Recover, Refocus, Reimagine: Coming Back Strong and Making New York the Healthiest City in the World
In addition to claiming the lives of nearly half a million Americans and over 29,000 New Yorkers, the pandemic and its associated economic crisis are causing health needs of all kinds to pile up across the city. The impact has been particularly severe for lower-income individuals and people of color. The unprecedented effort to distribute a vaccine has been plagued by inequity and inefficiency, and refocusing it to fairly protect all New Yorkers is the first and most important step in a lengthy recovery.
Our health impacts every facet of our lives and our livelihoods—housing, jobs, mental health, safety, food insecurity, and education—which is why repairing and reimagining New York City’s health systems will be a top priority in a Donovan administration.
New York City was caught unprepared for the pandemic, and it cannot happen again. We must strengthen our emergency response channels and boost our resources. It is the responsibility of city officials to work with experts, community organizations, health care providers, and private organizations to formulate a rebuilding strategy that will have the most wide-ranging and long-lasting impact on the health of our communities. We cannot simply aspire to bring back what we had; we must create a new system that is more accessible, efficient, and prepared to meet our health needs now and for years to come.
The city’s clear first priority must continue to be halting the spread of COVID-19, but we can’t stop there. We must learn from this experience and make sure we create a more resilient health care system that works for everyone.
Rebuilding our public health is critical, which is why we will work to provide quality and affordable health care for every New Yorker who needs it and wants it. This includes working with the Biden administration and our state government to insure every New Yorker, but not waiting on Washington or Albany by launching a three-tiered New York City public option focused on giving every New Yorker access to quality primary care.
It is also critical that we take steps to make our neighborhoods healthier and address environmental determinants of health. One major obstacle to accessing care is simply having a health center nearby, and through Shaun’s 15 minute neighborhoods, we will ensure that a high-quality health center can be found within minutes of any New Yorker’s front door. New Yorkers will also have access to fresh food, parks, and safe, open streets that will together make it easier for residents of our city to enjoy healthy and active lives.
We will also strengthen health care services for immigrants, individuals in the criminal justice system, and individuals experiencing homelessness. Loss, social isolation, and fear have magnified mental health challenges, so a coordinated strategy to address these challenges is a key part of our plan to help New Yorkers. We are committed to addressing the maternal mortality crisis, fighting for sexual and reproductive rights, and ending the HIV/AIDS epidemic.
Our city needs leadership that will take bold steps to repair our broken health care system and reimagine how we bring quality care to every New Yorker, creating healthier communities across the boroughs.
Our plan will focus on:
- Ending the COVID Crisis
- Ensuring Every New Yorker has Access to Adequate Health Coverage
- Investing in Health Equity and Access to Public Health
- Addressing Parallel Health Crises and working toward Long Term Health and Wellness
Ending the COVID Crisis
New York City was the early epicenter of the COVID-19 pandemic, overwhelming our hospitals, shuttering our businesses, and taking the lives of nearly 30,000 of our fellow New Yorkers. We know now that much of this suffering was preventable. But, due to an insufficient response at the federal level, our city and our country were caught flat-footed, and by the time we started taking the virus seriously, it was too late.
During Shaun’s time as Director of the Office of Management and Budget under President Obama, he worked alongside Dr. Anthony Fauci and other medical experts to contain the Ebola and Zika epidemics, and helped to prevent them from becoming pandemics like the one we are currently living through. The Obama-Biden administration literally wrote a pandemic playbook for the incoming Trump administration. However, the warnings were tragically ignored and President Trump bungled the federal response, resulting in needless and preventable suffering.
At the same time, New York City and State—despite their best efforts to contain this virus—also took many missteps in their management of this pandemic. In particular, the City’s current response has been haphazard and uneven, in large part due to a lack of coordination and communication between a number of government agencies responsible for handling our public health response to this crisis.
