Our Top Takeaways from APHA 2019

The annual conference for the American Public Health Association (APHA) took place earlier this month in Philadelphia, a bustling city with an impressive public health pedigree. The city contains what will become the first safe injection site in the United States, and is in many ways the home of important ideals such as justice, racial equity, and equality. A few of FPHNYC’s staff joined thousands of other public health professionals  to talk about these values, the challenges currently facing public health, and exciting directions for the future. Here’s what we learned.

Nora Landis-Shack, Senior Associate – Strategic Partnerships & Fundraising

Changing laws, policies, and funding priorities means that interdisciplinary collaboration is more important now than ever before.  Speakers at several of the sessions I attended spoke about the power of public-private partnerships to enact real, sustainable, and powerful change in public health. The Fund for Public Health is uniquely able to connect individuals and private philanthropy to innovative projects that make us healthy and makes New York City’s Health Department one of the best in the country, if not the world. As I reflect on APHA, I’m thinking about how we can continue to support those relationships to ensure continued innovation is made possible.

Sydney Sasanow, Financial Analyst

The sessions I attended at APHA emphasized the importance of incorporating community feedback into program development and design to build trust and encourage buy-in. This is especially important in the fight against epidemics like opioid use and vaping. Community-partnered efforts can help us more directly and meaningfully address not only the symptoms of epidemics, but also their root causes in the social determinants of health like access to housing, healthy food, and clean, safe environments.

Aviva Goldstein, Senior Director – Strategic Partnerships & Institutional Philanthropy

The field of public health is becoming increasingly diverse with stronger representation from people of color and people of all ages and genders. Several presenters focused on men’s health and one panel focused on unorthodox ways of reaching black men – barbershops, churches – and how to develop messages that resonate.  It reminded me of a comment our former commissioner, Dr. Mary Bassett, recently made about how white men and women and black women achieved life expectancies over 70 by the 1970s. Black men didn’t achieve this until 2004. The Fund has helped the Health Department develop innovative programs focused on men’s health and men’s role in women and children’s health.

Sara Gardner, Executive Director

There’s a growing body of evidence suggesting that structural racism is a leading driver of racial disparities in health, particularly sexual and reproductive health. But there is a lack of literature focused on what can be done to address these disparities. Thankfully, APHA featured many presentations focused on advancing racial and health equity. I saw many promising examples of local and state jurisdictions building organizational capacity and investing in transformational leadership needed to address structural racism and implement racial equity agendas, and also attended several presentations focused on empowering community voices. I was struck by a presentation focused on #ListentoBlackWomen, a community-based approach to understand and address structural racism by focusing on and highlighting the experiences of Black women with health and social justice. These programs reminded me of work being done by the Health Department here in NYC to advance justice for all New Yorkers, particularly when it comes to our health.

We look forward to staying in touch with and continuing to learn from all the incredible presenters, organizations, and partners we met at APHA 2019. Interesting in learning more about the Fund? Sign up for our newsletter!

 

Funding Expands Current City Efforts to Reduce Drug Overdose Epidemic

New York City (NYC), like the rest of the nation, remains in the midst of a drug overdose epidemic. In 2017, more New Yorkers died from drug overdose than from suicide, homicide, and motor vehicle accidents combined; opioids were involved in 82% of those deaths. DOHMH has successfully implemented a number of interventions and programs to address the overdose epidemic; however, sustained high rates of overdose death in NYC warrant expansion of current initiatives and implementation of new strategies.

The Fund for Public Health in NYC (FPHNYC), in collaboration with the New York City Department of Health and Mental Hygiene (NYCDOHMH), was recently awarded the Overdose Data to Action (ODTA) $2.4 million grant from the Centers for Disease Control and Prevention (CDC).

The ODTA program uses a multi-faceted approach to combat the opioid crisis, which includes surveying people who use opioids, educating clinicians around prescription drug monitoring programs, facilitating an ongoing public health-public safety partnership, enhancing community-level interventions in targeted neighborhoods, and developing anti-stigma trainings and toolkits for clinicians.

