By Michele Leight

On a crisp November morning I exited the subway at Chambers Street to attend a forum at DC 37, celebrating 100 years of New York City’s Child Health Clinics, and was greeted by the historic sight of City Hall bathed in sunlight. I learned about this event because a young activist handed me a flier as I walked out of a public forum a week earlier at The New School, entitled “Reforming Healthcare: Four Solutions from the US Congress.”

As I read the flier, my head was spinning with data and statistics presented by four senators and one congressmen that have authored four major pieces of healthcare legislation as they brainstormed and debated the hottest topic on any policy makers agenda today – affordable and accessible healthcare for all Americans. This heartening bipartisan effort consists of the following proposed legislation: The Healthy Americans Act (Bob Bennet, R-Utah, and Ron Wyden, D-Oregon); The Every American Insured Act (Richard Burr R-North Carolina); The Universal Health Care Choice and Access Act (Tom Coburn, M.D., R-Oklahoma) and The United States National Healthcare Insurance Act (John Conyers, D-Michigan) (A report on the proposed legislation and the issues raised at this event will follow).

Motivated by The New School forum, my research revealed that 400,000 children are uninsured in New York State. This was frankly staggering. On January 9th, 2008, I watched Governor Elliot Spitzer’s State of the State address, in which he said:

“We cannot wait while children who suffer from asthma and diabetes go untreated. We will not wait while, tonight, some children in this very city go to the emergency room for illness than could have been prevented if they had a regular family doctor....Not on my watch.... In my upcoming Executive Budget, I will propose that New York State fully fund the expansion of our children’s health insurance program. There will be affordable coverage for every single child in this state.”

It is no secret that the costs of healthcare are spiraling out of control for Americans of all socio-economic backgrounds, but most disturbingly for those without health insurance.

Far too many people I have interviewed in New York – and America - look at the ER as their local doctor. For years, when the health problems were small and preventable, they avoided going to the doctor – or taking the kids to the doc - because they feared the costs. Even though some Americans work 10 hours a day, and Saturdays, they are not making the kind of salaries that generate enough income to pay for health insurance. This can be deadly if they, or one of their children, develop a chronic health condition that requires consistent professional treatment. The longer an illness is left untreated, the more expensive it is to stabilize. That is why preventive care is so critical, especially for children.

The panel of senators and congressman in the packed auditorium at The New School got me thinking about children, the most vulnerable in society. While our leaders try to steer this great country to universal healthcare coverage  - however it is achieved, and it will take time – what is to become of American children who are out of the loop of coverage?

I do not know how people manage in New York with children if they do not have health and prescription drug insurance. The costs without it are totally absurd. I decided to attend the Child Health Clinic Forum in my community on November 7th, 2007, hoping to get some answers.

It was reassuring to find myself at the Child Health Clinic’s kick off celebration of a year of events all over New York City, in a room filled with healthcare providers, consumers, professional, community and faith-based based organizations, parents, policy makers, and labor organizations - all focused on keeping New York’s children healthy and safe by connecting them to insurance and ongoing comprehensive primary and preventive care service, regardless of their ability to pay.

Welcoming speeches were moderated by Judy Wessler of CPHS, (Commission on the Public Health System), and the speakers included the Honorable Christine Quinn, President of the New York City Council, HHC President Alan Aviles, (represented by Iris Jiminez-Hernandez), and DC 37 Executive Director Lillian Roberts.

The keynote speakers were Dr. Katherine Lobach of the American Academy of Pediatrics, (Topic: History of the Child Health Clinics), and Dr. Ben Ortiz of HarlemHospital, (Topic: Children’s Health Status in New York City), moderated by Jennifer March Joly.

The photographs here are a testimonial to the entertainment provided by children from Chinatown’s Head Start Program, and the beautiful artworks were created by children from Health and Hospitals Corporation Child Health Clinics.

The Child Health Clinics are managed by Health and Hospitals Corporation, (HHC), and I was impressed to find their pamphlets printed in many languages, including two I was familiar with from my childhood in India  – Bengali and Punjabi. It appears that every attempt is being made by HHC to communicate with and reach the diverse communities that comprise the melting pot that is New York.

