Having completed a strategic review, we have reaffirmed our focus on the health of people in cities. More than half the world’s population resides in cities, and from our home city of New York we can have a powerful impact on health issues here, nationally, and abroad.
We have identified three critical priority areas with important long-term health impacts that challenge our city and our nation: creating environments that support healthy aging, strengthening systems that prevent disease and promote the public’s health, and, developing and supporting implementation of interventions that eliminate health disparities. Along with the continued development of our Library, these priority areas will serve as the primary focus of our efforts over the next several years.
1. Promoting Healthy Aging
One of the major demographic challenges facing the United States and the world is the aging of its population. This phenomenon is occurring most rapidly in cities. This is good news. It reflects improvements in health and advances in economic and social development that have led to longer life expectancy. It presents special challenges, however, for all societies to assure that older people receive support to protect their health and quality of life, and continue to contribute to their communities for as long as possible.
In New York City, the population of people over age 65 will increase by 44 percent over the next 10 years making it the most diverse older population in the country, if not the world. Current healthcare reform initiatives are focused on controlling the high cost of caring for older persons with severe chronic disease at the end of their life. NYAM champions a complementary focus on prevention and healthy aging—creating the environments, policies and programs that allow people to live longer and healthier lives fully engaged in and contributing to the life of our city. We are also at the forefront of educational and policy initiatives that target workforce development and creating models for care coordination in the field of aging, all aimed at helping older adults lead healthy, independent lives.
NYAM leads New York City’s participation in the World Health Organization’s global network of 35 Age-friendly Cities and over the next several years, will undertake an effort to create a nation-wide network of cities that will promote healthy and active aging.
2. Preventing Disease and Promoting the Public’s Health
Working in partnership with local, state and national public health and community leaders, we tackle the root cause of avoidable illness, disability and death. Personal healthcare is a critical factor in maintaining and restoring health and has attracted most of the resources and political and public interest in the health policy world. However, it is only one influence on a person’s health. Research shows that there are multiple determinants of healthy behavior that affect both the understanding of healthy choices and the ability to make them. Examples of such determinants include neighborhood environments that allow people to buy healthy and affordable foods, exercise in safe spaces, and the ability to avoid pollution and unhealthy housing conditions that contribute to asthma, lead levels that impair intelligence, and social isolation for older people. While government has the ultimate responsibility to assure that conditions under which people live are as healthy as they can be, it can’t do the job alone. The collaboration of government, business and academia, healthcare providers and payers, media and community leaders is required in order to create healthy communities. NYAM has a critical role to play in these collaborations.
At the national level, we provided research to create a Return on Investment analysis for community-based prevention in areas of diet, exercise and tobacco use that have proved instrumental in the allocation of $600 million in the new Administration’s stimulus package. This is the beginning of a continuing effort to increase the focus of U.S. healthcare reform on prevention, working with our national partner Trust for America’s Health.
At the State level we have worked closely with the State Health Commissioner in shaping the statewide Prevention Agenda, which seeks to develop community-based partnerships among hospitals, local health departments and community groups to tackle the ten biggest causes of illness and premature death in New York State and promote primary care and prevention as critical priorities for personal health services.
With the City, we are working to develop, intervene and evaluate the impact of community-based activities to promote healthy diets, exercise and prevent tobacco use in Harlem and the South Bronx in collaboration with the New York City Department of Health and Mental Hygiene, elected officials, and a broad base of community groups.
3. Eliminating Health Disparities
The existence of vast national disparities in health status, access to care, and healthy conditions in communities to support healthy behavior is a national disgrace. Nowhere are these disparities more apparent than in cities. While other organizations work to address a variety of important health policy issues, especially access to and the financing of healthcare, we seek to complement their efforts by looking “upstream” to tackle the root causes of avoidable illness, disability, and death. NYAM researchers document disparities, update and refine our understanding of the factors that shape disparities, and use that information to design and test innovative interventions and evaluate their impact. Some programs we develop and evaluate are meant to improve an individual’s knowledge or shape an attitude that will transform behavior. Other programs work to strengthen ties between people to build sustainable social support. Many have resulted in policy change that has affected millions of lives.
