Image courtesy of jarbo / Jared Cherup.

With a Big Mac checking in at 540 calories and a medium order of fries at 380, healthy fast food may seem like the ultimate oxymoron. But that has not kept New York City officials from trying to regulate consumption of fast food chicken, fries and tacos for some 18 years. Their efforts, though, have had only mixed success.

In 1990, City Council first started debating plans that would require fast food outlets, which today make up about 10 percent of the city's approximately 20,000 restaurants, to post nutrition facts. A series of almost identical bills flickered in and out of City Hall until 1998, when the subject was finally dropped.

Mounting concern over the so-called "obesity epidemic," prompted city officials to take another look at New York's Taco Bells, McDonald's and KFCs. In December 2006, members of the Board of Health voted to force some fast food restaurants and restaurant chains to provide calorie counts on their menus. The board also banned the use of transfats, which have been found to raise cholesterol and increase a person's risk for heart disease, in every New York City restaurant from Burger King to Bouley. This decision followed a Food and Drug Administration rule introduced in January 2006, requiring food manufacturers to include information about transfat content on labels.

Out Damned Fat

There was some grumbling over the transfat ban. A representative of the Heart Association, for example, wondered whether it would force restaurants to substitute other equally unhealthy substances, and some restaurant owners expressed fear that moving away from the artificial cooking oil could raise costs and reduce flavor.

Despite such concerns, the health department has reported widespread compliance with its rule. The health department found that 94 percent of the restaurants it inspected in the first three months of the ban had stopped using transfats for frying or as spreads. (The restaurants have until July 1, 2008 to stop using the fats in baked goods or to fry dough or cake batter.) "Despite claims to the contrary, New York City restaurants have shown that it's easy to get artificial transfats out of spreads and fry oils," health commissioner Thomas Frieden said in September.

"We removed all transfats in 2007 and the products are still high quality and taste great," said Starbucks spokeswoman Tara Darrow.

Post Those Calories

Efforts to persuade fast food restaurants to post calorie content, though, have proved more difficult. The Board of Health's December 2006 order only applies to restaurants that already provided the calorie counts on Web sites or in some other public place. It would have covered about 10 percent of the city's restaurants, mainly large chains with standardized menu offerings.

In June 2007, the New York State Restaurant Association sued the Board of Health to block the rule. The group said the mandatory posting infringed on the businesses' First Amendment rights, because it would have forced restaurant operators to say something against their will. The trade group said that restaurants that had previously provided their nutrition information in a brochure or on a Web site were being unfairly punished by having to list their calorie counts on menus and wall posters, since the restaurants that never offered that information were absolved of the requirement. The association also claimed that the law violated the Food and Drug Administration's 1990 Nutrition Labeling and Education Act, which specifically exempted restaurants from having to label their food with nutrition facts. Hearing the arguments, Judge Richard Holwell of U.S. District Court in Manhattan threw out the law in September 2007.

This January, pushed on by Mayor Michael Bloomberg and Health Commissioner Thomas Frieden, the Board of Health voted for another, slightly modified version of the calorie-listing law. It would require every fast food and chain restaurant -- not just ones that already offer calorie counts -- to list calories as prominently as prices by March 31, 2008. The New York State Restaurant Association sued again, arguing the revised rule still violates the restaurants' freedom of speech and is preempted by federal requirements.

In a phone interview, Rick Sampson, president and chief executive officer of the Restaurant Association, questioned the efficacy of providing calorie content. "For the last 17 years," he said, "the FDA has required every packaged food to list nutrition info right on the box, but still, obesity is at an all-time high."

To counter that, Sampson called for more public education about healthy eating habits aimed at children and their parents. "The restaurants have sat down with the commissioner about this, but he will not listen," Sampson said. "We would like to make even more nutrition information available, like the amount of sodium in the food, but that won't fit on a menu board and the commissioner will accept nothing but posting calories on a menu board," he said.

The health department, though, argues that it is the restaurant association that is being intransigent. "We had hoped that the restaurants would work with us to address these pressing concerns of obesity and diabetes," said Sabrina Baronberg, deputy director for physical activity and nutrition. "Unfortunately, it seems they'd rather go to court than put calorie information where their customers can use it and see it.

She believes labeling will work. "When people have access to calorie information, they use it," Baronberg said. About three quarters of consumers say they look at calorie information on packaged foods in supermarkets, and about half say that nutrition information affects what they choose to buy."

Fast Food Nation

Healthy or not, millions of New Yorkers eat fast food. And so, the health department and industry critics say, restaurants bear some responsibility for the obesity epidemic. "Studies show that eating out contributes to obesity and people are eating out more often," said Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest. "Americans are getting about one third of their calories from eating out. We've gotten used to having nutrition labels on our packaged foods, and Americans want this information when eating out."

According to Wootan, posting the calories online, on hidden posters near the bathrooms or on the under-side of tray liners, as many restaurants do, are not helpful. "You don't see Burger King listing their prices over by the restroom," she said. "And if people have time to go home, log on to the Internet and study a Web site before they go out to eat, they'd just stay home and cook dinner."

And so the battle rages on. Will New Yorkers improve their health and change their eating habits as a result of the rule?

Baronberg sees a huge impact. "We think that this regulation could reduce the number of people who suffer from obesity by 150,000 over the next five years, preventing more than 30,000 cases of diabetes," she said.

Others, such as Morgan Downey, executive vice president of the Obesity Society, are more cautious. "Definitive scientific studies are not available" on whether posting calorie content "will reduce or lessen the prevalence or impact of obesity," Downey said. "Nonetheless, the Obesity Society believes that more information on the caloric content of restaurant servings, not less, is in the interests of consumers."

 

Image courtesy of lornagrl / Lorna.

At Harmony Variety Discount in East Harlem, the meat and cheese case is empty, but the beer refrigerators are packed. A sign outside the Lexington Avenue Bodega calls in customers for 99-cent, 24-ounce cans of Miller Lite and packs of Newports for $6.50.

For eight years, owner Mohammed Saleh has provided the low-income neighborhood with a place to grab a six-pack and cigarettes -- not fresh fruits or vegetables.

He tried to sell healthy foods for six months last year, but no one bought them.

"Nobody buys them," said Saleh of fruits, vegetables and even low-fat milk. "If you ordered healthier food, the store would lose money."

Saleh's second location on the Upper East Side, however, sells such healthy products successfully. Grocers on the Upper East Side may stock leafy lettuce and ripe grapes, but 20 blocks north, similar products are noticeably absent.

The Grocery Gap

Residents of Harlem, Central Brooklyn and the South Bronx often have no choice but to shop at stores like Harmony Variety Discount, which fail to provide healthy options.

Supermarkets are few and far between - some city zip codes are without them entirely - leaving many residents scrounging for affordable meals at fast food restaurants, small grocers or bodegas. Instead of the Whole Foods or Associated Supermarkets found in more affluent areas, many residents in Harlem must rely on Popeye's or McDonald's - options that do not reinforce a healthy lifestyle.

In response, the Bloomberg administration in 2006 launched a healthy bodegas initiative in Harlem, the South Bronx and Central Brooklyn. Its goal: to make fruits, vegetables and low fat milk more accessible in an effort to stifle the epidemics of diabetes and obesity - diseases directly associated with diet.

Since the program began, the Department of Health and Mental Hygiene contends it has been a success. But does measuring the number of participating bodegas accurately measure whether fruits and vegetables are served at kitchen tables throughout the city?

What's In Stock?

In both Harlem and the northern and central sections of Brooklyn, bodegas are the main place to purchase food. According to a health department study released in 2007, two out of three food retailers in East and Central Harlem are bodegas in comparison to one in three food stores on the Upper East Side. In Bedford-Stuyvesant and Bushwick, approximately 80 percent of food stores are bodegas. Only 28 percent of those bodegas carry apples, oranges and bananas, according to a similar study on access to healthy foods in Brooklyn by the health department.

These neighborhoods are also more likely to be overrun by diseases that flourish among those with unhealthy eating habits. A resident of the South Bronx, for instance, is about six times more likely to suffer from diabetes than a resident of the city's more affluent neighborhoods.

