Pursuing Racial Health Equity

Summer 2020

NYHealth aims for all New Yorkers to be as healthy as possible and to get the best care when they need it. But not all New Yorkers have equal opportunities to be healthy; wide disparities persist across race, ethnicity, geography, gender, education, employment status, immigration status, income, and other factors.

For NYHealth, health equity means that everyone has the opportunities and resources they need to be as healthy as possible and that no one is disadvantaged.

Racial and ethnic disparities in health are especially pervasive and persistent, so achieving health equity requires particular attention to the health needs of New Yorkers of color. Systemic racism in the United States is a public health issue that dates back hundreds of years, as exemplified by the enslavement of African people, and has persisted through discrimination in housing, education, economic opportunity, the justice system, and myriad other ways. The COVID-19 pandemic is just the most recent example of racial disparities in health, with death rates and hospitalization rates more than twice as high for Black residents as for their white counterparts. Black and Hispanic New Yorkers are also less likely to have health insurance and adequate access to care and more likely to experience food insecurity, complications with childbirth, chronic health conditions like diabetes and asthma, and premature death.

Mural installation through a project with the Niagara Falls National Heritage Area.

Over the years, health equity has been an underlying theme of much of NYHealth’s work, but it has not been an explicit focus. In 2020, as our nation reckons with the murders of George Floyd, Breonna Taylor, and so many others—and as communities of color rightly live in fear that they will not receive equal justice—we are re-examining our approach to health equity, particularly through the lens of racial inequities.

As a first step, we are reflecting on the work we’ve done to address health equity issues in communities of color in New York State, as well as some of our analytic work that can offer insights into opportunities for improvement. This is an ongoing process—there is always room for us to do more and to do better. As we take a look at what has worked and where we’ve fallen short, we can identify gaps that could inform future work to improve racial health equity in areas like food security, maternal health, and veterans’ health. Below are some examples:


Ensuring equitable access to healthy food
Disparities in food security in New York State are serious and persistent; Black and Hispanic New Yorkers are much more likely than their white counterparts to experience food insecurity. NYHealth’s efforts to ensure equitable access to healthy food include securing universal free school lunch in New York City; providing seamless access to nutrition benefits during the COVID-19 pandemic; and supporting Isabahlia Ladies of Elegance Foundation, which is training young people to advocate for quality produce and healthier foods in supermarkets in Brownsville, Brooklyn.

Empowering expectant parents
Black and Hispanic New Yorkers are much more likely than their white counterparts to experience serious complications with childbirth. NYHealth has supported the development of the ExpectNY tool to help expectant parents in New York City and Long Island make informed decisions about where to get high-quality maternity care. Another project is supporting the Building Service 32BJ Health Fund to develop a high-value maternity care network for its members, who are predominantly lower-wage union workers and women of color.

Meeting the needs of minority veterans
Racial and ethnic minorities made up 21% of New York’s veteran population in 2015, a proportion that is expected to rise to 37% by 2040. An assessment from the Center for a New American Security makes recommendations for better meeting the unique needs of minority veterans. Black and Hispanic veterans are also more likely than their white counterparts to be incarcerated. A project with the Urban Justice Center is working to meet the health and legal needs of justice-involved veterans at Rikers Island.

Engaging patients of color as partners in their health care
Although all patients should be valued as partners, patients of color can face unique obstacles, including racism, bias, mistrust, and gaps in communication between patients and physicians. In 202o, NYHealth issued a request for proposals, “Patients as Partners: Advancing Equity,” our first program focused explicitly on racial health equity. Five grantees were selected to engage patients of color as partners in their health care at both the systems and individual levels to ensure their priorities, preferences, and experiences guide efforts to develop a more equitable health system.

Training health care providers on equity issues
One promising way to improve health equity is to ensure that health care providers are culturally competent and are well-trained on issues like implicit bias. The Greater New York Hospital Association teamed with community-based organizations to train primary care residents on the social determinants of health—those factors outside of the health care system, including racism, that affect how healthy we are.

