| New York City Launches Sweeping Health Care Agenda: Take Care New York
April 2004 — Gay Men's Health Crisis (GHMC) congratulates and supports the New York City Department of Health and Mental Hygiene (DOHMH) for its bold Take Care New York: A Policy for a Healthier New York City. With this initiative the City proposes an aggressive public health agenda to address ten priority areas for intervention that could greatly improve the health and well being of all New Yorkers. In each of these ten areas of concern, the City has established concrete goals for improving specific health indicators over a four-year period. Much of the focus of the Take Care New York initiative, which marks the City's first comprehensive policy statement on healthcare, highlights proven prevention interventions, a strategy that GMHC whole-heartedly supports. The people of GMHC understand the tremendous role that prevention can play in this effort to save thousands of lives and limit the need for more costly medical interventions. Since many of the health improvements envisioned by TCNY will come from greater public awareness of these health and prevention messages, we urge the City to give this campaign the highest public profile, with the Mayor leading the way, dedicating a week of special events to each priority area in turn, throughout the year.
Although, the Take Care New York initiative lists each of its ten health priorities separately, it is important to note that all of these problem areas overlap and exacerbate each other. This is especially true within the sphere of HIV/AIDS. Some of the overlapping issues that disproportionably affect the HIV community include race and ethnicity disparities, depression, domestic violence, immunization, cancer, and infant mortality. These and other co-morbidity factors, unfortunately, continue to make miserable and shorten the lives of people with HIV infection.
After reviewing the entire Take Care New York document, GMHC offers the following analyses, comments and recommendations from a holistic perspective on three of the proposals that most directly impact the HIV community. For its part, GMHC accepts the challenge to raise awareness of all of these health issues among its own community of clients and employees. But, like the City, we also recognize that no one sector can or should address these health problems alone. The ultimate success of the initiative will depend on joint cooperation among city agencies, businesses and community-based organizations, health care providers and individuals. GMHC looks forward to working with all of its partners for the improvement and achievement of the health indicators set forth in Take Care New York.
Take Care New York: Ten Priority Areas for Intervention
- Have a Regular Doctor
- Be Tobacco-Free
- Keep Your Heart Healthy
- Know Your HIV Status
- Get Help for Depression
- Live Free of Dependence
- Get Checked for Cancer
- Get the Immunizations
- Make Your Home Safe
- Have a Healthy Baby
One: Have a Regular Doctor or Other Heath Care Provider
Not surprisingly, the top priority intervention proposed by Take Care New York is to increase the number of New Yorkers who have regular access to a doctor who knows about their health needs. Dependable health insurance, routine doctor visits and access to culturally competent health professionals are essential elements of any health system that aims to promote positive health outcomes. For people with HIV, having access to health insurance is probably the most critical feature of their health care landscape. Yet, in 2001, New York City was home to almost two-million people who lacked health insurance, even though an estimated 40% of the uninsured were eligible for public health insurance. Without a dependable source of health coverage, individuals will have little chance of benefiting from preventative care or affording the medications they may require to stay healthy.
Target: increase the proportion of adults with a specific source of health care by 5% by 2008.
To do this, the report suggests several policy goals and accompanying city actions. To increase the number of people with public health coverage, the report recommends
- closing gaps in eligibility for public health insurance,
- attaining an "adequate" supply of health professionals who are able to treat diverse populations,
- simplifying enrollment and recertification documents, and
- instituting presumptive eligibility (making coverage available for an individual from the point he or she applies for public insurance)
For the private health insurance system, the report proposes that companies contracting with the city must provide their employees with "at least basic health coverage" and that the city should provide guidance on which health plans would be most suitable for companies doing business in New York. Elsewhere in the report are additional recommendations to increase access to care and treatment; such as promoting availability of smoking cessation medications through HHC (define; the public hospital system?), reducing drug costs for blood pressure and cholesterol-lowering drugs and gathering data through Medicaid managed care plans to determine whether enrollees have received HIV counseling and testing.
