Bronx Connections Local Lens: Health

WFUV News, in partnership with Norwood News and BronxNet Television, presents a five-part series on national issues affecting voters in the lead up to the 2020 presidential election, seen through the local lens of Bronx neighborhood communities. Part three looks at health.

Health and healthcare were always going to be pivotal to the 2020 presidential election, even before the COVID-19 pandemic catapulted them to the top of the political agenda. According to a recent Pew research poll, 68 percent of voters said healthcare was a “very important” issue to them, second only to the economy.

People are rightfully concerned. According to the National Center for Health Statistics, the ten leading causes of death (heart disease, cancer, chronic lower respiratory diseases, unintentional injuries, stroke, Alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease, and suicide) accounted for 74.2 percent of all deaths in the United States in 2015.

Meanwhile, the Organization for Economic Cooperation and Development (OECD) compiled the major causes of death across the world and found that in 2015 the U.S. had lower than average mortality rates for cancers, but higher than average rates in a number of other categories, relative to comparable OECD countries. Taken as a whole, these latter illness categories accounted for the majority of deaths in the U.S. in 2015.

Meanwhile, as reported by Business Insider, in a September 2018 University of Washington study, out of 195  countries surveyed from 1990 to 2016, the United States ranked 27th in the world for healthcare. This is not surprising given the U.S. is one of the few developed nations that lacks universal healthcare, meaning healthcare provided to all residents regardless of their ability to pay for it.

Since 2009, the Robert Wood Johnson Foundation’s county health ranking report has ranked the Bronx as the unhealthiest county in the state. The pre-pandemic healthcare situation in the Bronx has, for years, been tied to high rates of diabetes, asthma, hypertension and other illnesses.

Then, COVID hit. To date, the State health department has reported 3,394 COVID-19 related fatalities in six months. That’s more deaths related to COVID-19 in the borough than people killed in the twin towers on 9/11.

Another fact that gives more context to these deaths is that they occurred in a borough where, according to Data USA, the median age is 34.4, the pre-pandemic poverty rate was 29.1 percent, there is a culture of inter-generational families living in the same home, making social distancing almost impossible, and where the pre-pandemic, annual, household income was $38,467.

In Manhattan, the 2018 equivalent household income estimate was more than double that at $82,479, according to the U.S. Census. In Queens, it was $64,987, in Brooklyn $56,015 and in Staten Island $76,287.

Though some individual zip codes in other boroughs had more COVID-19 deaths per capita than Bronx zip codes, taken as a collective, the Bronx had the worst death rate per 100,000 people of all five boroughs. Unsurprisingly, the City health department reported that most deaths occurred in the poorest zip codes, and among communities of color.

But why is healthcare such a contentious issue? One possible answer is cost. A 2012 OECD study which covered most of the developed world, found that public spending on health per capita in the U.S. was greater than in all other OECD countries, except Norway and the Netherlands.

According to a Sept. 2019 report by the U.S. Congress Ways and Means Committee, U.S. drug prices are nearly four times higher than the combined average price for 11 other similar countries. Committee staff analyzed 2018 pricing data for 79 drugs sold in the U.S., United Kingdom, Japan, Canada (Ontario), Australia, Portugal, France, the Netherlands, Germany, Denmark, Sweden and Switzerland.

“With one exception, we found that individual drug prices in the U.S. ranged from 70% (Lantus Solostar – a type of insulin) to 4,833% (Dulera – a prescription asthma medication) higher than the combined mean price in the other 11 countries,” the report read. “Compared to individual countries, drug prices in the U.S. ranged from 0.6 to 67 times the price for the same drugs.” A report by the American Hospital Association found similar findings.

In a heated exchange at the first presidential debate, President Donald Trump and former Vice President Joe Biden laid out their differing plans to change the current system of healthcare.

Since he took office, Trump has worked not only to dismantle The Affordable Care Act, also known as Obamacare, but neither has he come up with any alternative to it.

Were he to succeed in dismantling it, women, in particular, would be deeply affected given that under Obamacare, at least one form of all 18 FDA-approved methods of birth control for women must be covered by health insurers without cost-sharing. Given Trump’s pro-life stance, as well as that of many of his supporters, this is another reason why the healthcare debate is never settled.

When it comes to costs, Trump says a free market system would help drive down drug prices, an assertion that has been countered by some who say it is government intervention in other countries rather than the free market that often determines the cost of drugs.

“There’s nothing symbolic,” said Trump. “I’m cutting drug prices. I’m going with favored nations which no president has the courage to do because you’re going against big pharma. Drug prices will be coming down 80 or 90 percent.”

His theory is that favored nations, which would give the United States and Medicare access to the lowest drug prices, would help lower-income Americans manage their healthcare costs more than Biden’s plan of expanding the Affordable Care Act.

In September, the president signed an executive order adopting this favored nation approach, after failing to reach agreement with pharmaceutical industry groups. Stephen J. Ubl, President and CEO of Pharmaceutical Research and Manufacturers of America (PhRMA), subsequently released a statement which called the order, in part, “irresponsible and unworkable.”

