Guest blogger Cindy Brown, executive director of the New York Coalition for Transportation Safety (NYCTS), examines the health disparities that exist on our roadways and the resulting cost to life and society.

More often than not, bicyclists and walkers hit by a car end up in the hospital emergency room.  Unfortunately, many never leave the hospital because they die from their injuries.  New York State’s Statewide Planning and Research Cooperative System (SPARCS) data show that throughout New York State, excluding New York City, 35,796.98 individuals per 100,000 — or roughly 4,006,610.16 people— were hospitalized from 2016-2018. Of those ~four million hospitalizations, 755.35 per 100,000, or roughly 84,543.25 of them were the result of a motor vehicle crash.  That’s just over two percent.  While this may not seem like a large percentage, consider that such hospitalizations were avoidable.

Even more striking is new research that shows glaring health disparities exist even in the realm of pedestrian and bicyclist crashes. A recent report from the Governor’s Highway Safety Association analyzed traffic fatalities by race and ethnicity, and identified a new-found health disparity— traffic crash fatalities disproportionately affect black, indigenous and people of color (BIPOC).

Why would this be?

It all harkens back to the social and behavioral determinants of health that we all have come to understand have an immense bearing on a person’s health.  Not even a walk in the neighborhood or leisure bike ride on our roadways shields us from the effects of outside forces.  In this case, transportation is the social determinants of health factor at play. Neighborhood and built environment are key determinants in pedestrian, cyclist, and motorist accident outcomes on our shared roadways.

Report Findings

American Indian/Alaskan Native persons have a substantially higher per-capita rate of total traffic fatalities compared with all other racial groups. Of all races/ethnicities, American Indian/Alaskan Native persons have the highest annualized, age-adjusted traffic-related pedestrian death rates. The analysis also found that a disproportionately large percentage of fatalities are accounted for by motor vehicle traffic crashes, especially among Native American and Hispanic persons.

Black persons have the second highest rate of total traffic deaths, including pedestrian and bicyclist traffic deaths. Black children ages 4-15 have the highest rates of fatalities of all motor vehicle accidents. Asian persons have the lowest per-capita rate of involvement for virtually all categories of traffic deaths, and white persons generally have lower traffic fatality rates than BIPOC (with the exception of motorcycle driver and passenger deaths).

There are measurably higher levels of vehicle traffic in census tracts where low-income and BIPOC populations are more concentrated. The report also references two studies, one of which found people who live in areas of high economic hardship have an increased risk of being in a severe crash and dying in traffic crashes more often and at a higher rate than residents of more affluent neighborhoods; the other found that injury risk for pedestrians and cyclists is 20-30 percent higher among children of manual workers than those of intermediate and high-level salaried employees, which illustrates an effect of socio-economic status on crash involvement.

Causal Factors

The report draws compelling conclusions about why this is happening, and how we can work to eliminate this disparity. This issue is deeply entrenched in other factors that affect crash risk and access to life-saving care after a crash. Existing health inequities, lack of infrastructure such as lighting in low-income areas, and the effect of socio-economic status all point to existing, underlying disparities as the main driver of the disproportionate number of BIPOC represented in fatal traffic crashes. In many instances, individuals with low income cannot afford a car, and therefore utilize walking, biking, and public transportation as their main forms of transportation. Public transportation hubs are typically located in high traffic areas. 

Historically, in an effort to move motor vehicles faster, existing communities were often divided to build new high speed roadways that would ease congestion and meet the needs of drivers.  It resulted in the creation of wide, multi-lane streets with high speed limits and traffic signals blocks apart.  Right turns on red were permitted and bicycle lanes were non-existent. Shopping and other types of services were frequently on one side of the road and housing was on the other, either because of zoning restrictions or political influence. When these roads were built, the needs of all users were not a consideration. Today “all users” are to be considered when new roadways are built, or old ones are rebuilt. However, many of these existing roads have yet to be rebuilt and are still traveled daily. Without assessment and investment in improving these roads, they remain dangerous for those who must travel them. 

Actionable Ways to Work toward Equity in Traffic Safety

Eliminating these underlying disparities may seem like an insurmountable task, but we have the collective power to work toward mitigating this particular issue by digging deeper and working to address the root of the problem. The report emphasizes this point, calling for a more equitable allocation of resources to address pedestrian safety needs in BIPOC communities. On state and community levels, leaders must prioritize planning and investing in infrastructure within the areas and neighborhoods that have suffered from years of discrimination and disinvestment. Addressing other underlying issues such as poverty and lack of access to mental health services could also be useful in addressing crash prevention.