There are few proposals within this first recommendation that HIV/AIDS advocates will be opposed to; the general goal of increasing access to health insurance to promote regular medical care, HIV testing, and check-ups is an essential part of preventing illness and disease. By advocating for a more consumer-friendly public insurance system, fewer people are likely to fall through the cracks in Medicaid, thereby strengthening the relationship enrollees' have with their providers. However, the details of these proposals remain somewhat vague, and it is unclear how and when these policy proposals will be implemented and assessed in the years to come. For example, the education campaign that will promote the availability of public health coverage must be done in multiple languages and at a reading level that all New Yorkers will be able to understand. The outreach programs and the expanded use of medical technology will need to be funded, but it is unclear where the money will come from. Many of the policy recommendations begin with the verbs "consider" "review" and "advocate", which are far from iron-clad directives and suggest that the city will need permission from elsewhere to accomplish these goals.
For people with HIV/AIDS, talking to and working with a regular doctor is an integral part of one's ongoing care. In this report the City has identified some fundamental steps to achieving a more integrated and reliable health care system. Now it needs to assure New Yorkers that the resources needed to make these proposals a reality will be forthcoming.
Four: Know Your HIV Status
The Take Care New York initiative adequately describes the HIV/AIDS epidemic in New York City and prescribes proven interventions to reduce the number of new HIV infections in the five boroughs. We are particularly pleased with the City's unequivocal and public support for syringe exchange programs and harm reduction for drug users. However, there are several missing pieces in the City's plan. Chief among these is the lack of any mention of behavioral interventions for HIV prevention for individual and communities at risk of transmission or for those who are already HIV-positive. Nor is there discussion of initiating or expanding HIV prevention efforts in clinical settings, such as NYC hospitals or STD clinics. While the City plans to advocate for health insurance and Medicaid coverage of HIV testing, we believe that both private health insurance and Medicaid should also cover prevention counseling by physicians and other healthcare workers. Significantly, in a sphere where the City has taken an increasing role, there is no mention of school-based HIV prevention efforts, crucial for young people at a time when they are at high risk of HIV transmission and often do not have basic information about how to protect themselves and their partners.
Strangely, the City plans to use a reduction in AIDS deaths as the measure of its success in HIV prevention, when a reduction in the incidence of new infections should be its primary goal in this area. More completely documenting the epidemiology of HIV transmission and infection in New York City should also be a priority for the Health Department. Currently there is a woeful lack of information on the state of the epidemic, particularly in regards to risk category, which limits the City's ability to adequately judge local needs for both HIV prevention and care. Finally, while the City's plan offers support for many new interventions to address HIV/AIDS in New York, there is again no budgetary commitment associated with its goals nor a plan for implementation of either its programmatic or policy recommendations.
Six: Live Free of Dependence on Alcohol and Drugs
Substance abuse is a strong co-factor in HIV transmission and efforts to treat and prevent drug and alcohol dependencies are important tools in HIV prevention. While we again applaud the City's plan for its support of harm reduction activities, we would also like to stress the importance of these additional points:
- Drug treatment and harm reduction programs, especially those specifically designed to address the needs of the gay, lesbian and transgendered communities and of those who are HIV-positive, need to be established and expanded;
- Harm reduction programs need to be extended to correctional facilities for both adult and juvenile offenders;
- The City needs to advocate strongly for the abolition of the Rockefeller Drug Laws and the expansion of alternatives-to-incarceration programs for non-violent drug offenders
- The City needs to advocate for wider accessibility to buprenorphine and other substitution therapy in high-need areas;
- The City needs to establish programs specifically designed to treat and reduce the harm associated with methamphetamine, particularly among men who have sex with men.
Once again the City proposes to simply use a reduction in drug-related deaths as a measure of the initiative's success. We would rather the City develop additional relevant metrics to measure reductions in drug-related harm. For example, reductions in the number of hospitalizations for non-fatal drug-related medical incidents or increased numbers of individuals enrolling in alternatives-to-incarceration programs might be better measures of progress in this area.
Although GMHC has not yet heard a commitment to fund many of the worthy proposals set out in Take Care New York, we believe that this bold policy document can help stimulate much-needed health-focused education and awareness. In particular, we are eager to help foster greater access to proven, but underutilized interventions than can help reduce HIV transmission and minimize the harm of substance abuse in the city. We applaud Take Care New York and urge the Mayor and the media of New York embrace this important campaign to help New Yorkers take better care of themselves and each other.
© 2004 Gay Men's Health Crisis |
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