Title: The Mayoral Candidates and Public Health

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Brian Lehrer: Brian Lehrer on WNYC. Now for the second part of our Health and Climate Tuesday's discussions for today, we will look at the issue of public health in New York City and where the candidates stand on a range of policies regarding that ahead of or during, now, the voting in the mayoral primary election. Public health hasn't received the same attention as other issues, for sure.

The candidates spend a lot of time talking about affordability, housing, public safety, other things, but if we learned anything from the COVID-19 pandemic, we all know how scary a public health crisis can be and how important it is to have leadership that's prepared in case of an emergency. There are also many public health implications of what's going on at the Trump administration with respect to New York City as well.

Joining me now to talk about the impact that the mayor has had and can have on public health and where the candidates stand on some of these issues is Marisa Donnelly. She's an epidemiologist and the New York correspondent for Your Local Epidemiologist, that group. Her latest article is a public health voter guide that you can find on both the news organization, The City, and the Your Local Epidemiologist New York-focused newsletter.

It's simply called Your Health, Your Mayor. What health policies do the mayoral candidates support, and what can a mayor do about health in the first place? Marisa Donnelly, PhD, Dr. Donnelly, welcome to WNYC. Hello.

Dr. Marisa Donnelly: Thank you so much. I'm really excited to be here.

Brian Lehrer: I'll start with the first question you pose in the newsletter. What does the mayor have to do with health? Is this not an issue that usually goes to different job titles?

Dr. Marisa Donnelly: Yes. Thank you so much. The mayor has a tremendous impact on public health. Just in your intro, you talked about public health emergencies like the COVID-19 pandemic. I think oftentimes that's what we think about when we think public health, but the reality is that public health touches so many different components of our life. The mayor selects who the health commissioner is, the budget, what policy priorities on public health issues like chronic diseases, overdose prevention, mental health, vaccines, as well as emergency preparedness get passed.

These really aren't just niche health issues that we're talking about. We're talking about who gets health insurance, whether moms survive childbirth, if kids and teens have access to mental health care in schools, and whether community hospitals get to keep their doors open. The mayor has a tremendous impact. I think that we're really trying to highlight all the many issues that they can influence and that are really on the ballot.

That was the purpose of our guide, was to do the homework for you, look at all of the data and try to get a sense of really what do these candidates say in terms of public health, what are their track records say and what plans have they put forward to make sure that New Yorkers stay healthy and that we keep investing in the programs to keep our families healthy and our neighbors healthy?

Brian Lehrer: Here's the first public health question I was going to ask in the debate on Thursday, if we had had time. According to the City's health department, there are big disparities in life expectancy in the City. A Black New Yorker born today would be expected to live to age 76 on average. For Asian American New Yorkers, it would be until 86, a full 10-year difference; age 82 for Latinos and whites. This includes a Black infant death rate about three times that of whites and Asian Americans. Do the candidates have any specific plans for reducing these life and death racial health disparities?

Dr. Marisa Donnelly: I'm really glad that you're calling that out because I agree that this is a huge issue and it's something that is not just being talked about in New York City, but also on the national stage, right? Chronic issue or chronic health disease is really a conversation that's being had at national levels, and you're absolutely right. The fact that there's a 10-year age or age gap in Asian American New Yorkers and Black New Yorkers is a huge disparity, right?

These racial disparities are caused by a lot of things. Some of these are chronic diseases. Heart disease and diabetes are significant drivers of some of the racial and ethnic disparities that we see among New Yorkers, as well as screenable cancers, and also overdose rates. The opioid epidemic is still definitely an issue in our city, and then all of this has been compounded by what we saw during the pandemic, where certain neighborhoods were hit harder than others, which caused differences in death rates due to COVID across racial and ethnic groups.

Really, what I'm thinking about when I think about health disparities in the election is the Healthy NYC Program, which is a program that's been going on in the City. It was established under the current Mayor Adams, and the goal of that program is to increase the life expectancy of New Yorkers to 83 years old by 2030 across the board, so for all populations, all racial and ethnic groups.