Arguing that access can make all the difference, the Bloomberg administration launched the multi-faceted healthy bodega campaign, specifically aimed at getting low and reduced fat milk in bodegas in low-income neighborhoods alongside fruits and vegetables. Over the course of two years - the original deadline is this December - it hoped to cover 1,000 stores.

It tested several approaches, like selling sliced individual apples in bodegas, some with greater success than others. Overall, said advocates, the milk initiative seems to be having more of an impact than efforts to get produce in the stores, and the health department says it has reached its target to get storeowners committed to selling low fat milk. (So far, the fruits and vegetables program has also not been rolled out entirely - it should be out in full-force this spring.)

The department launched its fruit and vegetable pilot program last year at 60 locations, which, officials admit, was not entirely successful. The revamped full-fledged initiative will affect far fewer stores than some advocates initially expected. A health department official said about 450 bodegas will participate, all of which already sell some fruits or vegetables.

The cost of the initiative, according to the health department, is less than $300,000 annually, which is attributed entirely to staffing.

"We have seen more low-fat milk on their shelves," said Charmaine Ruddock, the project director of Bronx Health REACH, a community group that has launched its own healthy bodega program in the South Bronx. "There is an increase in awareness of eating healthier. The challenge, of course, is getting these healthy foods in there."

And Its Impact

Few would argue against eating healthy foods and making them more accessible (Though some did so this week at City Hall - see related stories here and here.) The challenges the health department faces are not over its goals but on its ability to make them a reality and enforcement.

The campaign is not penalty oriented. So, said Sabrina Baronberg, the deputy director of the physical activity and nutrition program at the health department, enforcement is done by follow-up visits from health department officials and through a questionnaire.

Even if bodega owners do stand by their commitment, it's difficult to gauge whether demand will naturally follow supply.

"We know there is focused demand in the community," said Baronberg. "It's not true that people in these communities are not interested."

What is true, said some advocates, is participating has proved to be difficult for some owners. Some bodegas do not have adequate space for fresh produce, while others cannot afford to lose profits on a product whose shelf life is relatively short.

"Lets say you stock up on watermelons for Memorial Day and it rains," said Joel Berg, the executive director of the New York City Coalition Against Hunger. "If you're a small bodega, you're out."

In East Harlem, some storeowners echoed that sentiment. Some storeowners said they don't have the space to expand beyond candy, toilet paper and other grocery items. At Harmony Victory Discount, price is a deterrent to selling fruits and vegetables, which are more expensive than other types of food.

"Eating healthy is expensive," said Ali Saleh, the owner's brother. "People come in here with $3, and they still owe us a quarter."

Health department officials said they are exploring ways to help bodegas get loans so they can afford to either purchase fruits and vegetables or revamp their stores to make room for them. Those loans, though, will not necessarily make such food more affordable to their customers.

Transforming Neighborhoods

Many say it's still too early to tell whether the city's healthy bodega initiative is getting more residents of low-income neighborhoods to eat healthier. Either way, some said, it certainly can't hurt to try.

This program is just one of many in the administration's public health crusade, which advocates characterize as one of the most progressive in the country. While this particular initiative is no panacea, they say it is certainly positive.

"It certainly hasn't hurt, but it hasn't transformed bodegas citywide," said Berg.

 

Image courtesy of Susan NYC / Susan.

As children we learned that an apple a day keeps the doctor away, but we never questioned where that apple would come from or how much it might cost.

While some New Yorkers enjoy the "luxury" of a grocery store just down the block, many low-income families live far from any place to buy healthy, high-quality produce at affordable prices. Hundreds of thousands of New York City residents live in neighborhoods with no supermarket, no green grocer and no farmers market. Families must go to great lengths to purchase food outside their neighborhoods or make do with what corner bodegas supply -- largely canned and boxed goods.

No wonder the New York City Department of Health and Mental Hygiene found that 12 percent of adults in some neighborhoods ate no fruits or vegetables on a daily basis. As one would expect, the existence of these "food deserts" throughout the city has a devastating impact on the health and waistlines of New Yorkers.

According to the health department, about 500,000 children citywide are obese and at risk of developing life threatening diseases - diabetes, heart disease, and high blood pressure - as adults. Life expectancy in some poor communities is eight years shorter than in wealthier neighborhoods, such as the Upper East Side or the West Village. While various factors lead to these problems, research has shown that a diet lacking fresh fruits and vegetables is among the major contributors.

To begin to address this public health crisis, children and families in all New York City neighborhoods must have access to fresh affordable produce. Poor, hard-working families across the city shouldn't have to tackle multiple subway lines, buses or cab fares after work or on the weekend in order to purchase high quality fruits and vegetables at prices they can afford. Rather, families everywhere - in Melrose, Harlem, Bedford-Stuyvesant, Bushwick, Jamaica, Corona and Willowbrook - need healthy food options, at reasonable prices, where they live.

A Cart Around the Corner

Help is finally on the way. Thanks to Mayor Michael Bloomberg and City Council Speaker Christine Quinn's "Green Carts" initiative, families even in places without good grocery stores soon will be able to purchase affordable fresh fruit and vegetables conveniently, and on a regular basis, where they live.

The recently passed green cart legislation will create 1,000 new licenses for vendors to sell fruits and vegetables in neighborhoods that have high rates of obesity and diabetes, and where consumption of fresh produce is low.

While this may not be legislation that will change New York City's food landscape forever, it provides a new solution to the age-old problem of how to provide all neighborhoods - particularly those with a desperate need - access to healthy affordable food. The green carts initiative can be implemented quickly and will have a broad reach in the city's poorest communities.

Increasing Access

The food industry is a powerful lobby, and it had engaged in an all-out fight to derail this legislation. Despite the fact that carts will operate where supermarkets and other fresh food outlets don't exist, the industry argued that the carts will create unfair competition. If only that were true -- there would have been no need for green carts.

Ideally, every neighborhood would have a grocery store or supermarket within walking distance of the majority of its residents. Supermarkets relieve a neighborhood's food deficit, anchor a community and provide good stable jobs. For decades, communities have been lamenting the lack of such stores - especially when other neighborhoods have lavish food outlets on every corner.

The city is studying how to lure supermarkets and green grocers back to our communities, and we're optimistic this will eventually mean more grocery stores where they are needed most. The increased presence of a once or twice-weekly greenmarket would also be a major improvement in neighborhoods lacking options.

But waiting for the perfect answer ignores the immediate healthy dangers these children and families across our city face. It would be the equivalent of arguing that until we have a perfect health care system, people should not seek treatment at all.

Our city's low-income children and families cannot afford to wait three, five or 10 years to get better access to fresh produce. While we hope for supermarkets and farmer's markets in the future, we need to be able to buy apples and bananas for snacks today, and green beans and salad greens for dinner tonight. Lives literally depend on it.

The green cart initiative addresses this real need - in real time.

We are looking forward to seeing these carts in neighborhoods all over the city, where for the first time in decades, hundreds of thousands of families will be able to conveniently buy fresh produce. And at the same time, we will continue to support the mayor and the City Council in their efforts to develop more supermarkets and farmer's markets and improve the capacity of existing grocers to sell fresh produce at prices New Yorkers can afford.

Jennifer March-Joly is executive director of Citizens' Committee for Children of New York, Inc.

 

Images courtesy of lornagrl / Lorna, jarbo / Jared Cherup and Susan NYC.

Mayor Michael Bloomberg has made public health a signature issue for his administration. During his six years in office, the city has waged war on smoking, focused on improving care at public hospitals and promoted a range of initiatives aimed at getting New Yorkers to take better care of themselves.

Many of these efforts have proved successful. Smoking has declined sharply, the number of AIDS deaths has dropped and an increasing number of New Yorkers see a regular physician. Even traffic deaths have hit a record low. But one area stubbornly resists the improved health picture: obesity.

About one fifth of all New Yorkers is obese, with the rate far higher in some areas. "We see obesity going up across the city, regardless of neighborhood, but also we see disparities between neighborhoods," the health department's Cari Olson said in an interview with Gotham Gazette last year.

