The next mayor of New York City will step into office on January 1, 2022, after one of the most challenging periods in the history of the City’s health care and public health systems. As expected, most of the current attention in health policy is still focused on the COVID-19 pandemic as the City heads toward recovery, manages vaccine distribution, and plans for future pandemic preparedness. Although this will continue to be important in 2022 and beyond, the next mayor will also have to address a litany of other health policy issues.
While most health policy happens at the state and federal level, the mayor of New York City is in a unique position to influence health care locally. This includes overseeing the New York City Department of Health and Mental Hygiene, one of the largest public health agencies in the world, and NYC Health+Hospitals, the largest public hospital system in the country. The Office of the Mayor also plays a significant role in developing and implementing innovative programs, facilitating interagency coordination, and funding thousands of community-based organizations that address socioeconomic needs of New Yorkers—needs that are significant determinants of individual and population-wide health.
As the mayoral primary elections approach on June 22, United Hospital Fund sought to develop a roundup of candidates’ positions on important health issues that align with our mission to build an effective and equitable health care system for every New Yorker. We analyzed websites of all primary candidates certified by the Board of Elections (Republican and Democratic), identifying four important health policy issue areas commonly addressed by most candidates. Nine certified candidates (Eric Adams, Art Chang, Shaun Donovan, Kathryn Garcia, Ray McGuire, Dianne Morales, Scott Stringer, Maya Wiley, and Andrew Yang) either had sufficient information on their websites or had completed a UHF-fielded candidate survey to be included in our roundup.
As is clear from the responses, a wide range of approaches across the key issue areas distinguishes the candidates on health and health care.
Coverage and Access
Even with arguably the most robust safety net for health insurance coverage and access in the country—along with some of the country’s largest health systems—too many New Yorkers still struggle to obtain coverage and care. Whether through health insurance coverage expansion, enhancing direct access to health care services, or a combination of both, all candidates in the roundup recognize the importance of this issue and have proposals to address coverage and access gaps for New Yorkers.
The disparate impact of COVID-19 on communities of color was just the latest example of health disparities in New York City. Even before the pandemic, life expectancy in some Black communities and other communities of color was more than 10 years shorter on average than in the highest-ranking, predominantly white neighborhoods. All candidates in the roundup recognize these inequities and their underlying root causes, as well as the need for solutions that stretch far beyond the health care system. Candidates’ solutions range from various approaches to addressing underlying factors like poverty, housing instability, and food insecurity to strategies for focusing health care access efforts in the most affected communities. Several candidates specifically call for reducing disparities in maternal health outcomes, recognizing the deep inequities in maternal morbidity and mortality in the City.
Long before the pandemic, policymakers, providers, and community members were concerned about the growing mental health and substance use crises in the city. Access to appropriate behavioral services is plagued by the same inequities in health care more broadly and further hindered by historic stigma. This is a multi-faceted issue that spans a broad continuum from anxiety and depression to psychotic disorders, as well as a similar range of substance use disorders. Nearly all candidates suggest approaches to addressing the behavioral health needs of New Yorkers, ranging from better access to services, an enhanced behavioral health workforce, and better prevention and harm-reduction approaches. Several candidates also connect behavioral health policies to broader safety and justice strategies with a focus on reducing police involvement in behavioral health crisis response.
Managing the City Health Agenda
The approach to managing the City’s health agenda affects the mayor’s ability to address health and health care issues in New York City. A majority of the candidates in the roundup had at least one stated approach about how they would organize City government or the health care system to meet the needs of New Yorkers. Some of these proposals focus on COVID recovery and future pandemic preparedness; some suggest significant restructuring of how the Office of the Mayor will manage health-related issues and foster interagency collaboration; and others recognize the tools, techniques, and resources that will be required to achieve their broader health policy goals.
The full roundup of candidate positions on these health issues can be found on UHF’s website (link). The roundup presents either exact language from the candidates’ websites and supporting materials found on those websites, or direct text from responses to the UHF-fielded candidate survey. Some candidates have much more detailed plans than others, and the roundup strived to include at least bullet-level detail for anything relevant to the issues described above. We strongly recommend voters and other interested stakeholders visit candidates’ websites for additional detail and for positions on issues not included in the roundup. Links to source material are provided on the roundup pages.
Identifying candidate positions on health issues is a new undertaking for UHF, and we attempted to obtain more detailed positions by fielding a survey of all mayoral candidates active in the race. Unfortunately, only a limited number of candidates fully responded to the survey. Their full responses are available here, and portions of the survey responses from primary certified candidates Art Chang and Dianne Morales are included as part of the roundup.
As we emerge from the pandemic, health and health care must be a major focus of the next mayoral administration. United Hospital Fund looks forward to collaborating with the Office of the Mayor and relevant agencies to address the issues highlighted in this roundup, as well as the many other programs and policies that can help build an effective and equitable health care system for every New Yorker.