Additionally, we have seen a dearth of culturally-specific and in-language public health messaging, a gross lack of transparency at all levels, and the uneven and unequal distribution of vaccines—with Black and Brown communities not receiving their fair share of shots.
Although we are hopeful that this pandemic will be behind us by the time the next mayor takes office, it is critical that the next administration is ready on day one to continue containing this virus and ensuring that we are adequately prepared for any future outbreaks.
We are committing to the following policies and programs:
Unite the City’s disparate activities into one unified response
The city’s current response to the COVID-19 pandemic has been inconsistent and disorganized, primarily due to a lack of coordination between various government agencies.
There are a number of agencies, hospitals, academic medical centers, researchers, health centers, and pharmacies that are all doing their best to contain this pandemic, but by doing so separately, absent unified leadership, the result has been many New Yorkers feeling confused and overwhelmed. By bringing these various groups together, we will greatly benefit all New Yorkers and ensure a streamlined and efficient response to this pandemic.
In order to cut through the confusion and unify our response to COVID-19, and any future public health threats, we are proposing that all COVID-19 emergency response and preparedness measures be led by the New York City Department of Health and Mental Hygiene (DOHMH). Currently, the responsibilities for managing this crisis are bifurcated between DOHMH and Health + Hospitals (H+H)—leading to confusion and mismanagement. Moreover, H+H has other critical priorities. By diverting their precious resources toward COVID-19 management and tracing efforts, we are diluting their primary services and core mission. In order to enhance our response to COVID-19, the leadership of our response should rest with one agency, not two.
To that end, a Donovan administration will reestablish all public health messaging, data collection and analysis, and vaccine distribution under the leadership of DOHMH.
By uniting the city’s disparate activities into one unified response, regardless of the funding source, we can more adequately manage this virus, communicate to New Yorkers with one voice, and streamline our efforts in order to provide fuller transparency.
Repurpose contact tracing funding and activities for vaccine distribution
At the height of the pandemic, New York City and State implemented a robust contact tracing program to better track transmission of the virus. These efforts were helpful in containing the pandemic and keeping New Yorkers safe.
However, as we shift our focus from containment to inoculation, it is critical that we stand up vaccination efforts with as much funding as possible. With community spread already taking place in all five boroughs, the priority must be getting more shots into New Yorkers’ arms. This will only become more critical once the next mayor takes office. As such, a Donovan administration will immediately begin to repurpose contact tracing funding and transition towards robust vaccine distribution.
At the same time, we must ensure that we have contact tracers and other medical professionals ready for future outbreaks and other potential pandemics. Therefore, the Donovan administration will build and train a reserve of medical and public health professionals to be mobilized during pandemics, including volunteer clinicians as well as individuals prepared to serve as contact tracers.
Reorient the City’s vaccination campaign towards hard hit communities of color
Throughout his 30-year career in public service, Shaun has learned that the communities that are vulnerable before a crisis are the hardest hit during and after that crisis. That has entirely been the case when it comes to COVID-19 and our city’s most vulnerable communities. This pandemic has ravaged our Black and Brown communities, and our City’s response has been inadequate and at times, shameful.
As mayor, Shaun will focus our vaccination efforts towards the communities that need them most. This means using a neighborhood approach and getting trusted voices into those neighborhoods to help educate New Yorkers about the importance of getting vaccinated, while also listening to these communities about their reasonable concerns and fears. Doing this will help to build trust between these communities and the public health institutions that have historically overlooked them and even at times exploited them.
We also need to meet people where they are. Vaccination sites, although important, are not serving the communities that need them most. Part of this is because of a lack of meaningful outreach to these communities, but also because those who are in most need of the vaccine often do not have the time or the required to get vaccinated. That’s why Shaun’s administration will bring vaccines directly to the people who need them most by holding education and vaccination events at New York City Housing Authority (NYCHA) developments, naturally occurring retirement communities, and senior centers.