One of the critical factors in health disparities is the lack of diversity in the health workforce. NYAM works with partners to extend the educational pipeline for underrepresented students from middle school into health professions schools. In 2008-09 alone, more than 100 underserved minority middle school students had opportunities for academic support, career exploration and life skills development to build their motivation and capacity to pursue careers in the sciences, medicine, health and allied health professions.
4. Serving the Public
The NYAM Library, established with the Academy in 1847, is essential to the mission of the organization and today serves as the only medical library in New York City open to the public. It is one of the largest medical libraries in the United States, with Rare Book and Historical Collections that rival the holdings of the National Library of Medicine and Harvard’s Countway Library. In particular, its collection of “grey literature” (defined as resources that are hard to find, not indexed in any accessible database, and usually in the form of white papers or technical reports) is extensive and growing as a national resource through its free subscription service. The Library boasts large, and in many cases, exclusive holdings of primary source materials relating to clinical medicine, disease, and public health in the United States. Its Americana collection includes 85 percent of the books, pamphlets, periodicals, and broadsides of medical interest printed in North America between the late 16th century and the early 19th century. The Library also serves as an invaluable resource to our staff, the 2,000 NYAM Fellows and Members, and the community at large.
Our Commitment
NYAM is the principal institution in New York City with an independent and non-partisan commitment to evidence-based decision making. As such, we are in a distinctive position to assemble diverse stakeholders on a given issue and support collaborative problem solving. This enables us to maximize the potential for win-win solutions to important public health problems. By convening critical opinion leaders—from legislators to those directly affected—we can articulate a shared vision in the approach to public health issues, which translates into action.
We accomplish our objectives through:
- Research—NYAM contributes directly to the knowledge needed to shape health policy and programs in cities with its expertise in social epidemiology and community-based participatory research. We focus on the broad determinants of health—models of care, policies and programs that emphasize public health and prevention and the social factors of education, economic development, housing, and sense of community. These are embedded in the neighborhoods in which people live and profoundly affect their ability to lead healthy lives and make healthy choices.
- Policy Advocacy—Advocating sound, evidence-based public policy is critical to NYAM’s goal of advancing the changes needed to improve peoples’ lives and health. Some evidence comes from our own research in areas of health disparities, other from our systematic review of the literature on best practices drawing on the resources of our Library and its global connections. We use our convening power to conduct our own exploration of critical issues with stakeholders, and we work with partners in the areas we select for action.
- Education—Our Conference Center provides a venue for programs that inform the public, policymakers, providers of and payers for health and social care, including those health workers on the front line of direct services. Our 2,000 Fellows and Members, who are the best and brightest in the health and health related professions, sponsor meetings on a variety of medical, health and scientific problems. These meetings provide a unique opportunity for the public to join experts from across New York City’s great medical institutions to discuss and debate the latest developments in biomedical research, clinical practice and health policy. And, our Library supports these efforts by providing public access to our valuable collection of medical and public health information.
- Community Engagement—Historically and to this day, our dedication to New York City includes work in the school system. Over the past 20 years, NYAM’s school health program has developed curricula and trained more than 40,000 teachers who have in turn educated five million students and their families to make healthier choices in areas such as diet, exercise, tobacco use, skin care, reproductive health, and strengthening their self-esteem. Our Junior Fellows and Scholars programs help under-represented minority youth understand the excitement of pursuing health careers, beginning in middle school. We are now providing health programming to established community-based organizations in underserved communities, especially those serving young people. With a new commitment for sustained engagement to improve the health status of residents of East Harlem, we are working in partnership with the New York City Department of Health and Mental Hygiene, elected officials, and a broad base of community groups to develop, intervene and evaluate the impact of community-based activities to promote healthy diets, exercise and prevent tobacco use in Harlem and the South Bronx.
Urban Health
When NYAM refers to urban health, we mean: The hallmarks of urban settings are size, diversity, density and complexity. These all have an impact on the health, well being, and human potential of those living and working in cities. While these four factors broadly affect everyone, they create health disparities that cannot be explained by an individual's behavior alone, but are directly related to differences in the physical and social characteristics of neighborhoods. Understanding and intervening to eliminate these disparities is fundamental to NYAM’s research and action to improve urban health.