As obesity rates rise, so has the prevalence of diabetes. A recent report by the City University and the Public Health Association of New York found the number of New Yorkers with diabetes has risen 250 percent in the last decade and that the death rate from it has almost doubled.

The administration has not ignored the problem. It has, among other things, replaced whole milk with the low-fat variety in school cafeterias, worked to make school food healthier in general, tried to get bodegas to stock more wholesome products and so on.

How successful are these programs? That remains unclear.

The city's most recent Public Health in New York City report featured pages and pages of indicators in a section titled "The Health Department by the Numbers." Few of the statistics concern obesity and fitness. The report does cite the implementation of the FitnessGRAM program in schools and other exercise programs, along with its efforts to remove transfats from city restaurants. But other than that, it has little to say on overweight New Yorkers, and the department's "Ten Steps to a Longer Healthier Life," largely ignores diet and exercise other than to tell New Yorkers to "keep your heart healthy."

In light of that, Gotham Gazette decided to assess some specific city programs intended to curb the obesity epidemic. We found some successes, some failures with work left to be done.

Putting Bodegas on a Diet: Many New Yorkers must shop at small groceries, which offer a smorgasbord of chips but not fresh produce. Can the city make storeowners change their ways?

Reading, Writing -- and Running? The Department of Education has implemented a FitnessGRAM so parents can help their kids shape up. But in an era when standardized tests influence so much of the school day, traditional phys ed classes often fall victim to a lack of time and space.

Affordable Greenmarkets: City and state efforts seek to make the bounty of city farmers markets available to low-income New Yorkers.

Beefing Up the Menu: Calories mount up quickly at fast food restaurants, and the Bloomberg administration hopes people will scale back -- once they know just how fattening their favorites burgers are. But restaurant owners are fighting back.

Also this week:

Curbside Vegetables: Will produce pushcarts encourage people to eat healthier foods?

Permit for "Green Carts": The City Council passes a measure to create a new class of street vendor.

 

Date unknown. Image courtesy of National Archives and Records Administration / New Deal Network

WPA Nurses assisting patients at Rikers. The original caption read "The New York City institutions have an unusually high proportion of inmates who require such services."

For eight months, John, a 56-year-old resident of the Bronx, lived as clandestinely as possible, doing his best to cloak the three scarlet letters symbolically etched on his chest: H-I-V. He avoided prescription lines and ignored cravings for Ensure - considered a clear sign that someone has "the virus."

On Rikers Island, human immunodeficiency virus goes by another name. Whether it's a passing reference to "the monster" or the prying questions including, "You live in the House In Virginia?" John, like the thousands of others who go in and out annually, did everything he could to keep his status a secret. "I found myself trying to conceal it more than take care of it," said John, who declined to give his last name.

Because on this 413-acre island nestled between the Steinway section of Queens and the Bronx, health care was not John's first priority. And in the view of some advocates, providing medical care to prisoners is not one of the city's top priorities either.

Receiving and delivering health care is a balancing act on Rikers. Officials must constantly weigh the relative importance of security, privacy and health as they attempt to care for a population that is not only transient, but is also disproportionately afflicted with mental illness, substance abuse and debilitating illnesses, like HIV.

Clinics on Rikers now are run by a private company whose contract was just renewed for another three years. Though the quality of care has improved since the days when a private hospital ran the clinics, many advocates argue the system still has an attitude of us versus them, of prisoner versus guard and of control versus the powerless -- certainly not conducive to quality care. As the city prepares to likely review the standards that guide health care within the correctional system, decisions made in the months ahead will have an effect on thousands of people who, after leaving Rikers, will return to families and neighborhoods across the city.

A Transient Population

At any one time on Rikers, there are approximately 14,000 inmates, adding up to about 100,000 admissions in a given year. They are not mass murderers, but alleged drunk drivers or drug addicts, among others convicted of misdemeanors, and about 80 percent are being detained prior to trial.

About a quarter are mentally ill, according to the health department, and a third are seen as extremely frail, plagued by severe drug addictions or chronic illnesses.

An average inmate stays 40 days, but the most frequent discharge from Rikers Island is on day one. The population is constantly changing, moving from facility to facility or from imprisonment to freedom.

Rikers has seen its fair share of turmoil. Its health contract has been passed from a nonprofit hospital to a for-profit, private medical center to a private corporation in a little more than a decade. Scrutiny over the island's health care has fluctuated too.

Now overseen by the city's Department of Health and Mental Hygiene, the clinics on Rikers are run by Prison Health Services, a private, for-profit company based in Tennessee. It manages the health and dental care of 10 of the city's 11 jails, nine of which are on Rikers Island. The other is the Manhattan Detention Center. (The Vernon C. Bain Center in the Bronx is not covered by the contract.)

All nine jails on the island have their own clinic, and the whole population is served by one infirmary. Inmates in more serious condition are sent either to Elmhurst Hospital Center or Bellevue Hospital Center.

Barriers to Care

The climate of control and authority that is part of any prison system affects health care. By far the largest complaint about medical care on Rikers, according to former inmates and prisoner advocates, is what they see as the indifference of some corrections officers and employees of Prison Health Services to the inmates' health. Former prisoners, like John, have waited for several hours before seeing anyone at the clinic - a tactic some claim corrections and Prison Health Services's employees use to assert their authority. Prisoners say that those who complain are sent back to their cells. All they can do is wait.

Health department officials said they receive similar complaints and are encouraging Prison Health Services to promote an atmosphere of respect.

"There is concern about the question of respect particularly," said Louise Cohen, deputy commissioner for health care access and improvement at the Department of Health and Mental Hygiene. "It's clearly a problem when you have an adversarial population. People already feel dehumanized. They don't have control over their own lives. They don't have the freedom to move around."

The department, Cohen added, investigates and takes seriously every inmate complaint it receives.

Gotham Gazette requested figures on the number of complaints received by the health department, including the numbers that were eventually substantiated, since Prison Health Services took over the contract in 2001. The department said it did not track such complaints.

Some inmates who have been behind Rikers' bars said they are subject to intimidation, not health care. Casimiro, whose last name is being withheld, spent 16 years in and out of Rikers Island. He has had 67 arrests, some violent, some drug-related. And time and time again, he said he was treated like an animal.

The 40-year-old former inmate turned group counselor said he had carried other inmates to the clinic, while corrections officers stood by unwilling to call for help. When Casimiro himself visited the clinic, medical charts were often in plain view for any passerby to peruse.

Jason, a 41-year-old Harlem resident who spent eight months on the island in 2000 and whose last name is being withheld, has been HIV positive for more than two decades. He did not disclose his status during the initial mandatory intake procedure for fear of the stigma (All inmates get a medical examination within 24 hours of arriving at Rikers.)

Several days later with a lingering feeling that his body was "shutting down," Jason approached a corrections officer and dislcosed his status. The officer, he said, didn't believe him, claiming he "had no proof."

"They looked at me like I was lying," said Jason. "Their job is to question you."

That attitude, Jason recalled, kept him tight lipped for the rest of his stay on the island, no matter how his body felt.

Given the population at Rikers, some skepticism is justified - but how much? Some medical professionals, including those intimately familiar with the conditions at Rikers, contend the health department and Prison Health Services successfully balance the challenges posed by the population with providing quality health care.

"It's very hard job working out there in extremely challenging circumstances," said Dr. Eric Manheimer, medical director of Bellevue Hospital Center, which houses the men's inpatient prison ward for Rikers. "Generally they (Prison Health Services staff) are qualified... They make good decisions... What we've worked out with the staff over there is a very low threshold to send (inmates) to us."

Some of the prisoners' complaints are beyond the health department's jurisdiction, like those pertaining to corrections officers. The department's role, officials said, is to ensure inmates have access to care and address health issues that may have been ignored for too long, like providing testing for sexually transmitted diseases for all inmates.

According to the department of health, about 5 percent of inmates at Rikers come into the intake process saying they are HIV positive. Another 25 percent, according to the department, submit to a voluntary test that is offered to every inmate. The testing, the department says, is part of the preventive care it attempts to provide on the island. The department has also implemented full discharge plans for HIV positive inmates, and over the last year it has seen 98 percent of them make it to their first appointment outside of Rikers.

