Public Health Voices

The official newsletter of the Public Health Association of NYC

Photo Caption: Members of the Policy Committee. (Front row, left to right: Elaine Congress, Nina Rothschild, Kavitha Das. Back row, left to right: Shakiba Muhammadi, Sharon Mosley, Alison Braid, Lovelyne Julien, Colette Prophete, and Abby Ross.)
Welcome to the Public Health Association of New York City’s newsletter, Public Health Voices!  The Public Health Association of New York City (PHANYC) is delighted and proud to promote this new tool to disseminate information and to generate lively and informed discussion about hot topics among members of the public health community in New York City.  PHANYC is a meeting ground for public health professionals and students living and/or working in New York City.  Employed by a variety of organizations – the government, hospitals, non-profits, NGOs, universities – and/or enrolled in one of several graduate programs in public health in the New York City area, they are united by their interest in promoting health and preventing illness.

As readers who have participated in PHANYC activities over the years know, PHANYC has a rich history and continues to offer engaging and stimulating discussions in its monthly policy committee meetings and in its annual public health breakfast and all-members meeting/student symposium each Spring.  The public health breakfast in May 2016 featured speakers on diverse topics ranging from maternal and child health initiatives at the New York City Department of Health and Mental Hygiene (NYC DOHMH) to Zika to health care reform with a focus on the Affordable Care Act versus the New York Health Act to alcohol advertising on New York City public transit.  And the student presentations at the annual meeting in June on topics ranging from a stop smoking initiative using Twitter at a university in Turkey to increasing awareness of stroke risk in Ghana were terrific.
The lineup of engaging speakers and discussions about important topics continues in Fall/Winter 2016-2017.  Mark your calendars now for an exciting series of events: monthly policy committee meetings every first Tuesday of the month, which includes robust discussions following presentations, develops a formal policy agenda, and plans ahead for special events; an annual legislative breakfast; an annual meeting and a student symposium; and a student networking event this winter. Per view our members, we often share events at NYC universities such as the Aid in Dying forum sponsored by the New York Bar association this month, View the events calendar to learn more.
For 2016-2017, policy priorities for PHANYC include: reproductive, maternal, neonatal, child, and adolescent health; health promotion and disease prevention; and emergency preparedness.  Although these are our major areas of interest, we are not confined to them – and if you have a major public health issue to discuss or want to share suggestions about potential speakers, feel free to attend a meeting and raise the idea. See the PHANYC in Action section to learn more about the public health policies that policy advocates have recently presented to our committee.
The goal of this newsletter is to generate fresh ideas for and participation in PHANYC.  PHANYC wants to take full advantage of the incredibly talented pool of public health professionals in New York City and bring them together for a rich dialogue.  In this publication, students and professionals will find articles on topics as diverse as palliative care in dentistry to the lessons learned from the Affordable Care Act. Future issues will focus on an equally tantalizing array of issues including presentations at APHA by PHANYC members and interviews with current PHANYC members who are doing interesting work and are potentially willing to provide career advice and/or serve as mentors.  Our hope is that this new publication will broaden awareness of and participation in our organization’s activities so that we can solidify connections and establish new networks, encourage collaborations and dialogue, and build a richer and stronger organization.
A warm note of thanks, finally, to the three individuals who have been the driving force behind this newsletter – Moria Byrne-Zaaloff, a recent graduate of NYU’s College of Global Public Health, who has been ably assisted by Lovelyne Julien, who just graduated from the same program and by Alison Braid, who is currently earning her MPH degree at the University of New England.  Congratulations on a job well done! 
Happy Holidays from all of us at PHANYC,
Nina Rothschild, DrPH, MPH
President of the Public Health Association of NYC

