Brian Lehrer: Brian Lehrer on WNYC. We've talked about democracy and authoritarianism at 100 days. Now we turn to our health and climate Tuesday section. As regular listeners to the show may know, we're covering health and climate stories on the show every Tuesday and have committed to do that at least for the first 100 days of the Trump administration. That's been so these vital stories don't get lost in the mix of other actions coming out of the administration that tend to make more headlines. Our take today will be the chainsaw they've taken to public health budgets, as it might affect people locally. For example, last month, the US Department of Health and Human Services rescinded hundreds of millions of dollars for public health work across New York City and New York State. In the city per se, the health department was stripped of at least $100 million for infectious disease prevention funds. Joining us now to discuss how the city has been hit by the Trump administration and what this all means for responding to disease outbreaks, vaccine outreach, and more, starting on day 101, is Dr. Michelle Morse, interim commissioner of the New York City Health Department and an internal medicine and public health physician.

Dr. Morse, welcome to WNYC. We love to have health commissioners on this show because that's one of our things. We've had a lot of your predecessors, and belated congratulations on becoming New York City Health Commissioner.

Dr. Michelle Morse: Thank you so much, Brian. It's an honor to be on with you. I listen to your show all the time.

Brian Lehrer: Oh, thank you. I see the cuts primarily affect two types of grants that the New York City Health Department received from the Centers for Disease Control, something called the ELC program and COVID-19 supplemental funding. Let's take one at a time. What is the ELC program?

Dr. Michelle Morse: Absolutely. Thank you again so much for bringing attention to this concern. I want to start by saying that overall in our New York City Health Department's budget, about $600 million are federal funding. To your point, of the hundred million that was suddenly rescinded very recently, the ELC program is one of the core public health programs. This funding from the CDC supports our ability to do things like run our Local Public Health Laboratory. That laboratory, for example, can turn around the results of a measles test within a few hours.

This is a core function to us in the New York City Health Department. It also supports things like us being able to use surveillance and data to know if we have rising rates of things like tuberculosis, if we have rising rates of Hepatitis A, et cetera. It's our pulse check for what's happening in terms of health across the city that requires significant infrastructure to be able to do and to monitor a city of our size of 8.5 million people. Another area in the ELC grant, of course, is actually modernizing our data systems.

What we learned during COVID is we were actually having millions and millions of volume of testing, and that our data systems actually were struggling to manage that volume of information. In our increasing efforts to prepare for whatever may be coming next in terms of public health threats, we have to have modern data systems that can manage the volume of a city of our size. Those are some examples of the kinds of things that were covered in the ELC grant.

Brian Lehrer: Are you willing to or interested in putting this in a national context? Because it seems to me that one of the major things that they've been doing in the area of public health, as well as other things, is erasing data from the past. That's some of the most egregious, but also halting the collection of data, all kinds of public health data going forward.

Dr. Michelle Morse: It is certainly a huge concern of ours. I like to say that in the New York City Health Department, data is our superpower. It really is the lifeblood of public health in so many ways. We are concerned that there may be changes in our ability to trust national data at the CDC level because of some of the cuts that have happened and some of the removals of certain data programs and websites from the CDC, unfortunately.

One example that is particularly salient for us is New York City, where we have one of the most egregious racial inequities in maternal mortality between Black New York women and other New Yorkers. The program that monitors the causes of maternal mortality, it's called PRAMS, was removed from the CDC website and is no longer available. That's of huge concern to us because we use that data and look at that data to be able to see how does New York City compare to what's happening nationally in terms of maternal health and reducing maternal mortality. That's just one example of the kinds of concerns that we have.

However, my commitment as the city's doctor and as the acting health commissioner is that no matter what happens at the national level, we will continue to invest in data systems across New York City to protect the health of New Yorkers, and we will continue to use science, evidence, and trusted sources of information to make decisions, policies, and make sure that New Yorkers are protected no matter what.

Brian Lehrer: The example that you gave makes me think of another aspect of what the Trump administration is doing that's part and parcel of the same thing. We know they've been canceling grants and programs that promote diversity, equity, and inclusion, DEI, in all kinds of ways. I think that's putting public health researchers in a tough place where they feel they have to censor their grant applications, at very least. Here's one example. NPR reports that, "Health disparity is among hundreds of terms the Trump administration is telling federal agencies to avoid or scrub from government websites, research, and databases."

I'm curious how might restricting the study of disparate health outcomes in a city like New York, as part of no DEI impact your ability to promote public health and honestly minimize some of those disparities here in the city?