Judy Wessler, who is on the planning committee of The Commission on the Public Health System, and coordinator of the Child Health Project said:

“We want to honor what we know of the history and role of these clinics in providing services to children for 100 years....The outcome of the work of many people who have been involved in this effort will be healthier children, who have health insurance and a place to go to get good primary and preventive care services... We will also be collecting the voices of parents and young people, along with residents, community organizations, and others to write an important Child Health Policy Agenda for the city of New York. This agenda will be a guide, from a community perspective, of what we need to be doing to make our children more healthy and safe.”

Ms. Wessler introduced the first speaker, Christine Quinn, President of the New York City Council, who said:

“I was determined to be here this morning, to be with all of you who are celebrating that for 100 years you have been taking care of New York families and their children... In the months ahead we need to think strategically about which families are being served and which are not...We need to move forward with a more aggressive, targeted approach towards access to quality care and a medical home for all New York families. Thanks to the Health and Hospital Corporation we have the best public health and hospital system in the city – in the country.”

Ms. Quinn continued:

“We have a joint vision that people deserve healthcare, even though we sometimes disagree about how to get it. We are lucky to have people that care as much, who will back us up. 100 years ago the child health clinics began as milk stations. 100 years from now people will say: ‘Isn’t it odd that there were uninsured children in New York City?’”

It was not that long ago that babies and families in New York got sick from unpasteurized milk.

The next speaker, Lillian Roberts, Director of DC 37, touched on another critical issue:

“It is time for daycare to take off 24 hours a day,” she said.

This is a serious problem with no easy solutions. I have interviewed many single mothers in New York for my book, who describe how their kids ended up in juvenile hall or the foster care system – or jail - because they were overwhelmed by the pressures of juggling home, work and kids after being abandoned by the father of the child. Many mothers could not keep a roof over their kids' heads because they could not work the necessary hours to pay the rent and put food on the table. Unable to find someone to care for their children when they went to work, they feared leaving their kids alone, which is also against the law if they are young. So they lost their jobs and their kids.

This is a disparity I see in America, compared with other wealthy nations, where kids can be dropped off at a well-run daycare center that does not cost a fortune, or is free - enabling both parents, or a single parent, to work with peace of mind, knowing their children are safe.  It would be kinder, smarter and far less expensive to the taxpayer to help these mothers and parents up front, with fully funded daycare, so families are not ripped apart and cast adrift in extremely expensive alternatives that cannot replace a family home, even if it is somewhat dysfunctional. This might also discourage single mothers from taking in totally unsuitable partners out of desperation, who often end up abusing the children. There are enough examples of the tragic deaths of young children at the hands of boyfriends and stepfathers in the news. Of course, no child should be left if the care of an abusive or addicted mother either.

Ms. Iris Hernandez, Senior VP of HHC’s seven Manhattan child health clinics, representing HHC President Alan Avilas, said:

“HHC manages 27 child health clinics, offering a medical home for 35,000 patients, with asthma and health screenings, and check-ups, whether they are located in a housing development or a busy commercial district.”

“We are committed to being here,” she continued,” and it is not uncommon to find doctors and nurses that have served multiple generations of a family. We have had staunch support from Christine Quinn’s office and we have teamed up with many community based organizations.”

The moderator of the event, Jennifer March-Joly, of the Citizens Committee for Children, introduced Dr. Katherine Lobach, of the American Academy of Pediatrics, who gave fascinating insight into the history of the Child Health Clinics.

In 1908, matrons from the milk stations went to the tenements to find mothers who had babies, to give them free, clean milk. It was not that long ago that the infant mortality rate was high, and many New York babies had diptheria, whooping cough and tetanus. The milk stations soon offered treatment for colds, skin rashes, asthma and whooping cough as well. A vaccine for whooping cough brought the death rate from it down to zero. The City continued to give mothers free milk for their babies till 1947, and from the 1930s to the 1950s the baby health stations were included in the design for public housing projects. In 1955 the name of the milk stations was changed to Child Health Stations, and by 1960 an impressive 1/3 of all babies born in New York City (55,000) and 22% of preschoolers were enrolled.

“The Child Health Stations were often painted blue, which today is called ‘branding,’” said Dr. Lobach.

The clinics grew to a high of 99 child health stations in 1966, but by 1978 the fiscal crisis hit, and 21 were closed, leaving only 57. In 1990 they were re-named again - Child Health Clinics - and performed the same function as pediatric treatment centers.

