfiker documents his experiences as a physician in a Washington, D.C. ghetto. In 1983, Hilfiker moved his family into the Christ House, a medical recovery shelter for homeless men, and later founded an AIDS shelter in 1990. This moving narrative depicts vivid personal encounters with a ravaged health care system divided by race and poverty.

Jones, James. 1993. Bad Blood: The Tuskegee Syphilis Experiment. Free Press.

An analysis of experimentation by the United States Public Health Service from 1932 to 1972 on poor African American men infected with syphilis. Jones argues that by purposing deceiving and depriving the men of medical treatment, doctors perpetuated an ugly symbol of racism that has survived to this day.

Smith, David B. 1999. Health Care Divided: Race and Healing a Nation. University of Michigan Press.

Telling first-hand accounts and statistical evidence of inequality in health care outcomes move this narrative as it details changes from the 1920s to the present. Smith examines efforts by the federal government and courts over the years, giving special attention to the 1964 Civil Rights Act in the health care arena.

Vigen, Aana Marie. 2006. Women, Ethics, and Inequality in the U.S. Healthcare: “The Count among the Living.” Palgrave Macmillan.

A perspective of the disparities of healthcare as seen through African American and Latina women with breast cancer. Vigen crafts their stories in the context of current healthcare research, giving a voice to those marginalized in the healthcare debate.

Washington, Harriet A. 2006. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. New York: Harlem Moon.

Washington examines the history of unethical medical experimentation of African Americans. She details practices in the colonial era, following the introduction of Darwinism, social eugenics, and the Tuskegee Experiment

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Run On and See Where It Ends: Fighting to Make Health Equality a Reality

This post, by Health Justice Director Nisha Agarwal, has also appeared on Race-Talk, Huffington Post and AlterNet.

Saturday morning, April 17th, the auditorium of Junior High School 22 in the Bronx was crowded with community residents who had gathered for a town hall meeting. Health care reform had passed, but these folks knew that their problems were not over. Ensuring that most Americans have health insurance, while important, will not be enough to eliminate the racial and ethnic disparities that have been dyed deep into the U.S. healthcare system and that reveal themselves, vividly, in the Bronx.

To save black and brown lives and to improve the vibrancy of those lives requires looking beyond access and focusing on quality. It requires, among other things, an examination of the practices of major health care institutions, which deny low-income people of color the highest quality of care they have to offer even when those people have health insurance.

The specific issue that community members had gathered about is this: in New York City, prominent private hospitals–facilities like New York-Presbyterian, Montefiore Medical Center, Mount Sinai–operate two different systems of care for patients with the same kinds of health problems but with different types of insurance. There are, for example, cardiology “clinics” for patients with Medicaid, a public insurance program, and there are cardiology “faculty practices” for patients with private insurance. Sometimes the clinics are right next door to the faculty practices, but Medicaid patients won’t be allowed into the faculty practices, and privately insured patients are not sent to the clinics.

What is more, the hospitals allow valuable and finite resources to be allocated unequally between the two systems of care. For instance, clinics often do not have enough financial support from the hospital to perform basic care coordination tasks like sending notes back to the patient’s primary care physicians, while faculty practices often receive administrative and other forms of support so that such tasks are routinely able to be done.

More significantly, board certified faculty physicians, the top docs, spend only a fraction of their time in the clinics–a mere half a day a week for four months out of the year in one case–even though they are required by law to spend the bulk of their time supervising resident doctors and caring for patients in the clinic setting instead of in the faculty practice. Hospitals do nothing to shift the balance and, as a result, Medicaid patients do not have a single, board-certified physician who is ultimately responsible for their care, whereas privately insured patients do. Here is a chart summarizing some of the main inequalities:

The impact of these differences are felt on the bodies and backs of low-income patients. At the town hall meeting, Medicaid beneficiaries spoke of being bounced from one doctor-in-training to the next within a fragmented clinic system, where fingers and toes were almost amputated and cancer remained undiagnosed until dangerously late. And they spoke of how these outcomes were not race neutral. In New York, people of color are far more likely to have public insurance than whites, which means that when hospitals create two systems of care based on insurance they are also perpetuating a de facto segregation based on race. (For more background and helpful stats on this issue, please see this excellent monograph on medical apartheid in New York City by the Bronx Health REACH coalition, the group that first brought this problem to light.)

Representatives of health care institutions have argued publicly that community residents are missing the point. The source of the problem, they claim, is with the Medicaid program and not with the hospitals. Doctors’ offices are reimbursed at extremely low rates through Medicaid and therefore can’t afford to see publicly insured patients in their faculty practices. The clinics have been set up to provide an avenue for care that otherwise wouldn’t exist.