DOHMH’s data-driven approach to the opioid epidemic has served as a model for jurisdictions across the US. ODTA funding will enable DOHMH to target, enhance, and evaluate high quality surveillance and prevention strategies to decrease the rate of opioid misuse and opioid use disorder, increase the provision of evidence-based treatment for opioid use disorder, decrease the rate of emergency department (ED) visits due to misuse, or opioid use disorder, and decrease the rate of drug overdose deaths, including deaths involving prescription and illicit opioids.

“With this new grant, we’re joining our partners at the NYC Health Department to curb the opioid epidemic that has impacted the lives of so many New Yorkers. We know by scaling evidence-based programs there is potential for people who abuse opioids to reclaim their lives,” said Sara Gardner, FPHNYC’s Executive Director.

The FPHNYC and the NYCDOHMH have a history of implementing successful programs through CDC grant funding. DOHMH has been at the forefront of drug surveillance and research across the country for the past 15 years and has established a comprehensive public health surveillance system with broad and deep relevant expertise to monitor, track, and respond to drug-related harms in NYC.  This award allows DOHMH to enhance its multi-pronged and comprehensive initiatives and efforts to monitor, track, and respond to drug-related harms in NYC.

This publication was supported by Grant or Cooperative Agreement number NU17CE924978-01-00, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Join the Fight Against E-Cigarettes

Download our resources below to learn more and join the fight.

“I’d never smoke. I vape.”

While New York City has seen its youth cigarette smoking rate drop dramatically over the past decade, a new menace has taken the place of combustible tobacco: e-cigarettes. The increase in sales and use of these products (including e-cigs, vapes, e-hookahs, mods) indicates an alarming public health trend. Despite e-cigarettes being on the market for less than ten years, e-cigarette use is now more than three times as common as smoking cigarettes among youth. The rise in popularity of these products threatens decades of progress that’s been made in fighting youth tobacco and nicotine use, yet public funding has not kept pace to address this emerging public health threat.

There is a common belief that e-cigarettes are harmless, but they are not. We know that almost all e-cigarettes contain nicotine, which is highly addictive, and e-cigarettes also release carcinogenic or otherwise toxic chemicals. While the long-term health effects of e-cigarettes are still unclear, developing brains can be more vulnerable to nicotine dependence. Nicotine can also negatively affect a young person’s memory and concentration, decreasing learning ability. Further, there is now substantial evidence that e-cigarette use increases the likelihood of trying traditional combustible cigarettes.

E-cigarette companies—many owned or funded by Big Tobacco—have had success marketing e-cigarettes to youth by heavily utilizing social media, deploying a variety of fun and kid-friendly flavors, using bright, stylish packaging, and by making nicotine content and health risks unclear. These are the same tactics that worked so well for cigarettes decades ago and they are working again.

The NYC Health Department is taking a “Policy, Systems, and Environmental Change” approach to address the alarming rise of e-cigarettes and to counteract industry tactics to prevent and decrease the use of e-cigarettes among youth. The strategy, titled “Defeat Flavors and End Nicotine Dependence (DEFEND)” includes surveillance and evaluation, retailer education, a media campaign, and community and school outreach. Some of the funding for this work is carved out of existing tobacco control budgets, but new funding streams are needed to fully tackle the growing problem of e-cigarettes while continuing the critical work of reducing tobacco use across NYC.

The FDA has repeatedly delayed their health and safety review of e-cigarettes, and the market for these products has only grown. State and federal grants for e-cigarette prevention are not materializing as fast as industry sales.  As the number of youth who vape continues to grow, new and nontraditional funding streams are urgently needed to address this public health epidemic.

An incubator of public health initiatives, the Fund for Public Health in New York City (FPHNYC) is poised to build partnerships and mobilize resources to support the NYC Health Department’s vital work in this area. As a national leader in reducing combustible tobacco use, NYC will address this newer threat head-on for the health of all New Yorkers. FPHNYC is proud to be on the front lines.

Make a stand. DEFEND your community.