In 1992 a successful initiative for identification and treatment of asthma was launched and won awards for the Child Health Clinics, which were transferred to Health and Hospitals Corporation management in 1994; but by 1998 oversight of 41 clinics were transferred from the central HHC office to regional networks, and the Commission on the Public Health System raised concerns about consistent management. In 2006, only 24 Child Health Clinics remained open in New York, serving babies, children and teens all over the city.

A member of the audience asked Dr. Lobach what her earliest memories of the clinics were: “Ðelivering birth certificates,” she said, “and ‘Little Mother’s Leagues:’ where eight year olds were looking after babies.’” (As they still do in the developing world today, in addition to household chores and working in the fields or domestic service). Dr. Lobach stressed that better services were needed for teenagers. I totally agree. The dangers facing American teenagers today are unimaginable for those of us who are several decades older - we have never had to deal with the issues that confront them every day. Dr. Lobach advocated early health education. Personally, I believe it can never be taught early enough, and it is the primary focus of my book. "Harvest of Innocence." We are not born with knowledge about nutrition or self-protective strategies – it has to be taught, early.

When I interviewed dozens of teenagers for my book and a film, I found a huge disparity in the level of self-protective strategies amongst the kids who had early health education, who went to private or well funded public schools – including information about drugs – and those who did not. What kids do not know today can permanently endanger their health or even their life.

What is encouraging about the Child Health Clinics is that they offer a wealth of information to families and children, but, based on what I have heard directly from teenagers in this city, health education needs to be taught in kindergarden. It should be the most important subject on every public school agenda. Whatever the costs up front, it will potentially save millions of dollars in future healthcare and re-hab costs.

Jennifer March Joly introduced the next speaker, Dr. Ben Ortiz of Harlem Hospital, (which is affiliated with Columbia University College of Physicians and Surgeons), who spoke about the current health status of children living in New York City. It was an eye-opener. “We need clinics for children, not the ER,” said Dr. Ortiz, adding: “3-5% of kids in the US have asthma, in New York it is 6-8%, and in low income neighborhoods it is 35%. It is the leading cause of school absences in New York City.” (For those who have children with asthma, please read “New York State Attorney General's Office warns "Urban Children at Risk" Because of Widespread Pesticide Use in Public Housing, Schools and Parks” on this site.

Dr Ortiz went on to say that childhood obesity has doubled in the past 10 years, while one in five New York children are already obese. 27%of New York Head Start kids are already overweight or obese – especially Hispanic and African American kids – which is double the rate of whites.” (Obesity is closely linked to diabetes, and there is an epidemic of Juvenile Diabetes in America.

For national and New York City and State diabetes statistics go to www.cdc.gov)

Kids did not have these health issues in the past. They are directly related to unbalanced diets, deep-fried foods laden with saturated fats, highly sugared sodas, lack of fresh fruits and vegetables - and not anywhere enough exercise. It is expensive to put healthy food on the table, especially in New York City. And kids will gravitate towards greasy processed foods if that is all they know. One round of french fries from the average fast food joint contains a whopping 400 calories, or more. One soda contains about 7 teaspoons of sugar. Diabetes, heart disease and obesity are connected to diet. Other states in America – and other nations - face similar problems with their youngest citizens, but the good thing about New York is that nothing that really needs attention can be swept under the carpet for long. It explodes out in the open because people care. While traveling internationally for work, I have learned that New York is a symbol of freedom and justice across the globe.

From Tibet to Bangladesh, India to Hong Kong, people have this idea of New York as a trailblazer for change for what it has achieved for ordinary people, struggling people, the poor and marginalized, or people who are different but who are not denied a chance at the American dream. This does not happen in most other countries.

Thousands of immigrants have sailed into New York harbor, most of them equipped with little more than hopes, dreams and a suitcase of clothes. Now they come by plane. Many have suffered persecution and great hardships getting here. Historically, New York has absorbed more immigrants than any city in the US. They give birth to children, American citizens, that need healthcare. HHC Child Health Clinics is committed to reaching these families as well as those they already serve.

I grew up in India where I saw unbelievable poverty, disease and starvation at a young age. I saw more tiny children with swollen stomachs from malnutrition than it is possible to imagine. Those images are always with me. Things are improving but there is still no food for many of them, let alone child health clinics. But there is still time to inspire them. I do not see children in rags begging at traffic intersections in New York or America, as I still do on my visits to developing nations. It is a deeply disturbing sight and I never get used to it, no matter how many times I see it. I believe what is done here in New York is a huge inspiration to the rest of the world. I like to think that the good things we achieve here for those who cannot fight for their own rights are copied elsewhere - in time.