"If we can improve the health of those that are incarcerated than we can improve the health of the communities that they come from," Cohen.

Still, admitting to a chronic illness within the confines of Rikers creates another set of obstacles for the prisoner and not just from fellow inmates. Former Rikers inmates say that they have, for example, seen corrections officers insist on wearing rubber gloves when they interact with prisoners who are HIV positive.

Privacy in the Open

Mayor Michael Bloomberg has made public health a hallmark of his administration, and that focus has had an effect on Rikers Island. The health department is creating a network of records accessible throughout all the Rikers facilities so doctors will know a patient's history if they had been previously incarcerated or were being moved from jail to jail. Patients will soon also have the option to disclose past medical records so physicians can get a more well-rounded view of their ailments. Currently, doctors have access only to information on the care patients received on Rikers Island.

Despite these efforts, though, the challenges of providing health care in jail continue to persist to the detriment of inmates, said some advocates. One of the largest concerns for inmates is privacy.

All consultations with medical personnel are supposed to be private. But, inmates said, in a clinic with no walls and diagnoses occurring side by side, confidentiality is impossible. (The health department refused to allow Gotham Gazette to visit a clinic on Rikers, because of privacy issues.)

"There is no confidentiality in jails," said Dale Wilker, a staff attorney at the Prisoners' Rights Project at the Legal Aid Society. "There are standards for it, but guards are right there and overhear. It's something the medical staff must jealously safeguard, but that's difficult in the treatment rooms."

Part of that security is warranted. Rikers clinics are among the few areas on the whole island where inmates from separate units converge in one space. It is there, inmates confirm, that drugs, weapons or other contraband are traded. Because of that, inmates may have reasons for asking to see a doctor that have nothing to do with medicine.

"We do not inform the Department of Correction law enforcement or the courts about their records," said Cohen. "We do, however, recognize the need for security. All patients need to be in the line of sight of a correction officer at all times."

A History of Neglect

Given the difficulties of providing private health care in the city's jail system, who would take it on?

In the 1990s, the city first awarded the contract to a for-profit entity, St. Barnabas Medical Center. During the three years of St. Barnabas's tenure, accusations surfaced that the hospital denied basic services to inmates to cut down on cost.

When its contract expired in 2000, the city turned to Prison Health Services - the for-profit, private company that holds a virtual monopoly on correctional care throughout the country. Under their care, complaints have received far less attention, but periodically rise to the fore.

Nonetheless, Prison Health Services isn't going anywhere anytime soon. The city recently renewed its contract for another three years for $366 million. It expires in December 2010. When the city first signed the contract with Prison Health in 2000 it was for $254 million over three years.

This nearly 20 percent increase, adjusted for inflation, occurred despite the company's less than favorable reputation throughout the country. It was found to have flawed and even occasionally fatal medical care in New York's upstate prisons. Health officials said no local, nonprofit hospital bid on the contract last year.

Oversight and Accountability

St. Barnabas's contract was set up so the medical center could pocket any extra profits, providing an incentive for it to keep health costs at a minimum. That meant steep reductions in hospital visits and keeping specialists out of the island's locked hallways.

Health department officials say prison health's contract does not resemble its predecessor's, but is based on the cost of care for health policies set up by the city. This way, the department contends, the company has no drive to reduce care to save money.

Oversight and accountability for health care at Rikers rests with the city's Board of Correction. The nine-member board has jurisdiction over every aspect of the correction system, from phone calls to health care.

Three sets of standards guide its work: general provisions covering most aspects of the correctional system from uniforms to telephone calls, mental health standards and the health care standards, which include inpatient and outpatient care and privacy rights.

These rules, said city officials and advocates, govern the ins and outs of the city's jail system. They can protect an inmate from an overbearing corrections officer or an employee disclosing personal medical records to the rest of the population. It is also these regulations that might soon change.

Governing Rikers Health Care

The board embarked on a revision of the city's general standards in 2006. This sparked objections from the advocacy community, which claimed the new rules slashed inmates' rights and gave the Department of Correction an even heavier baton. Advocates claimed their concerns were not adequately heard. Some board members, including Chairwoman Hildy Simmons, refute this claim.

The board approved the new rules late last year. They are currently being reviewed by the city's Law Department.

According to some board members, the health care correctional standards are likely to be next on the agenda. Simmons said it was too early to know whether the board would undertake a full review. She emphasized any review would roll out in three stages: an initial discussion, a formal review and formal action to approve or deny the proposed revisions.

Both the executive director of the Board of Correction Richard Wolf, and Deputy Director Kathy Potler declined to be interviewed for this story.

Paul Vallone sat on the oversight branch since 2002 and voiced concerns over the review process on the general standards. He said he hopes the board will open up the process more this time. "A lot of lessons were learned during that last process that will go and make this process a lot smoother," Vallone said.

Some advocates, many of whom claim that the board has a cozy relationship with the Department of Correction, are skeptical. Jennifer Parish, director of criminal justice advocacy at the Urban Justice Center, said if the board is going to change the mental health standards or health standards it should start by consulting the community and not the Department of Correction.

"It seemed the process was driven by (corrections commissioner) Marty Horn and the Department of Correction saying, 'We want these standards changed and here is the way we want them changed,'" said Parish of the recent review. "That's the cart leading the horse, because the whole role of the Board of Correction is to oversee and monitor the Department of Correction."

Prisoners' advocates saw the last review as having eroded civil liberties by approving monitoring of phone calls and inmates' mail. In light of that, some would rather avoid a review of the health standards entirely. The standards for both mental health and health have not been reviewed since they were promulgated in the 1986 and 1991 respectively.

A Yardstick for Care

While advocates and inmates complain and vehemently criticize the quality of care on Rikers Island, in many respects the city is ahead of the correctional health curve. Most jails require a medical examination within a week of arrival. The city does it in a day.

Most jails do not provide drug treatment. The city's methadone clinics have been championed by some prisoners' advocates.

And the health department contends it is not the face of an inmate it sees, but that of a patient.

"We care about correctional health," said Cohen. "We care about our patients, and we think we are doing a good job." But, Cohen agrees, there is always room for improvement.

 

When Catalina Martinez of Ridgewood walks into a pharmacy to get a prescription, the task may not be as easy as it seems.

Beyond the long lines and their physician's unintelligible handwriting, Martinez, like thousands of other New Yorkers, faces a seemingly insurmountable wall at their local drugstore: a language barrier.

"When I go to the pharmacy, I see that the bottles are in English and I want to know what it says on the bottles," said Martinez, who was interviewed through a translator. "So many times I leave the pharmacy without knowing what it is saying. That's scary for me."

According to immigrant and health care advocates, the majority of pharmacies, particularly in the outer boroughs, do not provide translation services to their customers. This leaves thousands of New Yorkers with limited proficiency in English to fend for themselves. Labels remain untranslated, so crucial instructions from the pharmacist may be incomprehensible.

Unlike hospitals, which, under state regulations, must provide translators, pharmacies are under no such requirement. That, some city leaders say, may soon change.

Where Regulations Stand

For the hundreds of thousands of New Yorkers who do not know English, the local pharmacy and its rows of bottles with labels reading Zoloft or Ambien can be baffling. With Americans increasingly reliant upon prescriptions, advocates say an inaccurate translation -- or none at all -- can pose a significant danger.

The 2000 Census showed that nearly half of New York City households speak a language other than English, and one out of four New Yorkers do not speak English at all. That leaves 25 percent of the city's population scrounging for health care in their own language or care at a facility offering translation services.

While the state approved regulations in 2006 that set out language requirements for hospitals, pharmacies were overlooked, said some advocates. According to a recent report by the New York Academy of Medicine, two thirds of city pharmacies do not translate prescription labels, despite the fact that 88 percent said they served limited English proficiency patients daily.

A report released late last year by the advocacy groups New York Lawyers for the Public Interest and Make the Road by Walking details nearly a dozen anecdotes from Brooklyn and Queens residents who do not speak English.