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Addressing the Risk for Falls for Seniors

This post was originally published in May 2019

May is Older Americans Month, a time to celebrate and look out for our older neighbors, friends, and loved ones. One significant risk seniors face is falling, which can lead to serious injury, hospitalization and even death. In the U.S., one in three older adults falls each year and there are nearly 300 falls-related deaths per year in New York City. Falls are the leading cause of injury hospitalization among older New Yorkers, but falls are preventable. With the population of older adults expected to increase by nearly half by 2030, it is vitally important to identify and address fall risks. Doing so will protect against cascading health care costs associated with a fall and will preserve quality of life.

In 2017, the Fund for Public Health in New York City (FPHNYC) collaborated with the New York City (NYC) Health Department to secure a grant from the Staten Island Foundation to study fall risks among Staten Island seniors.

Staten Island is an important place to study this problem. Of NYC’s five boroughs, Staten Island has the highest rate of falls-related deaths (33.5 per 100,000 aged 65+ years compared with 27.5 per 100,000 citywide), and Staten Island is the only borough where the falls hospitalization rate for older adults has increased in recent years.

During the year-long study, FPHNYC and the Health Department conducted in-person surveys of 203 Staten Island seniors aged 65 years and older, examining social engagement and support networks, overall health, and possible fall risks related to their home environment.

Among the study’s key findings: falls were most likely to occur at home, and 27% of falls occurred on and around stairs. Nearly half of the survey respondents lived in one- or two-family homes, making the exposure to stairs more likely. Nearly two-thirds of respondents who fell reported they were alone when they fell, while almost three-quarters of respondents reported they did not own a medical alert system.

These findings point to clear prevention messages for Staten Island seniors – messages that DOHMH is delivering to older adults, their formal and informal caregivers and their health care providers. Furthermore, these findings can inform planning for home-based falls prevention interventions. The Health Department is reviewing programmatic approaches to making improvements to homes of older adults when falls risks are identified.

The full report is available here.

To learn more about this important work, please visit the Health Department’s Preventing Falls in Older Adults page or download a falls prevention checklist.

Sparking and facilitating Health Department research projects is one key way that FPHNYC promotes public health across NYC. To learn about how you can support the health of older New Yorkers, please contact Aviva Goldstein at [email protected]

Disease Detectives: Combating New York City’s Measles Epidemic

For the last 10 months, the New York City Department of Health and Mental Hygiene (Health Department) has been part of the response to stop the largest measles outbreak in the United States since 1992. In NYC, there have been 642 cases confirmed as of July 29, 2019, since the outbreak began in October 2018.

In 2000, when there were only 86 cases in the United States, measles was declared eliminated from the US, meaning there was no continuous transmission of the disease for more than 12 months. Nationally, the rates of people vaccinated against measles have been very stable since the Vaccines for Children program, which began in 1994. However, even in areas with high vaccination coverage, pockets of unvaccinated people can exist and measles can  spread easily in those communities. On July 10, FPHNYC invited friends and supporters to join a conversation with Dr. Jane Zucker, Assistant Commissioner for the Health Department’s Bureau of Immunization, to explore the resurgence of measles and what’s being done to stop the epidemic. Dr. Zucker’s insights are summarized below:

The majority of cases (72%) remain confined to the neighborhood of Williamsburg (ZIP codes 11205, 11206, 11211, 11249), with 93% of cases occurring in the Orthodox Jewish community. Measles is a highly contagious disease from which every case can spread to 15-18 new individuals. The median age of infected individuals is 3 years old, with 80% of confirmed cases occurring in children, of whom 90% have never been vaccinated.

On March 27, 2019, the Health Department activated its Incident Command System for the measles response to mobilize needed staff and resources throughout the agency. Onset of the disease can be prevented with post-exposure vaccinations, but they have to be administered within 72 hours after exposure, so the Health Department works around the clock. For every reported case of measles’ infection, Health Department employees contact lists of individuals who may have been exposed. The Health Department also provides alerts to providers, uses the press to spread the word, and engages in community outreach.

