West Farms 10460: The Public Health Toll of Coronavirus

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Brian Lehrer: It is The Brian Lehrer Show on WNYC. Good morning again, everyone. Now, we continue with our election-year series West Farms 10460. We're talking about a neighborhood nestled between The Bronx River, Southern Boulevard, The Bronx Zoo, and the Cross Bronx Expressway, West Farms. We're doing this to tell the story of a neighborhood in a city reeling from the economic and health tolls of the coronavirus pandemic, and to make it clear that there's a long history of disparity in this city that persists into the present and this neighborhood, well, there's maybe no more perfect example of it. Vital to talk about in this mayoral election year.

We're also going to be speaking to people in the neighborhood working to foster community well-being. These conversations, we hope, will inform future conversations with elected officials. Candidates for the open city council seat there where a part of West Farms is situated in District 15 that Richard Torres used to represent before he got elected to Congress. We'll have those candidates on, and the crowded field of mayoral candidates as well. We're going to ask them about West Farms in The Bronx.

In a year where calls for efforts to advance racial justice are so urgent. Most Black and Latino neighborhoods like West Farms deserve recognition, obviously, not just for the problems of poverty, but maybe even more importantly for the efforts of the people who have built the community up.

Today we'll talk about the community health profile of West Farms. The New York City Department of Health and Mental Hygiene has its own community health profile of each community district for the one that includes West Farms, last released in 2018. It shows that the area has higher rates of obesity, diabetes, and hypertension than the city wide rates at 22%. The rate of diabetes in the area is twice the city's rate of 11%. There are also higher rates of new HIV infection, hepatitis, infant mortality, and premature death overall.

Now, given that some of these medical conditions are associated with more severe coronavirus infection, the health toll of the pandemic has unsurprisingly, been heavy. 1 out of 14 residents has had a confirmed case of COVID, and 1 out of 388 people are confirmed to have died from COVID. That's a high rate in any population, according to the city's Department of Health and Mental Hygiene. We don't have data about the rate of vaccinations on such a granular level at this neighborhood level, but nationally, public health officials have sounded the alarm about inequitable access.

What we can say is that the number of people tested for the coronavirus in the ZIP code 10460 is about 20% less, the rate is 20% less than the city-wide average. That's bad for a neighborhood that has more virus than other neighborhoods, to be sure. With me now are Dr. Sybil Hodgson, medical director of the Montefiore Medical Group West Farms Family Practice, and Dr. Diana Hernandez, associate professor of Sociomedical Sciences at the Columbia University Mailman School of Public Health. Dr. Hernandez. Dr. Hodgson, thank you so much for coming on with us today. Welcome to WNYC.

Dr. Diana Hernandez: Thank you. Happy to be here.

Dr. Sybil Hodgson: Good morning. Thank you for having me.

Brian: Listeners, continue to help us report this story. As we said last week, when we started the West Farms 10460 series, we want to hear from anyone who in normal times would be taking the 2 and 5 trains to and from West Farm Square, East Fremont, East Fremont Avenue, that stop, of course, or any of the buses in that vicinity. We are opening up our lines right away. What would you like the rest of the city to know about the health toll of the pandemic in West Farms if you live or work in the neighborhood, or if you have family members who live or work in the neighborhood, what would you like to candidates running for city council and for mayor to know .

You can share your demands for your next city council member and the next mayor of the city. You can also shout out people or organizations in the community doing important work today in the area of health, or share community resources that people may or may not be aware of that enhance community well-being. 646-435-7280. Anybody may call, but first priority for anybody with personal connections to West Farms 646-435-7280, or you can tweet @BrianLehrer.

Dr. Hodgson for you as medical director of the Montefiore Medical Group West Farms Family Practice, can you describe for our listeners, what that practice is like in general, who you tend to see, how it kind of represents the neighborhood in particular ways?

Dr. Hodgson: Sure, thank you. Our practice, we describe ourselves as a neighborhood practice. We are located right next to the West Farms train station. As soon as you get off the subway, we are one of the first buildings you see. We are a family practice, meaning that we see persons of all ages, so newborn and all the way up. We tend to have a group of patients that are, we feel a lot of young people, and then we have a large amount of persons over the age of 65. Really, we do see lots of families.