While we wait for these better roads to be built, we can take action now to keep ourselves safe.  There are dozens of pedestrian safety laws in New York State.  Unfortunately, many people are unaware of these laws and enforcement is spotty.  One simple law is to walk facing traffic when a sidewalk is not available. Why? Because the driver can make a psychological connection with the pedestrian’s face.  Studies document that this reduces crash incidence. Unless we know this law exists, would anyone consciously think about what side of the road to walk on?   Dozens of laws similar to this one can be found on the state’s website and on NYCTS’ website dedicated to raising awareness about pedestrian safety.

Pedestrian safety is another pressing public health issue.  Our community and state leaders must adopt the same view and treat traffic crash involvement as the health disparity issue it truly is. This means more diverse representation within the leadership of our state and city transportation agencies and traffic safety committees. More diverse representation in leadership would also foster more effective safety education campaigns and outreach efforts to address the specific needs and cultures of BIPOC communities.

The report also calls for some additional research needs, such as better public health data, state level Fatality Analysis Reporting System (FARS) data analysis, and a deeper understanding of the role of race in crash outcomes by examining the National Emergency Medical Services Information System (NEMSIS) database that collects State and Territorial EMS injury and fatality data from 911 calls.

The Road Ahead

The term “social determinants of health” may be relatively new, but the reality of the concept is as old as time. BIPOC have endured bias and disparity in nearly every aspect of society for centuries. Unfortunately— but unsurprisingly—the issues of pedestrian safety and traffic fatality are no exception to this trend. The GHSA’s new report is eye-opening and confirms the need to take strides toward more equitable roadways.

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About the New York Coalition for Transportation Safety )   

The New York Coalition for Transportation Safety is a non-profit, statewide organization originally established in 1982 as the New York Coalition for Safety Belt Use, Inc. The Coalition was founded jointly by the Medical Society of the State of New York and the American Association for Automotive Medicine.

Initially the Coalition was a single focus group that sought to reduce motor vehicle related trauma in the State of New York by increasing the use of safety belts by motorists. In time it became apparent that many factors contribute to the complex picture that is motor vehicle injuries. We expanded our scope to include safety programs for pedestrians and bicyclists, as well as motorists, and changed our name to the NY Coalition for Transportation Safety to better reflect our expanded our efforts.

Our mission is to reduce the number of injuries and fatalities occurring on our roadways through outreach and education programs aimed at pedestrians, bicyclists and motorists. During its thirty-eight years of operation, the NY Coalition has received grants from federal, state, local and private agencies. Grant funds are used to develop and conduct public information and education campaigns in a variety of locales.

​About the Suburban Hospital Alliance of New York State

The Suburban Hospital Alliance of New York State advocates on behalf of hospitals in the Hudson Valley and Long Island regions. It engages key lawmakers and regulatory decision-makers in Albany and Washington to ensure reasonable and rational health care policy prevails.

About the Nassau-Suffolk Hospital Council (NSHC)   

The Nassau-Suffolk Hospital Council represents the not-for-profit and public hospitals on Long Island. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NSHC serves as the local and collective voice of hospitals on Long Island.

About the Northern Metropolitan Hospital Association (NorMet)  

The Northern Metropolitan Hospital Association represents the not-for-profit and public hospitals in the Hudson Valley region. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NorMet serves as the local and collective voice of hospitals in the Hudson Valley.

Guest blogger, Nefertiti Townes, who oversees health insurance programs at the Nassau-Suffolk Hospital Council (NSHC) talks about her 12 years working to help Long Islanders understand their insurance plans and other programs and coverages for which they may be eligible. The pandemic made this work especially challenging.

Helping Everyone Get Covered

About 95 percent of New Yorkers have health insurance – one of the highest rates of coverage in the United States.  However, even with this success, there remains a population of underinsured individuals– mainly our aged, blind and disabled folks– who for one reason or another are not enrolled in Medicaid programs for which they are eligible.  Then there is the population of individuals who have insurance, whether it’s public or private, who don’t understand how their plans work– the intricacies of co-pays, deductibles and the like.

