Meet the New NYC Health Commissioner

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Brian there on WNYC and now we'll meet New York City's new health commissioner.

Dr. Alistair Martin was appointed by Mayor Mamdani earlier this year to lead the

City's Department of Health and Mental Hygiene as its full name goes.

The largest and oldest local health department in the country.

We'll talk about his vision for the role.

How public health connects to the mayor's affordability agenda.

How the department is advancing health equity or trying to at a time when the federal government

is moving in the opposite direction. We talked with the previous health commissioner

under Mayor Adams about how funds that were supposed to address health equity in particular

with the huge health disparities by race that exist in the city have been cut off because you're

not supposed to look at it that way anymore, quoting to Trump.

Plus the latest news out of the agency. Dr. Martin, welcome to WNYC.

Congratulations on your appointment.

Thank you so much, Brian, and it's a pleasure to be here.

Introduce yourself to listeners. Who are you? How'd you get here?

Well, thank you again, Brian. You know, my story starts in Queens, just like yours does, Brian.

Good evening, Brian.

Good evening, Brian.

That's right, and a little part of Queens called Jackson Heights, where I saw my mom at the time

who was a high school teacher really struggling with her own challenges with regard to

affordability and making it even back then in this city.

We eventually moved over across the river to New Jersey, and then I eventually went to

medical school up in Boston, did my training there, and I have to say, you know, as an emergency room

physician, what I have seen time and time again, Brian, is that the ER is the epicenter

for public health challenges. What we're seeing every single day, you go to an ER,

in Queens, in Brooklyn, in Manhattan, and it's always the same set of challenges, Brian.

Folks who are struggling with addiction and coming in with overdose.

Folks who are coming in because they don't have a home and they have no rules to go.

Folks who are struggling with food insecurity and are simply there because they need a warm meal.

And so, you know, I think you can only see that.

And can I jump in on that? Because even more directly, people who, for whatever reason,

can't afford good primary care. They don't have good health insurance, whatever. They don't

have access to preventive health care. And where does that wind up getting expressed

in your emergency rooms, right?

That's exactly right, Brian. And the reality is that the emergency room plays the social safety net

function, but it also plays this function of really dealing with and grappling with some of our

biggest public health challenges, Brian. And I think as an ER physician, as an ER nurse, as an ER

clinician, you can only see that so much, so often. Before you decide, I'm either going to do

something about this or I'm going to complain about this for the rest of my life. And I chose

about 12 years ago to begin to do something about it. I left the emergency room, right?

And I started creating programs to address the very challenges that I was seeing in the ER,

first starting programs, addressing addiction, then helping to make sure that we were getting

vaccines into the arms of some of our most vulnerable patients. And then most recently,

really focusing, Brian, on the question of what can health care and public health do

to address financial instability? Because at the end of the day, it's the poverty that is really

making people sick, Brian. And so I'm excited to bring all of those lessons. And from my time

working at the White House and state government, right back here, you know, right to the city that

I was born in to serve the people of this great city. So you worked in the White House as an

advisor to Vice President Kamala Harris. And it certainly sounds like your vision for public health

aligns with Mayor Mamdani's. How do you start to implement that in a practical way?

To what you just said, can the Health Commissioner fight poverty? Or how do you connect with the

affordability agenda of the new mayor? That's right. That's right, Brian. So coming in, I've got

three big priorities, Brian. The first is really to invest in just the core public and mental

health components of the agency, Brian, and to do that in an era where we're going to get to this,

where the federal government is making it awfully hard for us to do the work of protecting

New Yorkers every single day from the public health perspective. There are threats to our

funding. There's the toxic environment with regard to the communications around vaccines they've

created. But the bottom line is we are not sitting here and waiting for Washington DC to come in and

tell us what we're going to do to keep New Yorkers safe and healthy. We're going to step in when the

federal government is step back. On the second priority, it's really advancing the mayor's vision

on affordability, but doing that through the public health lens. We're going to talk a lot more

about this, Brian, but the big four areas we're going to push forward on our Medicaid coverage,

helping New Yorkers who are eligible for Medicaid really stay on Medicaid. You know, in just a few

months in the new year, it's going to be a lot harder for folks to stay on Medicaid because of the

coming changes from HR1. The second is with regard to helping people enroll in cash assistance

benefits, things like SNAP, WIC, EITC lifeline. Every single year, Brian, folks are leaving billions

of dollars on the table right here in the city because they're not enrolling in these programs.

