Health Equity

Bring health care resources directly into low-income areas

Two major reasons that the pandemic hit lower-income communities the hardest are lack of access to healthcare and a near total failure by government to effectively reach those communities on the ground. During the pandemic and after, health professionals should be paired with local organizations and workers to go into those same communities and set up in NYCHA complexes and open storefronts, partnering with public and private providers, creating a one-stop shop for basic exams, preventive care, and resources to live a healthier life. These locations would be accessible to any New Yorker, including those who are uninsured or undocumented. 

Launch MyCity to bring health care resources directly into low-income areas. There are plenty of City services—but too many obstacles in the way of receiving them. Our MyCity program will give the New Yorkers most in need greater access to services by bringing the City right to their computer, smartphone and doorstep. We will do that by equipping City workers with computer tablets linked to the City’s unified digital platform and send them into the areas of greatest need, and by creating a single online portal for access to all City services, with one common application for New Yorkers to fill out in order to receive City services that can improve their health and welfare.

Treat social issues as part of health care

Poverty, homelessness, unemployment and food insecurity all directly lead to poor health—yet hospitals are largely not equipped to address those issues. By utilizing the extra capacity in H+H hospitals to co-locate social services, we will address both the social and physical causes of illness, leading to much better outcomes and cost savings. 

Poverty is the single biggest cause of health disparities, leading to poor outcomes stemming from stress, violence, unhealthy living conditions, pollution, poor nutrition, homelessness, mental illness and more. Poverty traps people in a cycle of sickness, ensuring that people are more vulnerable when crises emerge, like the COVID pandemic. From my experience, I know that only holistic approaches will create longer-term outcomes.    

My administration will address the root cause with the following measures:    

• Eradicate housing and food insecurity  
• Create safety on the streets and in families’ homes  
• Deliver equity with a focus on education  
• Provide opportunities for personal growth and employment    

My signature proposal is to deliver Universal Child Care in Centers of Community Care, coordinated with DOH programs that improve infant and maternal health and build partnerships to provide free or low-cost baby and women’s hygiene products.   

From my experience seeing the positive outcomes of intensive, coordinated delivery of services in child welfare, healthcare and education, I know that intensive, coordinated services delivered disproportionately to the most underserved communities are the only way to make sustainable progress.  

As Mayor, I will ensure that programs to deliver the root cause solutions addressed in the prior question are robustly funded, staffed with great people, coordinated at the Mayoral level and down the ranks. But City Hall can’t do it alone. Communities and community-based organizations must be partners.   As Mayor, I will engage with communities and CBOs on the ground to align around needs assessment and prioritization. In doing so, we must also address inequities related to disability, gender, language/culture, and immigration.  Trust is a major missing factor. Developing trust will not happen overnight; it will have to be earned. Without it, all the best-intentioned plans will be difficult if not impossible to execute.   

Provide primary care options near each New Yorker’s home Shaun Donovan’s campaign is focused on making all of the services and opportunities that New York has to offer as readily accessible for all New Yorkers as they have historically been to those most well off. This is the motivation behind Shaun’s central 15 minute neighborhoods policy, which commits to providing each New Yorker a great public school, rapid transportation, fresh food, a good park, and a chance to get ahead within 15 minutes of their front door.

High-quality health care must be part of every resident’s neighborhood, and as such, a primary health facility will also be included within 15 minutes of every New Yorker’s home, addressing the unacceptable lack of health care options in many New York City communities.
Address the gaps in the maternal mortality crisis and reproductive health New York City faces stark inequities in maternal health outcomes, and the issue has been front and center for advocates and communities of color. Black and Latinx women are more likely to die and more likely to experience severe complications related to pregnancy and childbirth than White women, even when they deliver at the same hospital, controlling for socioeconomic and insurance status. To address this crisis, we pledge to create a major initiative to eliminate maternal mortality disparities. We will:

• Expand access to high-quality prenatal care for women in the shelter system, justice system, and public schools
• Promote and invest in quality improvement programs, cultural competency, and simulation training for providers
• Expand access to doulas and community health workers in underserved areas
• Ensure that every New Yorker who visits NYC Health + Hospitals for prenatal care is screened by a social worker to identify needs and address social determinants of health
• Expand group prenatal care programming to all NYC Health + Hospitals locations • Expand prenatal outreach programs to at-risk mothers, linking with existing programs like Growing Up NYC and Healthy Start, and build local outreach workforce of community health workers, linked to H+H sites, to follow at-risk mothers throughout pregnancy and pre- and post-partum monitoring
• Promote workforce development particularly in communities of color to build a health care workforce that is representative