Dr. Michelle Morse: Thank you so much for lifting that up, Brian. It is a major challenge for us. It's partially challenging because in so many ways, health equity and equity in general is really baked into our approach to public health overall, not just in New York City, but the whole entire field. Public health is all about using data and the engagement and information that we get from New Yorkers, from communities across the city, to say these are the top priority health issues, and if we work on these and improve them, we're going to be able to improve and protect the health of everyone.

Even though that sounds just logical and normal and routine, in many ways, that is what health equity is. It's using data to drive resources according to need and make sure that the communities that have, for whatever reasons, the most unfair health outcomes actually see improvement. We are concerned about that for sure. At the same time, core to public health is using data to drive action to improve health for all. The other thing that I'll just say about this is, even though health equity has become politicized, let's say, it is embedded in how we in New York City have developed our Healthy NYC campaign.

Healthy NYC is our vision for getting New Yorkers to have the longest life expectancy that the city has ever seen. Our goal is to get to 83 years by 2030. We want to do that in a number of ways. One of the top killers, the top killer of New Yorkers, is cardiovascular disease and diabetes. We know that some communities bear a much larger burden of those diseases than others. We have to be able to target and focus our interventions and our resources to be able to make sure we achieve our overall goal of 83 years in life expectancy. Part of the way we do that is we look at chronic diseases by place, community, zip code, et cetera, and by race and ethnicity.

What we see actually is that 40% of the premature deaths, that's death before the age of 65, in New York City are to Black New Yorkers. Whatever solution we use to intervene upon that is going to improve everyone's health. Being able to know specifically where the challenges are is the lifeblood of public health, because then we can focus where we do our intervention. This is a big challenge for us, and I know many institutions are facing it. We, again, are continuing to do our work in a way that's based on data, science, and truth.

Brian Lehrer: Are you afraid, though, that as you do what you just described, including not just collecting data, but actually prescribing health interventions at the policy level that are designed to promote health equity, that you're going to get punished by the Trump administration in the future?

Dr. Michelle Morse: It's a time of a lot of anxiety in public health. I think we are very concerned by some of the signals and signs that we see, particularly the recent release of an HHS budget that cuts significantly into programs that talk about health equity. That is certainly something that we're paying very close attention to. I think your point about the risks of retaliation is real. We are seeing certainly that there are consequences to many of the actions that are happening in public health, unfortunately.

Now, at the same time, I think part of what our commitment is in the New York City Health Department, and generally to improve the health of New Yorkers, is that we still need to feel confident in using tried and true approaches to protecting the health of New Yorkers. Even if those approaches are politicized, I think my responsibility as the city's doctor and in working in the Adams administration, which has prioritized health, is to say that we know based on evidence and experience.

It's our 220-year anniversary, so 220 years of experience in the New York City Health Department, we will continue to use our tried and true strategies that have kept New Yorkers safe, and we will continue again to use evidence and data despite some of the challenges that we're facing in public health right now.

Brian Lehrer: Listeners, we have time for a few calls or texts if you have questions or even stories from your own work in a health field or from you as a patient, that helps us report this story. This is the New York City Health Commissioner's 100 Days report on impacts of Trump administration changes so far to public health, potentially certainly to public health funding in New York City. 212-433-WNYC for Dr. Michelle Morse. 212-433-9692, call or text. I'm going to mention one other related thing that's in the news, just to mention it to our listeners because it's new and they may not have heard it yet.

It's not exactly on your beat as health commissioner, I don't think, but tangentially, it certainly is. You can comment on it or not. Since we call this a health and climate Tuesday section of the show, there's also the news that the Trump administration has fired all the scientists who are writing the current edition forthcoming of the National Climate Assessment. The way Scientific American reports it today, "President Trump has dismissed hundreds of scientists working on the congressionally mandated National Climate Assessment, raising concerns about whether the void will be filled with pseudoscience."

It goes on to say the sixth installment of the congressionally mandated report, which was due to come out by 2028, has typically been put together by about 400 researchers, many of whom are top scientists at universities who volunteer their time. The assessment is used to craft environmental rules, legislation, and infrastructure project planning. It is seen by experts as the definitive body of research about how global warming is transforming the country, and that certainly includes public health impacts of warming. Dr. Morse, I wonder if that' in your portfolio as health commissioner in any way.

Dr. Michelle Morse: Absolutely, Brian. This is certainly something we've been looking at very, very closely, watching very closely, have certainly been concerned about the ways in which climate change will impact the health of New Yorkers for a number of reasons. It's part of our scenario planning that we do for emergency preparedness. It's also a part of the surveillance work that we do, so that we know actually when there are changes in health related to climate. I'll just share one example. Unfortunately, we have about 500 deaths per year related to heat.