And so we want to help connect people to those programs, working with our agency partners.

The third is helping folks erase their debt. What we know still to this day is that medical debt

is the biggest driver of personal bankruptcy. We've already helped to erase about 135 million

dollars. Brian, we want to amplify that. And the fourth piece on affordability is with regard to

helping to prevent evictions. We know from the data, it's very clear, if you walk into that

courtroom alone, if you're facing an eviction, odds are you're not going to be able to keep your home.

But we are right to council city and many New Yorkers who could be accessing these lawyers to help

them are not. So we want to play that connecting role. The last big priority, Brian, is really to make

the invisible visible and make the work that we do in this agency much more visible. And we'll

talk more about that, Brian. And listeners, do you have a question for the New New York City

Health and Mental Hygiene Commissioner, Dr. Alistair Martin appointed by Mayor Mumbani, 212-433-WNYC,

212-433-9692, call with a question or text with a question or a story. Help us report the story

of the public health challenge facing New York City today, 212-433-9692. I will note, as I

referenced in the intro that your predecessor, Dr. Michelle Morris made racial health equity

as centerpiece of her tenure. Some of the stats black New Yorkers have the lowest life expectancy

of any racial group in the city, about 78 years compared to about 83 years for white New Yorkers.

This is according to your department statistics. Black women are five times more likely to die during

or just after pregnancy than white women in New York City, also New York City Health Department stats.

And meanwhile, the federal government is actively working against equity initiatives.

One thing that always blows my mind is somebody who likes to look at data, pulling socio-demographic

data from federal data sets. They're removing data that provides context and they're canceling

NIH grants for health disparities research as KFF has reported. So how do you advance this work

without federal support? Well, I know you love to look at the data, Brian. You are a

masses and public health graduate. Is it Columbia, Brian? Yeah, Columbia. Boy, you really did

That's right. That's right. Well, look, we love data as well here in the agency and we are not

going to stop using that data to make sure that we deliver for New Yorkers in every single part of

the city and making sure that we stay committed to our work with regard to health equity.

Let me give you a story. Just this last Sunday, Brian, I was with one of our dualists

who is part of our by my side doula program. Her name is Masada. And I was out with her,

Brian, doing a client visit. And it turns out that this client was in the middle of a really

challenging situation with her partner. And it was a domestic violence involved. And so she had

to be, she had to move to a domestic violence shelter. So we went to visit this client and the client

told me a story. She said, you know, with my son, who I just delivered, you know, the pregnancy

had been going well, except for the fact that when I got to the hospital, I was feeling contractions

and had been seen by a team, by the team there. And they did an evaluation and found that I was

dilated. So they were, you know, ready to to deliver the child. She said, it's not clear what

happened. It was maybe a miscommunication or something got mixed up long story short. The next

thing she knew, she was looking at discharge paperwork, Brian. She was going to be discharged from

the hospital, even though she was close to delivering. She picked up her phone and she called

Masada, who was her doula, that we provide from the New York City Health Department. She went to

the hospital, Brian. And within six hours, she delivered. Now, I don't know what was happening

at the level of that conversation at the hospital, but the bottom line is that patient could have

been discharged and maybe things would have been all right. Or maybe she would have been one of the

next, you know, young black women that this, to six, demonstrate have a much, much more dangerous

time when it comes to pregnancy and delivery. It was the actions of that doula that we, that we

helped to fund and deploy that really made that case a success as opposed to a failure. That is

what it looks like, Brian, to stand by equity, to continue to push that kind of work forward. And we

will not stop doing that no matter what the federal government says. We have a very interesting

caller who used to be in the New York State Assembly, who's going to bring up one way to address

health inequities in New York State. And I have a feeling you might be able to guess what that's

going to be. But first, I want to read a text that came in and I'm just going to acknowledge

that this kind of thing frustrates me so much because of what it leaves out. But based on what we

were describing before about racial health disparities, listener writes, I'm a physician working at a

federally qualified health center where we see mostly people who can't afford their health care.