Meeting New Yorkers where they are also requires that the next mayor do a better job of reaching non-english speakers when it comes to educating New Yorkers about the importance of getting vaccinated. As mayor, Shaun will ensure that we are using in-language messaging when educating New Yorkers about the vaccine and other public health issues.
President Obama would often tell his team to not let a crisis go to waste. In that spirit, Shaun believes this pandemic has presented us with an opportunity to get more New Yorkers the care they need. As such, a Donovan administration will use vaccine distribution to sign people up for health insurance and connect people to primary care for underlying conditions—services that will be more accessible to New Yorkers through Shaun’s efforts to expand health insurance at the federal and state level and supplement coverage with a city-level public option, and through expanded access to primary care in the 15 minute neighborhoods model, respectively.
For all of this to take place, we need to make sure that our city is receiving the adequate amount of vaccines to meet the needs of its residents. Shaun will work closely with colleagues in the Biden administration, many of whom he already has a strong working relationship with, to ensure that our city gets the vaccines—as well as protective equipment, funding, and other resources—that it deserves.
By focusing our vaccination efforts on the demand side instead of the supply side—while still bolstering our supply by working closely with Washington—and meeting residents where they are, we can better serve the communities that have been hardest hit by this pandemic and ensure that all New Yorkers, regardless of their zip code, are able to protect themselves from this virus.
Enhance data systems and increasing transparency
The devil is the details, and the details are in the data. If we are going to properly prepare for the next public health crisis, we need to enhance our data systems, including syndromic surveillance and interoperability between health information exchanges and DOHMH.
One of the biggest challenges we faced during the COVID-19 pandemic was trying to predict when and where outbreaks might occur. Leveraging our data with approaches like syndromic surveillance—which allows public health officials to monitor disease indicators and detect outbreaks in real-time—will help our pandemic preparedness and keep our city safer in the event of any potential future outbreaks.
We must also ensure that we are being as transparent as possible in all government decisions, but particularly when it comes to our pandemic response. Currently, some government officials have not provided the public with the information they need and deserve—this leads to a lack of trust between our city’s residents and the health care system, which can impede other efforts like contact tracing and inoculation. As such, the Donovan administration will enhance public data dashboards so that New Yorkers are able to get the information they need in real time and have increased confidence in our health care system.
Engage primary care in both planning and emergency activation
Primary care is the first line of defense when it comes to protecting our health, and regular visits with a primary care doctor can help identify health problems early on so they don’t become health emergencies later in life.
The Donovan administration will partner with primary care physicians and organizations to not only plan for the next pandemic, but also engage them when it comes to emergency preparedness and activation. By doing so, we can get out in front of the next pandemic and develop strategies with organizations and physicians that are closest to the people. This type of planning and engagement will become even more meaningful once we begin to implement our other plans, including 15 minute neighborhoods, which will ensure that every New Yorker has access to primary care, among other services, within 15 minutes of their front door.
Primary care facilities have also been underutilized in terms of vaccine distribution. The Donovan administration will partner with primary care providers in order to make the COVID-19 vaccine more accessible to New Yorkers and help build trust with those folks who may be skeptical of inoculation.
Plan for an annual vaccination campaign
Although we are hopeful that the COVID-19 pandemic will be behind us by the time the next mayor takes office, there is a very real possibility that COVID-19 could threaten public health every year. Therefore, we will partner with primary care providers and community-based organizations in each 15 minute neighborhood to ensure that if needed, getting a COVID-19 vaccine is as easy as getting a flu shot. The Donovan administration will dedicate the necessary resources to ensure we are prepared for a COVID-19 vaccination booster campaign to increase overall immunity.
Ensuring Every New Yorker has Access to Adequate Health Coverage
About 600,000 adult New Yorkers currently lack access to health insurance, about half of which are undocumented. Many of these individuals are on the frontline of the fight against COVID, keeping our businesses running; taking care of our old or homebound; working to provide some semblance of normalcy and comfort for those who are lucky enough to be sheltered from these risks. This pandemic has further demonstrated the need for us to protect our own and provide the basic right of health care to all.