To end the outbreak, the Health Department has worked with and supported the work of community partners. The Health Department has placed ads in Yiddish-language publications and worked with trusted community partners such as Hatzalah, yeshivas, and women’s groups to reach community members. New services, including a hotline for requesting home vaccination, have also been introduced. Additionally, for the first time since a 1940s smallpox epidemic, a Commissioner’s Order was issued requiring vaccination. The order requires people who live, work, or go to school in delineated ZIP codes to be vaccinated with the measles, mumps, and rubella vaccine (MMR). In June, the State of New York removed the option for religious exemption to vaccination, and all schools and child care facilities must exclude unvaccinated children unless they have a medical exemption.

As a result of these efforts, reports of new measles cases have been decreasing. Between April 9 (the date the Commissioner’s order was issued) and July 29, 2019, 5,513 vaccinations were administered to children from Williamsburg, a 72% increase from the same period last year. However, activation and emergency measures remain in effect.

NYC’s strong public health infrastructure has made this comprehensive and innovative disease control response possible. For information on what you can do to support NYC’s fight against epidemics, whether communicable diseases like measles or dangerous conditions or behaviors such as obesity, opioids, and tobacco, please contact Aviva Goldstein at [email protected].

The Challenges We Face in the Fight Against Measles

The measles epidemic has grown rapidly over the past eight months; there are now over 550 cases in New York City alone. This outbreak has posed many challenges, particularly in combating the spread of anti-vaccine misinformation. Additionally, the City has had to question how to balance civil liberty with civic accountability, the right to refuse vaccination or the necessity to protect those who cannot receive vaccines. Dr. Oxiris Barbot, the Commissioner of the New York City Department of Health and Mental Hygiene, writes eloquently about these challenges, and opportunities, in her latest piece for Health Affairs.

You can access the article here.

Renewing Investment in Design for More Active, Healthier Lives

Maintaining a healthy lifestyle isn’t easy. It can be even more challenging to go for a walk when your neighborhood doesn’t feel safe, or visit the park if the closest green space is a subway ride away. The environments in which we work, live, and play can have a profound impact on our health and wellbeing.

In 2010, with the help of funding secured by the Fund for Public Health (FPHNYC), the NYC Department of Health, Department of Design and Construction, Department of Transportation, and Department of City Planning jointly published the New York City Active Design Guidelines (ADGs). The original Guidelines were the first of their kind, created for design professionals and policy makers with the goal of designing healthier communities from the ground up. The ADGs emphasized design strategies that increased opportunities for physical activity, including walking and exercise, more accessible green spaces, improved access to fresh food stores, and active transportation such as walking and biking.

The ADGs provided a comprehensive set of design guidelines for the built environment, focused on the promotion of health and grounded in scientific evidence. They have been incorporated into design projects here in NYC and adapted both nationwide and worldwide. Since publication, there has been more research on the importance of the built environment for health, particularly the impact of the built environment on mental and social wellbeing.

Now, nearly ten years later, FPHNYC is again partnering with the Health Department to update the original ADGs with new research and recommendations for addressing additional priorities such as social cohesion and mental health. It is estimated that 20% of the adult working population has some type of mental health issue at any given time, and that three of the top five leading causes of disability in NYC are mental health related. The built environment can have an impact on these and other health outcomes. The updated ADGs, which will likely be published in late 2020, will go beyond just physical activity to address “whole person health,” which includes physical, mental, and social health, and will address the issues facing communities across NYC that still suffer from poor health. Solutions include improving access to green space, involving the community in the design process, and renewed investment in designing public spaces with an eye towards addressing health inequity while improving social cohesion.

Recently, Active Design was included in the OneNYC plan, demonstrating a commitment to these strategies in the Mayor’s vision for NYC. The updated and expanded ADGs (“ADG 2.0”) will offer design solutions to make the healthy choice the easy choice. FPHNYC is actively searching for philanthropic partners to support this essential work.

To learn more about how you can support emerging innovations in public health like the ADG 2.0, please contact Aviva Goldstein at [email protected].