We've been seeing generations of families since our doors have been open. We see the common diagnoses, which would be diabetes, high blood pressure in our adult population. I would also say that we do take care of patients with HIV, hepatitis. We really provide full-service care, because we are very much aware of the disparities and access to health care in that area, and so we utilize ourselves to connect patients to all sorts of care when they come in and become patients at our facility.

That means that we can connect you to any type of specialist list that you might need, depending on your diagnosis. Also, we are able to provide mental health and behavioral health, which is really important. Especially during this time with COVID, there has been a lot of mental health challenges that have come out of this, and so we really are able to manage that as well.

Brian: How's the neighborhood doing, COVID-wise, in your estimation from the frontlines?

Dr. Hodgson: Oh, it's been devastating. devastating. We initially, and I think a lot of physicians realize this, when everything first happened, I can't believe I'm saying this, almost a year ago. Basically, the mantra was to stay home if you're not feeling well. People really did that, so we didn't hear from patients for a long time. Then obviously, we had to flip quickly to telemedicine because we were not seeing people in the office initially when everything first happened. We started using telemedicine, which has really been challenging to implement because that means you need to have some sort of device to connect to, and those are challenges.

We didn't hear from a lot of patients, and then when we started seeing people again in the office, and started proactively reaching out to patients, we started curating our list of patients that we had not been in contact with for six months, we realize a lot of people were scared to come in. They thought leaving their home would mean that they were going to get COVID, and so they didn't want to leave their homes at all. They were not connecting with any type of health care.

A lot of people's diabetes went completely out of control. They ran out of medicines, and didn't contact us a call to pharmacy to get refills. People missed very important appointments and procedures, so it's really had a devastating effect in the community.

Brian: Can I ask you a vaccination question at the neighborhood level before we bring in Dr. Hernandez? I happen to live near another Montefiore Medical Group Family Practice in another part of The Bronx. I see that they are offering vaccines. Are you offering vaccines, and how accessible would you say the vaccines are to people in West Farms?

Dr. Hodgson: I would say this, obviously, the vaccine availability is dependent upon how much we receive, and that we all aware of that is a challenge at the highest governmental level about how much is being allocated to New York, and then how much New York is allocating to the various counties and communities. Fortunately, Montefiore has received vaccine. We started receiving vaccine, like the end of December, and we followed the rules as far as getting it to all of our frontline healthcare workers.

Then, when the rule changed, we were allowed to vaccinate adults 65 and above, we started offering it to the community. We, at West Farms, are not doing it, but we have multiple Montefiore sites that are, and we are trying to connect our patients to those sites, and many of them are only a few bus stops away. The plan is when we get more, we will probably have it at our location, so it's really about the supply of vaccine.

Brian: All right, Dr. Hernandez from the Mailman School of Public Health at Columbia University, from a public health perspective, when you're investigating the root causes of health disparities like some of the ones that I laid out from West Farms compared to the city as a whole, where do you start to look?

Dr. Hernandez: This is really in some ways rooted in legacy issues of poverty, of disinvestment in communities, most certainly of the concentration of disadvantage at the neighborhood level. When you think about a place like The Bronx, there are many kinds of reference points to this, but you have one of the most impoverished congressional districts in the United States. That has been a long-standing designation, so this is not new. You also have the concentration of people of color, and low-income people of color, in many ways, rooted in policies around redlining. That's the kind of practice of discriminatory lending on the basis of the racial, ethnic composition of a neighborhood.

You also have other planning decisions such as actually putting in the Cross Bronx infrastructure, which essentially separated the neighborhood structure in some ways, to facilitate moving from suburban areas into the central core of the city, but really also decimating and compromising the very fabric of the community. Then also introducing issues such as air pollution and the disproportionate amount of it. Really, at the root cause of the health disparities that we see in COVID are also long-standing health concerns around obesity, diabetes, hypertension, which you'd mentioned are higher, not just in West Farms, but also in The Bronx in general, in comparison to city averages.