We believe that a true public option should exist at the federal level with state-level support—and Shaun is committed to working with colleagues in the Biden administration to make sure New Yorkers and all other residents of our country are covered. However, where other levels of government fall short, the City must stand in to preserve the health and wellbeing of its citizens.
We are committing to the following policies and programs:
Work with the federal and state government to expand health coverage
New York State has long been a national leader in expanding access to health care. Most of this progress has been through expansions of the state’s Medicaid program. In the 1980s, New York expanded Medicaid to cover undocumented pregnant women. In 1990, New York created the Child Health Plus program to provide coverage to children not eligible for Medicaid, including the undocumented. In 2001, in accordance with the Aliessa decision, the State expanded Medicaid coverage to immigrants permanently residing under color of law (PRUCOL) such as individuals granted Temporary Protected Status (TPS) or stays of deportation. In 2007, the State expanded the benefits provided through the Emergency Medicaid program—the only source of coverage for many low-income New Yorkers—to provide for end-stage renal disease and cancer treatment.
The Affordable Care Act (ACA) offered New York State additional opportunities to lower the uninsured rate. Pursuant to the law, the State expanded Medicaid in 2013, providing an additional 2 million New Yorkers with coverage. That same year, the State launched its health insurance marketplace, known as NY State of Health. Today, more than one in four New Yorkers are enrolled. In New York City alone, 1.7 million residents are enrolled in Medicaid, 500,000 in the State’s Essential Plan, 160,000 in Child Health Plus, and 110,000 in Qualified Health Plans. Through these efforts, the state’s uninsured rate has been cut by more than half—down to 5%.
Still, we must ensure that every single New Yorker has the coverage they need to access high-quality health care, and this requires more action at the federal and state levels.
As President Obama’s Director of the Office of Management and Budget, Shaun Donovan helped implement the Affordable Care Act. As mayor, he will work closely with colleagues now in the Biden administration to scale national efforts to provide coverage through the Affordable Care Act and Medicare. Additionally, Shaun will work with New York State to expand eligibility for the Essential Plan to all low-income New Yorkers, regardless of immigration status.
Establish a three-tiered public option in New York City, prioritizing universal access to primary care
Well-funded primary care has been found to lead to high-quality care and better health outcomes for patients and improved experience for clinicians, at lower costs. Because of its potential benefits, primary care continues to be one of the main drivers of health inequity in our city—people of color have less access to primary care and have more preventable hospitalizations and emergency department visits than other New Yorkers.
Not only is addressing the issue of inequitable access to care a responsibility our city has toward its most vulnerable, it is a necessary step toward rebuilding our economy and strengthening our city. By ensuring that all New Yorkers are healthy—particularly those that put themselves at risk every day to carry out essential tasks—we can truly commit to the all-hands-on-deck approach to recovery that this crisis demands.
To this end, we will fill in any gaps in federal- and state-level coverage through a New York City public option that prioritizes providing access to high-quality primary care. Every member will be assigned a primary care doctor who will manage their care, including prevention, chronic disease management, behavioral health, and referral for care. The program will offer a three-tiered system of primary care physicians on a sliding fee scale based on network chosen, and members will enroll in a specific institution within their network. The three networks are:
- Health + Hospitals: in addition to primary care, members will receive full service, including pharmacy, specialty care, imaging, inpatient care, and others, for additional co-pay
- Federally Qualified Health Centers (FQHCs): in addition to primary care, members will have access to a wide range of services, including dental and behavioral health, while referral to specialists, imaging, inpatient care and others will not be covered in the program
- Community Doctors: members will have access to services offered by their local primary care physician
Networks of FQHCs and community doctors will be established through agreement to set criteria including managing care and referring patients as needed, and will receive annual grants to do so.