Also, at the same time that that happens, we know that there are a number of ways that we can prevent those deaths. It includes improving energy security, making sure that New Yorkers who are living in poverty are able to pay their electricity bills and use air conditioning. We also have programs to give out air conditioners to New Yorkers who are at risk heat heat-related injury, particularly in the summertime. Yet again, it goes back to the tried and true approaches that I use as a physician and as a public health doctor. Every day we have to look by geography and neighborhood, and by racial and ethnic groups.

What we see is there are neighborhoods across New York City where these deaths are more likely. That's where we have to focus our interventions and resources. That's what we're doing. Unfortunately, what we know is that the summers are going to get longer, and that means that there is a risk that that number of heat-related deaths that's already unacceptable could go up. We're working very closely with our partners across city government to look at ways in which we can try to protect New Yorkers' health as climate change happens, frankly, in front of our eyes.

Brian Lehrer: Let's take a phone call. Here's Ann in Manhattan. Ann, you're on WNYC with the acting New York City health commissioner, Dr. Michelle Morse. Hi, Ann.

Ann: Hi. Thank you so much for taking my call. I am in public health and actually teach a couple of undergraduate classes locally focused on public health. We cover surveillance early on in the semester. Usually, I give an assignment for them to look up. There's a link to federal data that has information about, in this case, adolescent health and mental health across all 50 states and have them do an exercise where they look things up from their state to try to bring the data alive for them a bit and to help them take a topic that's normally, I think, a little dry and wonky and see how it is very important and applicable to real life.

That was the week that that data disappeared off the federal website, and it offered the opportunity to talk about, from my perspective, this is not a political issue. Knowing the health of people and having the information that you need to help people live healthier and longer lives is not a political issue. I was also very happy that New York City's website, which I think the average person probably does-- is second to none in the country; it still has a tremendous amount of information available. I'm so thankful for that. Again, just echo all the concerns about the disappearance of the federal data.

Brian Lehrer: Thank you very much. A report from the front, there from Ann in Manhattan. Dr. Morse, I want to get to the second main area that had originally been reported of federal government cutbacks that affect New York City under the Trump administration. They moved away from COVID-19 as a major concern. Some may argue that that happened even in the first Trump administration, but can you talk to us about some of the loss of funding there and why you think it may still be important even as far down the road as we are now from the worst of the pandemic?

Dr. Michelle Morse: Absolutely. We are certainly concerned, again, about any changes to resourcing our vaccination programs. That's unfortunately what the impact would be if this $100 million remains rescinded. What those resources did was a number of things to make sure that we were able to tell New Yorkers about it's time to get your flu shot, it's time to get your COVID shot. Those resources to do the public engagement and public information are critically important, and they were a part of these funds.

Another piece that was a part of these funds is one of the most evidence-based interventions we have for improving vaccine confidence and improving vaccine vaccination rates. Using community health workers and community engagement staff across the city in neighborhoods with lower vaccination rates to do the boots on the ground, community engagement in the places where New Yorkers want it in the language that they want it, in the locations that they wanted to make sure that all New Yorkers have access to vaccines, which we know are safe and effective.

Particularly focusing on COVID and flu vaccines during the fall and winter months, it's lifesaving. That was also a part of these funds that were funded by the CDC. Although it's true that we're no longer in the emergency phase of the COVID pandemic, it is very clear that COVID is still with us. We still see plenty of COVID, and the vaccine again is incredibly effective, safe, and protective. I just want to give one example of how much its improved life expectancy by having the COVID vaccine.

In 2021 to 2022, we saw a 48% decrease in COVID-related death or mortality because of the incredibly successful COVID vaccination campaign across New York City that was funded by federal dollars. That is thousands of lives saved. We know, unfortunately, that this fall and winter we're going to see COVID reemerge again. We need to be able to plan for that. Arm New Yorkers with the information they need to protect themselves, remind them of the safety and efficacy of the COVID vaccine, and put the pedal to the metal on our vaccination campaign.

These funds potentially going away would mean that that ability is compromised, and we still have to find ways to protect New Yorkers. I'm worried about that. I am extremely worried about our ability to continue to make sure New Yorkers have the information they need when public health funding that is so central to our day-to-day work is at risk of going away completely.

Brian Lehrer: We're getting texts from listeners who want to ask you about other individual public health programs in New York City and if they're being affected by the Trump administration cuts. One is about HIV prevention and treatment. Another one says, "Can Dr. Morse speak about the public health impact of violence prevention and intervention, gender based violence, and gun violence in the city, as the CDC's Violence Prevention Unit has been gutted and the DOJ, the Justice Department, cancels and eliminates its violence prevention grants."