Addressing the needs of formerly incarcerated New Yorkers
Racial inequities are inherent in our criminal justice system; these have a ripple effect on the health of people who have been incarcerated and their families. Amid the COVID-19 pandemic, NYHealth made a grant to expand emergency telehealth services to New Yorkers recently released from incarceration, with a particular focus on justice-involved Black and Latinx males. Another project is supporting formerly incarcerated New Yorkers with virtual discharge planning and re-entry services, including wellness check-ins, connections to health and food access benefits, and housing. NYHealth is also helping child welfare agencies to provide educational services and programming to children of incarcerated people during the pandemic.

GrowNYC Farmstand in Brownsville, Brooklyn.

Analytic Work

More Diverse and Older: Demographic Implications for New York’s Health Care System: This publication examines how New York State’s demographics are expected to change over the coming decades and how the health care system will need to prepare to care for an older and more racially and ethnically diverse population.

Complications of Childbirth: Racial & Ethnic Disparities in Severe Maternal Morbidity in New York State: This analysis finds persistent racial and ethnic disparities in potentially life-threatening complications during or after childbirth. Black women in New York State are 2.3 times more likely than their white counterparts to experience such complications. Rates among Hispanic women were 1.7 times higher and among Asian women 1.5 times higher than for white women.

Nutrition Incentives for New Yorkers in Need: A number of nutrition incentive programs in New York State are designed to make it easier for food-insecure families to purchase and consume fresh produce. This issue brief highlights many of these existing programs, next steps for their continued development, and recommendations for how to make it easier for New Yorkers to participate in these programs.



Tackling the Opioid Crisis in New York State

Nearly 9 million opioid prescriptions were dispensed in New York State in 2015. Between 2011 and 2014, approximately 145,000 New Yorkers annually abused or were dependent on opioids.

The opioid crisis in New York State is multifaceted, and solving it will require a whole range of interventions. Among other approaches, curbing the epidemic will involve: analyzing and sharing data to demonstrate the scope and diversity of the problem; educating health care providers and giving them tools to address prescribing patterns; encouraging public health departments to screen for opioid use and refer users to treatment; and working with law enforcement to emphasize treatment over incarceration.

NYHealth is supporting a number of activities to combat the opioid crisis.

Analytic Work

Follow the Money: Pharmaceutical Manufacturer Payments and Opioid Prescribing Patterns in New York State
This report examines how payments from opioid manufacturers to physicians may have influenced opioid prescribing in New York State. Financial relationships between physicians and drug manufacturers are common, including payments for speaking and consulting fees, as well as for various gifts such as meals. Between 2013 and 2015, drug manufacturers spent more than $3.5 million in opioid promotion activities with thousands of New York State physicians. The report finds roughly 1 in 10 physicians who prescribe opioids received a payment, and physicians who prescribe more opioids got more opioid-related payments.

Targeting an Epidemic: Opioid Prescribing Patterns by County in New York State
To better understand the scope of the epidemic, NYHealth produced this data snapshot examining trends in opioid prescriptions and opioid abuse in New York State. The analysis examines prescribing trends by county in New York State from 2010 to 2015, using publically available data from the Centers for Disease Control and Prevention. Most research on the opioid epidemic has focused on state-level data, which masks important differences between smaller geographic areas. Understanding geographic variation within New York State is essential to ensure that resources and interventions are targeted appropriately.


