Revitalizing the Public Health Infrastructure of New York City

The Public Health Association of New York City (PHANYC) announces a ground breaking project to analyze the public health infrastructure of New York City, identify its strengths and weaknesses, determine the impact of changes in the health care delivery and financing systems on it, and, above all, make legislative, regulatory, and public policy recommendations for strengthening and revitalizing the City's public health systems. Funding for the project has been provided by the New York Community Trust.

PHANYC

The Public Health Association of New York City is the local affiliate of the American Public Health Association. Its members come from the entire spectrum of health professions, as well as students and health care consumers. It has been active for more than six decades in promoting public understanding of public health issues, needs, and problems, and in advocating for public policy in support of the health of all New Yorkers.

Project Directorate

The Infrastructure project is directed by a distinguished panel of public health professionals:

Lorna McBarnette, Ph. D., Dean of the School of Health Technology and Management at the State University of New York at Stony Brook and former Executive Deputy Commissioner of the New York State Department of Health.

Annette Ramirez de Arellano, Dr. P.H., former Executive Director of the Hispanic AIDS Forum, former Associate Dean of the School of Health Sciences at Hunter College and consultant to the Secretary of Health of Puerto Rico.

Victor Sidel, M.D., Distinguished University Professor of Epidemiology and Social Medicine at Montefiore Medical Center and the Albert Einstein College of Medicine; past president of both the Public Health Association of New York City and the American Public Health Association.

Public Health in New York City

New York City has been a leader in public health for much of this century. Its public health infrastructure is complicated and substantial. Core public health functions are the responsibility of the Department of Health, but certain important activities are the province of other agencies, including the Department of Mental Health, Mental Retardation, and Alcohol Services, the Department of Environmental Protection, the Health and Hospitals Corporation, the Human Resources Administration, and the Department of Sanitation. In addition, the New York State Department of Health and other State agencies have vital roles in assuring that public health functions are carried out appropriately. In recent years, however, New York City's ability to protect the health of its population has been threatened in several ways. The City's public health agencies have experienced significant funding and staffing reductions that threaten their ability to carry out their functions appropriately. This has occurred at a time when the health status of many groups of the population has deteriorated; new and re-emerging infectious diseases pose a major challenge; rats and other pests continue to affect many communities adversely; and asthma rates have increased dramatically, while cardiovascular disease, cancer, and other chronic illness rates continue at high levels.

Major changes in the health system in general also affect the public health system. Competitive and profit-oriented health insurance and providers threaten the existence of a viable health care delivery system. The future of the Health and Hospitals Corporation and of community health centers is uncertain. The proportion of the City's population that is uninsured continues to grow at alarming rates. The movement toward managed care in both financing and provision of health care confronts public health with major challenges as well as with opportunities.

The Need for Examination of the Public Health System

The complexity of public health functions, their location in multiple agencies, the many health problems confronting the City, and the speed at which change is affecting the health care system make it imperative to examine the infrastructure devoted to public health, the resources it commands, its success or failure in carrying out its responsibilities, and the ways in which it might be improved or enhanced.

A comprehensive examination of this sort is long overdue. PHANYC, an independent and neutral, non- governmental body of health professionals, is ideally suited to conduct such an examination.

The Project

PHANYC will hold a series of six Public Health Leadership Seminars during 1998 and 1999 to analyze the City's public health infrastructure. Participation in each seminar will be by invitation and will be limited to about 25 public health professionals. Each seminar will address a specific set of related core public health functions through informal, but targeted discussions. Brief background papers, presenting an overview of important topics by knowledgeable professionals, are being commissioned from distinguished public health practitioners for advance distribution to set the tone of the discussions.

The results of the seminars will be published in a series of preliminary reports. The conclusions of the entire project, stressing public policy recommendations for strengthening the City's public health infrastructure, will be published in a final report. All reports will be made available to policy makers and the public in print and on the internet.

The Seminars

The seminars that make up the core of this project are listed as follows:

Is the City Fiddling While Public Health Fails? How Can We Reverse the Decline of Public Health in New York? (May 29, 1998)

• What is public health? What are the special responsibilities of public health in New York City?
• Who is responsible for public health in New York City? What are the roles of local, state, and federal government, community-based organizations, HMOs and insurers, hospitals, medicine, and schools of public health?
• What is public health "infrastructure"? What should constitute it? What does constitute it in New York City?
• What are the determinants of health? How do employment and personal income, occupation, housing, education, and medicine relate to public health?
• What value do we place on public health in New York? Has this changed? What does the public think public health is?
• Public health expenditures comprise roughly 3% of total health care expenditures (nationally). Is this an appropriate allocation for public health? What would we do with additional funding?

Surveillance and Response: Programs Related to Environment, Community Health, Occupational Health (Two Seminars, Fall, 1998)

• What are the surveillance functions of government in New York City and how do they relate to state and federal functions? What are the roles of public bodies in addressing illness and the conditions that cause it? In addressing problems of occupational health?
• How effective are essential public health functions in New York City, including: surveillance and monitoring of community health status and treatment outcomes, data collection and dissemination?
• Are prevention, health education, and health promotion activities in the city effective and sufficient? Should managed care organizations carry out some of these functions?
• Is the city capable of responding to emergent and other conditions (epidemics, catastrophe, violence, substance abuse, new pathogens)
• Is the city responding appropriately to chronic disease patterns?
• Are inspection and monitoring for pest control and pure food, air, water, asbestos, and lead adequate? Are sanctions for violation adequate and are they being imposed properly?
• Are public health activities in these areas improving?

Policy Development, Planning, and Assessment (Spring, 1999)

• What do planning, coordination, control and regulation mean in the context of New York City public health?
• Who is responsible for public policy development and planning?
• Are public health agencies capable of carrying out their missions? Are public health agencies appropriately staffed and funded? Are their staffs appropriately educated and trained?

The Role of Public Health Agencies in Ensuring the Availability, Accessibility, and Quality of Personal Health Services (Spring, 1999)

• Is new legislation or regulation needed to ensure that the health care system operates optimally in New York City?
• What should be the respective roles of public and private bodies in the provision of medical care to the population?
• What are the roles of public health agencies in assuring access to health care and its afford ability to the population of the city?
• Are public and private bodies carrying out these functions adequately?
• What is the appropriate role for public hospitals in New York City? Are they fulfilling that role? Can voluntary hospitals fulfill that role? Is a public benefit corporation, such as the Health and Hospital Corporation (HHC), the best instrument for fulfilling the public hospital role? What are the alternatives?
• What is the appropriate role for community health centers in New York City?

Towards Revitalizing Public Health: What is to Be Done? (Spring, 1999)

• What are appropriate New York City public health infrastructure development agendas for the near, intermediate, and long terms?
• What needs to be done in New York City to assure the conditions under which the population can be healthy? Does this require only stronger support for traditional functions or is there also need to implement new functions and/or structural reforms?
• What areas need further attention?
• How can communities be engaged effectively in the enhancement of community health?
• How do we attract the attention of policy-makers and the general public?

Further Information

For further information regarding PHANYC's project on "Revitalizing the Public Health Infrastructure of New York City," please contact Robert A. Padgug at: phone: 212-724-7467; fax: 212-724-7467; e-mail: rapadgug@ix.netcom.com