Testimony: Dr. Michelle Morse, Chief Medical Officer at the Center for Health Equity and Community Wellness Testifies on Women's Health Inequities in NYC

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Good morning, Chair Schulman, Chair Louise, and members of the committees.

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My name is Doctor.

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Michelle Morse.

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I'm the chief medical officer and deputy commissioner of the Center for HealthEquity And Community Wellness at the Department of Health And Mental Hygiene.

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On behalf of our commissioner, thank you for inviting me here today to speak about inequities in women's health in New York City.

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While disparities and inequities are often used interchangeably, throughout my testimony, I will be using inequities instead of disparities, to highlight the term inequities because it reflects the reality that the gap that we see in health outcomes today are the result of avoidable, unfair, unjust, systemic policies, and practices in our society that can be changed.

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The health department addresses health and social inequity across New York City in partnership with community, faith based, and healthcare organizations.

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The department's work focuses on social determinants of health such as housing and economic status as well as environmental and commercial determinants and addresses both up stream and downstream factors to improve the health and well-being of New Yorkers.

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In 2021, The New York City Board of Health Resolution declaring racism a public health crisis highlighted the long history of structural racism impacting services and care across all institutions.

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Structural racism is a system that excludes marginalizes and harms black indigenous and people of color across New York City through discriminatory housing, employment, education, healthcare, criminal legal and other systems, all of which result in avoidable and unjust health outcomes for chronic disease and many other illnesses.

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The New York City Health Department works to eliminate racial inequities and health outcomes and premature mortality, which is defined as death before the age of sixty five years.

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I understand that committees have expressed interest in addressing the leading causes of death nationwide for women, noted by the Centers for Disease Control including heart disease, cancer, stroke, chronic lower respiratory disease, and Alzheimer's disease.

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I'll be addressing these topics as well as the impact of diabetes on women and the New York City health department's ongoing efforts to address these issues.

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Of note, the New York in New York City, specifically, the leading causes of death for women in 2021 were heart disease cancer COVID 19, chronic low respiratory disease, and Alzheimer's.

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It's important to note that February is both Black History Month and American Heart Month.

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These designations help bring awareness to the historical and systemic issues that contribute to the inequities that we're discussing today.

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The city takes a comprehensive approach to addressing health inequities.

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The Center for HealthEquity And Community Wellness itself was created to ensure a comprehensive and strategic approach to reducing racial inequities in premature death, many of which are driven by chronic diseases.

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As you know, heart disease continues to be a leading cause of death for women, while breast cancer is one of the leading causes of cancer death for women.

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Our analysis also shows that among women, rates of hypertension, or high blood pressure, our highest among black women.

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A recent community health survey found that 42% 42% of men say the number again of black women reported being diagnosed with high blood pressure compared to 31% of Latino women, 20 5% Asian Pacific Islander women and 23% of white women.

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These inequities stem from a range of causes, including structural racism's impact on access to health, resources, wealth, quality of services, and the reality of clinical research being historically conducted with white men as was already noted by the chairs and with subsequent findings, often incorrectly applied to women.

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In addition, cerebrovascular disease or stroke was the 4th leading cause of death in women.

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In our efforts to combat heart disease, stroke, and high blood pressure, the health department has developed innovative programs we launched the take the pressure off program in 2016, a hypertension initiative, which takes a place based approach to addressing inequities in high blood pressure.

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This program recently received a grant from the CDC to address high blood pressure in Brownsville, Brooklyn which is a neighborhood where we have an action center that is highly impacted by inequities and cardiovascular disease, which you can see on the graph, the map, excuse me, to my left.

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Take the pressure off has taken a comprehensive community based approach by linking a federally qualified health center, the BMS Family Health And Wellness Center, the Brownsville Community Culinary Center, night shift elements, and insurers to collaborate on improving hypertension awareness, management, and connection to care.

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Take the pressure off offers a hypertension 101 workshop for community groups to promote awareness and understanding of hypertension.

0:15:03

Over the past year, we've completed 45 presentations and trained the trainer events.

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In addition to heart disease, We appreciate the council's focus on cancer affecting women since it's the 2nd leading cause of death for women.

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In 2021, the rate of death from cancer was about 14% higher among black New Yorkers compared to the citywide average.

