Faces of Public Health: Patricia Yang

Patricia Yang, New York City Department of Health and Mental Hygiene

Three months have passed since Hurricane Sandy hit the East Coast. And while the number of people displaced by the storm has gone down from tens of thousands to the hundreds in different communities, some people are still without power or a permanent place to live. Others face the daunting task of rebuilding businesses and homes while protecting against mold and dust, which can cause or exacerbate respiratory problems. For many, the stress has rekindled mental health issues that might have been at bay, or created new ones or just made tough times even worse.

NewPublicHealth spoke with Patricia Yang, DrPH, Chief Operating Officer and Executive Deputy Commissioner at the New York City Department of Health and Mental Hygiene.

NewPublicHealth: Hurricane Sandy hit just over two months ago. How’s the city doing now?

Dr. Yang: There are people in parts of the city for whom the storm is a distant memory, and their daily lives are virtually unaffected apart from what they might hear on the news or read in the papers. But in the areas that were most directly affected by the hurricane, life for many is far from normal and may never return to what it was pre-storm. Those areas in particular are parts of the Rockaways and Coney Island and Staten Island. So there are still thousands of people who don’t have basic utilities and for whom grid power and heat have not returned. And we’re heading into the coldest winter months.

NPH: What’s the role of the public health department both now to help people deal with the aftermath, and looking ahead to prepare for the next disaster?

Dr. Yang: We’re working with other city agencies as well as not-for-profits and volunteer groups, really marshaling around a number of aspects. One is obviously to try and restore as many households onto the grid and with heat as possible. Although we are not the lead, we need to get health and safety information out to homeowners, contractors and volunteers who are helping to remove debris. We are doing everything from distributing [medical masks] to giving them information on how to avoid risk of injury, to how to minimize exposure to dust and mold.

We’re simultaneously trying to help people stay safe in cold weather when there’s no heat and/or electricity. A key focus for the Health Department right now is to continue to support and keep safe and healthy those New Yorkers who are still living in their unheated homes even while we are urging them to stay in alternative locations.

NPH: Do you have an estimate of how many people that is?

Dr. Yang: We think it’s in the thousands. This is a city of more than 8 million people and is a densely settled urban area. Homes range from high rises that lost power and heat, to one-and-two-family structures. 

NPH: What are the ways in which you’re trying to help them?

Dr. Yang: We bought over 10,000 electric blankets and were donated some space heaters, which themselves can pose a risk if not used properly. What we have been doing since shortly after the storm is door-to-door canvassing. We started in the high-rises because we were most worried about people who may have attempted to shelter in place in their homes and thought they could ride out the storm but didn’t expect their electricity to be cut out. That might be an elderly person or a person with chronic medical conditions who is now suddenly isolated without running water, with spoiling food and possibly out of medications on the 20th floor in a high rise building without a working elevator, running water or lights. That’s why we first focused on the high-rises first.

We’ve had great assistance from federal and state partners. The National Guard has been here and they’re literally the boots on the ground doing the door-to-door canvassing. City and federal assets have alternately set up incident management teams for the canvassing operation. We are getting data daily from the National Guard troops as they go door to door knocking. If someone answers their door, they check on how well they’re doing and what needs they might have. The guards are checking whether they have heat, running water, electricity, a critical food need, mobility or prescription medication or other clinical needs.

The National Guard canvassing data is being entered into a database that started with the Health Department and then broadened. We’re finding out where there are people who wish to evacuate but don’t have a place to go, people who have construction or demolition debris or tree limbs that need to be moved in order for repair to start, and more. We contracted with the Visiting Nurse Service of New York to conduct home assessments, help with medications, and refer to the health care system for any ongoing needs. We’re using tablets now, which allow for real-time data entry in the field and triage to City agencies for follow-up.

NPH: What are the health issues that concern you as the recovery continues?

Dr. Yang: One of the most immediate and widespread needs has been people who couldn’t get to their pharmacies or their pharmacies had been wiped out or they couldn’t reach their doctor to get a prescription written. In addition to activating the Emergency Pharmaceutical Assistance Program, we worked with chain pharmacies to allow them to waive financial liabilities such as copays for people who didn’t have insurance or full drug coverage, or had lost their jobs as a result of the storm or couldn’t get to a working cash machine in order to get the money for the copay.

NPH: What are other critical needs right now?

Dr. Yang: As the immediate impact subsides, the stress and trauma from the aftermath of the storm and the prolonged recovery period is a growing and continuing concern. We are out in the communities and in the Restoration Centers providing mental health counseling and referral.

Apart from the ongoing issues such as environmental hazards and mental health concerns is our role in helping communities gets back to pre-storm operations to the extent possible. We are monitoring the restoration of primary health and mental health care services in the directly affected areas, and helping local businesses such as restaurants and child care programs reopen.

NPH: Looking ahead to the next disaster, what do you want in place now that you didn’t have before Hurricane Sandy?

Dr. Yang: In terms of the Health Department, a critical issue is how to get people more prepared for and engaged in their roles in emergency response. Much of it is doing what they do every day, just faster and more intensively, but also a little bit differently, a little bit more cross-disciplinary in terms of approach and mindset.

In terms of emergency response, a goal is closer coordination with partners including other City, state and federal agencies; health and mental health providers; and voluntary groups. Unlike H1N1, an event like the storm impacted and required the response from so many parts of the city.

The toughest part is community resilience, which will continue to determine the degree to which people survive and rebound from disasters. It depends on all those social determinants and root causes of health that we in public health understand but that in many ways go beyond our ability alone to influence. The question going forward is how to move from the tail wagging the dog, to the whole dog wagging the tail.