By Moria Byrne-Zaaloff, Editor-in-Chief/Public Health Voices

Recent national events have caused many public health professionals to question the success of Patient Protection and Affordable Care Act (PPACA) and the future direction of the US healthcare system. In an effort to gain a better understanding of ACA and how changes might affect the landscape of our current healthcare system, I sat down with Dr. Sherry Glied, Dean of the New York University’s Robert F. Wagner Graduate School of Public Service and Professor and former Chair of the Department of Health Policy and Management at Columbia University’s Mailman School of Public Health from 1998-2009. Dr. Glied shared her thoughts on success stories and areas for improvement in the ACA, predictions on the impact of overhauling the law to build a health care system model, and what we can do to influence policy leaders to make the right decisions about the US health care system.
Lessons Learned From ACA
The greatest accomplishment of ACA was successfully providing 20 Million people with health coverage, 16.4 million of whom had been uninsured prior to the law's passage. In fact, ACA produced the largest decrease in individuals without insurance coverage since 1965 when Medicare was established. “This is  very big news in terms of improvement in insurance coverage,” said Glied.
Enrollment in ACA proved what Dr. Glied already knew – Americans didn’t have health insurance because they couldn’t afford it. Federal subsidies available upfront provided families and individuals, whose incomes were between 100 percent and 400 percent below the federal poverty level with the financial resources to buy health insurance.
Another important lesson learned from ACA -- there were enough providers to accommodate the expansion of Medicare coverage called Medicare Advanced. “There had been a concern that there wouldn’t be enough providers to meet the number of newly enrolled patients and that access to care would be an issue," said Dr. Glied. “This was not at all the case.” Dr. Glied reported that the health care system doesn’t seem to be overwhelmed by increase in coverage. Even areas with traditionally low access to care, weren’t overwhelmed by new patients with coverage.
ACA also extended the life of the Medicare Trust Fund by changing payment arrangements and “improved the financing of Medicare.”  Medicare has played a central role in changing the US health care delivery system. Medicare programming was particularly instrumental in the future of the health care system since the introduction of in the early 1970s of the DRG, or diagnostic related grouping in which Medicare pays a fixed amount based on the patient’s diagnosis, and in 1992, of the physician fee schedule, (a rule for scheduling updates to payment policies, payment rates, and other provisions for services). The ACA successfully improved the financing of Medicare by improving the efficiency of the Medicare program and cutting costs.
ACA has also increased the focus on primary care as well as integration and coordination of medical care across service lines. The law created provisions to improve primary care, such as: scholarships, loan repayment, and training demonstration programs to invest in primary care physicians, mid-level providers, and community providers; temporary increases in Medicare and Medicaid payments to primary care providers; support for innovation in the delivery of care, with an emphasis on achieving better health outcomes and patient care experiences; enhanced support of primary care providers; and investment in the continued development of the primary care workforce. Training and a focus on improving the health care system ushered in a wave of new ideas and enthusiasm.
The development of the Innovations Center of the Centers of Medicare and Medicaid Services has introduced exciting new ways of delivering care that is more efficient and saves money. Models were created which emphasized more team-based initiatives that rely on connections between the health and social service systems and created connections between hospitals and the communities. In 2010, it may have been uncertain whether these programs would work, said Dr Glied. Yet, there was a sense that health professionals should try anything they could  to improve patient care. “We needed to innovate...(to improve the quality of patient care) and I think that ACA has been a big driver of this kind of innovation,” said Dr. Glied.
US Health Insurance in 2017 and Beyond
“We are about to enter a world (under the new presidential administration) where people are about going to talk about using regulations instead to get people coverage. We already know that the barrier is money not regulations,” said Dr. Glied.
According to Dr. Glied, regulations alone won’t fix the health care system. In the 1990s, New York State implemented regulations to create an even playing field between the HMOs and individual insurers such as Blue Cross/Blue Shield. The result of requiring all insurers to institute a community rating system and guaranteed services to all applicants for insurance was mass exodus of patients from individual insurers, followed by a dramatic spike in premiums. Health insurance became out of reach for most New Yorkers with monthly premiums exceeding $1,000 for the least expensive policies.“Without a system of subsidies to persuade healthy people to stay in the market,” said Dr. Glied, “the whole system is going to explode on you”.