It’s my job and that of my staff to connect with these individuals and screen them for programs and coverages they perhaps did not know about or did not know how to go about applying for. When the pandemic hit in March 2020 and our office, like all others, was placed on lockdown, we were not sure how successful our outreach efforts would be.  Prior to the COVID-19 pandemic, my team and I would routinely go out into the field, promoting our services at libraries, health fairs, and other community-based events. The pandemic forced us—and the rest of the world— to quickly pivot. Thanks to revised guidelines from the Department of Health and the New York State of Health Marketplace, my team and I were able to successfully transition to assisting our clients over the phone. I’m proud to say that our number of clients remained fairly steady throughout COVID-19, with no significant decline. Remarkably, we found that access was not affected. Client eligibility for Medicaid-type programs increased from 64% prior to COVID, to 72% during the pandemic. This increase in eligibility is a reflection of the unfortunate realities of COVID-19— many people became unemployed, lost spouses, lost alternative sources of income, lost employer-based insurance, or experienced other hardships.

We offer three programs to assist distinct populations.

Aged, Blind and Disabled Insurance Enrollment Program. This is a collaborative effort with the New York State Department of Health and the Suffolk County Department of Social Services. As the program’s name suggests, this initiative provides enrollment assistance to people over the age of 65 and adults and children who are blind or disabled throughout Nassau and Suffolk counties in applying for a multitude of Medicaid services, such as spenddowns, coverage of long-term care services, or a buy-in for working people with disabilities. Individuals can be over income guidelines required to qualify for Medicaid. Strategies like a Pooled Income Trust can preserve a client’s excess income to be used for daily expenses, such as rent, food, and utilities. A spenddown is another strategy that preserves a client’s excess income, as long as that income is spent in its entirety on a monthly basis, exclusively on healthcare services. A Pooled Income Trust is a legal arrangement between an approved not-for-profit entity and an individual. An individual sends their income to the trust– the trust pays bills for them. A spenddown reflects the medical expenses a person incurs that are greater than or equal to the income eligibility limits. Both of these situations eliminate excess income or resources that would make the individual otherwise ineligible for Medicaid. Many people do not realize that Medicare does not pay for long-term care services, but for those elderly with limited incomes, having Medicaid can mean the difference in having an aide assist with daily living skills or access to subsidized transportation.

Community Health Advocates (CHA).  Through this program, we also assist insured individuals with understanding, utilizing, and navigating their health insurance benefits. The CHA program is overseen by the Community Service Society of New York State, which has a grant from the New York State Department of Health.  The Nassau-Suffolk Hospital Council receives funding from the Community Service Society to service individuals in Nassau and Suffolk counties. The CHA program also enables my team to provide clients with help in understanding consumer rights and responsibilities under the Affordable Care Act, education about the NY State of Health online marketplace options and referrals to Navigator agencies or the Marketplace for assistance when appropriate.  When many people lost their jobs during the pandemic, we were able to offer them guidance and referrals.  Through the CHA program we serve an average of 55 consumers each month, and our number of CHA clients remained the same throughout the COVID-19 crisis.

Medicare Telephone Assisters (MTA). This is a grant-funded program through the New York State Department of Health (NYSDOH). The NYSDOH provides us with a list of consumers to be contacted monthly. MTA clients are enrolled in Medicaid and are seeking to enroll in Medicare. These clients are required to apply for Medicare as a condition of continued eligibility for Medicaid. Whether the consumer is eligible or ineligible, proof must be submitted to the Department of Social Services. We assist clients with this process. During the pandemic, we also helped people understand notices they received from state and local governments regarding their benefits under the Families First Coronavirus Response Act (FFRCA). 

Why Assistance Is Needed

There is a tremendous body of research documenting the positive effects on health access and outcomes that come with having health insurance coverage.  It’s especially important that vulnerable populations – such as the aged, blind, and disabled – have health insurance so that their health issues do not accelerate and worsen.  Data from the Long Island Health Collaborative Community Health Assessment Survey shows that when asked what prevents people in their community from getting medical treatment, “No Insurance” was the number one answer among both Nassau and Suffolk County residents for four consecutive years since the survey’s 2016 inception. Although this survey reflects responses from all age groups, it underscores how vital health insurance is overall.

With all of the recent and ongoing changes in healthcare, it can be a challenge for the average consumer to navigate their options. Programs like ABD, CHA, and MTA are in place to provide much-needed guidance when it comes to lengthy applications and enrollment processes, ensuring the client has all of the documentation needed to complete their application, and ultimately get the health insurance they need.