There are more specific goals as part of that, like reducing cardiovascular disease and diabetes by 5%, and also reducing pregnancy-associated mortality among Black women by 10% by 2030, so what I'm looking for is if candidates have supported this Healthy NYC Program, which has some pretty phenomenal goals, and if they have laid out plans to continue investing to reduce health disparities.

There's really two candidates that I have seen really take a stand for chronic disease and reducing maternal mortality. Those are Adrienne Adams and Brad Lander, and I want to say that this is definitely not an endorsement by any means. This is just trying to gather the data and explain what I'm seeing. Adrienne Adams, for example, has passed bills that got Healthy NYC codified into law to reduce chronic illness and health disparities.

She has also declared maternal death a public health emergency and convened the Maternal Health Steering Committee. Brad Lander has also supported Healthy NYC and has actually led some of the audits of the chronic disease programs and called for equity-informed investments in public health and has also released a plan, if he were elected mayor, to combat maternal mortality, which includes things like increasing the number of doulas in New York City and creating midwife-led birthing centers. These definitely are issues on the ballot and ones that I hope whoever wins the race continues to invest in because it's an issue that many, many New Yorkers are confronted with daily.

Brian Lehrer: Listeners, as we did with our Environment and the Candidate segment just before, we invite your phone calls with any questions for our guest now, Marisa Donnelly, epidemiologist and the New York correspondent for the group, Your Local Epidemiologist. If you have any questions about the mayoral positions, those who are running in the Democratic primary, and any public health issues other than the ones we talked about in the last segment pertaining to climate and other environmental, health, and justice issues, give us a call or any candidate you're supporting based on issues in this category.

212-433-WNYC 212-433-9692, call or text. I see that high up in the article, you wrote is the category maintaining Medicaid and public health funding. Of course, many of our listeners know Medicaid funding is a hot issue nationally right now, as President Trump's so-called 'big beautiful bill' includes half a trillion dollars of cuts to the program over time compared to what it would be, so give us a little background on this.

Who in New York City, what percentage of the population, if you know that number or any demographic descriptions, relies on Medicaid for their health insurance, and do we know how much money New York City, in particular, would lose if the bill passes?

Dr. Marisa Donnelly: From my perspective, Medicaid funding is the biggest public health issue that we are facing right now, especially in this election, but also nationally. There is currently a bill going through Congress that would cut Medicaid funding nationally by $800 billion. If that bill passes, about 1.8 million people in New York state would lose their health care coverage. That is a terrible number of people to be without health care.

In New York City, more than 4 million New Yorkers rely on Medicaid for their health care coverage. This is 60% of kids and 50% of births, so any loss to Medicaid funding would be felt among millions of New Yorkers, so this isn't just talking about losing insurance coverage. This is talking about having more crowded ERs, people not getting chronic diseases treated, people not getting screened for screenable cancers.

I've talked about maternal death a couple of times, but this would cause an increase in maternal deaths, so this is a tremendous issue. The mayor of New York City cannot stop the federal funding cuts, right? They can push back hard. The New York City mayor has a huge platform and, I think, has a unique ability to take a stand against federal changes like this. I think thinking about our city specifically, though, they can also do things, if Medicaid were to be cut on the federal level, to help protect New Yorkers.

This is expanding eligibility at the City level, creating stopgap programs, and generally fighting for funding. They can also work to increase Medicaid funds in the City by doing things like raising taxes or trying to make Medicaid spending more efficient, so I think that this is a huge issue. What is really reassuring to me about the candidates right now is that all of them, to some degree, have made statements about preserving Medicaid funding.

I feel very confident saying that all candidates on the ballot, or at least all major candidates on the ballot, are against the federal Medicaid funding cuts. What varies, though, is the plans that they've put forward to actually prepare for the event that Medicaid does get cut federally. The three candidates that I thought stood out in terms of their plans for what to do if Medicaid gets cut at the federal level are Adrienne Adams, Michael Blake, and Brad Lander.