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Specifically, breast cancer is one of the leading causes of death in women in New York City.

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In 2021, black women died from breast cancer at a rate 41% higher than the citywide average.

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In our efforts to detect and treat breast cancer, the health department contracts with a mobile mammography van program to provide no cost mammograms and patient navigation within the neighborhoods that have the highest rates of breast cancer mortality.

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The program aims to decrease barriers to care such as access to transportation, insurance status, and ability to pay.

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In the past 18 months, the program provided screenings to over 4800 eligible women.

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Notably, colon cancer, while not specific to women, is another area of focus for us.

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The New York City Health Department funds patient navigation services at 2 health service providers located in neighborhoods with the highest rates of colorectal cancer mortality.

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Patient navigation services enable timely screenings by providing education, support, and access to resources to reduce barriers to care for those who are uninsured or under insured.

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We're currently working with partners through a committee hosted by the NYC Health Department on how to improve access to colonoscopy for patients without insurance.

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I now want to turn to Alzheimer's disease also in the CDC's top 5 causes of death among women.

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The health department has a new program called building our largest dementia infrastructure, also known as Bold, which seeks to improve the health status and quality of life of New York City residents with Alzheimer's disease and related dementia and of their caregivers.

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To achieve this goal, this initiative aims to create a diverse multidisciplinary coalition, which will include a wide range of stakeholders who recognize how structural racism and socioeconomic inequities have increased the risk factors for ADRD and worsened outcomes for a large proportion of New York City residents.

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Some of these risk factors include smoking, high blood pressure, diabetes, and obesity.

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In the coming months, we look forward to creating a plan that is data driven addresses social determinants of health, improves coordination, supports reduction in risk factors, and aligns with the CDC's healthy brain initiative road map.

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Through this process, we also aim to increase awareness and understanding about the importance of risk reduction, early detection, access to quality care, and supportive services for affected individuals and their families.

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On chronic lower respiratory disorder, cases of asthma and related inequities are significant area of concern.

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Children are in especially vulnerable population.

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In 2016, the rate of asthma related ER visits amongst children ages 5 to 17 was more than six times higher in very high poverty neighborhoods.

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Compared to low poverty neighborhoods in New York City.

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Because asthma can have the most harmful effects on children, the health department has significant resources to address and improve these inequities we see facing kids and families across the city.

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Our office of school health provides various services for children in school, including medicine administration and education.

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Our East Harlem Neighborhood Health Action Center offers free counseling, education, and other support services for kids with asthma.

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And our Tremont Neighborhood Health Action Center offers cost free pest control services for eligible families, and our healthy neighborhoods program provides free home assessments for kids and adults diagnosed with persistent ass by a healthcare provider.

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While diabetes is not technically within the top 5 causes of death listed by CDC, it is an important condition to under stand as we discuss health inequities in our city.

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Diabetes has increased diabetes prevalence has increased over the past 10 years, leading to enormous harms to New workers, including vision loss, blindness, kidney and nerve damage, heart disease, stroke, and amputation.

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Our data under score the unfair burden that diabetes has in related complication present to communities of color in New York City and communities experiencing high poverty.

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A critical tool to achieving reductions in diabetes rates is a longstanding successful evidence based initiative known as the diabetes self management program.

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As you may know, recent federal approval of changes to the state's Medicaid program would make the diabetes self management program reimbursable through Medicaid, which would represent great progress if we ensure it's accessible by as many groups as possible.

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In addition, with the initiative from the council, local law 52 passed in 2023 to develop and implement citywide diabetes incidence and impact reduction plan will also be a critical tool in achieving reductions in diabetes rates.

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The health department leads number of programs which aim to address the root causes of chronic conditions and inequitable health outcomes.

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Working upstream on cross cutting issues like food and nutrition security, tobacco cessation, health insurance access, and others allows us to prevent disease and impact many of the top 5 causes of death altogether.

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On food and nutrition security, our groceries to go program provides eligible New Yorkers with up to $270 a month in credits to buy groceries.

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Health Bucks coupons can be used to purchase fresh fruit and vegetables at all New York City Farmers Markets.

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Our shop healthy initiative, combat's predatory advertising and commercial practices that aggressively promote unhealthy food products, which are often targeted towards communities of color.

