Program seeks to reduce New York City death rate

Outreach efforts target persistent ills of the poor

April 12, 2004|By John J. Goldman | John J. Goldman,LOS ANGELES TIMES

NEW YORK -- Elizabeth Drackett, carrying a blue canvas bag filled with medical forms, reminder cards, stickers, special passports and posters of celebrities urging cancer screenings, is visiting doctors in Harlem. Printed in large letters on her tote is the name of her employer: the New York City health department.

Drackett's visits are an integral part of Take Care of New York, an ambitious program designed to cut the death rate in the city by 2008. Officials said the effort is one of the most comprehensive in the health department's 138-year history.

"We have spent two years collecting data on the vital signs of New York, our patient," said Dr. Thomas R. Frieden, the city's health commissioner. "Now we are recommending a treatment regimen."

The focus is on the persistent illnesses that kill most people, such as heart disease, cancer and AIDS. Measures include: distributing free nicotine patches to smokers who want to quit; recommending the distribution of free condoms in gay bars; addressing the basics of health care, such as increasing the number of patients screened for colon and breast cancer; and trying to promote the expansion of health insurance coverage for employees of small companies.

The program borrows a page from the playbook of pharmaceutical companies that routinely send representatives to physicians' offices with health information and samples of new and established drugs.

Drackett, who was born in Harlem 38 years ago and whose mother still lives there, is seeking to enlist doctors in health campaigns that make up the core of Take Care New York.

After a short walk along 116th Street, she enters a storefront clinic to talk to Dr. Regina Pozner, who has been in practice for 51 years, 23 of them in Harlem. Pozner routinely treats such illnesses as diabetes, arthritis, heart disease, hypertension, asthma and infections -- maladies common in the community and whose consequences are magnified by poverty. They are precisely the kinds of problems the health department is trying to ease.

The goals of Take Care New York include helping 300,000 more people find a regular doctor, cutting the number of adults who smoke by 240,000, persuading 200,000 more people 50 and older to undergo screening for colon cancer, and 90,000 more women to have mammograms. Public health officials want 150,000 more people 65 or older to get annual flu shots.

The administration of Mayor Michael R. Bloomberg predicts that these steps will save thousands of lives and prevent hundreds of thousands of illnesses each year.

"This health policy is the first step toward fundamental change in the health landscape of New York City," concluded a report prepared by the city's Department of Health and Mental Hygiene, which outlines dozens of activities and policy directions. Some build on existing programs; others require new efforts.

Among program recommendations are exploring the possibility of requiring businesses with city contracts to carry basic health insurance for workers and encouraging fast-food restaurants to use healthier ingredients and cooking techniques.

In neighborhoods with high rates of infant mortality, plans are under way to begin home visits by public health workers to first-time mothers within a month of childbirth.

"It has a very heavy focus on prevention," said Dr. Allan Rosenfeld, dean of the Mailman School of Public Health at Columbia University. "It is a mixture of tried and true techniques and innovations."

"The key is setting an agenda based on data," Frieden said. "What's new and different is the proactive focus."

The health commissioner said New York's agenda was based in part on the experience of the Los Angeles County Health Department, which began surveys monitoring the health of its population in 1997. The surveys have become increasingly sophisticated, providing data for more than 60 indicators of health such as obesity, poverty, parental support, prenatal care, tobacco use, insurance coverage and more than a dozen diseases.

Calling on doctors to push the health department's agenda takes persistence and sensitivity. So far, the program has been limited to Harlem, the South Bronx and the Bedford-Stuyvesant and Bushwick sections of Brooklyn, where the needs are greatest.

"We are not there to regulate. We are there to add value. We want to be a resource and provide information that will help [doctors] in their practice," said Kelly Larson, the program's director at the health department.

The Los Angeles Times is a Tribune Publishing newspaper.

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