They're all very strongly against Medicaid cuts, but they've also talked about doing things like restoring Article 6 funding, which would increase New York City public health funding by about $90 million per year, increase the amount of doulas that can be covered with Medicaid funds, for example, that would help maternal mortality, and then also do things like increasing revenue, like I said, by cutting down unnecessary spending or reforming property taxes.

Brian Lehrer: Are they different? Are the candidates very different on these things?

Dr. Marisa Donnelly: Of the three that I mentioned, Adams, Blake, and Lander, I would say that they're pretty similar in terms of their approaches. As for the other candidates that I don't see with really detailed plans for what they're going to do, in general, they all support Medicaid, and they're all against the funding cuts, so there's not a huge difference across candidates for this topic.

Brian Lehrer: Here's a question from a listener in a text message that I'm sure you're going to want to push back on the premise of, but I want to give you that opportunity. The listener writes about life expectancy disparities. "If people live longer, it's because of the choices they make in lifestyle and diet." Always, sometimes, or never, Dr. Donnelly?

Dr. Marisa Donnelly: I would say most of the time not. I think there is some degree that's a personal choice, but when you're talking about health disparities in New York City, zip code of where you live is actually the best predictor of how long you will live. It actually is less about what you're able to decide and more about what you have access to in your own neighborhood.

Do you have an affordable grocery store that you can go to and buy healthy foods? Do you have a job that you'd you don't have to commute hours to so that you can go on a walk in the evening? Do your kids have playgrounds that are safe to play on? These are actually issues that really are not in our control as individuals, but that the City and government has the ability to impact by doing things like creating government-funded grocery stores in neighborhoods, creating teen spaces where kids can go spend time together that's safe and clean.

I really would push back on the idea that your longevity is really up to you. I think a lot of it has to do with the environmental conditions that you're in and the economic conditions that you're in as well, which absolutely are impacted by the mayor's policies.

Brian Lehrer: Another question relevant to life expectancy disparities. In a way, you just touched on it. Listener simply asks, "How does the air quality in the Black community affect longevity of Black elders?"

Dr. Marisa Donnelly: That is also a really good point, and that's one that I've looked in a little bit, too. New York City actually has some of the highest asthma rates among kids out of any city in the United States, and those high asthma rates are not spread out evenly across the City. The Bronx, some communities in the Bronx actually have some of the highest asthma rates in the City, and that has a lot to do with pollution, both from traffic and expressways, but also from buildings and infrastructure.

This is something that affects longevity. I don't have good numbers in front of me or off the top of my head on how it affects elderly communities specifically, but I do know that asthma, due to air quality and pollution, are going to impact longevity of New Yorkers as well.

Brian Lehrer: Here's a question about one of Zohran Mamdani's proposals as it might relate to public health. Question is, "What do you think of Mamdani's plan to create city-owned grocery stores, one in each borough, in food deserts, regarding healthy, affordable food?" writes that person.

Dr. Marisa Donnelly: I love that idea, honestly. I think access to food is something that we should all have as a human right, access to healthy food. I think that that could have an impact on chronic diseases, especially something like diabetes and longevity. I think I would like to see additional details on how that plan gets funded and how you make that sustainable long term, but I think that if the logistics of that could be worked out, I think that's a great idea.

Brian Lehrer: Listener texts, "Can you please ask your guest about mask bans as a threat to public health?" It says, "Many people still wear masks in public to prevent getting sick from COVID or anything else going around, filter out harmful matter from air pollution, and/or because they're immune-compromised. Mask bans are anti-science and further stigmatize masking, subjecting elderly, immunocompromised, and disabled people to harassment." Any thought?

Dr. Marisa Donnelly: Yes, I think that right now we're seeing there is a big conversation around personal medical freedoms and the ability to take your own health into your own hands, and I think that masking is an interesting component of this because some are against masks in public for safety reasons, but the reality is if you have an immune-compromising condition or you live with somebody with that, a mask can help protect yourself and those around you, so I definitely think that masking should be a person's choice and they should be able to make that choice to protect themselves and their communities.