The divide is not mostly racial. It is mostly economic. I think it's divisive to focus on the

racial issue. I wish we could all agree that at least all citizens deserve public provision

of at least basic medical care. So again, I come back to the line in that. I think it's divisive

to focus on the racial issue. But again, as a little bit of a data geek, Dr. Martin, what do you do

when you see that there's a percentage of the people who economically can't afford their health

care? The next question has to be, who are those people? And do they fall into any patterns?

And then when you know the patterns, then you can start coming up with specific

solutions that address the specific conditions of specific populations that need that help. But

but we see so much of this conversation that's even in good faith. Let's assume this doctor is

writing in good faith. But this is something that I think stops us from solving the real problem.

But go ahead. Exactly. One other thing about it is that, and likely the doctor was writing in good

faith, but what it does not include is the legacy. Hundreds of years of disinvestment, disempowerment,

racism, Jim Crow, things that have four years chipped away at that community member's ability

to stand on their own two feet and to have financial stability. And so I think it is not

fair nor accurate to remove race from the conversation with regard to economic stability. Now,

I think that we can do both. I think that we can really make the conversation

also include the economic dilemma, the economic component here out of the public health department.

And that's what we are aiming to do here is really begin to grapple with what we are calling

Brian the health wealth gap. Every single place we look across the city, we find the same

specific outcomes, where individuals have more income, where they're higher assets,

where the socioeconomic status improves, you see health outcomes improve. And the opposite

is also true, where assets are lower, where the socioeconomic status is worse, where incomes are

lower, you see health outcomes also decrease. And so we are going to do everything that we can.

We can't solve all the problems in health care, you know, out of this agency with regard to

health care affordability, but we want to do what we can to try and address the financial

instability that is making people sick, Brian. And former assembly member of the New York State

legislature, Richard Gottfried on the Upper West Side, you're on WNYC. Hello.

Well, good morning, Brian. I'd like to talk to the commissioner about the New York Health Act,

which is a bill in the New York legislature to create publicly funded universal health

coverage for all New Yorkers. Mayor Mamdani, when he was in the assembly, was a co-sponsor of the

bill. Mitchell Katz, the head of the Health and Hospital Corporation, supports it. And as mayor,

if Mayor Mamdani were to be speaking out for the bill now, I think that would make a lot of

difference to getting an active and helping every New Yorker have access to complete health

coverage without any financial barriers. Dr. Martin, talk to former assembly member Gottfried.

As I remember, thank you very much for that question. You know, I'll say just a few words of my

personal background on this. And then we'll talk a little bit about the policy implications. But

you know, I got to spend a year of my life actually between medical school and residency.

Did a little something a little bit different. I went up to Vermont, moved everything,

including my cat, and you know, got an apartment in Montpelier and worked for the governor of Vermont.

And what were we there to do? We were there to really explore how we could help move the state,

back then it was called Act 74, which was an act that compelled the state to implement a

single-payer system. I was there to help figure out how we could get that done and to work on

the messaging and the upcoming referendum that would be asked of the state of Vermont. And so I

learned an incredible, incredible deal in that time, in that period. And I come away with

your same position assembly member that, you know, something is deeply, deeply broken with our

current healthcare system. It chews up and spits out poor people and makes it incredibly challenging

for everybody else to access it. And so I'm all for big ideas. I'm all for transformation.