For more information about any of the enrollment assistance programs offered by the Nassau-Suffolk Hospital Council, please call 631-435-3000 or visit coverage4healthcare.com.

Editor’s Note: In the Hudson Valley region, consumers can access insurance enrollment assistance from the following agencies:

• Aged, Blind and Disabled (ABD) Insurance Enrollment Program: Westchester Disabled on the Move (WDOMI)
• Community Health Advocates (CHA): Westchester Disabled on the Move (WDOMI), Emerald Isle Immigration Center (Bronx), Legal Aid Society, Medicare Rights Center
• Medicare Telephone Assisters (MTA): Westchester Disabled on the Move, Community Service Society (as provider of FE services)

Additional Resources:

• Part A & Part B Sign-Up Periods: https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods
• Part B Late Enrollment Penalty: https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-late-enrollment-penalty
• Part A Late Enrollment Penalty: https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-late-enrollment-penalty
• Must Apply for Medicare as a Condition of Eligibility for Medicaid: https://www.health.ny.gov/health_care/medicaid/ohip-0112/

A year ago, our hospitals were besieged with patients suffering from a severe respiratory illness known as COVID-19.  Those early days were chaotic and intense both for patients and the healthcare workers who tended to those patients.  Many lives were saved, many lives were lost. 

But now, just a year later, our country has three good, safe, and effective vaccines that all protect against severe illness and death.  The Food and Drug Administration (FDA) rigorously studied each one, and it is truly a testament to our nation’s brilliant scientists and public health experts that these life-saving vaccines were developed and tested in less than a year.  It is a remarkable feat, and we are all beneficiaries of this extraordinary behind-the-scenes work.

The distribution of vaccines has been no less remarkable, even as demand outpaced supply.  However, that situation is looking better each day.  Our hospital associations have been working with the state’s Regional Vaccination Networks, known as HUBs, and their partners – hospitals, local county health departments, and federally-qualified health centers – to get a shot in as many arms as possible.  We have all payed particular attention to individuals of color who were and continue to be disproportionately susceptible to COVID-19.  Our regions, along with the state, have made vaccinating this group a priority from the start.   Northwell Health serves as the HUB for the Long Island region and the Westchester Medical Center serves as the HUB for the Hudson Valley region.

We are all anxious to return to normal, both in our personal and professional lives.  The vaccine is our opportunity to do that.  But we need everyone who is eligible for the vaccine to roll up their sleeve and take a shot not only to protect themselves, but to protect everyone else as well.  This is what is meant by the term “Herd Immunity.”    Herd immunity is reached when a significant percent of the population – about 80 percent – has received a vaccine and/or has become immune to an infectious disease because of exposure.  This widespread immunity means susceptible individuals are much less likely to come into contact with an infected person.

Have you herd? Immunity is the word!

This is the focus of a COVID-19 vaccination awareness campaign spearheaded by the Suburban Hospital Alliance on behalf of its member hospitals and the thousands of patients they serve. The greater the number of vaccinated means the sooner we can return to our normal lives and the sooner our local economies can recover.  And a healthier community leads to healthier hospitals because this highly contagious, infectious disease is kept at bay, allowing hospital staff to function under less stress and strain. 

Get Your Questions Answered

The Centers for Disease Control (CDC) is a good place to start to learn more about COVID-19, the vaccines and eligibility.  The Ad Council and the COVID Collaborative also just launched their “It’s Up to You” campaign about COVID vaccination.  It’s an easy-to-navigate site packed with straight forward information and answers.  Visit GetVaccineAnswers.org (DeTiDepende.org in Spanish) and get your questions answered now so you can make an informed decision about the vaccine when it’s your turn.

Our region’s hospitals urge you to get vaccinated as soon as you can.  While the individual decision to get vaccinated might seem inconsequential in the grand scheme of herd immunity, the impact of your individual choice is significant and widespread. Get vaccinated and be part of the movement to end COVID-19.

Vaccine Resources

NYSDOH Am I Eligible App

VaccineFinder.org

About the Suburban Hospital Alliance of New York State

The Suburban Hospital Alliance of New York State advocates on behalf of hospitals in the Hudson Valley and Long Island regions. It engages key lawmakers and regulatory decision-makers in Albany and Washington to ensure reasonable and rational health care policy prevails.