In order to supplement the services available through FQHCs and community doctors, specialist visits and hospitalizations for all New Yorkers in the program will take place through Health + Hospitals. Voluntary hospitals will also have the option to be enrolled through agreement to provide secondary and tertiary services, including imagining, specialty care, emergency care, and inpatient care for enrollees.
The program will have no additive cost to the City, with investment continuing through the $100 million annually spent on NYC Care. After the establishment of philanthropic partnerships with the City to launch the program, costs should be offset by savings to Health + Hospitals due to increased primary care access—including reduction of uncompensated preventable hospitalizations and emergency department visits.
Investing in Health Equity and Access to Public Health
In addition to ensuring every New Yorker can pay for health care, we must identify and remove the other obstacles that prevent our residents from getting the care they need. Whether it’s increasing physical proximity to health centers, refining our use of data to improve health outcomes, or taking aggressive approaches to ending longstanding and worsening mental health and opioid use crises, we must make the necessary investments—prioritizing communities that have historically received the least investment—to ensure nothing stands between New Yorkers and healthy, comfortable lives.
We are committing to the following policies and programs:
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.
We will further identify areas where even more substantial investments in health care infrastructure are long overdue and work to remedy these oversights. One area of focus is Staten Island, which currently lacks a public hospital. In Shaun’s first six months, he will ask his Deputy Mayor for Health and Human Services and commissioners—along with input from Staten Islanders and elected officials—to provide recommendations on what additional health care resources, including a possible Health + Hospitals expansion, are needed.
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
We also need to support residents in their reproductive health. For those who are choosing to not get pregnant, especially those still in school, we will expand access to contraception, including long-acting reversible contraception (LARC), in settings including school-based health centers. We will also strengthen education about sex and healthy relationships in schools so students are equipped with the necessary information to keep themselves safe. For those who are trying to get pregnant, we will expand access to pre-conception care and fertility treatment services at NYC Health + Hospitals.
Sexual health also extends into the trans community as they are often at risk of lacking treatment. To close this gap, we will strengthen health care services for transgender New Yorkers through DOHMH and NYC Health + Hospitals clinics as well as in the primary care safety net, and call on the federal government to safeguard protections against discrimination for transgender people.
Build a robust public health workforce pipeline
Improving access to and delivery of health care services will require bolstering our health workforce pipeline. In our Economic Development Platform, we make a commitment to create the largest comprehensive skills-based training program in the US for thousands of students in secondary (DOE) and post-secondary (CUNY) education, purposefully linked to workplace training and tightly aligned around the sectors where middle-income job growth will be strongest, including life sciences and health.
We also highlight the importance of—beyond repairing our economy and getting New Yorkers back to work quickly—looking to the future by investing in life sciences innovation. This includes engaging residents in the Bronx and Harlem in a comprehensive planning effort to collaboratively shape a vision for a dual uptown life-sciences hub that is anchored on robust job training, clear pathways to employment for residents, and a twenty-year development cycle.
We will align NYC Apprenticeship, CUNY science and health education, and the “Corporate 100,000 Jobs Commitment” to guide New York City students and workers to life sciences jobs across the educational spectrum.
One focus will be on developing lab technician apprenticeship programs that can provide a means of upward mobility and a path to PhD programs or other specialized training for any New Yorker, particularly those from disadvantaged communities and backgrounds, through practical lab and research experience.
Provide seamless access to health care for the homeless population and people leaving jail
As highlighted across this plan, we must make sure that members of our most vulnerable populations have adequate access to health care, and this includes our homeless and previously incarcerated neighbors. Inefficiencies in the delivery of health services to these groups and overreliance on incarceration as a response to homelessness, mental illness, substance use and poverty costs the city more in the long run and prevents people from receiving the services they need.
Addressing Parallel Health Crises and working toward Long Term Health and Wellness
As we overcome the pandemic, we must stay focused on addressing the other health crises that already existed throughout our city. From the opioid epidemic to maternal mortality to diabetes and obesity, the City should be working toward investments in public health that create long-lasting, healthy communities.