I have been talking with Senator, State Senator Rivera. And so those conversations will continue

between he and I now, with regard to the mayor, you know, the mayor is really focused right now on

really addressing our budgetary challenge that we're in right now. And I think that, you know,

I'll leave it to him and his team to really weigh in on the future of that act. But I share your

concern as some member with how broken our current healthcare system is. And we do have to,

we don't have to accept these constraints as they are. We can take times like this to reimagine

what the future of healthcare delivery and coverage look like.

Richard Gottfried, let me ask you one follow-up question real quick. Because I've heard a lot of

people who like the idea in theory say this should be national Medicare for all, like Bernie Sanders

has proposed. Because if you try to do it just at the state level, there just isn't the economic

base without taking too much money out of other things in order to have a universal single pay or

government only, you know, healthcare for all system. It's just, it's just too economically crushing

if one state tries to do it on their own. I think Vermont might have had an experience like that.

Just, just give me a 30 second answer because I think that's why a lot of your colleagues who would

be supportive in their hearts of the direction, who are in the legislature won't vote for it.

Yeah, there, there may be some states that would have that economic difficulty. New York is not one

of them. There have been any number of economic analyses done of the New York Health Act for New York

and similar programs in other states. It is eminently, economically and legally feasible here in

New York. And, you know, to say we want to do it nationally, you know, I always say that's like buying

a ticket for a raffle where the prize is a trip to Bermuda, but you have to go by train.

You know, we're just not getting there in the reasonable future.

I'm going to leave it there, former Assembly Member Gottfried. Thank you very much for calling in.

Can I jump in there, Brian? Yeah, sure. Yeah, so I just want to say that, you know, I think we can do

both, right? I think we can think transformatively and think about what the future of health

coverage looks like and healthcare access looks like while at the same time taking care of today.

And I think that the main challenge of today is that in January of this year, right, of this coming

year, because of the changes that have been made at the federal level, we're now going to make it,

they're now going to make it incredibly challenging for New Yorkers to stay covered if they

have Medicaid. They're going to have to do monthly work requirements. They're going to have to do

buy annual renewals. All of these things are just sort of extra hoops for folks to jump through

with the hope that they won't be covered. And what we are going to do in this agency and this

department and this city is help to make sure every single person who is eligible for Medicaid

can stay on Medicaid. And we're going to help to do that through making sure that folks get

reminders. We're going to physically be helping them enroll and do the renewals in our 11 clinics

that we have across the city in our three neighborhood health action centers. We're going to be

working across all of our city agencies to help do what we can as a health department to make sure

folks stay covered. Here's another listener question. Listen to rights. Does your guests have any

plans to make healthcare in prisons better, especially for women? Thank you very much. This is

absolutely a huge topic for us and something that we're putting considerable time and energy into

making sure that we get this right. And so it's not only for folks who are in prison that we need

to get it right for, but it's also for the recently released to make sure that they're getting the

services that they need to make sure that they're getting the health coverage that they need.

They're getting the benefits that they're eligible for. And so we are looking at this very

closely, but we're also looking at, again, making sure that that population who is recently released

can get the support that they need to remain stable on the outside. Here's a question from a listener

about coverage at the state level that's short of going to universal healthcare at the state level.

This is very of the moment. Listener from Brooklyn writes, I recently lost my job in health

insurance. It's really difficult to find a job, especially if you're over 50. Currently, I qualify

for an essential plan, that's one kind of New York state Obamacare plan, essential plan through

the marketplace. But according to Hocaultus plan, this will go away. When it does, I'd be expected to

pay more on my health insurance than rent going forward while not making any money. No, I still

wouldn't qualify for Medicaid. So what will you do about this? It's not just the poorest who are stuck.