About the Nassau-Suffolk Hospital Council (NSHC)   

The Nassau-Suffolk Hospital Council represents the not-for-profit and public hospitals on Long Island. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NSHC serves as the local and collective voice of hospitals on Long Island.

About the Northern Metropolitan Hospital Association (NorMet)  

The Northern Metropolitan Hospital Association represents the not-for-profit and public hospitals in the Hudson Valley region. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NorMet serves as the local and collective voice of hospitals in the Hudson Valley.

Greetings.

It has been about a month and a half since I took the reins of the Suburban Hospital Alliance of New York State (SHANYS) and its regional hospital associations – the Nassau Suffolk Hospital Council and the Northern Metropolitan Hospital Association – as president/CEO.  Fresh from my 13-year tenure as chief operating officer for SHANYS and its two regional associations, I can say the transition has been relatively smooth.  But, like it has for all my healthcare colleagues, the pandemic has presented tough challenges and continues to do so.

We began this year with the rollout of two coronavirus vaccines and a directive to get all healthcare workers, or the 1A group, vaccinated.  Our hospitals have made remarkable progress in this area, even while our frontline hospital workers battled a surge of COVID cases following the holiday season.   They have been at this fight for nearly a year, and I marvel at their strength, courage, and tenacity day in and day out.  I know it is physically and emotionally exhausting for them.

Behind the scenes, the Suburban Hospital Alliance has been working to decipher the myriad of COVID-related state and federal regulations directing our hospitals’ actions and daily operations.  There have been hundreds and counting.  It’s our job to help our hospitals understand these rules and the effect of legislation, such as the CARES Act and subsequent versions of it, upon their ability to do their best work every day, while remaining compliant.  The hospital industry in New York is heavily regulated.  That was the case before the pandemic, and it will be the case after the pandemic.

Our hospitals have made remarkable progress . . . even while our frontline hospital workers battled a surge of COVID-19 cases following the holiday season.

Healthcare policy is complicated. Plain and simple.  I spent half my career in Washington, DC, working for the late Congressman Maurice Hinchey, and during that time, I found myself drawn to healthcare policy precisely because it offered a level complexity that appealed to me and still does.  I knew I would never be bored.  That has turned out to be more than true.

I began working at the capitol during the Clinton administration’s attempt to reform healthcare.  Although the effort failed, the policy work that laid the foundation for the Children’s Health Insurance Program (CHIP) would not have happened if comprehensive healthcare reform had not been attempted.  I was no longer working in Washington when the Affordable Care Act (ACA) was deliberated and enacted.  It was the best deal the federal government could deliver at the time, and I think we will see it improved. 

It’s important to me to do work that contributes to the greater good.  I began my career in public service and was fortunate some 13 years ago to land at this organization.  Here I have been able to witness firsthand the fruits of healthcare policy borne out in programs that truly help constituents.  For some 20 years, the Hospital Council has overseen insurance enrollment assistance programs that have made a difference in the lives of hundreds of Long Islanders.  On a broader scale, the Suburban Hospital Alliance has influenced the decision-making process at the state and federal levels resulting in policies that are not only rational and practical for hospitals, but ultimately beneficial to patients.  New York’s out-of-network surprise billing law, upon which the recently-enacted federal law is modeled, is a good example.

In normal times, I would be spending my days in Albany right now meeting with legislators and advocating on behalf of our 50 hospitals located in the Long Island and Hudson Valley regions.  I am still doing that, but it is from behind a computer camera and through a zoom link.  It’s an untraditional way to advocate, but our important messages are being communicated just the same.  It’s a new “playbook” for all of us and maybe this makes it the perfect time for me and my organization to get a fresh start.

Please, always feel free to reach out to me or any member of my staff. 

About the Suburban Hospital Alliance of New York State

The Suburban Hospital Alliance of New York State advocates on behalf of hospitals in the Hudson Valley and Long Island regions. It engages key lawmakers and regulatory decision-makers in Albany and Washington to ensure reasonable and rational health care policy prevails.

About the Nassau-Suffolk Hospital Council (NSHC)   

The Nassau-Suffolk Hospital Council represents the not-for-profit and public hospitals on Long Island. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NSHC serves as the local and collective voice of hospitals on Long Island.

About the Northern Metropolitan Hospital Association (NorMet)  

The Northern Metropolitan Hospital Association represents the not-for-profit and public hospitals in the Hudson Valley region. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NorMet serves as the local and collective voice of hospitals in the Hudson Valley.