Brian Lehrer: Just one follow-up on that mask question, the listener continues, "Cuomo, Eric Adams, and other candidates are for mask bans. Zohran Mamdani has spoken out against restrictions to masking in public, but I don't know if you've looked at that in enough detail to know if those are relevant to masking health concerns, or those who are for restricting masking are only for restricting it in protests.

Dr. Marisa Donnelly: Yes, I actually haven't done much of a deep dive to feel like I can comment on that thoroughly. I think in general, though, masks are a way to help protect oneself and one's family. I think understanding the goal of the mask and when it's appropriate and maybe when it's not is something that is worth thinking about, but yes, I don't feel like I can really comment on that right now.

Brian Lehrer: On another election taking place, a listener writes, "I wanted to plug Antonio Reynoso as the candidate to support for Brooklyn Borough president." He is the incumbent. "Because in his first year in office, he spent his entire budget on addressing Black maternal mortality by funding the labor and delivery units at three public hospitals, Woodhull, Kings County, and Coney Island, now known as South Brooklyn." Do you have anything on that?

Dr. Marisa Donnelly: Yes. Maternal mortality is something that I do think is an issue that should be talked about, especially in the context of the mayoral election. It is a horrible issue. One woman on average in New York City dies from pregnancy-associated factors every week, and Black women are actually three times more likely to die than white women, so this is really a tragic issue.

I think what makes it maybe even more frustrating and sad is that most of these deaths are actually preventable with additional screening and things like anti-bias training and additional support for pregnant moms like doulas or midwives. This actually is an issue that I think should be an urgent and very pressing one at the top of people's minds. The good thing is that most, if not all, of the candidates recognize that this is an issue and have proposed policies that I think could have real impacts on improving maternal mortality, especially for Black women.

I think I mentioned this earlier, but this is increasing access to doulas and making sure that doulas are actually covered by Medicaid funds, creating midwife-led birthing centers, and actually guaranteeing income for expecting moms who might not have secure housing. Adrienne Adams, Michael Blake, Brad Lander, and Zellnor Myrie are all those that have pretty detailed plans for how to address maternal mortality and specifically Black maternal mortality. I would say that all candidates do support this in general. They just don't all have very detailed plans on how they would approach it.

Brian Lehrer: Another issue that you feature prominently in your article is reducing mental health issues and addiction. Mental health is top of mind or close to it for many of the candidates, in part because it interacts with public safety or perceptions of public safety and obviously in its own right as well, so where do you go in your article to compare the candidates on that?

Dr. Marisa Donnelly: Yes. There's two camps that I saw candidates fall into. First of all, I'll just say that this was the topic that all candidates support: improving mental health in New York City, which is great and amazing that everybody has this top of mind. Candidates fell in either into the bucket of addressing severe mental health, so this is, for example, if you see somebody in crisis on the subway, for example.

That's an issue that many talked about, and then the other camp is really addressing more general-population-level mental health, so this is mental health in teenagers, which is really high. About 1 in 10 high school students in New York City in 2021, which is the last year we have good data for this, reported a suicide attempt; amongst teen girls, it's about 1 in 4 that have reported self-injury, so there's a lot of general mental health issue going on right now, too.

The policies that I saw that many supported were increasing access to mental health in schools, in public schools, for example, like building peer-to-peer school mental health programs, so getting kids to help support each other, increasing supportive housing, especially for those with substance use disorder and severe mental illness. We know that stable housing is definitely related to substance use as well as mental health, and then increasing the number of mobile crisis units that respond to 911 calls and actually adding on clinicians to those response teams that can respond before police officers do, so trying to respond first, more with the mental health aspect instead of the policing aspect. I was actually really happy to see that all candidates supported increasing mental health in general, so that is really good to see.