However, we have very real issues in America with access to healthcare and health insurance, nutritious food and safe environments in low-income and struggling middle-class families and communities, which place children in terrible danger. I know how terrifying and serious an asthma attack is, because I live with someone who has it. The doctors phone number is on my speed-dial. It is always a concern, and it only makes me think of those who might not have that support system in place for when the next attack comes – especially if it is a child.

Hopefully there will be more Child Health Clinics in the years ahead, like there were in the past.

Celebrating great achievements and hard work is essential, so it was wonderful to be entertained by children from Chinatown’s Head Start Program dressed in dragon and butterfly costumes, dancing as only children can dance! Parents looked on proudly, aware of their responsibilities. Safeguarding the health of children is the greatest responsibility in the world, and it is a 24/7 commitment. An additional treat was the artworks beautifully displayed on the walls, created by school children from several Child Health Clinics, including Stapleton, Mariners Harbor, Melrose, Astoria, Junction Boulevard, Woodside, and the Ridgewood Communicare Clinic, and children enrolled at the Chinatown Head Start Program and the Columbia University Early Head Start Program. The teacher that coordinated the exhibit was Angela Fremont, from P.S. 69, Vincent D. Grippo School.

I was reluctant to leave the event because there was another panel that I wanted to listen to, but I was committed elsewhere – and running extremely late. The sound of children’s voices grew fainter as I gathered my belongings and made for the exit. I had learned so much, and was re-charged by their energy and joy.

Returning to the subway I passed City Hall once again, where a contingent of school children on a field trip was waiting to enter the building. Their energy ricocheted off the walls. They could not stand still. They jumped, hopped, twirled and ran, unable to contain that life force that is youth – just like the magnificent little dancers from the Head Start Program illustrated here.

I remembered how this neighborhood had felt a few days after 9/11, when there wasn’t a child to be seen anywhere, and the air was filled with dust and tragedy. So much improvement has taken place since then, although the memories remain. I remember how deserted Chinatown was then, but the community's spirit has bounced back, in true New York fashion, as evidenced by these beautiful Head Start kids.

With 400,000 uninsured children in our State, there is still a great deal of work to be done. I wondered how many of the children waiting to enter City Hall had health insurance, and how many of their parents knew there was a way to find it for their children if they could not afford it. I thought about the young activist who handed me the flyer outside The New School a week earlier, and how eager and committed she was. She was doing her bit for her community, and every bit counts. She - and senators and congressman at The New School - motivated me to attend the Child Health Forum. I am grateful to them. It is not every day I have the chance to celebrate something as wonderful as 100 years of keeping kids healthy in my community.

The young represent the future of all nations. If the health and safety of children is neglected, there is little chance of them becoming hopeful, healthy, contributing members of society when they are adults. Children trust that we, as adults, will protect them.

We cannot disappoint them. Any of them, in New York City, New York State - and across America.

Please stay tuned for announcements about important future events and celebrations to honor 100 years of New York City’s Child Health Clinics.

The planning and ongoing work of this effort is coordinated by the Commission on the Public Health System (CPHS).  The Planning Committee includes: American Academy of Pediatrics Chapters 2 & 3, Children’s Defense Fund-New York, Citizens Committee for Children of New York; Coalition of Asian Americans for Children & Families; Commission on the Public Health System; Council of Municipal Hospitals Community Boards; Doctors Council, SEIU 10 MD; Head Start of New York; Local 436, AFSCME; New York City Council; New York City Health and Hospitals Corporation; New York Immigration Coalition; and Parent to Parent of New York State.

The borough coalitions are being coordinated by: The Bronx Health Link; Brooklyn Perinatal Network; Northern Manhattan Improvement Corporation; Make the Road New York; and El Centro in Staten Island.

Funding for this effort is provided by the New York City Council, New York City Health and Hospitals Corporation, United Hospital Fund (for the survey), Metro Plus Health Plan, Healthfirst Health Plan and the Medical and Health Research Association.

Commission on the Public Health System, (CPHS), 45 Clinton Street, New York, New York 10002, or visit: www.cphsnyc.org or Phone: 212-246-0803, or visit www.nyc.gov/hhc

For more information on Governor Elliot Spitzer’s Plans for Health Insurance for All Children, visit www.nyhealth.gov