Close the maternal mortality gap

• Urgently expand pre-and-post natal community health worker and outreach programs to specifically focus on black mothers. In New York City, black women are estimated to be up to 8-12 times more likely to die from a pregnancy related complication than white women.
• Expand hospital-based midwifery services in public and private facilities, in accordance with recommendations by the DOHMH Maternal Mortality and Morbidity Committee. NYC families should have access to the same care options offered in countries with the lowest rates of maternal mortality and morbidity. Expand education efforts to ensure families understand midwifery scope of practice and ensure midwives are supported to practice to the full extent of their licenses.
• Expand doula programs. Families need a dedicated advocate to look out for their needs and support them to voice any concerns to the healthcare team. Doulas can help coordinate this communication to help ensure these needs are met. Expand education so that families understand the role of a doula and feel empowered to advocate for themselves.
• Focus expansion of home visiting programs to communities with the highest rates of maternal mortality and morbidity, promote best practices and safety standards across public and private systems.
• Work with medical care providers to aggressively combat implicit and explicit bias by engaging in training focused on the application of principles in respectful care, anti-racism, birth equity and reproductive justice, paying special attention to the history of inequitable outcomes here in New York City.

Improve maternal health outcomes by working in partnership with our Healthcare unions to decrease infant and mother mortality, especially across NYC's communities of color, and expanding accessibility of midwives and doulas as an option to improve preterm, delivery, and postpartum health outcomes of mothers and children:

• Create birthing centers in each borough that offers low- and no-cost services connected to private and public hospitals across the city to provide access to doulas and midwives for mothers from pregnancy to delivery to postpartum
• Ensure NYCH+H is complying with recently passed state law that establishes standards for treatment when an expectant mother arrives at a hospital with concerns about preterm labor
• Launch a public education outreach program for prospective mothers to understand their medical options before childbirth and increase awareness of prenatal health care
• Partner with CUNY and SUNY to create a certified doula training program
• Reduce racial disparities in outcomes by increasing access to care and addressing racial bias in healthcare providers:
• Conduct training and increase minority healthcare providers, to include midwives and doulas, to eliminate implicit bias in health care services
• Hire more culturally sensitive maternal care workers who speak different languages at NYCH+H
• Partner with local nursing schools, such as the Helene Fuld College in Harlem, to create high school partnerships that open a pipeline to train healthcare providers who will return to serve their communities
• Certify doulas and midwives as MWBEs so the city can increase contracts with them for educational and health programming to the most at-risk communities
• Hold city government accountable for fair and improved outcomes:
• Create a Maternal Morbidity Committee that will  track maternal morbidity, recommend research-based best practices, incentivize positive maternal health outcomes, and hold providers accountable
• Task the Department of Health with publishing maternal morbidity data report cards that track health outcomes, birthing complications, and postpartum health to hold hospitals accountable for reducing maternal morbidity and identify racial disparities
• Create a private and confidential system that allows women to report instances of disrespect and mistreatment from health care providers through the 3-1-1 hotline to be investigated by the NYC Commission on Human Rights

I will move to address city health inequities in my first 100 days as Mayor by launching NYC 5000, a five-borough culturally responsive team tasked with identifying and responding to gaps between human services and the communities most in need, including those most impacted by COVID-19 and a failed recovery and vaccine distribution response. We can then use that data to continue targeting communities for vaccine distribution, as needed, and to create healthcare strategies that target the historically underserved neighborhoods and subpopulations.    

My administration will also create a network of integrated community health clinics across the city to provide preventative primary care, as part of a citywide plan to boost the care economy, which will also include investments in elder care, affordable and quality childcare, early childhood education, homecare, disability and long-term care. I will also invest in education and training for care jobs, including support and training for primary caregivers and strengthening the CUNY School of Medicine. My administration would also seek to pilot a program providing access to doulas, midwives, physicians and nurses, and free prenatal care for expecting mothers; this is especially critical for Black mothers who are much more likely to die in childbirth than white mothers.    

Protections from the disruptions and damage brought about by the COVID pandemic require structural changes and the prioritizing of investments that strengthen public institutions and reduce inequality across the board. This is most critical in rebuilding for years to come. Healthcare is a right that must be accessible to everyone.

Health equity, and closing health disparities – especially those by race, ethnicity, gender, and sexual orientation – will be a top priority under Scott’s leadership, and led at the highest levels by the Deputy Mayor for Health & Human Services and the Chief Health Officer. Centering health equity within our executive team recognizes that closing health disparities requires approaches that focus on upstream social determinants of health, as well as changes to healthcare delivery – especially within our public hospital and healthcare system. 