Other policy experts say it’s too early to tell what the impact of the order will be. Some predict that while some patients with chronic conditions and high drug costs will benefit from it, other patients will absorb the costs through higher premiums.

For his part, if elected, Biden wants to not only stick to the health insurance marketplace created by the Obama administration, but also create a public health insurance option for the lowest-income Americans. Responding to criticism of his plan from the right, Biden explained that the public health insurance option he wants to create would not end private insurance.

“It’s only for those people who are so poor, they qualify for Medicaid,” said Biden, adding that those people can get it free in most states, except, he said, in those states where governors want to deny Medicaid to people who are poor. “Anyone who qualifies for Medicaid would automatically be enrolled in the public option. The vast majority of the American people would still not be in the option.”

Of course, central to the healthcare debate since March has been the coronavirus pandemic. Following the first debate, the president tested positive for COVID-19, and the next day was admitted to Walter Reed military hospital. Upon his release, he thanked his medical team, and said during his stay at the hospital, he learned a lot about the virus. “One thing that’s for certain – don’t let it dominate you!” he said. “Don’t be afraid of it. You’re going to beat it! We have the best medical equipment. We have the best medicines.”

Bronx City Councilwoman Vanessa Gibson, who is running for the borough presidency in 2021, finds the president’s messaging in this regard insulting, given the disparity in care between his treatment for COVID-19 and that available to her constituents.

“We all know that he has access to the highest level of health experts so no matter what he’s affected by, he will be taken care of,” said Gibson. “Not my average grandmother who lives in Highbridge, who has no healthcare, that lives in a building with no elevator, who has to walk up the stairs every day, or my mother of three, struggling to survive and take care of her kids, struggling with asthma and diabetes. That’s our reality in the Bronx,” she said.

Gibson wants to see her constituents get access to primary care. “Many individuals are underinsured. They are uninsured. They have no access to a primary care doctor,” she said. “So, what you have are many families that use emergency rooms as their form of primary care, which is not acceptable. We need to have a consistent pattern of sustainable healthcare that reaches all families.”

She also worries about undocumented and immigrant families’ access to quality care, saying many such residents are fearful of seeking medical attention for fear of getting deported.

Gibson also said most Bronx residents are affected by preventable pre-existing conditions such as asthma, high blood pressure, diabetes, obesity and heart disease, but making matters worse is limited access to healthy food.

A 2014 study by the City’s health department describing the food environment in the South Bronx neighborhood of Crotona-Tremont, for example, showed that, on average, there were 88 bodegas and 36 fast food restaurants per Crotona-Tremont ZIP code, compared to just 9 supermarkets.

Although 91 percent of bodegas sold fresh produce, 20 percent sold no fresh vegetables (excluding onions and potatoes) and 13 percent sold no fresh fruit. The councilwoman is working toward addressing this. Recently, she held press conferences advertising health bucks which give people additional money to spend on food when they buy fresh fruits and vegetables.

Meanwhile, throughout the pandemic, maintaining social distancing and encouraging mask wearing has been central to public health messaging by elected officials and health experts. At a town hall event shortly after Trump returned to the White House from Walter Reed, Joe Biden echoed this sentiment. “Masks matter,” said Biden holding up his own mask. “It saves lives. It prevents the spread of the disease, social distancing.”

He added that all he heard from the president was him telling people not to be concerned about the virus, essentially. “There’s a lot to be concerned about,” Biden said.

Margaret Aldrich is an immunologist at Montefiore Medical Center in the Bronx. She’s also encouraging her patients to wear masks. Her other advice – get a flu shot!

“We worry that the influenza virus will present itself at the same time that we still have coronavirus circulating and we actually don’t know what that would look like,” said Aldrich. “We believe that people can get both infections at the same time and we worry that one infection could make the other worse, so for now, we really only have a vaccine available for influenza.”

Emblem Health is a nonprofit health insurance company that covers many Bronx residents. According to Beth Leonard, chief marketing & communications officer, part of the group’s mission is to help residents manage all the preventable conditions that Gibson listed, from diabetes to heart disease.

“New York is so diverse. We’re excited that most of our associates live and work right here so we’re able to speak your languages, make sure that we understand the nuances of the cultural differences that different groups within New York City might have,” she said.

Leonard said, as an example, they’re working on a diabetes prevention program whereby, instead of promoting the typical food pyramid seen in health pamphlets, they’re adjusting it to make sure it’s culturally competent, and includes foods that culturally diverse groups eat.

In addition, she and her colleagues attend greenmarkets and other community events to encourage people to get insurance. The group aims to give residents access to the tools they need to care for themselves. They also operate neighborhood care locations and other places where residents can find information and healthcare.

It’s clear that health and healthcare are some of the most complex and important issues facing voters this election cycle with subjects ranging from the pandemic to mental health, and contraception to insurance for long-term illnesses. Whoever wins the presidency on Nov. 3, these issues will, no doubt, continue to dominate the national conversation for a long time to come.

*Síle Moloney contributed additional reporting to this story.