But when fears of Ebola gripped the city during his first year in office, Mr. de Blasio employed similar theatrics to calm fears — hugging an Ebola patient and eating at a restaurant where that man had dined — and he used his pulpit to support the broader efforts by medical workers to combat the deadly virus.
In the mayor’s first term, pedestrian political calculations and battles with Albany have tainted some of his efforts on issues related to public health. But in general, the bigger and more serious the crisis, the better the results.
Credit
Ruth Fremson/The New York Times
He was a steady hand during the Ebola pandemic fear, and the city’s health agencies have done an effective job educating the public about the Zika virus as it spread across South America and the Caribbean.
It is difficult to assess how much or how quickly Mr. de Blasio, or most mayors for that matter, has had an effect on the health of the city. Mr. de Blasio’s predecessor, Michael R. Bloomberg, spent an unusual amount of capital to combat obesity and smoking.
And even though Mr. de Blasio made a rhetorical sport of denigrating all things related to Mr. Bloomberg, he has chosen to keep and expand on some of his predecessor’s most important public health initiatives, including the fight against tobacco and pushing for calorie labeling at restaurants.
Judging Mr. de Blasio’s record is made more difficult because one of his main goals — addressing inequality in health care — requires multiagency cooperation and the programs can take years to show results.
There is also no simple metric to measure the physical well being of the city’s residents over only four years, but the Health Department’s annual summary of vital statistics tracks some key indicators, including life expectancy, infant mortality and the leading causes of death.
Advertisement
Continue reading the main story
Most notably, death rates attributed to three of the leading causes of death in the city — heart disease, cancer and influenza/pneumonia — have continued to fall during the de Blasio administration, extending the decline seen under the Bloomberg administration, when life expectancy in the city increased by three years.
Still, city officials said that wide disparities remain in the health of New Yorkers based on income, race and where they live.
The infant mortality rate for non-Hispanic blacks was three times higher than non-Hispanic whites, and the rate for Puerto Rican New Yorkers was 2.3 times higher, according to the data.
Credit
Chang W. Lee/The New York Times
The de Blasio administration has started a number of initiatives to fight these disparities, including using city property for primary care clinics to share space with community-based organizations focused on health.
One of the mayor’s most important initiatives has come in response to a problem that cities and towns across the country are dealing with: opioid addiction. The other, ThriveNYC — an effort to help New Yorkers with issues related to mental health — is personal; the mayor’s wife, Chirlane McCray, who is leading the program, has spoken about her parents’ depression and the drug use of her daughter, Chiara.
More than 170,000 calls, texts and chats have flowed into a confidential mental health hotline since it was established last October, forcing the Health Department to expand its staff.
Like in much of the country, opioid addiction and overdose deaths are on the rise in the city. The mayor, again with Ms. McCray playing a central role, announced a $38 million initiative to reduce opioid deaths by 35 percent over the next five years.
Fighting the opioid crisis also requires close coordination with the police. This year, the mayor announced that every opioid overdose — fatal and nonfatal — would be investigated, dedicating 84 police officers to this task.
Advertisement
Continue reading the main story
But Mr. de Blasio has had a harder time fulfilling his campaign promises related to health — essentially a single-topic platform on the fate of community hospitals, and one in particular, Long Island College Hospital.
“It was a clearly a key part of his campaign and it played a major role in separating him from the other candidates,” said James R. Tallon Jr., president of the United Hospital Fund of New York.
It was a fight he lost, and perhaps learned from.
Last year, when Mount Sinai Beth Israel, an 825-bed hospital that has served downtown Manhattan for more than 125 years, announced that it was closing its building and replacing it with a smaller one, City Hall was largely silent. It seemed resigned that there was little the administration could do to change the reality of the economic picture facing hospitals: Beth Israel was one of 19 hospitals in the city that have either closed or overhauled how they operate since 2000.
Credit
Joshua Bright for The New York Times
Nonetheless, Mr. de Blasio has vowed to protect all of the city’s 11 hospitals managed by the Health + Hospitals Corporation.
“No matter the odds, the mayor will always fight when it comes to New Yorkers’ health care,” said Olivia Lapeyrolerie, a spokeswoman for the mayor, referring to Long Island College Hospital and hospitals across the city.
City Hall has been working to restructure the organization and offered an infusion of $2 billion in subsidies for the public hospital system that, according to a 2016 report by the mayor’s office, was “on the edge of a financial cliff.”
Newsletter Sign Up
Continue reading the main story
Thank you for subscribing.
An error has occurred. Please try again later.
You are already subscribed to this email.