But it is the hospital representatives who are missing the point. The provision of care to Medicaid patients is not something hospitals are choosing to do out of the goodness of their hearts. Under federal law, hospitals are required to open their doors to Medicaid beneficiaries, and provide them care without discrimination, in exchange for accepting millions of dollars of government funding to modernize and upgrade their facilities.

Moreover, while Medicaid reimbursement rates for doctors’ offices are very low, they are much higher for clinic-based services. In order to integrate care, hospitals could simply shift their resources to the clinic and ensure that all patients, public and private alike, are seen in that setting, instead of siphoning off the privately insured patients to the faculty practices. The increased resources and mixed patient population would help ensure that the quality of clinic care would improve dramatically and that this high-quality care would be accessible to all on equal terms.

Of course, hospitals are choosing not to do this and, given the dubiousness of the financial arguments, one is left to presume that their motives are more suspect: one cannot attract wealthy, white patients from the Upper East Side and Westchester if those individuals will have to sit in the same waiting room as people of a different class or race. The fight to integrate our health care system and to reduce racial and ethnic health disparities is therefore going to be just as messy as the historic battles to integrate our educational system or our housing. But fight is what Bronx residents will do, even in the face of uncertainty and resistance. As one faith leader said at the town hall meeting, quoting a song from the civil rights movement of deep South, we must “run on and see where it ends.”

To learn more about Bronx residents’ efforts to eliminated segregation in New York City’s healthcare system, please click here or visit the website of Bronx Health REACH.

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Reading Between the Lines: Kids of Color & Mental Health Care

This post, by Health Justice Director, Nisha Agarwal, originally appeared on the Race-Talk.org blog of the Kirwan Institute for the Study of Race & Ethnicity and in the Huffington Post.

This weekend the New York Times reported on a new study which finds that kids on Medicaid are four times more likely to be prescribed antipsychotic drugs than their privately insured counterparts, and often for conditions for which the drugs are not FDA approved such as A.D.H.D. and conduct disorders. These drugs may not only have significant psychological impacts on the children who take them, but they also cause long-term physical harm. This is terrible no matter what, of course, but let us be very clear about what we are talking about here. In places like New York City, where African-Americans and Latinos are 3.5 times more likely to be on Medicaid than whites, the kids we are talking about are black and brown.

The children who are being systematically over-medicated and denied high quality mental and behavioral health services are disproportionately young people of color. What we are talking about, then, is race even if all but the most oblique reference to it has been scrubbed from the lines of the mainstream media coverage.

Let us also be clear about how this may be happening. The Times piece implies that certain problems with the Medicaid program, such as low reimbursement rates for therapy, contribute to the over-medication of children by creating incentives for doctors to prescribe antipsychotics or by reducing the availability of psychiatrists who accept Medicaid, thus funneling low-income kids to non-specialists who are more likely to provide treatment through drugs. This may very well be true, but let us unpack these dynamics as well from the racial justice tip.

In New York City, where I work, there are large, well-respected institutions providing high quality mental health services for children that refuse to accept Medicaid patients ostensibly because they don’t pay that well. This can be viewed as a rational dollars-and-cents reaction to an inadequate Medicaid system, but when you consider the close relationship between insurance and race, it starts to look like a modern version of Whites Only. Such policies become all the more difficult to swallow when you compare them to the approach of some community-based health care providers that also exist in the city and manage to make mental health services available effectively and equitably.

The directors of clinical services at these community health centers will tell you about how they’ve figured out their administrative and billing infrastructure so they can work around some of Medicaid’s challenges to provide high quality mental health care to all patients, regardless of their insurance. Providers like these fight alongside consumer advocates to preserve Medicaid and make it better because they recognize how critical it is to the lives of their patients. They don’t retreat from the system or take shortcuts, hoping that poor kids of color and their mental health problems will just go somewhere else. Indeed, they bear responsibility for their colleagues at other institutions, who disguise their discrimination in the form of a “rational” economic calculus.

You can expect to hear more about the doping of America’s children in the coming year, as more studies are released and blue-ribbon policy panels convened to address the problem. What you probably won’t see are many efforts to write race into the story or the solution. That is our job as racial justice advocates: to read between the lines and move in from the margins.

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Hospital Mismanagement and the Perpetuation of Racial and Ethnic Disparities

This post, by the Director of NYLPI’s Health Justice Program, originally appeared on the blog of the Committee of Interns & Residents, which is fighting for the right to unionize at St. Barnabas Hospital.  You can read more about CIR’s efforts here.