Welcoming the Commissioner’s Key Strategies for Public Health

On a crisp February morning, FPHNYC partnered with the Robin Hood Foundation to bring together some of our philanthropic partners to meet the new Commissioner of Health, Dr. Oxiris Barbot. The Commissioner spoke about her own personal experiences that drove her to public health, and outlined her vision for a healthier New York City during her tenure. She also shared her “key strategies” for the Health Department work, and emphasized an ongoing commitment to promoting health equity and community empowerment. Here are three of our main takeaways:

1. Dr. Barbot’s vision for NYC is a city where everyone can realize their full potential regardless of who they are or where they live. She emphasized her key strategies, which include continuing to promote health equity with an added focus on immigrant health, centering communities, infusing mental health into public health practice, bridging public health and healthcare delivery, and ending epidemics like obesity and hypertension.

2. The Health Department will address these strategies with a range of activities or “tactics,” including expanding and streamlining home visiting programs that improve the health and welfare of mothers and babies; leveraging the arts to promote mental health and social cohesion; developing a trauma-informed framework across all domains; focusing on the intersection of housing and health; and addressing each epidemic with innovative approaches.

3. Public-private partnerships remain essential. Grants and donations have helped raise awareness of key issues, test innovative projects that can be scaled into citywide initiatives, and change public policy on challenges such as smoking and food standards. As the city moves into a tighter budgetary period, private support will only become more critical for the Health Department’s ability to innovate and maintain its status as a model department nationally and internationally. By connecting private funders with city government, FPHNYC amplifies the Department of Health’s work to ensure all New Yorkers have the chance for a healthy life.

As public health professionals, it’s easy to sometimes get caught in the details of our day to day work. But when we take a step back and consider the individuals whose lives are changed because of improved access to prenatal care, rapid treatment for HIV, or information about a diet to control diabetes, we are reminded even more that this work is essential to making our city great. We continue to be inspired by the Commissioner of Health and her vision, and look forward to working with her to achieve a healthier NYC for all.

To learn more about how you can support emerging innovations in public health, please contact Aviva Goldstein at [email protected].

A Vision for Public Health in NYC in 2019

The start of a new year means a flurry of resolutions and commitments to make this year even better than the last. As we kick off 2019, we asked our colleagues at the Department of Health what their resolutions were for public health in New York City. From improving healthy food access, to supporting mental health, to ending the HIV and AIDS epidemics, their responses reflect their continued commitment to and passion for improving the health of all New Yorkers.

Dr. Oxiris Barbot, the City’s new Commissioner of Health and the chair of FPHNYC’s board, advocated strongly for the continued efforts of the Department of Health to promote health equity and improve access to care. “Access to health is a human right,” she said. “In 2019, we will continue to serve New Yorkers, regardless of their immigrant or insurance status. Our mission stays the same – to promote and protect the health of all New Yorkers.”

In recent years, FPHNYC has worked closely with the Division of Prevention and Primary Care, which advances population health by promoting high quality primary care and prevention. “New Yorkers can’t make healthy choices if we don’t have healthy choices. Through initiatives like National Salt and Sugar Reduction Initiative (NSSRI) to address the widespread prevalence of added sugars and salt, efforts to reduce smoking, and initiatives to improve access to quality health care, I envision a city where the healthier choice is the easier choice for all,” said Sonia Angell, Deputy Commissioner for Prevention and Primary Care.

Demetre Daskalakis, Deputy Commissioner for Disease Control has his sights set on ending the spread of HIV and AIDS. “In 2019 we will continue our work towards our goal of ending the HIV and AIDS epidemics in NYC by 2020. I aspire to make New York a status-neutral city where the same approach is used in initial patient care regardless of one’s HIV status,” he said.

It’s still important to remember that not all New Yorkers have access to the same resources; one’s zip code is far too often a predictor of one’s health. To address these issues, Dr. Aletha Maybank, Deputy Commissioner for the Center for Health Equity, committed in 2019 to “Continue to provide support to some of the most resource-deprived neighborhoods in our City by expanding access and utilization of our Neighborhood Health Action Centers, which provide a host of different services and programming where people can connect with their neighbors in Tremont, East Harlem, and Brownsville and surrounding neighborhoods.”

To ensure the next generation of New Yorkers grows up healthy and happy, Roger Platt, Acting Deputy Commissioner for Family and Child Health set his 2019 resolution to “Make NYC a place where children and their families have the best opportunity to grow and thrive through a focus on maternal health, school health and early childhood.”

