MAYORAL FORUM ON PUBLIC HEALTH
As part of the Mayoral Forum on Public Health, we gave every Mayoral Candidate running in the 2013
election an opportunity to submit answers to the following questions. We received responses from Sal
Albanese, Adolfo Carrion, John Catsimatidis, John Liu and Christine Quinn. Their submissions follow
the list of questions.
The coalition of community, professional and labor organizations supporting this forum came together
to ensure that issues relating to public health and access to health care become a key focus in the
upcoming citywide elections. The questions below address our concerns for the state of public health
in the City of New York and our desire for a full airing of the positions taken on these issues by all of
the candidates for Mayor of the City of New York.
Because health care issues are so wide-ranging, so complex, and so personal, this questionnaire alone
is insufficient to bring attention to all of the decisions that will face our next Mayor. Therefore, the
coalition will also prepare and distribute a Policy Paper addressing the full-range of concerns from our
member organizations, including both those listed below and those left out for the sake of reasonable
Certainly there are long-standing weaknesses in public health in the city that remain to be addressed,
some progress over the term of the current administration that should continue to be fostered, and a
hundred administrative decisions to be made by the next Mayor, each of which will have a profound
effect on access to care, prevention, wellness, and other issues for so many New Yorkers. We would
hope anyone pursuing the opportunity to be mayor of our nation’s greatest city would give attention to
these issues commensurate with the impact his or her decisions will have for millions of people.
As if we needed a reminder, the drafting of this questionnaire has overlapped with the continued
recovery from Hurricane Sandy, demonstrating huge fissures in the fabric of our healthcare system and
leaving large numbers of people stranded and vulnerable. With four hospitals temporarily closing
because of damage from the storm’s surge, the resulting patchwork of care exposed the vulnerability of
the health care network that we all rely on. The aftermath of this tragedy will continue for a long time.
We believe that community and labor have a critical role to play in improving health care services for
all city neighborhoods, with a special targeting of low-income, medically underserved, immigrant and
communities of color.
POPULATIONS to target
We know that each ethnic population is more likely to have better health outcomes if their provider
speaks their language or is knowledgeable of their culture. Too many New Yorkers are unhealthy
because they have inadequate housing, are unemployed or have substandard job, lack access to quality
education, nutrition, and safe areas for exercise and other factors that are described as the “social
determinants of health.” Even though New York City’s policy is not to ask patients about their
immigration status, many undocumented New Yorkers remain underserved and uncared for. And we
know that those living with physical or mental disabilities or chronic diseases like HIV/AIDS where
New York City continues to have an infection rate three times higher than the rest of the country, face
persistent barriers to getting the care they need when they need it. Many New Yorkers still remain
unserved and uncared for, including the undocumented.
1. What are the three most important policies your administration would put in place to remove
2. Eleven percent of the NYC disability population has dramatically more frequent diagnoses for
asthma, cardiovascular disease, high cholesterol, developmental disabilities including autism,
diabetes, hepatitis, and hypertension disease than those without. What would your
administration do to address these disparities?
3. What are you willing to do to ensure that support, programs, and funding are prioritized to
people living with chronic illnesses, such as HIV/AIDS, asthma, diabetes, mental illnesses, and
4. What steps can you take in the city to establish additional Early Intervention opportunities for
children affected by Autism and other developmental disabilities, and their parents?
PRIMARY CARE & UNDERSERVED COMMUNITIES
New York City is known as a “medical Mecca,” yet many neighborhoods are medically underserved
and the impact of health care disparities on those residents is tragic. The public and primary care safety
net facilities provide care to the bulk of the uninsured or publicly insured in New York City.
1. Would you match city dollars with state and federal dollars to expand, promote and increase
accessibility of primary care facilities in underserved communities? What types of programs
would you support?
2. How will you direct your efforts to ensure that all New Yorkers receive culturally and
linguistically competent care? How will you direct funds to provide accountability and
oversight over the implementation of this targeted care?
3. Community-Based Organizations have led the way in conducting community health needs
assessment, outreach and education, and enrollment in health insurance coverage. What steps
will you take to ensure that CBOs are an integral part of the ongoing, permanent decisionmaking
4. In a study of American medical schools’ commitment to a social mission, New York City’s
medical schools ranked toward the bottom. Are you willing to use the tax exemption powers
of the city to convince all health professional schools, including medical schools, that they need
to do more to train a work force uniquely suited for New York City, including ensuring more
underrepresented minority students are enrolled?
