The Latest Update from Jo Ivey Boufford, MD
In the early 1980s, America’s public health experts began to speak in earnest about the origin and nature of differences in health across the nation using the term “health disparities.” The term was referring to differences in health likely shaped by social and economic factors such as poverty, race, ethnicity, and social position, as well as access to health care and health care resources–what we now refer to as health inequities.
While the disparities concept was unheard of at the time of the Academy’s founding in 1847, our founders were pioneers in understanding that the health needs and interests of certain groups, such as women and the poor, were often ignored or misunderstood.
Their early fight for sanitation reform, for example, was important for all New York residents, but the city’s poor suffered disproportionately from extreme conditions that threatened their health.
Through 170 years of informing and shaping policy, initiating programs and community-based activities, the Academy’s work has been in the forefront of many battles to protect the health of groups living with what would eventually be defined as health inequities.
From helping to create the city’s Metropolitan Board of Health and Sanitation in 1866 (now the NYC Department of Health and Mental Hygiene), to uncovering high rates of maternal mortality in 1932, which highlighted a lack of attention to women’s health; fighting for equal opportunity in health care in 1965; and conducting community-based research on HIV/AIDS and needle exchange in the 1980s, the Academy has long led or supported efforts to reduce health inequities.
Today, the vibrant diversity that defines our cities—here and around the world—also contributes to great differences in health across social, economic, racial, ethnic and other groups. Mortality rates, for example, are almost 30 percent higher in New York City’s poorest neighborhoods, than in wealthier zip codes.
In the last ten years, the Academy directly addressed this stark, community-to-community disparity by becoming deeply-engaged and committed to the neighborhood that is our home, East Harlem.
In addition to opening our building to host local activities, we’ve formed partnerships, such as our 2009 School Health Program, part of the Strategic Alliance for Health, a Centers for Disease Control and Prevention-funded project; the East Harlem Community Alliance, where we now lead the effort to help neighborhood businesses expand their markets; and the East Harlem Healthy Neighborhood Initiative, where, along with the NYC Center for Health Equity and Mount Sinai Hospital, we work to increase the availability of healthy foods, improve the built environment, and promote exercise and health.
In 2016, we broke new ground by investigating and documenting the impact of the growing lack of affordable housing in East Harlem on resident health by conducting the neighborhood’s first Health Impact Assessment (HIA). A tool to inform policy makers, “East Harlem Neighborhood Plan Health Impact Assessment (HIA): Connecting Housing Affordability and Health,” is an extension of our work as members of the East Harlem Neighborhood Plan Steering Committee, leading the sub-committee on health and aging.
Beyond our community, we are also aware that there are some disparities that are not defined by economic or racial categories. Building on a nearly 100-year history of informing and supporting a harm-reduction approach to substance abuse, we have increased our work to help people who suffer from substance use disorders—a group that seldom has a way to influence the laws and policies that affect their treatment and care.
In 2009, the Academy held a conference called New Directions New York: A Public Health Safety Approach to Drug Policy, bringing together people from government, city neighborhoods, public health, drug treatment, the court system, policy makers and other stakeholders, to find ways to replace New York’s existing, criminal justice-based methodology for dealing with substance use with a public health and safety approach. The convening was instrumental in contributing to the reform of the state’s Rockefeller Drug Laws.
We followed in 2013 with the publication of the “Blueprint for a Public Health and Safety Approach to Drug Policy,” with our partners the Drug Policy Alliance. The report called on Governor Cuomo to create a multiagency task force modeled on the “four pillars approach” drug policy—prevention, treatment, harm reduction and public safety. Our harm reduction work continues today, as the nation seeks solutions to the growing opioid epidemic.
These highlights of our work in the city and the state target specific issues and groups of people, but the Academy’s ongoing mission includes addressing disparities in all our activities, whether it is ageism and inadequate attention to the needs of older adults through our Age-friendly NYC initiative; as a leader of the State Prevention Agenda working to ensure all New Yorkers have a chance to live their healthiest life; or advancing research into how to use Big Data and technology to improve health care safety and prevent chronic disease in all populations. We also use our expertise to evaluate disparity-reduction efforts across the city to help health systems and community-based organizations learn what works best to protect the public’s health. We are committed to assuring that the voices of affected communities are at the center of our work,
The health inequities we face today are perhaps more complex than those faced by our founding Fellows, but the Academy has evolved in the ways we work to ensure that we can continue to play our role in protecting and improving health for all New Yorkers, no matter where they live, how much they earn, what language they speak, or what set of life challenges they face.