Slide 1
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Advancing Health Equity:
An Ounce of Policy is
Worth a Pound of Cure
CONFIDENTIAL AND PROPRIETARY
Any use of this material without specific permission of DOHMH is
strictly prohibited
Aletha Maybank, MD, MPH
Associate Commissioner
Center for Health Equity
NYC Department of Health and Mental Hygiene
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Slide 2
Mission of NYC Health Department:
Protect and promote the health of
ALL New Yorkers
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Slide 3
19th & Early 20th Century Environmental
Policies
1842 New York’s water system established – an
aqueduct brings fresh water from Westchester.
1857 NYC creates Central Park, hailed as “ventilation for
the working man’s lungs”, continuing construction
through the height of the Civil War
1881 Dept. of Street-sweeping created, which eventually
becomes the Department of Sanitation
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1901 New York State Tenement House Act banned the
construction of dark, airless tenement buildings
1904 First section of Subway opens, allowing population
to expand into Northern Manhattan and the Bronx
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1916 Zoning Ordinance requires stepped building
setbacks to allow light and air into the streets
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Slide 4
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NYC Adult Smoking Prevalence
1993-2006
Nearly 250,000 Fewer Smokers
More than 75,000 Premature Deaths Prevented
3-yr average
3-yr average
3-yr average
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City and State
tax increases
Smoke-free
workplaces
% of adults
Free patch
programs
Media
campaign
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Slide 5
NYC Restriction of Trans Fat
% of NYC restaurants using trans fat-containing oils,
shortenings, or spreads
60%
Education
Campaign
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Health Code
Restriction Passed
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Phase I
Effective
50%
51%
50%
43%
40%
Survey 1
Survey 2
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Survey 3
30%
Phase II
Effective
20%
10%
1.9% 1.6%
Inspection Compliance
0%
June '05
Dec. '05
June '06
Dec. '06
June '07
Dec. '07
June '08
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Dec. '08
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Slide 6
Lots of lives saved
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Slide 7
Health outcomes
Neighborhood Differences Exist
Diabetes Deaths (per 100,000)
Asthma Hospitalizations
(per 100,000 Children)
AIDS Deaths (per 100,000)
Hospitalizations for
Drug Use (per 100,000)
Infant Deaths (per 1,000
Live Births)
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Slide 8
Life expectancy
Neighborhood Differences Exist
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Slide 9
Violence
Neighborhood Differences Exist
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Slide 10
Poverty and Race
Neighborhood Differences Exist
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Sources: Neighborhood poverty (based on zip code) defined as percent of residents with incomes below 100% of the Federal Poverty
Level, per American Community Survey 2007-2011. Population (based on zip code) defined as percent of non-Hispanic black and
Hispanic residents, per 2010 Census.
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Slide 11
Root Causes of Inequities
• Policies that created all
types of systems of
unbalanced power and
privilege
• Caused by historical
practice of exclusion &
discrimination across the
life course
• Led to geographic
concentration of poverty
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Slide 12
What have we learned and do?
Field of Health Equity
WEB DuBois
• The Philadelphia Negro
(1899)
• The Health and Physique of
the Negro American (1906)
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– Differences in the quality of health
between blacks and whites in the
early the 1900’s
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Slide 13
Field of health equity
continues to evolve…
•
1985 Report of the Federal DHHS Secretary’s Task Force Black and
Minority Health (Heckler-Malone)
“Report identified that, nationally, 60,000 people die
needlessly due to lack of access and quality health care.”
