A New York State of Health
Harmony Arcilla reflects on her time identifying strategies to increase public health across New York with The Prevention Agenda
When it comes to health,where you live matters more than your genetic code. In acknowledgement of this fact, in 2008, New York rolled out its first Prevention Agenda, the State Health Improvement Plan (SHIP) and an instructional guide to reduce health disparities at the local level. In the time since, New York State has jumped up in America’s Health Rankings from the 28th to the 10th healthiest state in the nation, and much of this progress can be attributed to the success of the Prevention Agenda.
Despite a snowstorm the night before, more than 650 individuals from across the state gathered on February 28 in Albany at the NYS Population Health Summit, to celebrate the launch of the Prevention Agenda 2019-2024, now in its third cycle. As SHIPs are renewed every six years, the New York State Department of Health (NYSDOH) unveiled the Prevention Agenda’s new vision, "to make New York the healthiest state for people of all ages.”As the Prevention Agenda Intern, I spent the last year with the NYSDOH trying to identify strategies that increase public health activities around the state. I was eager to learn how organizations—both within and outside of the typical “health sector”—can collectively work toward addressing health disparities in their neighborhoods and promoting the health of their community members.
Evidence shows that public health programs—ones that prevent chronic disease, control infectious disease outbreaks, promote healthy children and older adults, respond to natural disasters and environmental threats, and address mental and substance use disorders—contribute more to a population’s overall health than clinical care alone. But in a nation where only 3 percent of the budgeted $3.5 trillion healthcare spending dollars go toward non-clinical public health programs, how can states like New York promote health in their local communities?
From my experience, I have learned that the first key step in any successful community health improvement effort is listening.
Listening means learning about the experiences of New Yorkers. To this end, my work at the NYSDOH involved seeking, collecting, and analyzing input from more than 220 stakeholders across New York about what community members felt were the most pressing health issues in their neighborhoods. Feedback from public health and healthcare organizations, other government agencies, advocacy groups, community-based organizations, social services, academics, and community members themselves highlighted the changes in public health needs since the last Prevention Agenda in 2012. Some needs include an aging population—one in six New Yorkers are 65 years and older, and the opioid epidemic—drug overdoses have become the 4th leading cause of death in the state. Like the rest of the nation, other issues such as maternal mortality, violence, and e-cigarette use also pose emerging threats to the health of New Yorkers.
Remarks by Dr. Howard Zucker, the New York State Commissioner of Health, echoed the challenges of earning public buy-in that we talk about in class at Columbia Mailman on a daily basis. He acknowledged the difficulties associated with the nature of the field: that much of public health work involves reacting to emerging population health problems such as the current opioid epidemic, but when a community is healthy and thriving due to successful and proactive prevention policies, the work often goes unnoticed.
What people and organizations forget—or even sometimes ignore—is that health doesn't just happen within the clinical setting. It happens every single day in the community—where we all live, work, learn, and play. While healthy behaviors and healthcare are important, communities must acknowledge that social determinants of health—such as social and economic opportunities, education, neighborhood safety, the quality of physical environments, social interactions and relationships—are all critical factors that require more attention.
“Doing better doesn't happen overnight, nor it doesn't start with vague and lofty goals. It starts with seamless ongoing policies, targeted for achievable results,” Commissioner Zucker said.
Several sources of optimism were identified during the Summit.
- The Prevention Agenda provides organizations with an extensive menu of evidence-based interventions, such as upgrades and expansion in recreational spaces, affordable and local food purchasing programs, and opioid prescriber training, that can be implemented for different health goals.
- The Population Health Summit served as a peer learning opportunity, where stakeholders convened with different agencies from across New York to gather ideas, and identify potential multi-sector partnerships.
- The collaborative process to update the Prevention Agenda emphasized listening to and empowering individuals, thus energizing organizations to keep fighting for public health during uncertain political times.
While the Prevention Agenda seeks a broad range of improved health outcomes, the most critical goal is to enable New Yorkers to live to their full life expectancy. There's a lot of work to be done to continue improving the health of all New Yorkers, but I believe collaborative and engaged plans such as the Prevention Agenda establish a sense of hope toward the achievement of thriving communities across the state, the nation, and the world.
Harmony Arcilla is a second-year MPH candidate in the Sociomedical Sciences Department, concentrating in Health Promotion Research and Practice. She received her BA in Anthropology with a minor in Global Health from Northwestern University and worked with the New York State Department of Health to update the New York State Prevention Agenda 2019-2024.
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