Well, there are reasons why infection rates are higher and some of that has to do with crowded housing, it has to do with the fact that this is really the core, the basis of the essential workforce, folks that are actually having to interface with the public, and then you relying on public transportation and other things to actually get to work. That's one of the reasons why there's just a higher case rate in The Bronx.

Then when you think about the severity of illness, a lot of that also has to do with the fact that there are these pre-existing health conditions that, like we just described, around chronic health conditions, diabetes, hypertension, obesity, being the most relevant here, and that also then creating the pathway to a higher death rate. When we think about devastation in this community, it has a lot to do with those precursors for poor health that COVID somehow pounced on over the course of the last year, but especially at the height of the pandemic last spring.

Brian: You mentioned poverty as central and at the beginning of your answer, and West Farms is in what is generally referred to as the poorest congressional district in America. 31% of the people there live below the poverty line, and 60% of residents are rent-burdened, according to the city's community health profile of the area. Last week, in the first segment in this series, we spoke about the history of disinvestment and neglect in West Farms and adjacent communities, and these things make it harder to alleviate poverty.

Dr. Hernandez, part of your work at Columbia, I see, is to study the impact of what you call place-based interventions on the overall well-being of vulnerable populations. It would be good, of course, if we didn't need to solve these on a neighborhood by neighborhood basis, if society would finally do something to alleviate poverty, and/or greatly reduce poverty and the inequality that's only been growing in our country in recent decades, but in the meanwhile here you are as a public health professional, with the conditions on the ground that you find. What's an example of a place-based intervention and what ways does it begin to address a history of neglect and disinvestment?

Dr. Hernandez: A lot of what I do is actually what we call operationalizing housing and household energy as determinants of health. It's to say that where you live matters and where you live matters based on, of course, the neighborhood conditions and what that ultimately means in terms of school quality, the quality of medical institutions and other things that are essentially the rendering of services.

Also, it's about affordability, stability, and quality conditions of housing. When I have been doing these evaluations of either housing, or energy-related policies on the health and well-being of folks living in disadvantaged contexts, it has basically been about understanding the impact of, for instance, upgrading the energy infrastructure and buildings, or most recently, looking at the impacts of the Rental Assistance Demonstration Program, which is the privatization and also opening up of capital, improvements for public housing residents.

The legacy of this investment is really obvious, especially in the housing realm, not just for the purposes of explaining something like redlining, which I'd mentioned before, but also thinking about the mechanism of allowing housing to depreciate in its quality over time. When there are significant upgrades on, well, what does that ultimately mean for health in the proximal sense? Some of that is just about resident satisfaction, but long-term, in terms of eliminating conditions like mold, asbestos, lead.

These kinds of conditions that we know for a fact also have implications for health across the life course. Meaning that from pre-birth to old age, the more time people spend at home, and the more exposure they have to these poor housing conditions, it basically compromises health in a lot of different ways. That's been a big part of how, just evaluating what some of these housing interventions ultimately mean for low-income populations is an important way of understanding, first of all, the impacts of housing on health, but also just thinking about the solutions that help.

Brian: Listeners, we're going to take some phone calls in just a second for Dr. Hernandez and Dr. Hodgson. You can call in from West Farms, or if you live in another neighborhood of the city that has a similar health profile to what we've been describing in West Farms, The Bronx, West Farms 10460. You can call in with a question about public health, personal health or political health. What do you want the mayoral candidates to know, city council candidates to know about West Farms or any neighborhood like West Farms from a public health standpoint? 646-435-7280, 646-435-7280 or tweet @BrianLehrer.

Dr. Hodgson practicing at the West Farms Family Practice of Montefiore, just before we take a phone call, I'm just curious, as you were sitting there and listening to Dr. Hernandez, who's more of an academic lay out, the big picture, here you are in practice. What were you thinking?

Dr. Hodgson: I was thinking about the patients I see every day that fall into the categories of having housing insecurity, food insecurity, unemployment, and what do we try to do to address that, and understand how it impacts their health? One of the things that we do specifically, is we do social determinants of health screening for our patients when they come in, and we have a questionnaire that asks questions about their housing, their food availability, any concerns about violence in the home, any legal issues.