Anything for that, Lesona? Absolutely. And that's a really, really important

challenge that we are also concerned about, right? This is yet another example of the federal

administration and the policies that have passed from Washington DC that are affecting the lives

of New Yorkers here every single day. So with regard to the essential plan, yeah, it's not just

the fact that the essential plan itself has become destabilized and folks in that 200 to 250 percent

FPL. So just for the listeners, there's a segment of New Yorkers that are able to get

health coverage is extremely affordable because of the changes to the essential plan. And so

when that essential plan goes away in July because of the forthcoming federal policy changes,

it's going to get a lot more expensive for them. And at the same time, they're going to go back

into the traditional Obamacare market where they're going to see that premiums have increased

there because again, the federal government has not extended the subsidies for the ACA. And so

there are a number of these issues that we're really, really deeply concerned about. Now,

what we're thinking through on this, and I have to be completely honest with the listeners,

Brian, we at the city level don't have the ability to pull the levers on health coverage at the

federal level or to expand the FPL limits for who gets coverage with regard to the essential

plan. But what we can do is work with our state partners, we're in constant communication with

them. I mean, I'm constantly talking to Dr. Jim McDonald up there at Albany, who's the commissioner

of health. And what we can do is make sure that we are ready to receive people at our clinics.

Folks may not know this, but we have 11 public health clinics all throughout the city.

These are low cost to no cost clinics, Brian. And so folks can come in. We don't,

there's no concern of ability to pay or insurance status or immigration status. And we offer

you know, health care on a couple of very concrete challenges that New Yorkers face. And so we

recommend and advise folks to come to our clinics if they have no other source of options.

We're running at a time. I want to acknowledge one thing without going into it because I think

a lot of our listeners are familiar with the question, but I do want them to know that your

department just launched a $1 million media campaign regarding vaccines called Ask questions,

get answers, vaccinate, ask questions, get answers. And there's the answer, vaccinate. And

that's obviously in the context of the RFK junior era at the federal level. But with our remaining

time, I want to take one more caller who's going to bring up a public health issue that doesn't

get so much press. Sarah and Fort Green, you're on WNYC. Hello, Sarah.

Good morning. Thank you for taking my call. Marches and the Matriosis Awareness Month. And I

wanted to ask the commissioner if we might see a planned public health campaign about NWTRIF,

a condition that affects one in 10 women. It's as common as diabetes. But that is so underrecognized

literally that there's an average 7 to 10 year delay in diagnosis. It is a whole body inflammatory

condition that can affect bowel function, bladder function, lesions can be found in the lungs,

the diaphragm, the heart. It can cause infertility. And many, many women suffer from pain and other

symptoms for years before being taken seriously by a doctor. NYU in particular has a campaign

to say that pain is not normal, even period pain, even if your mom had it, perhaps particularly

if your mom had it, because it is a genetic condition or a hair condition.

And Sarah, I'm going to leave it there because we're running out of time in the segment. But

Marches endometriosis awareness month, she said. And I'll bet a lot of people heard from her call

right there descriptions of what endometriosis can do for the first time. So do you have anything

on that? And then we're out of time. I have to tell you, thank you so much to the listener.

This is an incredibly important diagnosis. I've taken care of

dozens of patients who have come into the emergency department with inexplicable pain,

which we later, later diagnosis endometriosis. And so this is absolutely an incredibly important

issue. We have a number of, first I absolutely take her comment and we will think about that.

Thank you very much about how we might do more on this, right? How we might raise the profile

and raise the conversation about this very important diagnosis. Here's some of the things

that we currently do. So the maternal hospital quality improvement network that we work,

we work to do across the New York City hospital ecosystem really focuses on how we address

disparities in maternal mortality, how we address morbidity with regard to maternal health,

and how we focus on clinical practice changes to make sure that we as a city are serving

every New Yorker, but in particular, making sure that we get it right for our city's women,

specifically on issues that relate to women's health endometriosis being one of them.

And so thank you very much for that suggestion and we will think about how we can do much more on that.

And we leave it there with a new New York City Commissioner of the Department of Health and

Mental Hygiene, Dr. Alistair Martin. And as we like to do with health commissioners,

we look forward to talking to you many times during your tenure. Thanks for coming on today.

Looking forward to the next one, Ryan. Thank you so much.