An important part of this effort is recognizing and addressing the environmental determinants of health—often linked to New Yorkers’ access to fresh food, safe streets and open streets, and public spaces like parks—in order to ensure everyone has the chance to live a healthy and active life. All of these and other positive factors will be prioritized in the design of 15 minute neighborhoods.
We are committing to the following policies and programs:
Tackle the growing mental health crisis
Prior to the pandemic, our city was already grappling with a growing mental health crisis, with the number of mental-health-related 911 calls increasing by 23% from 2015 to 2018 and nearly one in ten New Yorkers reporting having depression. The last year has only exacerbated the situation: nearly half of adults reported experiencing symptoms of anxiety related to coronavirus; over a third reported that they may suffer from depression and a similar number observed a negative impact on their children’s emotional and behavioral health.
In order to ensure that New Yorkers are getting the help they need in moments of crisis, we must move mental health response entirely into the domain of public health and away from law enforcement, and adjust City resources accordingly.
In order to carry out a comprehensive and aggressive response to this crisis, the Donovan administration will create a mental health interagency council, led by commissioners of key agencies such as the Department of Health and Mental Hygiene, the Department of Education, the Administration for Children’s Services, and the Deputy Mayor for Health and Human Services.
Our three-step approach will focus on identifying and preventing mental illness, strengthening treatment, and improving crisis interventions.
Almost one in ten public high school students in New York report attempting suicide. We need to expand school-based mental health services and early interventions to better identify and manage illness and improve outcomes. This includes increasing the number of social workers and psychologists in schools, as well as in shelters housing the 10% of New York City students that are homeless. It also includes expanding support for screening and early identification of mental health issues in college-age students—with a focus on CUNY and CCNY—especially those experiencing first- or early-episode signs of more serious mental illness and at risk of dropping out. Read more about our plans to support New York City students in our Education Platform.
We must also expand support for training, capacity-building, and implementation support for routine mental health screening in primary care and other frontline care settings, including congregate care services for the elderly, and we must strengthen our system of surveillance by investing in improved survey and data collection.
Going beyond early intervention and prevention of mental illness, we must improve its treatment for all New Yorkers by ensuring our community providers have more resources, and establishing access to mental health treatment as a priority within the city’s public option plan. This goes hand-in-hand with the 15 minute neighborhoods vision, which will ensure that mental health resources within primary care settings are available near each New Yorker’s home.
We must expand integrated, community-based services, particularly through investments in job training and improved workforce participation, telemedicine, and stronger hospital-based mental health services for those who need them—including by improving connections to care and other support services for individuals with mental health needs discharged from emergency departments.
We must also invest in a middle level of care between clinics and hospitals that includes partial hospital or day treatment as well as intensive outpatient programs, and we must ensure that our caregivers are receiving the appropriate support they need to stay healthy and effective in their work. This latter point is particularly salient given the toll that the COVID pandemic has taken on the mental health of our health care workers.
These investments must also include an approach to homelessness that reimagines the right to shelter as a right to housing and incorporates supportive services. A full 35% of individuals in homeless shelters suffer from serious mental illness, meaning that by quickly providing permanent housing and access to social services, improving the delivery of those services, and placing high value on community integration, we can help one of our city’s most vulnerable populations address both housing and health issues simultaneously. Read more about our plan to affordably and securely house all New Yorkers in our Housing Platform.
And we must recognize our failure in responding to mental health crises. As of 2014, there were about as many individuals with mental illness in Rikers as all 24 psychiatric hospitals in New York State combined. People with mental illness are 16 times more likely to die in a police encounter, and in New York City at least 16 people with mental illness have been killed by the police in the last five years alone.
