We did manage to do something right….

A new campaign from the CDC

If you’re on the front lines of public health initiatives, as members of the Staten Island Hunger Task Force, Take Care Staten Island, and the Staten Island Smoke-Free Partnership are, the idea that you’re going to be able to make a dent in obesity, alcohol or drug abuse, or smoking seems ludicrous.

However, on May 20, the Center for Disease Control reported the 10 biggest public health changes in the last ten years. The U.S. as a whole has:

• Reduced smoking from 23.5% of adults and 34.8% of youths in 1999 to 20.6% of adults and 19.5% of youths in 2009.
• Reduced traffic accidents, injuries, and fatalities: While the number of miles traveled went up 8.5%, the death rate declined from 14.9 to 11.0 per 100,000 people, and the injury rate declined from 1,130 to 722. Among children, the number of pedestrian deaths declined by 49%, from 475 to 244, and the number of bicyclist deaths declined by 58%, from 178 to 74 (with the possible exception of New York City—see Watch biker prove futility of NYC bike laws by crashing over-and-over again and New York City traffic goes three ways).
• Reduced coronary heart disease rates from 195 to 126 per 100,000 population and reduced stroke deaths from 61.6 to 42.2 per 100,000 population.
• Significantly reduced lead poisoning. In 2000, childhood lead poisoning was a major environmental public health problem. Black children and those living in poverty and in old, poorly maintained homes were affected the most. Because of state and federal lead poisoning prevention laws, lead poisoning dropped from 88.2% to 0.9% among children aged 1-5 years between 1976 and 2008.

So maybe it takes 10 years to see results. Or possibly longer: At least 15 years ago, Henry Spira and other animal activists started a campaign to reduce pain and suffering among laying hens. Last night, I noticed a band of type around the Hellmann’s Mayonnaise jar: “Contains Cage-Free Eggs.” Wow. Can’t be more mainstream than that.

Mind the Gap!

First, let’s start with the poverty line.  As of 2011, for the 48 contiguous states, the Dept. of Health and Human Services poverty lines are:

For a single-person household: $10,890
For a two-person household:  $14,710
Three persons: $18,530
Four persons: $22,350

The list goes up to eight, but let’s stop here. On Staten Island, 11.2% of people are at or below the poverty line. (Try to imagine living on $10,890 a year.)

Poverty line or up to 130% of the poverty line

If you make less than 130% of the poverty line, you’re eligible for food stamps (called SNAP or Supplemental Nutrition Assistance Program everywhere except New York State) and other programs such as WIC (Women, Infants, and Children) and Senior Farmers’ Market Nutrition Program (FMNP).

130% of the poverty line

If your annual income is higher than 130%–in other words, $10,890 x 1.3 or $14,147 for an individual or $29,055 for a family of four–you’re no longer eligible for food stamps but your children are still eligible for free school lunch.

The Unhealthy Neighborhood

A few years ago, it became obvious to food pantries and organizations like City Harvest that it wasn’t enough to just give food away.  They needed to give people healthy food. People in low-income neighborhoods have high levels of obesity, heart disease, and diabetes, at least partly because they can’t afford fresh fruits and vegetables.

The Mobile Market at the Stapleton Houses in January 2011. Russian-speaking volunteer (and founder of Software Management News) Nicholas Zvegintzov faces the camera.

City Harvest now delivers hundreds of pound of free fruits and vegetables twice a month to Melrose in the Bronx; Bed-Stuy in Brooklyn; and Stapleton on Staten Island. They also promote good nutrition in local schools, do healthy cooking classes and demos, sponsor health screenings and outreach, and work with “Healthy Corner Stores” that agree to sell at least a dozen types of produce.

However, researchers seem to have found another wrinkle in what makes a neighborhood unhealthy. In the “The Poverty Clinic” (New Yorker, March 21, 2011), Paul Tough writes about the Adverse Childhood Experience (ACE) study that assessed the health of patients enrolled in California’s Kaiser HMO between 1994 and 1998. At the same time as the researchers tracked health outcomes, they also surveyed their clients about ten adverse childhood experiences such as parental divorce, physical and sexual abuse, emotional neglect, and violence in their homes and schools.

The results were scary. The higher the ACE score, the worse the outcome. Compared to people with no history of ACEs, people with ACE scores of four or higher were twice as likely to smoke, to have been diagnosed with cancer, and to have heart disease. Even more scary: Patients with ACE scores of seven or higher who didn’t smoke, didn’t drink to excess, and weren’t overweight still had a risk for ischemic heart disease that was 360 percent higher than for patients with zero scores.

Not all researchers agree that traumatic childhood experiences and later poor health correlate as strongly as the studies seem to show, says Tough. However, it’s something to keep in mind when healthy-food advocates try to measure how their interventions affect the health of a child, a family, or a neighborhood.

NYC’s 2011 Budget: Who Speaks for Parks?

A water filtration pond in Conference House Park, 2009, before the nor'easter damage in 2010

Dr. Marcia Van Wagner, assistant comptroller in the New York City Comptroller’s Office, talked about the NYC budget Monday, May 17, 2010, on Staten Island.

Here are some highlights:

• Financially, New York City is the fourth largest government in the U.S. The federal government manages the most money, followed by California, New York State, and then New York City.
• Because of the Financial Emergency Act, passed in the 1970s when the city was about to go bankrupt, the city must balance its budget and also keep a reserve of at least $100 million (in practice, the cushion is $300 million).
• The city gets 60 percent of its revenues from taxes and most of the rest from the state and federal governments. Total revenues in fiscal year 2010 (from July 1 to June 30) were $60 billion.
• Fifty-seven percent of the money was spent on salaries, pensions, and benefits. The rest was spent on social services (17 percent), contracts, and other non-personnel expenses.
• Breaking down expenditures by function, 30 percent was spent on education (including salaries), 20 percent on social services, 13 percent on public safety (police, fire), 16 percent on pensions and benefits, and the rest on environmental protection, sanitation, health, and paying off debt.
• The city has a nifty acronym for methods used to balance the budget: PEG, or “Programs to Eliminate the Gap.” Van Wagner offered a few examples: Increasing parking-ticket fees would be a revenue PEG. Eliminating fire houses would be an expense PEG.

City Money: Why Make Non-profits Responsible?

According to the New York Times article “Nonprofit Groups Hopeful but Wary as City Aims to Cut Red Tape,” Mayor Bloomberg’s administration is about to overhaul its system for distributing city money.

Having a centralized office for efficiently distributing money to non-profits is the goal. Currently, non-profits are promised funding for various projects through city council members who then tell the relevant city department to fund the programs. However,  each department has different rules and different deadlines for proposals and reports. I’ve talked to heads of a number of organizations who depend on city funds for soup kitchens and pantries, and they all throw up their hands. The money is always late and the paperwork is arcane.

So anything that simplifies the process is good.

However, I don’t think a simplified process for distributing money is what we New Yorkers need. I think our attention is being misdirected.

Obama won!

Maybe the U.S. can now reopen the conversation about the role of government versus the role of volunteer and non-profit organizations that the Bushes and Clinton shut down.

A few years ago, if I’m remembering correctly, Bush II gave awards to a group of religious organizations for their work on behalf of the poor. The leaders of these groups said thank you very much, but pointed out that they had stepped in only because the government had slashed holes in the country’s support net. They’d expected to be running soup kitchens, drug rehab centers, and homeless shelters only for a year or two, just until the emergency was over. Here they were, though, still running their programs 10, 20 years later.

Time for a change, indeed.