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Take Care New York: A Focused Health Policy

2004; Springer Science+Business Media; Volume: 81; Issue: 3 Linguagem: Inglês

10.1093/jurban/jth118

1468-2869

Thomas R. Frieden,

Primary Care and Health Outcomes

The need for public health action to protect and promote health has changed.The leading causes of illness and death have shifted from acute, communicable diseases to chronic, generally noncommunicable diseases.Health departments not only must continue to address traditional and emerging communicable diseases along with the added threat of terrorist attacks, but also must take a more active role in preventing and mitigating the problems that cause the most illness and death today.The New York City Department of Health and Mental Hygiene recently released a health policy, Take Care New York, 1 to set priorities and focus on the leading preventable causes of illness and death.The policy identifies 10 key priority areas for action that meet all the following criteria: They present a large disease burden, killing thousands of New Yorkers and causing hundreds of thousands of preventable illnesses or disabilities each year; they have been proven amenable to intervention and public action; and they can be best addressed through coordinated action by city agencies, public-private partnerships, health care providers, businesses, and individuals.The 10 priority areas are as follows:(1) have a regular doctor or other health care provider; (2) be tobacco free; (3) keep your heart healthy; (4) know your HIV (human immunodeficiency virus) status; (5) get help for depression; (6) live free of dependence on alcohol and drugs; (7) get checked for cancer; (8) get the immunizations you need; (9) make your home safe and healthy; and (10) have a healthy baby.For each of these 10 areas, we identified examples of activities that could be undertaken and policy changes at the local, state, and federal levels that could help prevent or reduce disease burden.We also set specific and measurable objectives for health to be reached by 2008.Take Care New York activities include both primary prevention and prevention in the clinical setting.Having a regular doctor reduces disease burden and prolongs life.Quitting smoking, or not starting in the first place, provides the greatest potential impact on health.Influenza and pneumococcal pneumonia are largely vaccine preventable.Colon and cervical cancers can be prevented through colonoscopy and Papanicolaou smears, and breast cancer survival improves with early detection.Many other diseases that present large burdens are amenable to treatment-if properly diagnosed and effectively treated.People who abuse drugs and alcohol respond to brief physician interventions, and depression can be effectively treated in most people with counseling and/or medication.There are effective interventions for domestic violence, a leading cause of injury and hospitalization among women.Partnerships are increasingly important.Many Take Care New York activities focus on clinical care as an opportunity for prevention.Sufficient diagnostic and treatment capacity already exists, and key interventions are relatively simple, inexpensive,