“Unlike what has happened in other cities, Health + Hospitals will remain a vibrant public system — it is not for sale and the city will not abandon it,” according to the 55-page report.
But the financial stability of the city’s hospitals are vulnerable to forces far beyond the control of City Hall. Specifically, it is hard to predict how proposed changes to the Affordable Care Act being debated in Washington will affect the city.
For example, the increase in the number of people with Medicaid coverage under the health law would seem to be a boon to city hospitals, since they are required to treat anyone regardless of whether or not they have insurance. But the report found that once people gained insurance and more health care choices, many chose not to go to public hospitals. Still, public hospitals are the only options for the million New Yorkers who have no insurance, many of them undocumented immigrants. When treating those patients, the hospitals pick up the cost.
Advertisement
Continue reading the main story
Dr. Herminia Palacio, the deputy mayor for Health and Human Services, said that Mr. de Blasio subscribes to the theory that when it comes to public health, a holistic approach is necessary.
The point, she said, is that many aspects of the mayor’s agenda — from affordable housing to education — play a role in public health. She quoted Dr. Rudolf Virchow, a 19th century German doctor, for providing the guiding vision on City Hall’s approach.
Credit
Hiroko Masuike/The New York Times
“Medicine is a social science,” she said. “And politics is nothing but medicine on a large scale.”
Under the city’s Department of Health and Mental Hygiene, the department has created the Center for Health Equity, which focuses attention on certain neighborhoods deprived of sufficient resources and attention. Just like there are high-crime areas in the city, there are also sections — like parts of North and South Brooklyn and Harlem — that are high-disease areas. And similar to the police using CompStat data to develop strategies for reducing crime in certain areas, the city can use its extensive health data to push interagency health initiatives in specific areas.
To further the goal, the city is revitalizing underutilized Health Department buildings in some neighborhoods to provide more direct health services and to create partnerships between public hospital clinical services and community-based organizations. The initiative expands on the already robust network of district public health offices, providing a variety of services under one roof. In April, the department announced the creation of three Neighborhood Action Health Centers in East Harlem, Brownsville, Brooklyn, and Tremont in the Bronx.
On a tour of a health center in East Harlem, it was evident how grouped together services could provide vital resources to a neighborhood in desperate need of them.
Mac Levine, who runs a nonprofit that uses after-school programs to get children in high-crime neighborhoods focused on activities like urban gardening, had been struggling to find space for her headquarters for eight years.
Since moving into the Harlem building, she said, the group has doubled the number of volunteers to 1,000, and the number of children it serves has increased to 5,000 from 2,700.
Advertisement
Continue reading the main story
Her office is next door to a group that is working to improve the nutrition for new and expectant mothers. And that office is next to the Association to Benefit Children, which provides mental health support to young children among other services. In September, when a child was shot and killed a block from the center, the organization sent out its rapid response team to provide counseling, but it also is now present in the neighborhood so people can just walk in and get help.
Dr. Mary T. Bassett, the commissioner of the city’s Department of Health and Mental Hygiene since January 2014, said that she and the mayor shared the same vision for trying to improve the health outcomes for the city’s poorest residents.
Credit
Hiroko Masuike/The New York Times
“We both agreed wholeheartedly that inequality was driving poor health outcomes, disproportionally affecting communities of color,” she said. “I knew he wanted someone with a vision, and he wanted bold steps to move his progressive agenda.”
But Mr. de Blasio’s first four years will likely be remembered for how the city handled events beyond his or anyone’s control.
When a doctor, Craig Spencer, returned to New York from West Africa and tested positive for Ebola in 2014, hysteria threatened to outpace reason.
Around the same time, Kaci Hickox was ordered by Gov. Chris Christie to be held in a quarantine tent in New Jersey for three days after she returned from working as a nurse in Sierra Leone, even though she never tested positive for the virus. She was then released on the condition she return to her home in Maine — which also sought to quarantine her.
Dr. Spencer, by contrast, had traveled around the city before he was diagnosed with having the virus.
Mr. de Blasio and Dr. Bassett made it a point to eat at the Meatball Shop, where Dr. Spencer had dined. And when he was finally released from the hospital, the mayor was the first to offer him a hug.
He also championed the other medical workers who went to Africa to combat the virus at a time when many were being stigmatized when they returned home.
Advertisement
Continue reading the main story
“My tenure as commissioner has been dominated by microbes,” Dr. Bassett said. “In each challenge, whether it was Ebola, Legionnaires’ disease, or Zika, the mayor has shown unwavering support for public health.”
Continue reading the main story
Article source: https://www.nytimes.com/2017/10/16/nyregion/bill-de-blasio-public-health.html