The mortality outcomes measured by the indicators in this topic have received increased attention from the City in recent years, and there are policies that aim to address citywide issues as well as specific disparities within each of these areas. The City’s strategy to combat HIV-related mortality stems from efforts at the state level and is being implemented citywide. A new initiative to address the opioid crisis citywide also includes a place-based targeted initiative that may help to alleviate disparities. In addition, a number of DOHMH programs speak directly to disparities in infant mortality and cardiovascular death rates.
In an effort to address HIV transmission rates and mortality, the City has partnered with New York State on the Ending the Epidemic strategy, which may be reflected in the race and HIV-related deaths indicator over time. The City’s goal is to see fewer than 600 new HIV infections in the year 2020, down from an estimated 1,696 new infections in 2015. To achieve this goal, DOHMH aims to boost HIV prevention services (including pre-exposure prophylaxis and post-exposure prophylaxis medication to reduce HIV transmission), enhance the treatment and care of those that are HIV-positive, update the HIV testing equipment of the New York Public Health Laboratory, and provide educational programming in partnership with community organizations that serve vulnerable populations, including the LGBTQ community. In addition to these efforts, the City has also increased the hours of its Sexual Health Clinics and expanded HIV screenings, as noted previously in Quality of Health Care.
Rising rates of opioid-related deaths and the disparities in these deaths, which are the focus of the income and heroin deaths indicator, have prompted the City to take a series of other policy actions. In 2015, for example, it expanded the availability of naloxone, an overdose-reversing medication, by eliminating the need for a prescription. In 2016, DOHMH launched the “Save a Life, Carry Naloxone” ad campaign to educate the public about the medication and where to learn more information. Finally, in 2017 the City launched HealingNYC an initiative that aims to reduce opioid overdose deaths by 35% by 2022, through a range of strategies that include distributing 100,000 naloxone kits through DOHMH, the New York City Police Department, and NYC Health + Hospitals; connecting an additional 20,000 people to medication-assisted treatment; and reducing the opioid supply though a range of efforts including the creation of new Overdose Response Squads targeting dealers in high-risk neighborhoods. The City’s efforts have thus far been concentrated in the neighborhoods with the highest rates of opioid overdose deaths, including four low-income neighborhoods in the Bronx and one on Staten Island. Increasing access to prevention and treatment in low-income neighborhoods may help to reduce income-based disparities over time.
When DOHMH created the Center for Health Equity, it cited the same disparities that we highlight in the race and infant mortality indicator as a primary area of focus. Alongside the DOHMH Bureau of Maternal, Infant and Reproductive Health, the Center for Health Equity operates several programs to support women before, during, and after pregnancy with targeted services that have been shown to reduce infant mortality: the Newborn Home Visiting program provides breastfeeding support for new mothers in North and Central Brooklyn, East and Central Harlem, and the South Bronx; Healthy Start Brooklyn provides a range of support services for pregnant women, including prenatal exercise and infant safety classes, in Central and Eastern Brooklyn; the Nurse Family Partnership Targeted Citywide Initiative supports pregnant teens and women in foster care, homeless shelters, and at Rikers Island with nurse visits; and the Infant Mortality Reduction Initiative provides case management and education in neighborhoods with high rates of infant mortality. These programs target specific neighborhoods and populations in an effort to reduce racial and ethnic disparities.
Finally, cardiovascular health is linked to other health outcomes, including diabetes, exercise, and sugary beverage consumption. In addition to the policies described above, the policy initiatives outlined in the Quality of Health Care and Wellbeing topics may contribute to changes in disparities in the race and cardiovascular deaths indicator.