One of the things I've talked about before is they're defending the deportation of that guy, Kilmar Abrego Garcia, partly on the basis that he had been accused of domestic violence. Yet, at the same time, they've gutted the rape prevention office in the federal government on a systemic level. I wonder if that trickles down or HIV.

Dr. Michelle Morse: Thank you so much to your listeners for both those questions. I also just want to give Ann a shout out who called in earlier for reminding New Yorkers that the New York City website is still active and has tons of data. Thank you for that. I'll start with HIV, and then I'll talk about violence prevention. New York City is the largest hub of international travel in the United States. We are a city, unfortunately, that is often hit first and hardest by infectious disease outbreaks. That's not only true for things like measles, for example. It was clearly true for COVID, but it's also true for things like HIV.

What I want to say is that our prevention work around HIV over the past two decades has resulted in a 71% decrease in new HIV cases over the past 20 years because of funding that we get from the CDC to educate New Yorkers, get them tested regularly, and get them on treatment if they're diagnosed with HIV. It is no longer a death sentence. Considering that and the incredible progress we've made around HIV, this is a program and funding that has to be protected, particularly because of the progress we've made and the fact that we know what works for preventing HIV and for treating HIV.

I am concerned about the threats to our ongoing funding for our HIV prevention programs. Again, we are continuing to work with our city, City Hall, in this administration to make sure that our most core programs are protected, especially at a time when we can't predict what may be cut next at the federal level. When it comes to violence prevention, this is an area that I would say is just incredibly important and incredibly prioritized as well. We take a public health approach to violence prevention. That means, again, knowing what are the zip codes in neighborhoods that have an unique unfair burden of violence and what's driving it.

What we know, unfortunately, is that poverty is a huge driver. We have to work, again, a public health approach is addressing the social and structural determinants of health. We know that poverty is a key driver. We also know that, again, certain neighborhoods across the city, there's a handful of zip codes that have the highest rates of gun violence in our city. I want to give a huge shout-out to our credible messengers who we found partnered with over many, many years in the New York City Health Department to lead our violence prevention programs.

We've partnered very closely with hospitals across the city through our hospital violence intervention programs, or HVIPs, which are programs, again, that engage someone in the emergency room that's been a victim of gun violence and engages them through peers who themselves both understand or have personal experience with gun violence and help to interrupt that cycle of violence that can happen. Those programs are life-saving. They have helped to reduce rates of gun violence in New York City.

The CDC center that looks at that data and recently actually published quite a bit of data about it is, in many ways, the North Star for the data that tells us what works and what doesn't work in terms of violence prevention. Am I concerned about that center losing funding or not being able to publish accurate data about what is really happening with gun violence across our country? Absolutely.

Brian Lehrer: Let me get one more phone call in here in our last minute. Stuart in Brooklyn, you're on WNYC with New York City health commissioner Dr. Michelle Morse. We've got 30 seconds for you. Hi, Stuart.

Stuart: Yes, thank you. I just want to know whether there's any consideration for filing suit against the federal government for stopping these testing programs, like measles testing to prevent another pandemic, and if that's a possibility, have they considered that?

Dr. Michelle Morse: Thank you so much for that question. I will say the threats of measles are one of the things that keep me up at night. I will also say that our attorney general, Letitia James, did file in partnership with 23 other attorneys general, lawsuits to prevent that $100 million of CDC funding from being rescinded from the New York City Health Department. It's still held up in the courts right now. I did submit an affidavit in support of it, really describing what that $100 million does. From what I understand, yes, there are lots of efforts to make sure that when a commitment--- our contracts with the CDC are commitments from the federal government to the health of New Yorkers.

It has been very hard for us to see those commitments broken in some instances. There are potential legal remedies for some of that. We're not sure, of course, what the results of some of those lawsuits are going to be. We're continuing to push for protecting the funding. We've advocated actually to New York State to restore our Article VI match rate. We're losing about $90 million a year in state public health funding because of the lower match rate for Article VI that New York State City receives since 2019.

We're looking at other strategies as well to continue to make sure that we have the resources in the New York City Health Department to protect the health of New Yorkers. City Hall, of course, has been a great partner in us trying to do that as well.

Brian Lehrer: Dr. Michelle Morse, as of now, the interim New York City health Commissioner. She's also an internal medicine and public health doctor. Thank you very much for coming on and talking about the 100 days of the Trump administration impact on public health funding as it affects New York City, and of course, the potential actual health implications. Thank you very much. We look forward to talking to you again.

Dr. Michelle Morse: Thank you for having me, Brian.