Catalina Martinez is one of them. She suffers from gastritis and has a 14-year-old son prone to allergies, forcing her to visit the pharmacy often. A native of Mexico who has lived in Ridgewood for a decade, Martinez sometimes stops strangers on the street, hoping to get her prescriptions translated since the pharmacies she frequents do not provide language assistance. Sometimes, she said, she will not give her son medication for fear of administering it incorrectly.

"Maybe I have to give him this much medicine, sometimes I have to give less," said the 49-year-old. "Sometimes I won't even give it to my son because I won't know how to do it."

Martinez's apprehension is shared by many immigrants, said Nisha Agarwal, a staff attorney with New York Lawyers for the Public Interest. To address this, the lawyers group, along with City Councilmember Eric Gioia and Public Advocate Betsy Gotbaum, is drafting legislation that would require translation services be provided at all city pharmacies.

"Giving New Yorkers access to the information they need starts with simple, common sense steps, like providing translation services and extra medical instruction for those with limited English proficiency who are filling prescriptions," said Gotbaum in a prepared statement. "Our proposed legislation will help break down the barriers many currently face when seeking health care and ensure that no New Yorker is left guessing when it comes to questions about their medication."

Other council members have also expressed support for the measure. "Although I appreciate the efforts already taken by a number of pharmacies to help their customers read their prescription label in a more familiar language, these businesses still have more work to do," said Councilmember Joel Rivera, chair of the Health Committee, in an e-mailed statement. "People should not have to guess how to administer their medicine just because they can't read the directions. Clearly the consequences can be devastating. The translate of drug labels by pharmacies is not only a good idea, it is the right thing to do."

What Advocates Want

Advocates, like Agarwal, believe the city's existing human rights law, which prohibits discrimination based on race or ethnicity in public places, requires pharmacies to translate. So far, though, pharmacists do not interpret the law that way.

Both New York Lawyers for Public Interest and Make the Road by Walking filed a formal complaint with the state attorney general's office, claiming 16 pharmacies in Queens and Brooklyn routinely failed to translate drug labels or provide instruction to non-English speakers, thus violating their statutory duty. That complaint is pending, said Agarwal.

They hope the legislation currently being drafted will replicate what the state required from hospitals in 2006, making language access a requirement of quality health care. Agarwal said the legislation should be introduced in the coming weeks.

The specific standards for pharmacies would strengthen the current requirements under the human rights law, said Theo Oshiro, the director of health advocacy at Make the Road by Walking.

Oshiro said his group has already seen some success. Pharmacies in Bushwick, for example, stepped up their language education campaigns with signs announcing translation services behind some counters.

"I guess there has been spotty results; there has not been a whole chain setting out clear guidelines," said Oshiro. "We're still looking for that kind of sweeping solution, not only in Bushwick and in Woodside."

City officials spearheading the legislation say the proposal would simply turn an assumed right into an explicit one. Business leaders, however, disagree.

Business Barriers

James Detura owns his own pharmacy in the South Bronx where the population is predominantly Spanish speaking. Detura, who is president of the New York City Pharmacists Society, said a translation mandate would be catastrophic. It is already difficult to find any pharmacist -- due to a nationwide shortage of pharmacists -- let alone a bilingual ones, he said.

For communities that do not have one or two dominant languages, but three, four or even five, it could be next to impossible to meet strict language access guidelines. "What about a pharmacy that is in certain area of New York City when you've got Spanish and Russian?" asked Detura. "What do you do in a case like that? Are you going to have a separate pharmacist for each one?" There are enough pharmacies in the city, especially locally owned businesses that cater to certain communities, that customers who cannot find the services they need at one pharmacy can always find another one a block or two away, he said.

Detura also fears inaccurate translations. He said it may be easy to translate "one pill a day," but more complicated instructions may not be as readily interpreted -- especially if there are no services available for a local pharmacist to double-check a phoned-in translation.

But advocates said there are plenty of accurate resources for a local pharmacist, such as subscriber hotlines that can translate at the click of a dial. Oshiro also said they were not looking to require bilingual pharmacists.

Like Detura, others question whether the legislation would put an unreasonable burden on small, independent pharmacists. In response, Oshiro said the smaller pharmacies already do a better job accommodating immigrant populations' needs.

Instead, advocates argue that it is larger chains, such as Duane Reade and Rite Aid that fail to translate. Even if the big chains have the ability to provide the service (some have telephone translation networks or bilingual staff), they often do not advertise it to their customers.

A Bilingual Call

While many of the details must still be worked out, immigrant and health care advocates said they are keeping both business and health interests in mind. The idea is to save people's lives, or at the very least prevent confusion and sickness.

Convinced she became ill after incorrectly taking medication with a label she couldn't understand, Martinez said she cannot, nor can she give her son, medication with an easy mind.

If pharmacies cannot provide bilingual or trilingual employees, they should at least provide labels in other languages, Martinez said. That way, she added, she and thousands of other New Yorkers can take their medication with confidence.

Dally Sanchez spent her adolescence getting "treatment" - and the memories still sting: As a traumatized incest survivor, she recalls dealing with a social worker who couldn't talk to her Spanish-speaking mother, being restrained by staff at a youth psychiatric facility and a threadbare education in special-education classes that offered no hope of going to college.

"The reality is that in the mental health system, once you fall in there, you're not a person anymore," said Sanchez, now 27. "Somehow, having a label or having some sort of emotional problem or trauma removes your civil and human rights."

Sanchez's experiences are echoed throughout the city. In classrooms, clinics and emergency rooms, youth are labeled "crazy," "disturbed," "defiant," "loco" - indelibly marking their lives and futures. Among immigrants, people of color and the poor, advocates say, the mental health system is especially prone to misunderstanding and to overlooking youth in crisis. In marginalized neighborhoods, the system's shortcomings are compounded by the challenge of responding to the needs of different ethnic groups. The question of "cultural competency" has emerged as a major flashpoint in the debate over equity in mental health.

"There's a huge lack of cultural competency all across the board," said Sanchez, who today is YOUTH POWER! program coordinator with Families Together, a statewide mental health advocacy group. "There are huge amounts of people who are not getting the right services and who are being labeled with diagnoses that really aren't fitting."

"It's beyond disparities," she said. "It's called discrimination and racism."

Unmet Needs

In communities with high concentrations of immigrants, people of color and low-income families, youth with mental health needs must negotiate a chronically weak social-service infrastructure. Local service providers strain under tight budgets, most public schools have no comprehensive on-site health clinics, and families lacking health insurance may find psychotherapy financially out of reach.

A 2003 government survey of child outpatient clinics in the Bronx counted about 6,500 youth enrolled in services, mostly for behavioral issues like hyperactivity and anxiety disorders. More than 90 percent were black or Latino, with many from Spanish-speaking households.

According to the survey, the vast majority of the Bronx clinics were unable to meet clients' needs for day treatment. And with a six-week average waiting period, some 60 percent of people referred for services never actually entered treatment, suggesting that many thousands of city children with major mental health needs never make it to a clinic.

On a typical day at the Queens-based Child Center of New York, the multilingual staff of social workers and psychiatrists is stretched paper-thin, ready to field calls for help in Punjabi, Spanish, Haitian Creole, Russian or Cantonese.

"The biggest challenge that we face as practitioners is the waiting list," said assistant project director Reshma Shah. "Each one of us has so much of a caseload. And yet we have more and more of a population that really needs the services."

Language and Cultural Barriers

Immigrant families may struggle just to get help in the right language. In many cases, when bilingual staff members are unavailable, children of immigrants must take on the role of ad-hoc translator.

Cultural barriers, though, can be equally alienating. Adolescent emotional issues may fester silently beneath the social stigma surrounding mental illness.

In A's family, emotional suffering spanned two generations before she reached out for support. The Chinese-American teen, who asked to remain anonymous, wrestled with the scars of her father's suicide for two years until her own persistent sadness became debilitating.

A. initially resisted acknowledging her problems, as she feared she might be "mirroring" her father's actions. But eventually, a guidance counselor and others in her community persuaded her to seek a therapist through the Chinatown-based B. Wang Community Health Center. While she does not consider herself fully "recovered," she said, she has at least begun opening up about problems she previously tried to banish.

"In the Asian community especially," she said, "it is very hard to accept the idea of mental illness, since it is not often talked about."