• 1986 Creation of the Federal Office of Minority Health
• 1998 US DHHS launches Healthy People 2010
Identified as two overarching goals for the first decade of the
21st century: 1) increasing the quality and years of healthy life;
and 2) Eliminating health disparities
•
2002 Institute of Medicine published report Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health
Highlighted the health disparities between Blacks and Whites
and the impact of racial attitudes on health disparities
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Slide 14
Want Change? Build Power
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• Inequity exists because groups who benefit
from it hold power Power Over
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Solution => Inside-outside strategy
• Organizational capacity building
• Power of partnerships – finding allies
• Elevating voices in planning
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Slide 15
Inside – Outside Strategy
Inside
• Change narrative on what determines good
and bad health
• Power with
• Build internal capacity to your health
department;
– understanding of equity, including all -isms, other
forms of oppression
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Slide 16
Inside – Outside Strategy
Outside
• Building, finding and elevating
demand
Building demand
• Pioneers – Minnesota, Boston,
Alameda, Barhii
• Work with Orgs- Base-building and
run by community organizers
• Experience bringing and mobilizing
people around a common goal
• Typically work to address the social
determinants of health
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Slide 17
Finding and Elevating Demand
Brooklyn and Bike Lanes for All
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Slide 18
Public Health Framework:
Importance of Active Transportation
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More physical activity
may prevent 6,300
deaths each year in
New York City.1
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“The human body is the only machine that breaks down
when it is not used.” -Nicholas DiNubile, MD, Special Advisor, US
President’s Council on Physical Fitness and Sports
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Slide 19
America’s First Bike Path
Coney Island Cycle Path
Ocean Parkway, Brooklyn in 1894
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Slide 20
*It is Not Just About Bike Lanes…
•
•
•
•
Exclusion
Displacement
Opportunity
Triumph
*Inside strategy essential to recognize
and acknowledge
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Slide 21
Exclusion and Triumph
• Major Taylor’s first race,
Citizen Handicap, held
on Ocean parkway in
Brooklyn
• The 1st AfricanAmerican to become a
world champion cyclist
in 1899
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Slide 22
Misperceptions and Opportunity
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KD1
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Slide 23
Gentrification and Displacement
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Slide 24
Strategies for Bike Friendly
Communities
The importance of the “5 E’s” is well established:
• Engineering
• Education
• Enforcement
• Evaluation
• Encouragement
Our work in communities most negatively impacted by
health inequities, speaks to the need for a sixth “E”
• Engagement ….meaningful
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Slide 25
Improving Neighborhood Health
District Public Health Offices
• Locations
– South Bronx
– East and Central Harlem
– Central Brooklyn
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• Target and work closely with
NYC’s communities most in
need
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• Collaborate with local
institutions
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Slide 26
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Common ground
Goal to increase biking and walking
Brownsville and East New York, Brooklyn
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“THE STREETS NEED TO BE SAFER.”
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Slide 27
Meaningful Community Engagement
Collective Impact
Backbone Support:
The frame
Continuous
Communication: All
parts knowing what
is being done at all
times
Common
Agenda:
Getting there
together on
not at all
Shared
Measurement:
Gears and crank
Mutually Reinforcing
Activities: Pedaling
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Slide 28
Backbone Support
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The Department of Health and the Department of
Transportation working with a community organization
brought groups together with common theme
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Everyone wants optimal health for themselves, their
families, and their communities
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Slide 29
Mutually Reinforcing
Activities
• School programming
• Town hall meetings
• Community bike rides
Continuous
Communications
• In-person meetings
• Conference calls
• Electronic & printed
communication
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Slide 30
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Why is it tough to ride here?
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Powell Avenue, Brownsville
Pitkin Avenue, East New York
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Saratoga Avenue, Brownsville
Pitkin Avenue, East New York
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Slide 31
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Why is it tough to ride here?
Wide streets,
no markings
No bike racks
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Powell Avenue, Brownsville
Pitkin Avenue, East New York
Potholes
Double parking
Saratoga Avenue, Brownsville
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Pitkin Avenue, East New York
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Slide 32
Shared Measurement
• Process measures were tracked, such as number of
attendants at community forums, participants
engaged in school programs and the number of free
bicycle helmets distributed.
• Bike counts were conducted pre- and postinstallation of bicycle lanes.
• Street intercept survey was administered biannually
to cyclists along new bike lanes.
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Slide 33
Proposed Project Timeline
2012
• Create a priority list of projects
• Establish a 3 year plan for implementation
2013
• Implement Phase I
• Community evaluation and input
2014
• Implement Phase II
• Community evaluation and input
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2015
KD1
• Implement Phase III
• Community evaluation and input
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Slide 34
Brooklyn Active Transportation Community Planning Initiative
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Slide 43
The Larger Context
Advancing Health Equity and Policy
• #BlackLivesMatter– A Challenge to the Medical
and Public Health Communities– NYC Health
Commissioner Dr. Mary Bassett, NEJM
x
• Changing perceptions, norms, and systems
– Improved coordination of City Agencies
– Community members, especially those who have been
historically marginalized, MUST have a seat at the
decision making table – Value expertise at all levels
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Slide 44
“Cities have the capability of
providing something for everybody,
only because, and only when, they are
created by everybody.”
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Jane Jacobs
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