FEATURE

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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If you turn right on Fifth Avenue, you’ll pass the Harlem Academy; the Martin Luther King Jr. Towers; the fire-engine-red garage doors of Engine 58/Ladder 26, where a banner reads, Proud home of FF. Mike Corrigan, currently on active military duty with the US Army in Afghanistan. Freedom is not Free; and low-rise residential buildings and storefront churches that march up to the schist outcropping at 120th Street, which marks Marcus Garvey Park (called, before 1973, Mount Morris Park, the name preferred by today’s realtors).

Kaur and Singh live across from Marcus Garvey Park with their one-year-old son, Hukam. They have lived there for three years.


“I hear it every day,” says Leny Rivera, a Honduran-born New Yorker who lives on East 109th Street. “Neighbors talking about struggling with diabetes.”

Rivera was the first coach hired by City Health Works. Like the newer trainees, she has learned a counseling technique called motivational interviewing, in which, Kaur says, “you don’t tell people what to do, but guide them into identifying their motivation and their sources of ambivalence.”

“The biggest challenge,” says Rivera, “is food. Our parents raised us on certain foods, and we got accustomed. The members” — members being the term for people in the City Health Works network — “are mostly Puerto Rican and Mexican. They eat a lot of deep-fried foods. So instead of cutting things out entirely, we minimize: try it for a week and see how you feel. We’ve had some success, but it goes back and forth.”

Once a week, Rivera walks to the food pantry at Madison Avenue and East 109th to meet with members one-on-one. She has six members, all diabetic, all older, all from the neighborhood.

“You hear a lot of life stories,” she says. “People don’t have a lot of support. Low income. No insurance. They’re not being treated and have nowhere to go. When they hear about a program to help them, they are very grateful.”

Rivera emphasizes diet and physical activity, and encourages members with untreated ailments to see a doctor before the problems get bigger and more expensive.

“Hospitals have never been incentivized to care about wellness and prevent illness,” Kaur says. “They profit if you’re sicker.”

Singh puts it this way: “You go to the doctor one day out of the year. Where’s the health-care system for 99 percent of your life? That’s what’s missing, and that’s what we’re feeling. Clinical care accounts for only 20 percent of health outcomes. Thirty percent comes from health behaviors, 40 percent from your socioeconomic circumstances, and 10 percent from your physical environment. Yet we spend trillions on that first 20 percent. We’ve bet the farm on this hospital-heavy model. It’s like a sinkhole: you have to get bad enough to warrant medical care. But the time between when you feel a symptom and when you get really sick can be pretty long. And you’re kind of left to the wolves.”

This, says Singh, is where we can learn from other systems — for instance, the notion that entrusted people from neighborhoods can play an important role in people’s health, as he found in sub-Saharan Africa. There, community-health workers, strongly supervised and equipped with mobile phones, deliver items like antimalarial and antidiarrheal treatments.

“At a time in the US when we’re worried about costs,” says Singh, “when we’re not delivering high-quality care, when we’re not reaching vulnerable populations, there’s much we can learn from those systems abroad, and bring it to places like Harlem.”


On Saturday, September 21, 2013, members of the Somalia-based Islamist group al-Shabaab carried out an assault-rifle attack on the Westgate Mall in Nairobi, Kenya.

For Prabhjot Singh, this was no far-flung event. He had spent his early childhood in Nairobi, part of a relatively prosperous and cohesive Indian community of 70,000 that, between the British colonizers and the black African majority, had always lived a little uneasily in Kenya. Singh had been busy that day finding out if his relatives, who lived minutes from Westgate, were OK. They were.

That evening, in New York, at sundown, Singh and a friend took an after-dinner stroll along Central Park North. Minutes earlier, Singh had dropped off his wife and son at home. Now, walking on the park side of the street, he approached the T-intersection at Malcolm X Boulevard, with the park on his left and Central Harlem fanning out to his right. It was a mild night; people were about; Singh saw a family walking ahead of him.

“Osama!” came a voice from behind. “Terrorist!”

A hand grabbed Singh’s beard. A fist caught his jaw. Singh stumbled and ran.

He ran, and behind him he saw bicycles. Fifteen or twenty bicycles, ridden by what looked like teenagers. “Osama!” “Get him!”

The bikes quickly overtook Singh. More fists flew at him. Singh fell to the ground, and was surrounded.

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