As teens face alienation within their communities, social distance stretches between them and the people who are supposed to help.

Wanda Greene, a parent advocate with the Mental Health Association of New York City, recalled that her son, as a black youth, needed a clinician he could relate to. But in his early teens, when intervention was most crucial, he never had a therapist he truly felt comfortable with.

"A lot of my son's issues were: 'How can you tell me not to be afraid when you leave your office and you go home, and I have to return to my block?'" she said. "He may see drug deals going down on the corner, he may see gang fights - and that affects you."

Her son, now 26, is still dealing with his emotional problems, serving a long prison sentence that Greene sees as evidence that "the system failed him."

To encourage dialogue on mental health in the city's Latino community, the housing and social-service organization Comunilife is collaborating with state and city officials on a suicide-prevention campaign targeting Latina teens. Young Latinas are at higher risk of attempting suicide than white, Asian or black youth, according to government data.

The initiative, which centers on educational outreach posters, is just one step toward addressing vast, longstanding needs for culturally appropriate treatment programs. Comunilife President Rosa Gil noted that in focus groups used to develop outreach efforts, Latina girls talked about stress tied to community problems, like gang violence and unwanted pregnancy, and voiced fears that clinicians would not be able to understand them.

"The adolescents feel that the current mental health agencies do not help them," Gil said, "because they feel they're going to be blamed for these feelings. They don't believe that they should be on medication. They don't believe that the school system is supporting them. These adolescents feel very isolated."

Troubled Teens, Troubled Neighborhoods

Mental health advocates point to social and economic hardships that breed instability. For teens living in tough environments, treatment involves addressing not only physiological problems like chemical imbalances, but also the psychological affects of growing up in troubled circumstances.

Howard Raiten, director of mental health with the social-service agency AsociaciĂłn Comunal de Dominicanos Progresistas (Community Association of Progressive Dominicans), said that while mainstream clinicians tend to prioritize medication, mental health issues may be "rooted more in environmental situations than in biology," though biological factors can play a contributing role.

Raiten pointed to a corrosive, ingrained sense of hopelessness in the low-income immigrant neighborhoods his organization serves. "For years and years," he said, "people in these communities have not gotten recognition. They haven't been affirmed. They've been, and still are, very much invisible."

Shah said the social dislocation of immigration itself can push some people over the edge. "You lose your natural support system once you come into this country," she said. "So we have had cases where there might not have been depression or anything like that before. But once they move here - and due to inadequate social-support structure and services - the symptoms really come out."

Missed Opportunities

The shortage of mental health resources in some communities means that many youth do not get help until a crisis hits. That can lead to inappropriate care or even deeper problems.

"If you don't get them the right services, they start consuming the wrong services," said Greg Greicius, vice president of educational initiatives with Turnaround for Children, a group that helps public schools develop preventative mental health programs. "So they wind up accessing special-education services, they wind up going out of schools in an ambulance for a behavioral crisis and get seen in a hospital. This is often the worst way to try to get a child mental health support."

In New York's special-education system, Black and Latino youth are overrepresented, with blacks more likely than whites to be labeled "emotionally disturbed." Generally, students of color with disabilities are disproportionately placed in more isolated settings than their white peers, spending less than 40 percent of their school time in a regular classroom.

Black and Latino youth are also more prone to winding up in residential treatment facilities, housed under detention-type conditions, far removed from their communities.

Family Healing

Ethnic disparities in mental health, along with a growing recognition of cultural issues in treatment, have spawned alternative approaches that integrate psychological health with community identity.

Ruchika Bajaj, health policy coordinator at the Coalition for Asian American Children and Families, a pan-Asian children's rights group, said traditional psychiatric treatment can overlook the importance of family and culture in addressing adolescent mental health issues.

"The Western model targets individual youth, with family involvement being supplementary treatment," she said. "But for Asian American youth, this 'one size fits all' treatment model is not effective, because family dynamics and culture play an important role within Asian families. Effective treatment must incorporate cultural aspects as well as the family."

At the Child Center in Queens, for example, family members participate directly in a youth's treatment sessions. This fosters emotional communication within the household and helps build an intimate support network for the young person.

Comunilife, which serves low-income black and Latino communities, is developing a youth program offering regular psychiatric care along with holistic initiatives like peer-support networks, tutoring and arts enrichment programs. The project aims to engage the whole family - for instance, peer groups for fathers provide both concrete social supports, like job assistance, as well as a space to talk.

The Department of Health and Mental Hygiene has tried to target underserved youth through the Coordinated Children's Services Initiative. Backed by a six-year federal grant, the program has linked hundreds of families to teams of community representatives and social-service providers. Together, they create community-based, "wraparound" treatment plans that keep families intact during the recovery process.

Beyond enhancing services, some advocates look toward systemic reforms that can tackle the social factors driving psychological issues. In Sanchez's view, promoting mental health is not about clinics or hotlines, but more fundamentally, improving lives and communities.

"We need to build communities and communities' ability to take care of themselves," she said, by strengthening schools, social-service groups, and other community institutions.

That grassroots approach has resonance in Sanchez's own recovery. The turning point came when her "wraparound team" introduced her to a local peer-support group. After years of medication, institutionalization and counseling, what helped most was simply connecting with other youth going through similar struggles.

"Traditionally, historically, naturally - peer support is what helps people," she said. "Having the support from your family, from your friends, from your neighbors, from your community, helps people get over things and heal - in any culture, in any community."

Michelle Chen is a freelance reporter in Manhattan and a native New Yorker.  

When the newly renovated northern end of City Hall Park officially reopened in October, organizers planned a celebration complete with performances on the freshly cut lawn. But, said Skip Blumberg, a major force behind the park renovation, they thought better of it. The performances were to take place after dark, and the rats that frequent the park along with lunching city workers, might have stolen the spotlight.

Nine months after the rats of Taco Bell had their time in the limelight, attention more recently turned to rats in city parks, particularly in City Hall Park. But while such incidents capture headlines, they represent nothing unusual. Rats, said pest expert Dale Kaukeinen, are a constant presence in New York, whether or not they make the evening news -- or star on You Tube.

"No one should have to live with rats," the New York City health department says on its Web site. That may be true -- but we all do.

"If the presence of a grizzly bear is the indicator of the wilderness of an area, the range of unsettled habitat, then a rat is an indicator of the presence of man," wrote Robert Sullivan in Rats: Observations on the History & Habitat of the City's Most Unwanted Inhabitants.

Rats bite, are linked to disease and can cause damage by gnawing through walls, wiring and just abut everything else. Many of us find them downright terrifying. So, as long as rats have live in the city, New Yorkers have fought to control them.

Rat Census

Estimates of the problem vary. Although many say that New York City has one rat per person -- for a total of about 8 million -- others figure there could be as many as almost 100 million rats in New York City. More optimistically, several experts, including Sullivan, put the population as far smaller.

But rats do frequent many, if not most, parts of the city. While the rats of City Hall Park have attracted attention recently, rats are found in many city parks. “I don’t know of a park where you won’t see them,” Geoffrey Croft, president of NYC Park Advocates, a nonprofit group, told the New York Times.

The city received more than 30,000 rodent complaints last year, according to the Mayor's Management Report. And rats have been known to plague city schools, housing projects and cavort along even fashionable streets.

The People Triumph

There was, however, a golden age for rat control. At a so-called rat summit held in 2000, several speakers noted that federal and city programs kept the rat population in check from World War II until the 1980s. In 1949, according to Sullivan, a rat expert from Baltimore trapped rats in New York to try to determine how many lived here. He estimated there were 256,000.

"New York was the model for the country," wrote Jenny Laurie. "Restaurant owners and landlords were required to dispose of garbage properly and to keep sidewalks and basements in good repair (no cracks) -- or they were fined. The rat population was well under control."

That changed in the 1980s when, under President Ronald Reagan, the government cut funding for urban programs, including pest control. With the city facing a budget crunch, the rats roared back.

Fighting Back

Overall, New York may be almost as attractive to rats as to foreign tourists seeking bargains. A report released in October found New York to be the major U.S. city most vulnerable to rats. Kaukeinen, who co-authored the report with another pest expert, Bruce Colvin, said New York City's age, moisture and poverty rate combine to make it particularly enticing.