It also requires close coordination with multiple agencies that influence social needs and social determinants of health, including housing (NYCHA and HPD), education (DOE), criminal/legal and public safety (NYPD, DOC), and transportation (DOT, MTA), to name just a few. Health equity priorities often get lost in the shuffle in discussions about our economy, our budgets, our subways and our public housing system, and we must change this by centering it in our leadership. We will focus on health equity as a priority not only because poor outcomes are products of systemic and intergenerational privilege of certain communities over others, but because they are also measurable and discrete ways to hold ourselves accountable to improving the health of New Yorkers in most need.

• Improve quality of care for vulnerable populations
  • Expand models of culturally competent, trauma-informed care for marginalized populations across NYC, including new immigrants, refugees and asylees, and victims of trafficking and/or domestic or other forms of violence, and people involved in our criminal legal system.
• Strengthen culturally competent healthcare for LGBTQIA populations, especially transgender New Yorkers
  • Expand and invest in LGBTQ+ affirming health care facilities, especially outside of Manhattan.
  • Expand transgender healthcare services citywide.
  • Create a citywide Transgender Family and Medicine Center by replicating the success of the Mount Sinai Center for Transgender Medicine and Surgery.
• End our maternal mortality crisis
  • Create a city workforce of doulas, birth coaches and community midwives that not only provide home-based and alternative services but can serve as childbirth advocates for women of color receiving obstetric care through conventional hospital systems in NYC.
  • Expand prenatal outreach programming for at-risk mothers like GrowingUp NYC and Healthy Start.
  • Invest in a workforce of community maternal health workers who can connect women to prenatal and obstetric care, follow them throughout their pregnancy and provide continuity of care for a year postpartum.
  • Invest in improved maternal health surveillance and data collection from our public and private hospital systems, along with a system of accountability and performance monitoring and incentives for hospitals based on these metrics.

Preventing maternal mortality in New York

• Direct $4.35M to build birthing centers at every city-owned H+H hospital, and one freestanding center on the North Shore of Staten Island, targeting communities of color that have had the highest instances of maternal mortality. 
• Expand integrated midwifery services within the H+H hospital system.
• Create a council of midwives and doulas to help inform, craft, and implement policies and strategies related to maternal health.
• Establish maternal health as mayoral priority and task the Department of Health and Mental Hygiene to lead and coordinate citywide work on maternal health.
• Encourage and fund midwifery programs in the City’s nursing schools, particularly at CUNY colleges.
• Expand the DOHMH home visit program and provide greater access to at-home screenings for anxiety and postpartum depression, and connect families to relevant mental-health services.

The reality is that solutions to end racial disparities in our healthcare system actually start outside the healthcare system itself. Ensuring all New Yorkers have safe housing, access to transit, healthy food in their neighborhoods, and are empowered with information to make decisions that are best for them and their families, is key to reducing racial inequities. At the same time, the system must also shift to meet critical needs. Our administration will build on the progress that New York City Health and Hospitals (H+H) and the New York City Department of Health and Mental Hygiene (DOHMH) have already made to center healthcare delivery around racial equity.

Amend the New York City Charter to make ending racial health disparities the mandate of DOHMH
A Yang administration will amend the New York City Charter to ensure that ending racial health disparities is among the primary mandates of DOHMH. The leaders that Yang appoints to DOHMH and other relevant city agencies will represent the diversity of New York City and will make ending racial health disparities a top priority.

Build a diverse, culturally competent public health workforce
There is abundant evidence that shows that when communities of color are served by providers who they identify with, outcomes are better. A Yang administration will create a pipeline program for prospective healthcare providers of color to serve communities of color across the five boroughs. With the City University of New York (CUNY) and Health and Hospitals (H+H), we will expand fast-track pipelines into healthcare careers for New York City high school graduates, particularly those of color, who are eager to serve diverse communities in New York City, if they commit to serve New Yorkers upon graduation.

Require racial equity competency for all healthcare providers in New York City
Building on the tremendous work of the Center for Health Equity under former New York City DOHMH Commissioner Dr. Mary Bassett, a Yang administration will require racial equity competency as part of teaching and learning at all H+H hospitals, available to providers citywide in partnership with DOHMH, and a requirement for nonprofit organizations seeking City funding to deliver healthcare services.

Focus on improving Black maternal mortality and morbidity by expanding doula care
Doulas are critical in ensuring that all birthing parents, and especially Black birthing parents, can advocate for their needs during the birth process. The City has made important strides in centering this issue, but this work is far from complete. A Yang administration will expand New York State’s Doula Pilot Program by providing direct support to all parents who seek doula care with one-time grants to pay for this critical healthcare service, and with DOHMH, create a pipeline for more people of color to become birth workers and doulas. At the same time, we will continue to advocate for all private insurance and Medicaid to cover doula care for all patients.