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This program also increases the availability of healthier foods through countermarketing strategies and relationship building with food retailers, distributors, and community members.

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We're also changing the food environment to be healthier through the New York City food standards, which are evidence based nutrition criteria for all foods and beverages, employers served, and were developed to help lower the risk of obesity, diabetes, and cardiovascular disease by setting guidelines for any city government facility where food is served.

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We also do tobacco control initiatives because smoking is still a leading contributor to New York City deaths.

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Statewide tobacco is estimated to kill 22,000 people each year.

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These deaths contribute to inequities premature mortality.

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Finally, we offer health insurance enrollment and access through our office of health insurance services individuals with health insurance get more access to preventive care and are better able to manage chronic disease.

0:22:09

Given this hearings focus on inequities in women's health and the New York City department's work to address the harms, it is critical that we address birth inequities and priority as black women and birthing people.

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Even when controlling for social economic and educational status, black women and birthing people are still more likely to suffer from severe morbidity and mortality.

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These inequities are rooted in racism and structural inequity.

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Contributing factors include decreased access to care, residential segregation, and stressors from experiences of racism.

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Our family wellness suites are integral to disrupting these system and equities and are part of the city's plan to prioritize maternal and infant health.

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Family wellness suites in Tremont is Harlem and Brownsville.

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Our physical spaces for families to receive services, health education, and linkages to community resources.

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They provide birthing people and their families a safe welcoming and supportive space to participate in a range of parenting and birthing classes.

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Breast feeding support, connect to community resources, and receive critical supplies like car seats and packing police.

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These sites are staffed by community health workers, Dulas, lactation counselors, social workers, and other public health professionals.

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In FY 23, the Family Wellness Suite served over 15 families across the three sites and distributed over 1500 cribs and car seats and 43,000 emergency diapers.

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Finally, I would like to highlight the importance of taking a place based and race conscious approach to chronic disease.

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And this is highlighted on the map to my left yet again, showing the high rates of premature mortality in some New York City neighborhoods.

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This approach serves and greatly benefits women in New York City.

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The department's public health core program is an ecosystem of community health workers and community based organizations supported by the health department to center the communities with the most unfair burden of disease, be it COVID or chronic disease.

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Again, these are highlighted in the map.

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As the public health emergency ended, we shifted this program to integrate chronic disease as a focus because of the intensive partnership, trust, and network we have built over the past 3 years.

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Community health workers now screen community members for social needs and chronic disease and make connections to health and social care.

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One community health worker shared this about the impact of their work.

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This work allows us to build trust with community members who previously had little to no exposure.

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This will allow us we hope to have relationships where the community trust us as credible messengers for future health initiatives.

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This is a powerful insight that speaks to the importance of the role of community health workers in building bonds to create more healthy and equitable communities.

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I'd like to close my remarks.

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Finally, I know I've been talking for a while by highlighting the need for a comprehensive approach to addressing these key drivers of premature mortality.

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In November 2023, the city launched Healthy NYC, a citywide campaign for healthier, longer lives.

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This effort will require public and private sectors to work together to reach our goals.

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I wanna thank the council and Chairwoman for unanimously passing the legislation last week.

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That will require the health department to have an update every 5 years of population health agenda.

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This will ensure that our focus and goals around creating a healthier New York City outlive any one administration.

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Further, the Adams administration recently launched Women's Forward NYC, an action plan for gender equity, an investment aimed at making New York City a national leader on gender equity, including for transgender and gender expansive New Yorkers with the ambitious goal of becoming the most woman forward city in the in the United States.

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Supported through city dollars, private and public partnerships, academic institutions, and federal funding, This living action plan is a framework for all of the administration's efforts to addressing gender inequities going forward and taking immediate action to connect women to professional development and higher paying jobs, dismantle barriers to sexual reproductive and chronic care, reduce gender based violence against women, and provide holistic housing services, including for formerly incarcerated women and domestic and gender based violence survivors.

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The health department worked with our colleagues in city hall on the development of this plan.

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New Yorkers can now revisit the relaunch women.nyc, a one stop shop website to learn more about the action plan and access city services to support women in families.

0:26:37

Thank you for inviting me to discuss this important topic.

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I'm happy to answer your questions.

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