The Wages of Health

Manmeet Kaur and Prabhjot Singh made a commitment to serving their community. Despite enduring a terrifying act of violence, they haven’t broken it.

by Paul Hond Published Winter 2013-14
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Singh is the director of systems design at Columbia’s Earth Institute and teaches a course on global health practice at SIPA. He is also a physician at Mount Sinai Medical Center and co-chair of the One Million Community Health Workers campaign, an Earth Institute –based initiative of the African Union and the UN Sustainable Development Solutions Network. (The goal: one million health workers for sub-Saharan Africa by 2015.) He wears a burgundy turban, a long, black beard, a forest-green pullover, and designer jeans.

“Three or four years ago, the attitude of the New York health systems was, We don’t want to deal with community health. It’s such a money loser in this fee-for-service system,” Singh says. “That flipped immediately” — he snaps his fingers — “when health reform kicked in. Now there was a thirty-day readmission penalty: if patients came back before thirty days and you treated them, you wouldn’t get new money. Suddenly, doctors said, We’d better build a system to take care of people for thirty-one days.

“But what about the rest of the year? Why not make a system that takes care of people for 365 days, and not have them just come in and out of the hospital?”

“There’s a need,” says Kaur, “for a much more intensive community- based layer of the health-care system. Behavior changes are complicated. Socioeconomic factors that cause stress and influence health cannot be solved in a doctor’s appointment.”

Singh can attest. “As a primary-care physician, I know that in my fifteen-minute visit with a patient, I’m not equipped to give life coaching. And I’m not the guy to do it. So we’ve hired residents of East Harlem who are gifted motivators, trained in motivational interviewing techniques, who help people set goals around diabetes care, around living a healthier life.”

For the moment, the coaches are paid for with grant money from the Robert Wood Johnson Foundation and a service fee from Mount Sinai, New York’s largest private-hospital system. Kaur and Singh are working with insurance companies so that, over time, insurers will join the hospitals in financing the coaches.

“Our goal for this pilot,” says Singh, “is to get sustainable payments so that we know the pricing for the system. We’re figuring out all the connections, all the costs.” Singh and Kaur believe that their model will lower expenses for everyone: patients, hospitals, clinics, and insurers. “As that happens,” Singh says, “then this can spread.”

It’s about a thirty-minute walk from City Health Works to the high-rise condo at Fifth Avenue and East 120th Street. That path, which traverses the lower half of East Harlem, is checkered with fast-food joints, tenement walkups, and columns of the stark, huddled red-brick towers of the New York City Housing Authority.

Crossing East 96th at Third Avenue on a Friday afternoon, you pass the Mecca-facing domed mosque of the Islamic Cultural Center of New York, toward whose open doors flows a stream of men and boys in caps and tunics. Outside the gates, a South Asian woman in a chicken curry, telling a health-curious customer that meat is a necessity, which prompts a bearded, taqiyah-wearing man to suggest, in a barrio accent, that vegetarianism and bottled water are the way to go (he’s not there yet himself). Three blocks north, a food stamp–friendly greenmarket offers broccoli ($1.50/lb.), collard greens, snap peas, turnips, kale. Three elderly Puerto Rican women watch a stir-frying demo at an adjacent booth (broccoli and parsnips, olive oil, low-sodium soy sauce). The market, open on Fridays from April to November, is run by Harvest Home, a nutrition-minded nonprofit that receives support from EmblemHealth, New York’s largest private health insurer. EmblemHealth’s purple-on-white emblem is conspicuous here, and vans bearing the logos of other insurers cruise the area, competing for customers. So it makes a kind of thematic sense that when you turn and look west on East 99th Street, you see, half a mile away on Madison Avenue, looming like an obsidian monolith in a fantasy novel, the 434-foot black edifice of Mount Sinai Medical Center.

On Third Avenue, meanwhile, the food plot thickens: we have, clotted together, McDonald’s, Little Caesar’s, KFC, Burger King, Taco Bell, Dunkin’ Donuts, and, in a few groceries, modest arrays of apples and fresh vegetables that can’t shout like the playroom reds and yellows of the busy fast-food chains that saturate the diabetes epicenter of New York. Turn left at 110th (Tito Puente Way), walk under the elevated train at Park Avenue, past the Lehman Village Houses to the traffic circle at Fifth Avenue, where the future home of the New Africa Center rises above the northeast corner of Central Park. Below, in the autumn-mellow park, on a green-skinned lake, brown ducks paddle with their bills open, munching the algae-colored, protein-rich duckweed. This is where East 110th Street becomes Central Park North.

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