 ACA saved a floundering individual health care market from collapse by rebuilding Marketplace, New York State of Health (NYSOH) over time. By 2016, the
New York State healthcare marketplace had transformed into a “hybrid market with both subsidized and full premium coverage offered by both commercial and public program health plans, at prices often designed to capture market share, rather than avoid it”. The new health care proposal of the appointed Secretary of Health and Human Services will include interstate insurance competition. Dr. Glied believes that this “old-fashioned,” predicated based on a concept of how insurance companies worked 20 years ago. She stated that deregulating state insurance will only lead to a race to the bottom where patients are offered the lowest premiums with the least amount of benefits and those who need more comprehensive plans will be forced to pay higher premiums.
When asked about the proposed health care plan, Empowering Patients First Act, of incoming Secretary of Health and Human Services, Tom Price, Dr. Glied did have a few concerns. The plan would eliminate Medicaid Expansion and has a prerequisite of 2 year continuous insurance for those with pre-existing conditions and chronic illnesses.  “Moving to a two year continuous insurance requirement would definitely harm older and sicker groups. It's actually a stiffer continuous coverage requirement than already exists under HIPAA (1996), which only requires one year of continuous coverage with no more than a 63 day break.” According to Dr. Glied, refundable tax credits that you receive at the end of the year instead of subsidies paid upfront “won't work well for people who don't have the resources to pay for coverage throughout the year.”
What We Can Do to Improve Health Care in the US

She encouraged public health professionals to familiarize themselves with what is happening in health care right now, compare ACA to future health care policy proposals, and decide what will really improve US health care.
“I think that we have to be careful not to be seduced by the fact that regulatory reforms protect people with preexisting conditions and assume that reforms alone will somehow address the problems,” said Glied. “They could actually cause things to become much much worse than they were before ACA passed. We could end up with a situation like the NY State noninsurance group". (See previous section.)
Dr. Glied believes that it is the responsibility of public health professionals to think about the details of what the US health care system should look like. There might be aspects of the new health care bill proposed by Tom Price that works well and meets a number of health professionals' objectives. There could also be other ways, according to Dr. Glied, that it could be really really destructive. Dr. Glied insists that our health care system ensure people have access to care and health insurance coverage for substance abuse and mental health services.
If Dr. Glied had her way, there would be a long list of provisions she would love to add to ACA. She mentioned optimizing the cost-sharing model so that people can afford the level of care that they need most. She would also like to see the health care system become even more patient-centered, further improve coordination with the social and welfare programs, among other topics.
She  encouraged everyone to be opened-minded in looking at the new national health care proposal comes. Look at it seriously, she said, and determine what impact the proposal is likely to have.

By Policy Committee Chair, Robin Vitale, MA and Policy Committee Secretary, Kavitha Das, BDS, MPH, MS
Every year, the policy committee revises our comprehensive policy brief which enumerates PHANYC’s position on multiple public health policy topics from maternal and child health to emergency preparedness that our committee wishes to address. Once the final annual policy brief is completed, it is submitted to the board for approval.

As a committee, our goal for this coming year is to ensure it is relevant and more user-friendly. We are always open to speaking with members of the community about topics related to public health. Attached is the 2016 PHANYC Policy Brief.
Over the past few months, our committee has met with several advocates who seek the committee’s support of issues such as: Building Alcohol-Free Transit (BAFFT) by banning alcohol ads, Aid in Dying, and universal free school lunch in elementary and high schools. APHA sent a call to action to all chapters requesting support for the Prevention and Public Health Fund. PHANYC shared this initiative with membership. Learn more about APHA's call to action here.