Last summer, on her wedding night, Juana R. arrived at the St. Barnabas Hospital emergency department with severe abdominal pain.  A Spanish-speaker, Ms. R. needed an interpreter to communicate effectively with her providers, but she was never given one.  Instead, from the moment of her arrival at the ED, to her transfer to the ICU, to her eventual discharge a month later, she was systematically silenced by the hospital.  Invasive tests and procedures were performed without obtaining Ms. R.’s consent (she signed a litany of documents in English only).  Various medication regimens were attempted, many of which caused extreme pain and nausea, but Ms. R had no way of properly communicating these problems to her providers.  Only after legal intervention did this patient receive the communication assistance services she needed in order to understand her diagnosis and the reason for her admission.  Now, over a year after her discharge from Barnabas, Ms. R. remains emphatic that she will never again return to the hospital for care. She describes what she endured as a nightmare. [1]

As previously reported on this blog, Ms. R.’s case resulted in St. Barnabas Hospital being cited by the State Department of Health for failure to comply with public health regulations.  More broadly, her experience speaks to the ways in which poor hospital administration can compromise patient care and exacerbate racial and ethnic disparities in health care.

Well-known studies about the relationship between race and health care have focused on the individual patient-provider interaction – on how inter-personal biases and prejudices can sway treatment decisions.  However, in my experience as a civil rights lawyer in this field, I have found that institutional racism is a more salient factor than individual animus in explaining my clients’ negative encounters with the health care system.  Patients like Ms. R. are denied the interpretation services to which they are entitled not because of the ill will of particular caregivers, but because, more typically, hospitals like Barnabas are not managed well enough to have the policies and practices in place to ensure timely access to important support services – a systems failure that hurts patients and providers.

My office has also found that, across the city, health care institutions will steer Medicaid and uninsured patients, who are disproportionately people of color, into poorly equipped and under-staffed clinic settings while “better” patients (i.e. white, privately insured patients) are sent to the faculty practices.  At the broadest level, this upward redistribution of health care resources has meant that hospitals located in New York City’s low-income communities of color have closed down over the past decade, while facilities located in more affluent white communities have thrived.  In some cases, the hospitals that shut their doors had patient populations that were over 90% African-American, Latino and Asian.

Viewed in this way, the primary way to eliminate racial and ethnic disparities in health care is to overhaul the institutions that create and perpetuate racial and economic disparities within medicine.  This means more people like Ms. R. stepping forward and demanding investigations of unlawful practices at hospitals like St. Barnabas.  It also means more communities raising their voices against hospital policies that enrich some while impoverishing others.  Ultimately, it means more of us—all of us—speaking out against health care institutions designed to promote private gain over the public’s health.

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CNN News Story: Medical Care Double Standard?

Last night, CNN featured our campaign with Bronx Health REACH on separate and unequal care in New York City academic medical centers.  You can view it here.

It is unusual for mainstream media to tackle problems such as institutional racism in the health care system, and for that reason alone it was exciting for our campaign to get the kind of exposure that it did last night.  This was not merely a situation of “any press is good press,” either.  From our point of view, CNN’s coverage was sensitive, thoughtful and true to what we have heard in the community when the cameras are not running.

But the reaction to the story outside our community–outside the Bronx, outside the civil rights & racial justice community–has been far less approving.  The general tenor of the commentary by the CNN viewing public is that blacks should stop complaining because whites get bad care too.  This is tragic because it is partly true.  White people absolutely do get bad care within the American health care system, particularly if they are not wealthy or are uninsured.  In fact, one of the claims in our case is based on a federal law that, among other things, makes it unlawful for hospitals to discriminate against patients because they are on public health insurance.

However, it does not follow from this that blacks and Latinos should stop complaining about the inferior care that they systematically receive within the system.  No, the truth is we should all be complaining loudly and constantly about the failures of the existing health care system.  People of color are disproportionately and profoundly more likely to get the short end of the health care stick, and so we should be raising our voices and demanding change with all the energy we can muster.  But all of those white people who wrote on CNN’s blog, sharing their personal stories of pain within the health care system, should speak out too — not in opposition, but in solidarity.  Otherwise, the whirling maelstrom that is the American health care system will sink all our boats.

For a similar view, please check out this post by Dr. Neil Calman, one of the founders of Bronx Health REACH and the physician featured in the CNN news story.

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CNN features Bronx Community’s Civil Rights Campaign

For the past two years, we have been representing a community coalition in the Bronx in a case about insurance- and race-based segregation in New York City hospitals.  This Monday night, our campaign is going to be featured in an investigative news piece by Dr. Sanjay Gupta on CNN!  The piece will air during the Anderson Cooper 360, between 10pm and midnight; not sure yet which hour.  Please tune in and show your support!  (Or for those of you with more new-fangled technology, be sure to DVR it.)

Better yet, tune in with a group and use the story as an opportunity to talk about institutional racism in the health care system, and what can be done about it.  Check out our Community Discussion Guide to help you facilitate the conversation.  If you’re a health care provider, you get your own Provider Discussion Guide.

And please spread the word.  There’s been a lot of talk about the health reform proposals coming out of Washington these days.  Well, we’re offering a plan rooted in community activism, South Bronx style.

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