A Coordinated Response to the Opioid Epidemic in North Country
In 12 upstate New York State counties alone, the number of heroin overdoses jumped 417% between 2009 and 2013. In response to this emerging crisis, Essex County Public Health established the Essex County Heroin and Opioid (ECHO) Prevention Coalition, a multiagency collaboration to prevent and reduce heroin and opiate use and addiction. A top priority for the coalition is to launch a Screening, Brief Intervention, and Referral to Treatment (SBIRT) program in Essex County and beyond. An evidence-based, effective approach to combat substance use disorders, SBIRT can reduce health care costs, decrease severity of drug and alcohol use, and reduce risk of trauma. With a 2016 NYHealth grant, Essex County Public Health is introducing and implementing SBIRT in Essex County, and eventually in other North Country counties.

Women, Pregnancy, and the Opioid Epidemic in New York: A Health Care Provider Educational Approach
Health care clinicians often lack familiarity with key guidelines related to opioid use and safety, knowledge about opioid addiction, and the necessary skills to address the unique needs of these patients. With a 2016 NYHealth grant, the American Congress of Obstetricians and Gynecologists (ACOG) is working to improve obstetricians’ and gynecologists’ knowledge and awareness of opioid use and safety in pregnant women. The project will focus on engaging women’s health care providers in rural and upstate regions of New York State. ACOG will organize a multidisciplinary town hall meeting in upstate New York to gain a local perspective on the issue, as well as assemble a workgroup of experts to help develop, vet, and implement clinical education. Based on these meetings, ACOG will develop and implement hospital-based provider toolkits that include best practices on the care management of pregnant women who use opioids, targeting five upstate academic medical centers and their affiliate locations as pilot sites for training and education. ACOG will publish a final report on the implementation process, outcomes, and lessons learned from the pilot as a guide for how to best replicate the program.

Addressing the Opioid Epidemic by Improving the Electronic Health Record Prescription Process
One of several critical factors causing the opioid epidemic is physician-prescribing practices. Misused prescription opioids contribute to the epidemic of heroin use and heroin and fentanyl fatalities. In 2017, NYHealth awarded Weill Cornell Medicine a grant to encourage physicians at hospitals and federally qualified health centers (FQHCs) to prescribe opioids at levels consistent with Centers for Disease Control and Prevention (CDC) guidelines. Under this project, Weill Cornell Medicine will adapt a successful electronic health record (EHR) prescribing interface for generic drugs and modify it specifically for opioid prescriptions. This modified EHR will default opioids to CDC-recommended short-duration and low-dose formulations, but allow those defaults to be overridden by providers to ensure that clinical judgment is not constrained. The adapted EHR will be piloted first in a small setting to ensure that the system performs as expected, and then it will implemented at primary care sites within Weill Cornell Medicine’s system. Based on provider experiences with and evaluation of the EHR, a freely shareable implementation procedures toolkit will be developed and disseminated throughout the State. The toolkit will be used to replicate this intervention at the Institute of Family Health, an FQHC with 19 sites in New York City and rural regions outside of the City.

Replicating the Law Enforcement Assisted Diversion (LEAD) Model in New York
LEAD is an evidence-based, harm reduction-oriented program designed to reduce low-level arrests and recidivism and promote better health outcomes. Instead of making an arrest for certain criminal offenses (such as low-level drug charges), police officers, prosecutors, and defense attorneys work together to divert individuals directly to a case manager, who then facilitates access to a comprehensive network of services for drug addiction, alcoholism, mental illness, and other health-related issues. These individuals receive intensive case management and targeted social services, with greater coordination among systems of care. In 2014, the City of Albany, with NYHealth support, launched its own LEAD program, making it the first jurisdiction on the East Coast and only the third in the nation with this program. In 2016, NYHealth awarded a grant to the Katal Center for Health, Equity, and Justice to help replicate LEAD in other communities in New York State that are struggling with the devastation of the opioid epidemic. Katal will convene government agencies, policymakers, private funders, and other stakeholders, providing them with technical assistance to establish LEAD planning teams in their communities. Project staff will also facilitate peer-to-peer guidance and develop strategies for collaboration among police officers, prosecutors, service providers, community public safety leaders, and case managers to familiarize them with the concept of diversion and the LEAD model and protocol.