PHANYC’s newest board member is Sudha Sarode, MSPH. Sudha recently joined PHANYC and the board upon moving to NYC for a new job opportunity. She is an Education Program Manager at the Crohn's & Colitis Foundation of America based in NYC, where she manages education programming for healthcare providers. She has experience many different level of public health: federal, state, local, and nonprofit. Sudha also served on the Executive Board of the New Jersey Public Health Association and was selected as an Emerging Leader for the Behavioral Health Leadership Development Program sponsored by SAMHSA. She is passionate about systems change and maternal and child health.
Sudha received her Master of Science in Public Health degree with a concentration in Healthy Policy in 2012 from The Johns Hopkins Bloomberg School of Public Health and her Bachelor of Science degree from Rutgers University. Her hobbies include yoga, reading, and spending time with friends/family.
Lovelyne Julien, MPA, MPH, Member of the Editorial Team/Public Health Voices, recently met with Sudha for a brief interview.
1. What is your new appointed position and what are some of your responsibilities? I'm excited to be elected to the position of Secretary of the PHANYC Executive Board beginning October 2016! In this role, I take meeting minutes, maintain records, manage the account email, and facilitate communications. Like other board members, I'm involved in decisions regarding events, policies, and strategic direction. Since I was also Secretary of the New Jersey Public Health Association 2014-2015, I have a strong understanding of my responsibilities.
2. How do you hope to contribute to PHANYC to advance our organizational goals? Among other goals, PHANYC seeks to promote the health of New Yorkers, encourage dialogue among various health constituents, engage members through programming, and drive health policy. As Secretary, I have the unique opportunity to facilitate communications, which will help to advance our goals. I also believe in building a strong foundation through active involvement, hard work, and positive relationships. To that end, I will develop concise and accurate meeting minutes and respond to email inquiries in a timely manner. In addition, I will assist with programming logistics and participate on the policy committee.
3.  Why was joining PHANYC important to you?
There are so many reasons! As a public health professional, it's important to me to continue learning and stay up to date with what's happening in my field. PHANYC provides me the opportunity to stay informed about various topics, such as: maternity and child health, health prevention and emergency preparedness. Second, it was important for me to connect and network with other professionals who share similar passions. I'm grateful to work with such a committed and talented team. Last but not least, I wanted to be part of a leadership team that promotes population health and makes a positive difference in the local community. I definitely encourage all of you to stay involved in some way whether through attending a programming event or reading our newsletters!
4. Lastly, anything else that you want our readers to know about you?
Having positive mentors has enabled me to push myself professionally while staying true to my unique work style and staying balanced. With the support of my mentors, I have received my MSPH from Johns Hopkins, worked for major health non-profit organizations, and held various leadership positions.

Nina Rothschild, DrPH, MPH, MA, PHANYC President, is a City Research Scientist III at the New York City Department of Health and Mental Hygiene.  Currently, she works in emergency preparedness and in health and safety coordination in the Division of Disease Control.  Previously, she worked in HIV/AIDS community planning; in HIV prevention; and in the Bureau of Maternal, Infant, and Reproductive Health.  Before becoming President of PHANYC, she served as the co-chair of PHANYC’s Policy Committee.  She is also a member of the Alumni Board of Directors of Columbia University’s Mailman School of Public Health, where she serves on the Executive Committee and is the Board Secretary, Chair of the Governance Committee, and an editorial board member.  Nina graduated summa cum laude from Barnard College where she was elected to Phi Beta Kappa after her junior year and also holds an MA in English Literature from Columbia’s Graduate School of Arts and Sciences, an MPH from the Department of Sociomedical Sciences and a DrPH from the Department of Health Policy and Management at Columbia’s School of Public Health.  She absolutely loves animals and worries a great deal about the impact of climate change, especially on polar bears, and is also an enthusiastic traveler and collector of arts and crafts from all over the world.

Alison Braid Represents PHANYC at the Annual APHA Governing Council Meeting 

By  Lovelyne Julien, MPA, MPH, Member of the Editorial Team/Public Health Voices
Last month, Alison Braid, Social Media Specialist for PHANYC, represented PHANYC at the APHA Annual Meeting, "Creating the Healthiest Nation: Ensuring the Right to Health” in Denver. The Annual Meeting and Expo offers public health professionals from around the U.S and world the opportunity to come together to network, learn, and share research and ideas.
Each year, representatives from each chapter come together as part of the Governing Council to discuss the primary activities and deliverables of the Strategic Planning Committee and provide suggestions for next year. Alison represented PHANYC on the Council. Similar to a congressional session, the Council  discussed topics: such as committee work plans, creating long-term metrics for leading health indicators, monitoring progress of the Strategic Planning Committee and other topics, deliberated on each topic, and came to a consensus by popular vote. 
An MPH student at the University of New England, Alison she applied and won the APHA Leadership Challenge Scholarship to attend the annual meeting. Alison is an experienced technology and web professional and was most interested in learning how technology can be used to improve public health and learn about initiatives occurring nationwide.  Alison enjoys the challenge of applying her knowledge both in the classroom and in the NYC community.
Following the general session, the committee divided into breakout sessions to brainstorm on Strategies to Achieve the Healthiest Nation in a Generation: Impacting Leading Health Indicators. As a public health student interested in learning how technology can improve public health services, she joined the group focused on health information technology. Overall, Alison enjoyed being part of the process and learned a lot from the experience.
Alison Braid, PHANYC representative at the 2016 APHA Governing Council Meeting poses with other Region II representatives of the Council  Edna Pacheco Acosta (Puerto Rico) and Oliver Lontok (NJ).
An important outcome of the Governing Council meeting was the decision to support linking health equity to the strategic plan for anti-racism initiatives. As comprehensive, stratified subgroup data is unavailable for all the selected long-term metrics, the Committee is interested in partnering with the anti-racism initiative to analyze, feature, and advocate for the continued refinement of selected subgroup data for particularly relevant leading health indicators.
“The conference was so large and was overwhelming at first,” said Alison. “Yet it is such a huge opportunity to meet so many passionate and dedicated people and learn about the plethora of innovative initiatives going on around the nation.”
Alison’s advice to those wishing to attend next year’s annual meeting: find a passion and get involved. Join a committee before attending the meeting. There are many committees and a lot of work to be done. With the changes in government, many more challenges are likely to arise in public health. The meeting is also a great way to get to know people who are just as passionate and join forces on a research project or initiative. The conference is also a wonderful opportunity to share your research in poster or presentation form and see what others are doing. “The real satisfaction, of course,” said Alison, “Is in doing the work you are passionate about, building the bridges in your everyday interactions with others, and working toward achieving your goals.”