The black garbage bags, which some have described as a nightly banquet for rats, only exacerbate the problem. Some locations, such as parks with ground cover, prove particularly enticing. Blumberg noted that the catacombs in lower Manhattan provide hiding for rats, making City Hill Park vulnerable to the rodents. Our own bad habits make matters worse. Food left behind and carelessly dumped garbage cans serve as rat magnets.

Faced with the burgeoning rat population, Mayor Rudolph Giuliani formed a rat task force in 2000. Mayor Michael Bloomberg has stepped up the effort. As part of it, the city has tried to shift the emphasis from poisoning to depriving rats of their food. This has included advising people not to feed pigeons and squirrels because rats enjoy the leftovers and trying to enforce sanitation rules.

"You can bring a trainload or boatload of rodenticide into the city," Edgar Butts, who works on environmental health for the city, told the New York Times. "But as long as you have food and harborage, you'll have rats."

Kaukeinen said, under the circumstances, New York is doing fairly well. "New York is on the ball, " he said praising the administration for having hired consultant Robert Corrigan to train city workers to combat rats.

But, Kaukeinen said, fighting rats is a huge task that competes with other issues for money and other resources. Those involved in New York City, he said, "know what needs to be done, and they'd probably like more money to do it."

Cities can strengthen their program by aggressively enforcing garbage codes. Some, Kaukeinen said, have replaced the black plastic garbage bags piled at the curbside with rollout bins where people must place their garbage. No such proposal, though, appears to be in the works for New York City.

Changing behavior would also help. "We want rats to go away but we keep trash under our desks. We want the city to kill the rats, but we throw McDonald's bags out the car window," Corrigan has said. "This is a big complex problem for which there is no easy solution."

Some people, though, believe we should accept the rats in our midst. Writing in Gotham Gazette in 2000, Elaine Sloan, a member of People for the Ethical Treatment of Animals, said New Yorkers might want to clean up their city to reduce the number of rats, but she also advised city residents to change their attitudes about the rodents. Rats, she wrote, " are intelligent, curious and sensitive animals" who are "meticulous about cleaning themselves and take very special care of their young."  

About 1 million pigeons make their homes in New York City mating for life, nesting on windowsills, swooping down for scraps of food and leaving droppings on the shoulders of hapless pedestrians.

Pigeons – think St. Marks Square in Venice or London’s pigeon feeding ladyin "Mary Poppins" -- have long been a mainstay of urban life. But now several City Council members have proposed measures to limit the birds, sparking support, ridicule and heated debate.

Feelings about animals always run high (see the recent furorover the trial of a Texas bird lover who killed a cat), and the New York City pigeon has been a polarizing influence since it started taking over our cement landscape centuries ago. You either love 'em, or you hate 'em. You either find feeding them a therapeutic experience or duck for cover when one swoops by your head making a beeline for the remnants of a falafel.

But the actual threat these winged city dwellers pose remains open for debate. Some animal advocates claim they carry no risk, while several city officials say the pigeon threatens the health, public safety and quality of life of all New Yorkers.

Pigeon Politics

City Councilmember Simcha Felder of Brooklyn has no doubt pigeons pose a hazard. He has released a report contending that pigeon droppings can host a number of communicable diseases, such as ornithosis, encephalitis, Newcastle disease, cryptococcosis, toxoplasmosis, salmonella food poisoning and histoplasmosis. To confront this threat, he wants to create a "Pigeon Czar" to oversee the fight to contain the birds.

Felder also wants to ban the feeding pigeons, a proposal that sparked discussions from Chicago to China. The ban could carry a $1,000 fine for violators (the council member has since said the $1,000 is not set in stone, but that any penalty must be hefty enough to make a difference).

"We came up with what I think is a very humane solution to the issue of the pigeon population," said Felder. "For those people that love to feed pigeons, they should do so on their own properties."

Felder has offered several other proposals to control the pigeon population from contraceptives to locked trashcans with smaller openings. Keeping food off the streets and making trash inaccessible to the pigeons, Felder said, would have the greatest effect.

"A husband says to a wife, 'You want to go out tonight?'" Felder said of pigeon couples. "And instead of going to Radio City Music Hall, they go to a trashcan around the corner."

Felder's feeding legislation will probably be formally introduced in December. He said he is "confident" it will pass by the summer.

But some city officials have expressed reservations. When Council Speaker Christine Quinn was asked whether she would support Felder's pigeon proposal she replied: "I am not a fan of pigeons. I have no love of pigeons at all. I find them to be flying rats, and I have no use for them. I don’t want to comment on the legislation, and I will not let my personal pigeon position impact my professional pigeon position, which I will be taking later upon review of the pigeon possibilities in the legislation, and that’s my full use of alliteration for the day."

That irritated at least one New York City animal rights group, which likened comparing pigeons to flying rats to using a racial epitaph.

Pigeon Solutions

A number of other city legislators also have concerns about pigeons.

At the Staten Island Ferry Terminal, pigeons reportedly snatch away breakfasts and defecate on commuters, who already have to deal with daily trips that can include bus, boat and rail. This caught the attention of City Council Minority Leader James Oddo.

"The insult on top of that injury is to be standing there in the heat and the cold having a pigeon crap on you," said Oddo. "I don’t care about pigeons. I care about the people underneath the pigeons. The people that literally have to duck and weave and bob for the simple right to go to work."

Last month, he urged the Department of Transportation to consider feeding contraceptives to the birds. Oddo said the state Department of Environmental Conservation is considering the idea, and he expects approval early next year.

In Queens, the birds have honed in on the Amtrak overpass in Astoria - another site where passersby get slimy surprises from hidden nests above. City Councilmember Peter Vallone of Astoria, chair of the Public Safety Committee, recently asked Amtrak to consider hanging a net to protect pedestrians. He said the pigeon droppings, which can contain corrosive chemicals like ammonia, may cause structural damage to the overpass.

A Birdfeeder's Best Friend

The anti-avian proposals have some bird lovers and other members of the pro-pigeon population up in arms, or rather wings.

"I'd like to ask these council people or these people that run our government in the city, I would like to know is your goal to get rid of pigeons?" asked Anna Dove (she reportedly changed her name from Kuglemas), the founder of the New York Bird Club, which boasts 60 members. The group is planning a rally to protest the pigeon legislation on the steps of City Hall on Nov. 30.

Pigeons, said Dove, are not the dirty, disease-carrying animals many people believe them to be.

For now, the city's Department of Health and Mental Hygieneagrees with Dove, at least in part. The department said pigeons pose no risk to the general public.

Though those who work among a "large quantity" of pigeon droppings could be exposed to "some risk," city dwellers merely cleaning their homes or windowsills should not fret, according to the health department.

Feed the Birds?

Several national animal rights groups, including the American Society for the Prevention of Cruelty to Animals, support Felder’s measures. People for the Ethical Treatment of Animalshas also expressed support for pigeon control programs as long as the birds’ food supply is not cut off entirely.

"PETA does support reducing the pigeon population for the bird's own sake," said Michael McGraw, a spokesperson for PETA. "I don’t think anyone disagrees there are many more pigeons… It's worth remembering that it's not the pigeons’ fault they are here and that they're hungry."

According to the city health department, pigeon feeding currently is not prohibited, but it is discouraged. The department said the seed, bread or other leftovers can draw in less-sanitary urban wildlife, like rats (see related story).

According to a spokesperson from the Department of Sanitation, throwing food on any street or in any park falls within the city's littering laws. Enforcement, though, has been a challenge for the department.

The health department will not take a position on Felder's proposal until the actual bill is introduced.

Squawk If You Like

With the recent spate of pigeon proposals, some New Yorkers might question whether city officials' time can be better spent.

"I know cynics and critics like to scoff and mock, and people out there are saying, 'Aren’t there more important things to worry about than pigeons?'" said Oddo, who successfully championed a measure restricting aluminum baseball bats. "I don’t care about pigeons. I care about people that are commuting on the Staten Island Ferry who have to literally avoid being defecated on on a daily basis."