DEPARTMENT OF HEALTH AND MENTAL HYGIENE (DOHMH)
The Deputy Mayor for Health and Human Services currently oversees 11 agencies, including the
DOHMH. The DOHMH is chartered to protect and promote the health and mental wellbeing of all
1. What qualities would you look for in a Deputy Mayor for Health and Human Services and
in a Commissioner of the DOHMH?
2. The current administration has proposed eliminating the Office of Minority Health. As
Mayor, would you support this position and if so, what would you recommend in its place?
3. When budget cuts are necessary, the cuts targeted to DOHMH almost invariably slice
critical public health programs in low-income, immigrant and communities of color. How
would you open up budget-cutting conversations with a broader community beyond the
City Council champions of these programs to determine priorities for funding in the
4. What mechanisms beyond public hearings would you establish to ensure that the public’s
needs and concerns are taken into consideration in the formulation of DOHMH policies,
planning, implementation, and evaluation?
5. The DOHMH currently offers programs on fighting obesity, smoking cessation and
unintended pregnancies. How will your administration seek to enhance and improve those
6. In anticipation of forthcoming state cuts how would you maintain and preserve the current
level of Early Intervention Services for children and parents or their primary caregivers?
New York City and State face a number of decisions in the upcoming months that could prove
illustrative of the types of funding questions you will encounter as Mayor. The Medicaid Waiver
amendment proposal submitted by the NYS Department of Health to the federal government would
bring in millions of dollars, but decisions related to the distribution of those funds in a manner that
would address disparities remain. As another example, the City has also been receiving Tobacco
Litigation Settlement (TSAS) monies since 1998. New York will continue to receive for 25 years with
a current balance of $120 million year going to the general fund. Decisions must be made as to how
best to allocate these funds for public health initiatives to benefit New Yorkers.
1. Would you target specifically a portion of the tobacco litigation dollars to support public health
2. For both of these examples, how would you work with diverse communities and advocates to
determine which populations need additional services and to ensure that dollars are targeted to
safety net organizations serving communities most in need? What steps and within what
timeline would you implement this process?
3. What other revenues could be used for public health initiatives and services? How would you
insure the inclusion of the public in the prioritization and definition of these public health
initiatives and the provision of subsequent services?
4. What reforms would you recommend and support for the city’s contracting process? How
would you oversee the inclusion of cultural competency and language accessible services as a
criterion in the RFP scoring rubric?
HEALTH AND HOSPITALS CORPORATION
The HHC facilities serve a critical role in guaranteeing access to health care services in New York
City, particularly for the uninsured, immigrants, and people of color. They are also the only access
point of care for many New York City residents, regardless of immigration status. However,
reductions in funding and staffing have strained the ability for HHC to carry out is mission and have
unquestionably driven up Emergency Room use for patients who can no longer get timely
appointments. With the major pieces of the Affordable Care Act, including both the coverage
expansion and the planned cuts to the federal Disproportionate Share Hospital (DSH) funding that
HHC relies on, occurring at the exact same time that the next Mayor’s enters office, there will be
disruptive change in the health care delivery system to which HHC must adapt.
1. HHC is governed by a board of 16 members, ten of whom are appointed by the Mayor. What
criteria would you utilize in making appointments for HHC board members?
2. How would you ensure active participation by both community and labor in all levels of
governance of the HHC?
3. HHC, as part of its “Road Ahead” plan, has been privatizing services. The most recent is the
privatization of the dialysis services at all of the public hospitals, which many of our
organizations opposed. What is your position on the privatization of public health services,
particularly those that are direct patient care?
4. City funding for HHC remains critical, particularly with the anticipated loss of federal DSH
dollars after 2014. Will you continue to insist on adequate city funding for the HHC budget,
and resist additional cuts to HHC services during tough budget years?
5. Given the critical importance of clinical and patient satisfaction scores as factors in Medicare
and Medicaid funding received by HHC, how would you ensure the meaningful input and
involvement of healthcare workers who do the frontline delivery of patient care, such as
doctors and nurses, to achieve high standards in these scores?
6. Staffing standards are critical in determining patient care access and patient care safety.
Because of staffing reductions, many patients are waiting a long time to get an appointment.
Currently, some city nurses are being forced to care for ten or more patients at a time,
exceeding a safe workload. What steps will you take to ensure safe staffing levels exist in all
healthcare environments – including but not limited to the City’s child health clinics, schools
based health centers, and home care?