Dr. Cheryl Merzel Presents Posters on Higher Education in Public Health at the 2016 Annual APHA Meeting and Expo

By Staff

Dr. Cheryl Merzel, Director of the Master in Public Health program and  Clinical Associate Professor at NYU College of Global Public Health, presented two posters at the 2016 APHA Annual Meeting and Expo, including:

Authors: Cheryl Merzel, Andrew Goodman, Ohemaa Boahemaa
Title: How do we know they can do it? Evaluating student outcomes in public health practice-based learning experiences
Organization: New York University College of Global Public Health
View poster here.

Authors: Cheryl Merzel, Andrew Goodman
Title: Think after you act: Developing professionalism through reflection in the MPH practicum
Organization: New York University College of Global Public Health
View poster here.
Q1. Dental care often overlooked as part of palliative care. Why should dental care be integrated into all palliative care treatment models?

A1. Palliative oral care focuses on strategies for maintaining overall quality of life and mouth comfort. Many terminally ill patients and patients with chronic illness exhibit oral difficulties that affect their speech, taste sensation, swallowing and are prone to developing lesions in the mouth. Multiple drug use causes dryness of the mouth, which can lead to dental caries. A majority of patients who have one or more illnesses have dry mouth. It has been reported that dental caries are commonly seen in institutionalized older adults in the last year of life, affecting about 40% of the remaining teeth. A healthy diet is needed to maintain good health of patients with chronic illnesses and the mouth is vital to having a healthy diet and improving overall quality of life. Palliative Care (PC) is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness and chronic illnesses. It involves an interdisciplinary team of medical and allied health professionals addressing the health needs of the patient. PC is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment. Hospice is PC for patients in their last year of life.  In NY State, the Palliative Care Information Act was implemented to provide terminally ill patients with information and counseling concerning palliative care and end-of-life options. This is offered only to patients with an illness or condition that is reasonably expected to cause death within six months.   

Q2. How do you hope your research -- once published -- will influence the integration of dental care into palliative treatment models?

A2. The first step is to raise awareness on the issue and its importance to patients’ quality of life. Secondly, encouraging the inclusion of dentists and oral health professionals in the palliative care team is vital. Policy statements for PC at the national and state levels should include dentists and dental hygienists and PC guidelines should be created keeping oral health in perspective. Thirdly, help in driving the creation of standardized training modules that address the gaps in training and awareness for dental, medical, nursing and allied health professionals in the context of PC and oral health is key. In settings where a dental professional is not available, medical and allied health professionals need training to address oral health issues in PC settings and to provide referrals when needed.

Q3. What training and fellowship opportunities are there for nurses, doctors, and other health professionals who work in palliative care and are interested in receiving training in dental protocol? 