If people are willing to fill it out and want some help, we then connect them to community resources like food pantries or legal services, or behavioral health services. We really try to incorporate what we know about the lives of our patients into their health and wellness, and really try to meet them at the moment they come into the practice.

Brian: I'm curious about one thing that you may see in your practice, listening to Dr. Hernandez just then. We could infer from what she was saying that maybe people staying home during the pandemic could end up being worse off in terms of health, because of mold conditions and other things like that that are prevalent in the neighborhood. Are you seeing expressions of that in your practice?

Dr. Hernandez: Yes, we saw that pre-COVID, where housing environments where were not suitable and appropriate, and people truly having significant challenges with their environment, and how it exacerbated their disease conditions. Obviously now, with more people staying home and forced to stay home, it is much worse. The real challenge is where the solutions and how do you connect people to possible solutions, and how do you bring this to a higher level?

Oftentimes, the only safe place that people feel comfortable discussing something that's very private, and also can feel like you're maybe embarrassed about it is at your doctor's office. When a doctor is trying to understand why you're on all these medicines for asthma and it's still not controlled. I think definitely, there has been a quiet underlying challenge that has arisen with COVID, but I'm hoping because we now have brought all this to the forefront, that we can actually put some action behind it and really do things that make a lot difference to people's lives every day.

Brian: With Dr. Sybil Hodgson and Dr. Diana Hernandez in our series, West Farms 10460. Mike in Mount Hope, The Bronx, you're on WNYC. Thank you for calling in.

Mike: Hello, Brian, thank you for taking my call.

Brian: Sure.

Mike: I work for, it's called Bronx Health REACH. It's part of the Institute for Family Health. I think your guests got into the specific details, but overall big picture, 10,000 feet up in the air, if people just want to know, The Bronx is the unhealthiest county in New York state. It is 62 out of 62. Some people know this, but when we do meet with elected officials, we've had not 62 rallies. This is something they're learning about. They've never heard, so it would be great to have more awareness of this, but I think more important there's five boroughs of course, Manhattan is rank 6, Queens 7 , Brooklyn 15 and Staten Island is 21. Why is The Bronx so far behind?

I would see if The Bronx came in at 25 or 30, but we're 62. We're just basically saying when we meet with elected officials, we need to prioritize more resources to The Bronx to lift it out of its number 62 ranking.

Brian: Mike, what kinds of resources, for what, in your opinion, based on your experience and your knowledge?

Mike: We work with schools, we work with bodegas, we have health centers in The Bronx, getting those resources out. Places where residents can go and purchase healthier food. Programs that as a business, support the bodegas, for them to do business, for them to get healthier, fresh food and things like that. Just the increase in ensuring more people, heck even creating, you had mentioned, I believe, the political health. We have met with some elected officials where they say people are not going out to vote, and when those numbers of people are not going out to vote in the communities it's very, very difficult to get funding and resources because there's a low voter turnout.

Brian: Mike, thank you so much for an important call. Let's go next to Gail in West Farms, you're on WNYC. Hi, Gail, thank you for calling in.

Gail: Hi, Brian. Very nice to talk to you. I listen to your program almost every morning, usually when I'm driving in to the Bronx River Arts Center where I work and that's where I am. I'm in my car parked, but I wanted to tell or talk about, I've been the executive director of the Bronx River Art Center for over 20 years and boy, have I seen changes.

Brian: By the way, do I hear the elevated separate train going by?

Gail: Oh, yes, right overhead, that's right. I'm actually right under it, it just passed. That's the West Farms between West Farms and 180th street.

Brian: Just locating that sound for our listeners. Go ahead, Gail, continue.

Gail: We hear it every 10 minutes from our building. It's actually a nice sound. I've seen tremendous change, including most specifically our building. We saved it from being torn down. It's an 18,000 square foot warehouse building that the art center's been in since the mid-1970s, when it was born as part of the first Bronx River Restoration Project when the city gave them space in that building to work, and then we self-incorporated in 1987 and stayed in the building. From 2014 to 2018, we brought the building under a $13 million renovation.

