Bronx Borough President Ruben Diaz Jr. and the “#Not62 Campaign for a Healthy Bronx” steering committee held a virtual discussion on Wednesday, July 29 entitled, “A Discussion of Health Disparities and COVID-19.” The dialogue focused on why and how the Bronx ended up with the highest rates of COVID-19 cases in the State, from both a historical and an analytical perspective, as well as what could and should be done to shift that disparity.

 

Since 2009, the Robert Wood Johnson Foundation’s county health ranking report has ranked the Bronx in 62nd place out of New York State’s 62 counties in terms of health outcomes. In response to this, several interested groups came together in 2015 to build a collaborative campaign of partners and Bronx residents who pledged to live, work, play and pray in a manner that improved everyone’s overall health.

 

It represented a call to action, and was led by the Bronx borough president’s office, the Institute for Family Health – Bronx Health REACH, CUNY’s Institute for Health Equity at Lehman College, Montefiore Health System, and Bronx Neighborhood Health Action Center, an affiliate of the City’s department of health. Collectively, they aimed to address the social and economic conditions that impact the overall quality of life for residents in the borough, change health behaviors, and improve clinical care and the physical environment to help Bronx residents attain their highest level of health.

 

Diaz Jr. opened the Zoom meeting, explaining that the goal had been to get the Bronx out of the bottom spot on the ranking index by 2020, but this had not yet been achieved. “We are getting a little bit healthier than the previous year, so we are headed in the right direction, but we still are in the last place,” he said.

 

The speakers included Jane Bedell, M.D., the former Bronx head of the Bronx Neighborhood Health Action Center, Lessie Branch, Ph.D., race scholar and associate professor at the Metropolitan College of New York, and Denise Nuñez, M.D., a pediatric critical care physician at Montefiore. Dr. Oxiris Barbot, the former City health commissioner, framed the discussion by outlining the department of health’s response to the pandemic.

 

Diaz Jr. asked Barbot how far along the department was in implementing rapid COVID-19 testing and getting test results back in under half an hour. Barbot said that testing had always been everyone’s Achilles’ heel throughout the pandemic. “Not only as a City, but as a country, we’re nowhere near where we need to be in terms of having turnaround times that help people make real-time decisions that are going to help to reduce the transmission of this virus,” she said.

 

In terms of the types of tests available, Barbot said the most reliable test was the PCR test, and the most reliable way to get the PCR test was at a commercial lab or at a lab in a hospital. The problem, she said, was that there was limited capacity for such testing across the country.

 

Barbot said that while previously test results were available in 24 hours using this method, as more testing was rolled out to more people, that timeframe for obtaining results went up to 48 hours, and later to over a week, which she said rendered the test meaningless [given that immediate isolation was needed by anyone who tested positive, to curtail the spread]. To address this problem, Barbot said pop-up testing sites were set-up “in the field” in places like Tremont, and similar technology was used to perform another type of test which was faster but less reliable.

 

This rapid testing method, Barbot explained, sometimes caused false negatives and positives, meaning that some people tested negative in the field but when tested later in the lab, turned out to be positive and vice versa. Nonetheless, she said, this rapid test had its benefits. “In a community where we have high levels of virus, that are still circulating, the chances of a positive in the field being a true positive are going to be much higher, so that’s why that test is good, in communities where there’s high viral load,” she said.

 

Diaz then asked Barbot how far away she thought the country was from getting a vaccine, and what was the likelihood of a second wave occurring. Barbot said she felt it was inevitable that there would be a second phase of increased transmission. She added that until a vaccine, and definitive medication to treat the virus become available, people will have to assume that there will be more cases, especially as people begin to spend more time indoors in the fall.

 

Her recommendations were to wear a mask, to stay home if sick, to wash hands regularly, and to practice social distancing. “Anyone who thinks we’re going to test our way out of this pandemic are kidding themselves,” she said.

 

 

For her part, Bedell spoke about health outcomes, and the factors that contribute to lower life expectancy in the Bronx. She displayed a map of the City where lighter colored areas represented a higher rate of life expectancy and vice versa. “I want to draw people’s attention to the Bronx, which is only in the dark colors,” she said. Bedell said growing up in the Bronx decreases the chances of living a full life, because of the way assets and resources are distributed in the borough, compared to other parts of the City.

 

 

First, she described the population of the Bronx as being overwhelmingly made up of people of color, the majority of whom are young people. One third are first generation immigrants and as a result, 90 languages are spoken.

 

She then presented slides that showed that the Bronx has a high rate of overcrowded housing and multigenerational housing, which overlap with each other, increasing the risk of COVID-19 transmission. Diaz, as a Puerto Rican, explained that this multigenerational housing arrangement can be for cultural as well as economic reasons. “In my mother-in-law’s house, my wife’s grandmother is 84 years old, and she’s in the household,” he said.

 

Bedell explained how the practice of redlining had influenced the City and the health outcomes of people generally, explaining that banks in the U.S. had historically denied mortgages to certain people, mostly people of color in urban areas, preventing them from buying a home in certain neighborhoods or from getting a loan to renovate their homes. She said this practice, that was once backed by the U.S. government, started in the 1930s and took place across the country in many of the larger cities with large minority populations. “These redlining maps set up policies and practices that real estate businesses profited from, and that have left a tremendous legacy today in terms of housing, and therefore health,” she added.

 

Branch expanded upon Bedell’s presentation, explaining how advocacy, activism, urban policy, and Black optimism for social progress, are all key areas of intervention in health equity and access. She talked about how unemployment is higher in the Bronx than it is citywide, and that the national mortality rates of COVID-19, according to the Economic Policy Institute, are three times higher for Black people versus white people. Branch said that what puts Black and LatinX communities into situations of higher unemployment rates and COVID-19 infection, is policy.

 

She concluded that there was one positive, if it could be called a positive, that emerged from the pandemic. “So, what has COVID done?” she asked. “COVID-19 has made policy violence leveled against Black and brown communities visible.”

 

For her part, Nuñez spoke about the lessons learned from the pandemic in terms of treatment and survival, including how to monitor one’s health by keeping regular appointments with health care providers, eating well, getting vaccinated, and generally being more cognizant of our overall health from a preventative, rather than a reactive standpoint.

 

Diaz, who is serving his last term as borough president, ended the meeting by encouraging everyone to stay safe. “Thank you all. God bless you all, and God bless the Bronx,” he said.

 

Since the discussion took place, Barbot stepped down as health commissioner on Aug. 4 citing her disappointment that during the most critical public health crisis in this lifetime, the City’s health department’s incomparable disease control expertise was not used to the degree it could have been.

 

The borough president and the #NOT62 partners will continue to offer ongoing public outreach events covering various different health related topics, in the future.