In order to ensure that mental health crises receive the appropriate response, led by trained professionals, we will create a dedicated mental health crisis hotline to divert calls from 911 and invest in frontline mental health crisis resources, including social workers, counselors, and emergency medical technicians. We will also train all police and enforce their use of de-escalation techniques in situations where they may be present.
We must also invest in community-based housing and support programs to build on crisis response. People in crisis often need transitional and supportive housing programs, primary health care, community-based mental health and social services like Fountain House, and help with substance use challenges as a next step to help stabilize during and after a crisis, and to create on-ramps to longer-term recovery. These programs must focus on those too often unheard and unseen, like the elderly, who have specific mental health needs.
We also will expand funding for mental health and addiction Alternative to Incarceration (ATI) programs and pre-trial diversion programs, and commit to priority decarceration of Riker’s Island for people with mental health conditions, especially serious mental illness.
The Donovan administration will address the failures of the federal government to provide federal funds for needed inpatient psychiatric treatment, which is only one part of the needed multifaceted response to people in crisis. In the meantime, we will work with the State to establish a Mental Health Care Crisis Response Fund to cover this inpatient psychiatric care deficit as we advocate for federal reform. Read more about our plans to improve mental health crisis response in our Criminal Justice Platform.
We must properly support those with mental illness who have been incarcerated by improving delivery of services in our jails and prison, and by creating a specific program for people leaving our jails who have a mental health diagnosis and lack health insurance. These should be paired with targeted reentry low-threshold services that can effectively support individuals as they reestablish themselves.
Address the opioid epidemic
More New Yorkers die of drug overdoses than homicides, suicides, and motor vehicle crashes combined. After seven consecutive years of increases, the number and rate of overdose deaths in New York City finally declined in 2018. Despite that, data show that these decreases are not evenly distributed across neighborhoods, and that gains are not uniform across race, ethnicity, or socioeconomic status.
While much progress has been made, we need to go further and focus especially on neighborhoods where treatment has been limited. Through a comprehensive, whole-of-government approach, we will focus on prevention, treatment, and recovery.
The goal is not to shame anyone into not seeking treatment and help for their addiction but rather give them the tools they need in a harm-reduction approach to support recovery and reduce relapse. Our goal is to prevent opioid misuse and to do that we will invest in evidence-based prevention programs in schools, hospitals, and in partnership with communities. In coordination with our 15 minute neighborhoods, we will make connections to our health care services, including primary care physicians, to help residents sustain their recovery.
We will also aim to develop multilingual and culturally competent education campaigns so that the necessary information reaches the greatest number of people.
We must work on reducing inappropriate opioid prescribing, and that takes coordination with our health system. Through improved data sharing, education, and guidelines, we can change prescribing practices. This will encourage evidence-based alternatives that will lead to fewer people having their first exposure to opioids be through legal means.
The next step in assisting those struggling with opioid addiction is working toward preventing overdose deaths. With a focus on high-need communities, we will put Naloxone, an overdose-reversal medication, in the hands of everyone who needs it. We will provide training on how to administer this medicine so that those who are in dire need can be saved.
In the communities hit hardest by the opioid crisis, we must start by establishing the city’s first Safe Use Community Centers, taking substance use off the streets and making treatment options more accessible. Similar centers outside the US have been shown to lower drug-related deaths, ambulance calls, and HIV infections, all without increasing crime, injection drug use, or return to use.
We also need to reconsider who is responding to these overdose incidents. To reduce avoidable arrests and hospitalizations, we will strengthen the emergency response to crisis events by trained clinicians and peers, and keep the police focused on the most violent crimes.
Lastly, for those residents that are on the path to recovery, we need to offer support to help them get over the finish line and stay addiction free. To do this, we will expand access to medication-assisted treatment services.
For those who are both homeless and suffering from addiction, we will work toward housing them by investing in supportive housing units with high-quality, on-site services that are targeted toward those in recovery. We will also invest in street outreach service programs.
