Wednesday, 12 November 2014

The Social Movement is Alive

Without missing a beat, or even slowing down, the man said: “42nd street that way, (right arm pointing), 41st that way, (left arm).” I smiled intermittently for the rest of the day. I liked to think that this was a typical New York interaction, brisk, business-like but good-natured and well intentioned. My Samaritan, in a flash, and before I needed to say anything, diagnosed that I had emerged blinking and disoriented from the 42nd subway station into one of the ornate corridors of Grand Central Station, looking for inspiration. Equally quickly, no fuss, he solved it. Gratefully, I headed south.

Solving the NY subway, and eschewing taxis, was a means not an end. The ends were engaging first with the New York City Commission of Health and Mental Hygiene (quaint name), then with the New York Academy of Medicine – each headed by an impressive woman.

The Mayor of New York, Bill de Blasio, has social justice and equity at the heart of his concerns. This seems a good moment for New York to get active on social determinants of health. The Health Commissioner, Mary Bassett, had invited to me have lunch with her and fifteen or so of her senior staff, and then give a talk on ‘implementing the Marmot Review’ to those and another hundred staff. There is enthusiasm there. The one doctor in New York who contracted Ebola after his work with MSF in West Africa has diverted the Commissioner and staff in a major way, given the public fear of the issue. Their handling of the issue seems to have gone well. I did wonder, though, if some part of the tens of millions of dollars that New York spent on Ebola had been spent in West Africa…

City level of government may well be the most appropriate level for action on social determinants of health in the US, given the policy immobility of Washington. I was in New York the day after the mid-term elections revealed that with a Democratic President, and Republicans in control of the Senate and the House, who knew what would happen next at Federal level. There is real interest in the NY Health Commission in working across the organs of City government on social determinants of health. I showed them the work we have been doing on monitoring Social Determinants of Health and health inequalities. If London can do it, why not New York?
To the New York Academy of Medicine (to receive a public health award) and to, I hope, engage them as partners in potential activities with New York.

I reminded the audience at New York Academy of Medicine that when we launched the CSDH we said we wanted to foster a social movement. The number of people who said that the CSDH report, Closing the Gap, was influencing their work, suggested that the social movement is alive and well. The Acting Commissioner of Health for the State of New York – as distinct from the City – Howard Zucker, says he keeps a copy of the report on his desk.

Unrelated to social movements, a spare hour spent in the Frick Collection in New York is a revelation. It has a small, but astonishing collection: a Rembrandt self-portrait – one of the merciless self-examinations of his later years; three Vermeers; a Titian; Holbeins; two Turners; a couple of Constables; and a whole slew of Gainsboroughs. The next day, by contrast, between day meetings and the evening occasion at NYAM, I managed an hour at the Neue Galerie, with its fine collection of Gustav Klimt and Egon Schiele. Schiele, particularly captures what an edgy time that was to be in Vienna, early 1900s, soon before the whole empire came crashing down. Schiele and his wife both died, within three days of each other, in the pandemic influenza in 1918.

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