The Young Men’s Clinic - Filling in the Gaps Between Population and Clinical Health | Q&A with Silvia Cunto-Amesty
Silvia Cunto-Amesty, MD, MPH, MSEd, is an Associate Professor at Columbia University Irving Medical Center and Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health.
She is also the Clinical Director at the Young Men's Clinic, a health program founded by PopFam and operated by New York Presbyterian Hospital. The Young Men’s clinic is a pioneer model for the delivery of community-based health for young men and still the only clinic in the city tailored to that demographic. “An important aspect of my career has been my work with global health, which also has a lot to do with working with PopFam,” Dr. Amesty explained.
For PopFam’s 50th Anniversary, Dr. Amesty sat down with us to discuss her work with the Young Men’s Clinic, to reflect on her career so far, and to look ahead to the future of global health.
What drew you to the PopFam department as an academic home?
I am a family medicine trained physician, but I also have a degree in public health that I did as a fellow when I came to Columbia. So I had a lot of interactions with the PopFam department.
We sometimes joke in the Department of Family Medicine that we should be integrated with PopFam because we have very similar goals and objectives, especially ways of looking at systems and people. Not just the approach toward public health but the approach to individual health.
How has your work evolved over the years?
For the past 18 years, I have been doing clinical work at the Young Men’s Clinic, which is one of the few clinics dedicated to men’s health. That’s been my clinical focus and I’ve been doing research more related to HIV and sexually transmitted infection in marginalized populations.
An important aspect of my career has been global health, which also has a lot to do with working with PopFam. We have very close ties with the Dominican Republic, and we’ve built this bridge between New York and the people who come from the Dominican Republic, understanding what the needs are when they get here.
Tell us about the Young Men’s Clinic.
The Young Men’s Clinic (YMC) started around the late 1980s with the leadership of PopFam faculty. But really before that because there were a lot of demonstration programs that were bringing men in with focus groups and community engagement to understand what men needed.
Clinics are not places where men are generally welcome. Clinics are more targeted towards women in general. I came to the YMC when it had been around for about 10 years and we were seeing patients twice a week; we were using the family planning clinic space the days they did not have patient care. We wanted to have the men in one space for them, a space that was welcoming to them.
Once we provided the space, men came to get healthcare but, more importantly, they came for other resources––mental health, short term counseling, and discussions around life and issues developing relationships. It was more comprehensive than only sexual reproductive health.
I’m the Clinical Director now and we’re open five days a week. It’s a clinic that’s very dear to my heart.
Tell us about the work you do with marginalized groups.
One of the main aspects of the YMC—and, personally, one of the reasons I really love my work—is that we’re able to see people who are uninsured, underinsured, and migrants. Most of the time, these migrants may have some help, but they’re usually uninsured.
Mental health is a primary focus for our clinic because for some of these communities this is one of the aspects affecting their lives. We really offer comprehensive healthcare to try to help in any way possible.
How has your work at PopFam helped to shape the clinical work?
PopFam fills in those gaps of systemic thinking or structural thinking. Often medicine is focused on disease, but our clinical work is more focused on things like social determinants of health, for example.
Medical schools are still learning how to teach that effectively. Students might be aware of social justice and the concepts but if they experience social injustice and witness it, they really start putting the pieces together. It builds that awareness in students. And that really comes from the work PopFam does around the world in these issues of structural inequalities.
What are you most proud of contributing to at PopFam?
Being part of the Young Men’s Clinic has always been important to me. Men in general may not be marginalized, but services are not targeted to men in general.
I also feel like this is the other half of the equation when we talk about sexual and reproductive health. Working with women’s health is only half the population. If you’re working with STDs or unwanted pregnancies, it’s going to keep happening if you’re only providing resources to women.
I teach Immigrant Health which is very intimately related to the work I do in the clinic.
What is the most pressing challenge for public health right now?
We’re in a very difficult place and I think it’s time for public health to start getting together to think about how we can creatively continue the work we do, because the funding the global health world counted on in the past has been cut.
We’ll have to be creative in terms of how we build up and create funding for some of those countries. It’s tough but it puts you in a position where you really need to be more thoughtful and creative in how you can meet those needs.
How do you think the field will change in the next 50 years?
Global health has always been dependent on funding from wealthy countries. In some ways, that limits the kinds of things that can be done––the funding institutions tend to establish the agenda.
But once you break those systems, you have to put them back together. Every country and community can figure out how to navigate this world in a different way, which can be empowering.
Learn more about the Young Men’s Clinic.