End the AIDS/HIV epidemic
New York City has long been a leader in combating HIV/AIDs, most recently meeting the UN milestone of having 90%+ of New Yorkers with HIV know their status, 90%+ of New Yorkers diagnosed with HIV on treatment, and 90%+ of New Yorkers diagnosed with HIV on treatment virally suppressed. In 2018, the number of people newly diagnosed with HIV in the city fell below 2,000 for the first time since annual HIV reporting began. That said, racial, ethnic, and socioeconomic disparities persist, with much higher rates of new HIV diagnoses for individuals in high poverty neighborhoods.
First, we will enhance community-based education and outreach programs. These will be focused on the highest-need communities that are without other forms of support and where the disease is prevalent. We will also expand access to PrEP and PEP to reduce the spread of new infections.
Treat public safety and gun violence as health issues
As we work to keep New Yorkers healthy, their safety must be a priority. The Center for Disease Control and Prevention (CDC) describes a public health approach to violence reduction that focuses on identifying and addressing the root causes of violence in a long-term and sustainable way. This is in contrast with an approach that is focused on responding to crime and violence solely via arrest and prosecution, but does not seek to understand and deal with their causes.
In order to ensure safety while reducing the NYPD footprint and over-incarceration, we will implement a citywide, cohesive public health approach to violence through community-led public safety and racial justice initiatives, prioritizing targeted investments in the communities that have been most harmed by violence.
Another related public health and safety issue in our city is the prevalence of gun violence. By refocusing police resources away from issues like mental health crises and school safety, we will be able to better orient these toward closing the out-of-state gun pipeline and preventing or investigating serious crime. Further, given the lack of action by the federal government in this regard, City agencies will initiate and fund research on the causes and prevention of gun violence through a public health lens. Read more about our public safety proposals within our Criminal Justice Platform.
Prevent chronic disease
COVID-19 masked a “second pandemic” of untreated chronic disease, which will impact health well into the future. By prioritizing access to primary care, we will ensure that New Yorkers can constantly monitor their health and identify and treat chronic disease proactively.
More than half of adults in New York City are overweight or obese, and the rate of childhood obesity is rising. We will work with schools to coordinate healthy meal standards and ensure that the food being provided encourages healthy eating habits. We will also strengthen the New York City Food Standards and encourage further adoption among private employers. As we’ve committed in our Transportation Platform, we will bolster Open Streets to provide more areas for New Yorkers to get outside to walk, play, and exercise.
For those that do not have equitable access to fresh food in their neighborhoods, we will work to close that gap through our 15 minute neighborhoods. Over one million New Yorkers face hunger every year, including one in five children. The needs for food are mounting in the wake of the pandemic, as millions are pushed in poverty. Additionally, we will increase funding for community-based organizations to identify and enroll low-income families and seniors in critical benefits including SNAP. We will also increase funding for emergency food providers, including food pantries and soup kitchens as well as call on the Federal government to boost SNAP benefits and extend eligibility.
Climate is also a major contributing factor to overall health by increasing chances of suffering from asthma or heat-related health issues. Please see our Climate Platform to learn how we will work to close peaker plants and increase green space that will benefit overall public health.
Promote “NYC Healthiest City” commitments to revitalize our economy
The economic pressure related to the collapse in tourism has been immense—the hospitality industry alone provided as many as 400,000 jobs to our city before last March’s shutdown. Coming out of the COVID pandemic, New York City will again be one of the top tourism destinations in the world and we will work vigorously to extend the prosperity that tourism brings to all parts of New York City—and we will do so by not only making New York City healthier, but by communicating to all who would visit that New York is open for business.
Our campaign is committed to partnering with NYC & Company to publicize our “NYC Healthiest City” commitments, first aimed at getting locals to go out again, then to attract regional, international, and business visitors. Leveraging our city’s resources to let the world know we’re open again will help speed up recovery across a broad range of sectors. Read more about our plans to revitalize New York City’s economy in our Economic Development Platform.