The pigeon predicament has turned into a divisive issue. On the City Room blog, one reader stated: "A $1,000 fine is the minimum any pigeon feeder should have to pay for fouling our sidewalks and parks with these disease-ridden flying rodents."

But Dan Stackhouse disagreed. “The iridescent purple/green sheen on a pigeon’s neck is beautiful and mystified me as a kid. Carrier pigeons have won more Medals of Honor for animals than any other animal… Pigeons always try to get out of our way and never harm us except by the dreaded disrespect from above, which is not really their fault,” he wrote. “If these pigeon-hating politicians can’t come up with better things to say about rats, then I suggest they work on the rat problem first."

So maybe pigeons are misunderstood – or just unfairly pigeonholed. 

About half of high school kids in New York City have had sex. Roughly one in five female students admits she did not use protection the last time. Over 50 percent of students have never heard of emergency contraception. Given those numbers, it is hardly surprising that, according to the state, there were 23,000 pregnancies among young women aged 15 to 19 in 2004, with six in ten of them ending in abortion.

The statistics may sound like an alarm bell for policymakers and educators. Yet amid swelling evidence that sex is fact of life for many kids – and that many are making risky choices – New York State does not require schools to teach students about their sexuality.

Until recently, the state’s effort to fill that educational vacuum has been limited largely to telling teens not to have sex. The state and federal governments have poured millions of dollars into programs that promote abstaining until marriage. These programs exclusively push just saying no over any kind of safe sex or contraception.

But New York is rethinking sex education. Earlier this year, the state Department of Health rejected federal funding for abstinence programs, stoking a political debate over what to tell kids about sex and how. Progressive advocacy groups are urging lawmakers to focus not just on persuading kids to wait, but helping them make wiser choices, through full, broad-based sex education.

Knowledge Gap

New York City absorbed over $5 million dollars in abstinence-only program funding in fiscal year 2005, according to an analysis by the New York Civil Liberties Union. Nonetheless, community groups point to a persistent shortage of educational resources for teen sexual health. Currently, aside from abstinence-only education, youth throughout New York State sometimes receive sex-related information through community pregnancy-prevention programs or in school-based classes. But without a legal mandate, the state leaves it to individual districts and schools to determine how, or whether, to discuss sexuality with students.

Britta Ruona, a teen advocate with Planned Parenthood of New York City, says that when it comes to sex, her peers are not getting the guidance they need. In her outreach work in local communities, she said, it is not uncommon to find teens who think jumping up and down after sex can prevent pregnancy or that sexually transmitted diseases cannot be spread through oral sex.

“ A lot of teens, if they don't have a sex education class in their school, they'll get their information from another source,” Ruona said, “like the streets, and the media, and movies.”

The Bush administration has promoted chastity as the best way to fill the sexual knowledge gap and reduce unwanted pregnancies and sexually transmitted diseases. Federal funding for abstinence-only education ballooned from about $80 million in fiscal year 2001 to more than $175 million in 2007. In addition to so-called Title V grants for states , the Adolescent Family Life Act and Community-Based Abstinence Education programs funnel money directly to local organizations, many of them religiously based. .

While New York State accepted this money during the Pataki years, Albany recently declined its Title V funding, which had provided about $3.7 million in federal grants. Health Commissioner Richard Daines said he now plans to redirect state funds toward more-comprehensive sex-ed programs.

New York follows several other states, including Wisconsin and New Jersey in shedding its federal chastity belt. The move reflects rising concerns as civil-liberties and family-planning advocates criticize the ethics of abstinence-only programs, and new research questions their effectiveness.

“ Abstinence-only-until-marriage programs censor critical information about birth control and condoms, and they are not effective,” said Galen Sherwin, director of the NYCLU’s Reproductive Rights Project. “To focus exclusively on abstinence, to the exclusion of other critical information about prevention, is really just irresponsible.”

Teaching Chastity

“ Would you jump out of a plane if your parachute worked just sometimes? The truth is condoms fail.”

That’s the lesson on safe sex promoted by ProjecTruth, a federally funded abstinence initiative run by Catholic Charities in western New York. The program, which reaches thousands of young people each year in schools and community centers, teaches that a youth without premarital sex “is a richly rewarding lifestyle.” To warn students of the potential consequences of sex, the curriculum lists emotions it says many young people frequently feel after a first sexual experience: “used, dirty, lonely, confused, scared, ashamed, sad.”

“ We talk about children as holistic,” said ProjecTruth Director Judy Vogtli. “We're more than a sexual being; we're mind, body, spirit. So, there's no condom that protects the heart.”

Title V guidelines require grantees like ProjecTruth to stress “the social, psychological and health gains to be realized by abstaining” and the “harmful psychological and physical effects” of premarital sex, along with the idea that “a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity.” Under the latest rules for groups receiving grants grants under the community-based abstinence education program, curriculums cannot promote or distribute contraceptives, or instruct students about their use.

Critics say abstinence-only programs often use scare tactics and misinformation to deter teens from having sex–and still do not work.

The NYCLU recently examined 39 of New York’s abstinence-only programs, which collectively received about $11.5 million in state and federal funding in fiscal year 2005. The analysis found that over 60 percent of the funds went to curricula using biased or inaccurate information. Problems cited ranged from flawed or suppressed information about contraception to insensitive views on sexual orientation.

And according to a federal study released in April, youth who participated in abstinence-only programs reported about the same rate of sexual activity and the same rate of unprotected sex as peers who did not participate in the programs.

Civil-rights groups argue that the Bush administration’s abstinence focus marginalizes relationships that fall outside the traditional heterosexual, two-parent household and so excludes gay, lesbian, bisexual and transgendered youth.

Inadequate sex education for gay youth may deepen troubling patterns outside the classroom. New HIV diagnoses among men aged 13 to 29 who have sex with men in New York City have risen by about a third since 2001.

“ Not only do gay and lesbian youth often have to go without the sexual health information that all teens need,” said Ross Levi, director of public policy and education with the advocacy organization Empire State Pride Agenda. “They are further oppressed in being invisible, and in worst cases, demonized by the abstinence-only curriculum.”Informed Decisions

Critics of abstinence-only say sex education should empower youth to negotiate sex and its risks on their own.

Progressive sex education may find a home in New York City. The Sex Ed Alliance of New York City, which includes the New York AIDS Coalition, Planned Parenthood NYC, and other community groups, wants to see mandatory sex education in all public schools, in every grade, supported by school partnerships with healthcare organizations. The coalition is pressing city officials to develop a comprehensive curriculum to cover all safe-sex and prevention practices, along with relationship skills, while including the perspectives of different cultures, sexual orientations and gender identities.

But ultimately, the future of sex education in the city’s public schools depends on whether Albany and Washington view it as a budgetary and legislative priority.

In Congress, the fate of Title V is in limbo, as lawmakers remain gridlocked over the reauthorization of the act. As an interim fix, the national advocacy group Sexuality Information and Education Council of the United States is lobbying for amendments that would enable states to use Title V funds for comprehensive programs.

Advocates of comprehensive sex education in New York, meanwhile, are pushing the Healthy Teens Act. The bill, which passed the Assembly but stalled in the Republican-controlled Senate, would establish a grant system for “age-appropriate and medically-accurate” programs encompassing a full range of safe-sex issues.

Jason McGuire, a lobbyist with the conservative Christian group New Yorkers for Constitutional Freedoms, said the problem with comprehensive sex education is that “it assumes the teens will become sexually active.”

“ You don't take that approach in any other area in life,” he argued. “We don't talk about safer ways to snort cocaine.”

But Traci Perry, Planned Parenthood NYC’s vice president of public affairs, said, “Comprehensive sex ed is much more than simply pregnancy prevention. It’s about sexuality, it’s about relationships. It’s making good decisions. It’s being healthy in a number of ways.”

Jelani Addams Rosa, a 17-year-old peer educator with the NYCLU’s Teen Health Initiative, said sex education should reflect social realities. “The problem is not that teens are having sex,” she said. “The problem is the lack of knowledge of how to deal with yourself, and your significant other, once you’ve started to have sex.”

Michelle Chen is a freelance reporter in Manhattan and a native New Yorker.