And with the recent announcement of the expansion of the ThriveNYC initiative, mental health remains a key focal point for the City. Hillary Kunins, Acting Executive Deputy Commissioner for the Division of Mental Hygiene, set out her goals for the New Year. “In 2019,” she said, “we are excited to venture into our 4th year of ThriveNYC and the 3rd year of HealingNYC. These initiatives – focused on mental health broadly and the opioid overdose epidemic respectively – are helping us to take innovative public mental health approaches to prevent illness and death, expand access to effective treatment, build a prepared workforce, and work collaboratively across government and with communities.”

FPHNYC is grateful to work with such inspiring and motivated public health professionals. In the spirit of reflection, here’s a resolution of our own; in 2019, we commit to ensuring even more innovative and exciting public health programs can get off the ground and serve the health needs of New Yorkers. With that goal in mind, we think this year is already looking bright.

If you’d like to support our resolution and contribute to our work, please consider making a donation to FPHNYC. Your gift will support a wide range of public health programs that promote innovation and improve the health and wellbeing of New Yorkers.

Working to Empower HIV Patients and End the Epidemic

As the first health department clinics in the United States to provide immediate on-site access to HIV treatment, the New York City Department of Health and Mental Hygiene (DOHMH)’s Sexual Health Clinics offer a lifeline to patients seeking HIV treatment. Patients who enter the clinics unaware that they are HIV-positive or who were previously unable to access HIV treatment (due to lack of access, stigma, or having had difficulty engaging in care) leave feeling empowered to take control of their sexual health. In the words of one 32-year-old patient, “You have no idea how long I have been waiting to start medication for my HIV. It is such a relief to be able to start treatment.”

FPHNYC helps identify funding and facilitates public-private partnerships to advance new public health initiatives. Since 2016, FPHNYC has received $1 million from MAC Cosmetic’s charitable foundation, the MAC AIDS Fund, to enhance DOHMH’s HIV and sexually transmitted infection (STI) services and programming. This funding facilitated immediate access to antiretroviral therapy (ART) for Sexual Health Clinic patients newly diagnosed with HIV, enabling them to control their HIV and achieve and maintain viral suppression so that they do not transmit HIV to their sexual partners. The funding has also helped DOHMH improve the patient experience at the Sexual Health Clinics. With eight locations throughout the city, the Sexual Health Clinics offer safe and affirming spaces to patients of all sexual orientations and gender identities and expressions to access high-quality, status neutral prevention and treatment services. The Sexual Health Clinics see patients who are underserved, underinsured and have barriers to seeking medical care at a primary care facility. Expanding HIV and STI services at the Sexual Health Clinics is one of several NYC Ending the Epidemic strategies to reduce the number new HIV infections in New York City to non-epidemic levels and improve the health and well-being of New Yorkers with HIV.

MAC AIDS Fund provided funding for one of the DOHMH Sexual Health Clinics to pilot JumpstART, a program providing immediate access to ART for patients newly diagnosed with HIV. The successful program has since expanded to all eight Sexual Health Clinics. In 2016 and 2017, the Sexual Health Clinics initiated a total of 149 patients on ART, with 66 percent of them being newly or recently diagnosed with HIV. The MAC AIDS Fund is also helping DOHMH build an online patient portal for Sexual Health Clinic patients to check their HIV and STI test results, communicate with staff, and access educational materials regarding their sexual health.

In 2017, DOHMH announced that 2,157 people were newly diagnosed with HIV in New York City, down 5.4 percent from 2016. More New Yorkers with HIV are receiving care and achieving viral suppression. Also in 2017, 80 percent of people were linked to care within 30 days of their HIV diagnosis, compared to 65 percent in 2013; and among people receiving HIV medical care in New York City in 2017, 85 percent were virally suppressed, compared to 79 percent in 2013. These data show that New York City is on track to achieving our ambitious NYC Ending the Epidemic goals. Together, FPHNYC, DOHMH, and the MAC AIDS Fund provided proof of concept before City funds committed to bringing JumpstART to scale, a critical step in our efforts to end the epidemic.