Health commissioners advocate for shift towards preventative health care

According to New York State Department of Health Commissioner Dr. James McDonald, the health care sector’s tendency to hold onto traditions only leads to “lousy and inefficient practices.” McDonald and other health officials said that the sector is saddled with such outdated policies, but it must shift away from reactionary policies to preventative ones in order to effectively address health disparities across New York City and the state.

McDonald was the keynote speaker at City & State’s Healthy New York Summit, which was held at the Museum of Jewish Heritage in Manhattan on Thursday. The summit brought together health commissioners, lawmakers and nonprofit leaders to discuss the city’s roadmap to better health in the aftermath of the COVID-19 pandemic. 

In his keynote speech, McDonald highlighted the predictable health outcomes and disparities that were pronounced during the COVID-19 pandemic. Unsurprisingly, he said, lower income communities were hit with the most fatalities. 

“It wasn't a surprise who passed away during the pandemic, and it wasn't a surprise where the people were hospitalized,” he said. “But if we are willing to improve scope of practice in New York, when you see the demographic increasing, I don't see a future where we achieve health equity, when we’re going to have worse outcomes with the same groups we continue to marginalize. That's unjust. It's unacceptable.”

In order to fully address health inequities, McDonald stressed the importance of intentional policies that fully engage with the various social determinants that lead to disparate health outcomes within communities. 

“The simple way I think about social determinants of health is: what are the advantages or disadvantages to live in? If you live in a home that's safe, that's the advantage, if you have a great education, that’s an advantage. We can all have the same advantages. In other words, we don't lose when everybody has the same advantages. There's no reason why people can't have adequate housing. Housing is a critical social determinant of health,” McDonald said. 

McDonald also highlighted the benefits of Gov. Kathy Hochul’s 1115 Medicaid waiver, which he said will increase funding for emergency care and preventative services.

“We really know that it's the care outside the rooms that matters the most,” he said. “When you look at our 1115 waiver we achieved with the federal government, most of the money is going to care outside of an exam room, it's going into the social care network in the community. That's really a pivotal decision on our part. Because we know that's how it really affects people's length and quality of their life.” 

This sentiment was echoed by Dr. Ashwin Vasan, New York City’s Department of Health & Mental Hygiene Commissioner. Vasan unveiled additional details of the 1115 Medicaid waiver and the city’s Healthy NYC initiative, a long-term planning tool or “clarion call” that aims to extend life expectancy in New York City to 83 years by 2030. 

“This plan starts with one fundamental truth that we all have to accept: health care, while critical, is only part of the solution. Most estimates suggest that clinical care contributes only about 10 to 20% to overall health, most of the rest attributable to social, economic, environmental and behavioral factors. So, it's time we recognize and invest a proportional amount on prevention,” Vasan said. 

Vasan acknowledged that the city’s life expectancy rates have remained stagnant and have not yet returned to pre-pandemic levels, but he said that the 1115 Medicaid waiver will restructure spending towards preventative services that should increase overall life expectancy. 

“The Medicaid 1115 waiver will allow the state and the city to spend Medicaid revenue on activities that will make the biggest difference on health and health equity – social care,” he said. “This means that Medicaid revenue (for) health related social needs to meaningfully invest in the social determinants of health in communities and community-based organizations, from food banks, transportation, housing subsidies…and childcare for working parents.”

Vasan also noted the increasing need for collaboration among health care entities, through standardization of data and tech platforms to better facilitate changes. 

Regarding the state’s mental health goals, state Office of Mental Health Commissioner Ann Marie Sullivan praised Hochul’s previous allocation of $1 billion towards improving mental health access, most notably across New York City schools.

“The beauty of that budget was that it went from prevention to access, to care, to some very specialized services for the individuals most in need of intensive health in mental health. So, there's not just the commitment to do it, but the dollars are out there on the street. A big effort is in schools: we have about 1200 school-based clinics across the state. We want a school-based clinic in every school,” Sullivan said. 

Many of these school-based mental health initiatives are specifically focused on prevention, such as the state’s “Peer to Peer” program, which gives students a Mental Health First Aid kit they can use to better advise friends and classmates who may face mental health challenges. 

During the summit, panelists stressed that there have been major declines in youth mental health, with many experts observing higher rates of suicidal ideation among young people. 

“For most children that we're seeing throughout the clinics and referrals, we're seeing increased severity of their symptoms, as well as increased acuity, we're also noticing an increased trend in suicidal ideation,” said Kristy-Lee Jean-Pierre, the senior vice president for mental health services at The New York Foundling hospital. 

“There is a need for more intensive treatment,” she continued. “And because of the lack and the gaps in the continuum, we find a lot of times that kids are actually being pushed to the level of crisis before they're actually able to access a lot of the care that they need.” 

In order to address such gaps across the health care landscape, New York City Council Member Linda Lee advocated for solutions that better compensate mental health professionals and social workers, in order to better utilize existing systems. 

“When we're talking about access, I'm curious to see how even us on this panel here can think through, maybe there needs to be regulations in place, but how can we cut down some of the red tape and regulations?” said Lee, the chair of the Council Committee on Mental Health, Disabilities and Addiction. “How do we make sure that the left hand and the right hand know what the other one is doing so that we can actually utilize the dollars better?”

Above all, McDonald said, the health care system must be willing to look inward and address the inefficiencies and outdated policies that still plague the system and lead to worse outcomes for patients.

“When you embrace tradition and are not willing to change things, you settle for lousy health outcomes,” McDonald said. “Health equity is intentional. It's purposeful. We've got to champion these causes and move forward with these things. What's holding us up? I think it's tradition. I think it's protectionism, it certainly isn't access to patient care.”