Brian Lehrer: I also want to ask you about Medicare Advantage. We get so many calls and texts from New York City public employee retirees who are very unhappy with the deal that the City and a number of the bigger unions, like DC37 and the Teachers' Retirement System, struck with the City to move retirees from traditional Medicare to Medicare Advantage that is currently on pause, but I wonder if you have looked at that issue and compared candidates on how much they are promising to try to permanently block that switch or support it.

Dr. Marisa Donnelly: I looked at it a bit. My understanding of the issue is that Medicare Advantage programs can be cheaper, but they have much more narrow provider networks, so what you're seeing is that people who are on these plans might be paying a little less money for their Advantage plans, but they're having a harder time getting access to care or finding doctors that accept their insurance now, which is a problem, right?

If you have health insurance, you want to be able to use it. There was really only one candidate that I saw dig into this a bit more, and that was Zohran Mamdani, and he is against moving retired New Yorkers to Medicare Advantage plans, and he wants to keep people on Medicare plans instead of moving them to Advantage. That's kind of the high-level view of what I looked at, so I'll just stop there.

Brian Lehrer: All right. Let's get one more listener in here. Raul in East Elmhurst, you're on WNYC. Hi, Raul.

Raul: Good morning. Good morning. Thanks so much to you and to your guest. I remember Michael Bloomberg wanting to reduce the size of sodas, and industry just pushed back and taking our freedoms away, so as a society, we really need to push back and vote for people that can push back against companies because sugar is killing a lot of people, so that's my thought and that's what I wanted to share. Thank you so much.

Brian Lehrer: Thank you very much. We know that Michael Bloomberg was a very public health-oriented candidate. He bought the naming rights to the School of Public Health at Johns Hopkins, meaning he donated a lot of money to the School of Public Health. He definitely fashioned himself the public health mayor. I don't know if you have a minute to look back on his public health record or if candidates want to emulate that or not, but certainly, Raul, there, points to something that he did try to do and, I guess, was turned back, and that was, in some way, regulate the size of what? Fountain sodas and fast food establishments, I think.

Dr. Marisa Donnelly: Yes, thanks for that comment, Raul. I think that what you're getting at is an issue, and that we should be evaluating the role that industry or private companies play in public health. That is something that we should be looking into and understanding, and I think that that conversation is definitely being held at the national level. Doing something like reducing the size of soda, it sounds like maybe that would have some sort of effect, but to me, that's a topic that gets a lot of attention, but I think the reality is that we can't just be reducing the size of sodas.

We need to be reducing the cost of healthy food, and we need to make sure that healthy food is in communities. I think that the sentiment is there, but how we actually fix the problem of making sure that people have access to healthy food and that they are able to make the choice whether or not they want to have a soda or they want to have a different beverage or fruits and vegetables, to get that choice back to the individual, we need to be investing in communities and community infrastructure, things like grocery stores, farmers markets, walkable communities, communities with clean air. I think you're spot on with what the issue is. I think we just need to focus on how to actually effectively fix that problem.

Brian Lehrer: By the way, one footnote on the Medicare Advantage question, I just looked it up in an article just last week in the news organization, The City, that you're also affiliated with, headline Retirees' Medicare Advantage Backlash Resonates in Mayor's Race, and it says, "Adrienne Adams, Zohran Mamdani, and Zellnor Myrie are taking heat from retired city workers for refusing to sign a pledge to protect their health care from a cost cutting deal championed by a union that endorsed those candidates."

There's that at the end of that. We thank our guest on the mayoral candidates and public health, Marisa Donnelly, epidemiologist and the New York correspondent for the group, Your Local Epidemiologist. Her latest article is a public health photo guide that you can find on that same website I just cited, the news organization, The City, and in the newsletter of her group, Your Local Epidemiologist. Thank you so much for joining us. Very informative.

Dr. Marisa Donnelly: Thank you so much. Don't forget to vote.

Brian Lehrer: That's our Health and Climate Tuesday section of the show for this week, focusing this week on the mayoral candidates on both sides of those issues, meaning the health side, really, the environmental side and other, today, other because environmental is a health issue, too, and other health questions on today's show.

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