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| Dr. Rosa M. Gil |
Gil recalls looking out the airplane window in dismay, seeing a city blanketed in snow and knowing she didn’t have a coat or boots. She realized that she would be improperly dressed as she walked the frigid city hunting for a job in the days to come and indeed, pounded the Manhattan pavement in sandals for the first few weeks.
Gil’s status an immigrant with limited resources has helped to shape her life-long mission to improve the health of the needy, particularly those in the Spanish-speaking community who are mentally ill, homeless and/or HIV-positive. “That has become a passion,” she said. For the last 30 years, Gil has worked continually to alleviate health disparities as she climbed the ranks as a hospital administrator, health agency president, mayoral advisor and university dean in New York City.
“I’m a Cuban refugee and have lived in New York City most of my life,” said Gil, DSW, during a recent interview in her midtown office. “This city opened its arms to welcome me, so the least that I can do is give back. My way of giving back has been addressing the needs of New York City residents around health care.”
Gil, a NYAM fellow since 1999, is a dynamo with an energy level that belies her diminutive physical stature. She has been a powerful force in shaping the health policy of Mayors Edward Koch, David Dinkins and Rudolph Giuliani, the latter who called her “instrumental” to his administration. Under Mayor Koch, for example, Gil was the Deputy Commissioner of the then-new Family and Children’s Services Agency and instituted important changes to the child welfare system. Koch had revamped the agency in response to a horrifying string of deaths of abused children, including the notorious case of 6-year-old Lisa Steinberg, who was beaten into a coma by her adoptive father, Joel. Many people could have intervened to stop the abuse along the way but failed to do so, Gil said. “I call it the conspiracy of silence.”
Gil’s advances include opening satellite offices citywide to be more responsive to families, offering mental health services to children and adults, creating an office of teen health and pregnancy, and offering day care to parents who wanted to work. Most significantly, perhaps, Gil secured funding from Mayor Koch to help social workers obtain master’s degrees and get the appropriate training. All of these initiatives were designed to reduce families’ stress and increase the city’s effectiveness at managing cases. “If you want to protect children, you need to have professional personnel to be able to determine if the family is supportive and if a child needs to be removed from the home,” said Gil, who holds a Doctorate in Social Work from Adelphi University.
Under Mayor Giuliani, Gil made her mark as board chairperson of the city Health and Hospitals Corporation (HHC), the nation’s largest public hospital system. She simultaneously served as Giuliani’s Health Policy Advisor. Gil said two health crises struck her during her four years of service: too many people lacked health insurance, and hospital emergency rooms were being overused for primary care.
Many of the New Yorkers without health insurance were the working poor, Gil noticed. HHC teamed with GHI to offer affordable insurance to small businesses, but the program soon faltered for two reasons. Many companies did not buy the insurance, because even the low $100 monthly premium was seen as too costly; and many workers did not sign up for insurance even when it was offered because they couldn’t afford the employee contribution. “They don’t take it because it’s too expensive,” Gil said.
As the Mayor’s Health Policy Advisor, Gil also pushed hospitals to build more clinics in the community so that patients wouldn’t use hospital emergency rooms for primary care. The initiative helped to ease the emergency room load, but some hospitals ultimately closed their primary care clinics because of an economic reality: the state reimburses more money for emergency treatment than for primary care visits, Gil said. “We all know that having a primary care physician improves the health of communities because the care is not as sporadic,” she said. “However, financial policies do not support that public health goal.”
Gil is known as an expert in delivering culturally appropriate care to Hispanics and today, devotes her professional life to that pursuit. After nearly a decade of public service, and two years as Dean for Health Sciences at the City University of New York, Gil has returned to her role as President of the non-profit agency called Health Industry Resources Enterprises, Inc., (HIRE) that she founded in 1989. HIRE was formed to help the masses of mental hospital patients released into the streets under the state’s deinstitutionalization policy. The agency’s first clients were 25 schizophrenic patients who’d been discharged from the Bronx State Psychiatric Center and needed basic housing and food. “The reality is, if you’re homeless and you’re mentally ill, you need to have a roof over your head and you need to have food on the table” before you will consider getting counseling and taking medication, Gil said.
Through HIRE, Gil has helped to create more than 1,200 housing units and treatment slots for Hispanics and others who are mentally ill or living with HIV/AIDS. Today, HIRE provides housing, mental health and rehabilitation services to underserved New Yorkers in the Bronx and Queens with 300 employees, including psychiatrists, psychologists, nurses and social workers. Poor mental health is an incredibly forceful determinant of physical health status and is a (persistent challenge) among the disadvantaged communities, Gil said. “Stress for the poor people of New York is a constant. It’s not having enough money, and living in awful conditions,” she said.
Gil said that her goals have always been congruent with those of NYAM, and she considers the institution to be invaluable to New Yorkers. Fellowship in NYAM has been a great honor to her and a source of pride. “The Academy is a wonderful institution that opens up dialogue between policy-makers and practitioners about the health needs of New York City residents,” Gil said. “The Academy keeps a finger on the pulse of what’s happening in the city, puts out data and pinpoints relevant health issues that need to be addressed. It would be difficult to think of the health community in New York City without thinking of the Academy.”