It's incredible space, and we've grown tremendously inside the building with amazing art facilities, totally equivalent to anything and better than you'd see in Brooklyn or Queens. It's amazing. Our biggest problem is getting the community to come in. You hear all the problems and the people won't, and now with COVID, don't even want to leave their house. We have to be very careful of who can come in.

As a cultural institution, we are currently now allowed to open our gallery, anything that is non-sitting, at 25% capacity and on the average day, we come nowhere near that capacity at any given time, and it's free. It's free to walk in the door and we have the signs up. What I'd like to say is that this community is coming around, not only have we restored this facility, and with our commitment to the community, to bring culture and the arts and make sure culture and the arts is available and boy, is that rare when you have low-income communities like this, but also that there's so much new housing, so much brand new spanky, clean housing that's gone up in this neighborhood.

CBC is redoing all their Lambert houses, it's going to be amazing. Signature Urban Properties has built along, this building along the West Farms road, the largest housing complex for low and mid-income families since Co-op City. There's very various other investments in new housing in the neighborhood. There is so much hope here. There is so much hard work from many, many people myself included, and certainly the community board, Community Board 6, that all we need is some real attention from our new council district member, whoever, just continuing it. I know Ritchie Torres did, but here we go, a new one, make sure they know that this is great need and great progress.

Brian: Gail, thank you for your call. Thank you for your work with the Bronx River Art Center, and for shouting out some of what's good in West Farms as you did in that call. To wrap up the segment Dr. Hodgson and Dr. Hernandez, I want to ask each of you the political question that Gail implies, at least at the end of her phone call for whoever the next city council member is, for whoever the next mayor is. Politically, what's the most important thing for the sake of public health in West Farms? Dr. Hernandez, would you start?

Dr. Hernandez: I would probably say that in some ways, our borough is affected by this kind of reputational hazard, and in some ways that reputational hazard has also rendered it invisible, or at least labeled in such a way that the monikers around deep and entrenched poverty and the poorest congressional district, they just flow off the tip of tongue, and ultimately we should be thinking about this as unconscionable. Like at what point are we dealing with the fact that there is such deep levels of poverty that haven't moved, and that are only getting worse.

You have some of the highest unemployment rates to begin with in places like the South Bronx and that these families are facing a really difficult circumstances to date. To me, it has to be about dealing with these fundamental causes of health, first and foremost, and not taking for granted, that The Bronx is just labeled as a place where these things happen, but saying really that this is, it's unacceptable, period. What are the ways in which we bring in resources to people that are here rather than expecting resident turnover, but really, truly investing in the community and its residents in ways that lift them up from the confines of poverty,

Brian: Dr. Diana Hernandez, professor of Sociomedical Sciences at the Columbia University Mailman School of Public Health. Dr. Sybil Hodgson, you'll get the last word as medical director of the Montefiore Medical Group West Farms Family Practice. Same question.

Dr. Hodgson: Thank you. I would agree with Dr. Hernandez, that we know the label of The Bronx, and so now, let's get past that. I think the most important thing for elected officials to understand and to do is you can't make decisions about a community from a boardroom or from your office. You need to be present in the community, come to our health center, goes to the Bronx Art Center, come to the neighborhood, and really understand what's happening in this moment. Because I think that what's often misunderstood is, you can say these things about housing, but what is it about the housing that is really insecure and unstable and unsafe? You have to go into people's homes and understand how they're living.

The other thing we haven't mentioned today is the education. We have a whole generation of children that are being raised in this community and what does education look like for them? What are the opportunities for these children to have diverse experiences, and opportunities, and learning, in this environment? I really would encourage all elected officials for that area to really just come into the community, and really become a part of it, so that we can make changes that are really effective and really meet people where they're at.

Brian: Calling Dr. Hodgson, calling Dr. Hernandez. We had callers calling Dr. Hodgson and calling Dr. Hernandez. Thank you for so much information and perspective and for your service. Thank you for coming on.

Dr. Hodgson: Thank you.

Dr. Hernandez: Thank you.

 

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