A3. Training for individual professions varies based on the profession, school curriculum, and state laws on dental hygienists’ scope of practice. In nursing, oral care is one of the most basic nursing activities. Despite this emphasis, oral care in nursing homes in the US is generally poor. The NIDCR (National Institute of Dental and Craniofacial Research) admits that there will be an increase in demand for non-dental professionals to provide oral care to PC patients. Data on such oral health services, however, as well as on the number of non-dental professionals who supply them, are limited. Steps have been taken to address some issues: for example, the NY State government funded a project for identifying best practices for maintenance of oral health in nursing home residents. 

Q4.  Is training available that provides guidelines that can be directly related to their job responsibilities?

A4. A) The Centers for Medicare and Medicaid Services established the Minimum Data Set that mandates oral health in nursing home settings in the US. It measures quality of care in certified nursing homes & was updated to include actual observation of resident oral health.  B) Nurses commonly use an Oral Assessment Guide to meet the needs of various patient populations. Diabetes Oral Health Assessment Tool for Nurses is used for diabetic patients.

Q5. Would the inclusion of  dental care in the National Palliative Care Education and Awareness Campaign be a step in the right direction to expand awareness? Are there any other steps you would recommend?

A5. The Palliative Care and Hospice Education and Training Act was introduced in 2015 as an amendment to the Public Health Service Act to increase the number of faculty in PC and to provide support for research and education, including for an interdisciplinary team of providers -- but interestingly, dentists were not explicitly included in the PC team in this act. 

Q6. What additional reading would you suggest for members who are interested in learning more?

A6. Additional Resources: Palliative Care Information Act- New York State Palliative Care and Hospice Education and Training Act The National Consensus Project for Quality Palliative Care Palliative Care in Cancer
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Calendar of Events
December 12

New York Academy of Medicine Presents: Population Health Summit IV: Working Across Sectors to Address Social Determinants of Health The 4th annual Population Health Summit will seek to deepen and extend the understanding of ongoing efforts in New York State and nationally that demonstrate effective collaboration between health care and other sectors to advance population health. 

DATE: Monday, December 12, 2016

TIME: 8:00AM - 4:30PM

PLACE: The New York Academy of Medicine, 1216 Fifth Avenue at 103rd Street, New York, NY 10029

RSVP here.
December 13
Center for Disease Control is pleased to present the December session of Public Health Grand Rounds, "Public Health Law: A Tool to Address Emerging Health Concerns"

Speakers will provide an overview of public health law, describe how it is an essential component of contemporary public health practice, and discuss the emergence of modern concepts of public health law, including legal epidemiology.
DATE: Tuesday, December 13, 2016

TIME: 1:00PM (EST)

This session will be available via live webcast from CDC headquarters in Atlanta, Georgia.

Learn more about the event here.

Watch Webcast  here.
December 16
Fordham Law Schools proudly presents: "ADELANTE: Meeting the Social and Legal Services Needs of Central American Refugees in New York"
DATE: Friday, December 16, 2016

TIME: 9:00AM - 5:00PM

PLACE: Fordham Law School, 150 West 62nd Street, Costantino Room

RSVP here

For more information, please contact Dora Galacatos at
January 3
Policy Committee Meeting
DATE: Tuesday, January 3rd

TIME: 6:30 PM
PLACE: American Heart Association Building, 122 East 42nd Street, 18th Floor
February 7
Policy Committee Meeting
DATE: Tuesday, February 7th
TIME: 6:30 PM
PLACE: American Heart Association Building, 122 East 42nd Street, 18th Floor
Late Winter
Student Networking Event
DATE: Late Winter

PLACE: LGBT Center at 208 West 13th Street, NY, NY
March 7
Policy Committee Meeting
DATE: Tuesday, March 7th

TIME: 6:30 PM

PLACE: American Heart Association Building, 122 East 42nd Street, 18th Floor
April 4
Policy Committee Meeting
DATE: Tuesday, April 4th

TIME: 6:30 PM

PLACE: American Heart Association Building, 122 East 42nd Street, 18th Floor
April 7
Legislative Breakfast
DATE: Friday, April 7th

May 2
Policy Committee Meeting
DATE: Tuesday, May 2nd

TIME: 6:30 PM

PLACE: American Heart Association Building, 122 East 42nd Street, 18th Floor
June 1
 Annual Meeting and Student Symposium
DATE: Thursday, June 1st

TIME & Place: TBD
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