ENVIRONMENTAL HEALTH PROBLEMS

WEDNESDAY, SEPTEMBER 16, 1970

U.S. SENATE,

SELECT COMMITTEE ON

NUTRITION AND HUMAN NEEDS,

Washington, D.C.

The committee met at 10:05 a.m., pursuant to recess, in room 1220, New Senate Office Building, Senator George McGovern (chairman of the select committee) presiding.

Present: Senators McGovern and Javits.

Staff present: Kenneth Schlossberg, staff director; Gerald Cassidy, general counsel; Nancy Amidei, professional staff member; Clarence McKee, minority professional staff member; David Cohen, minority professional staff member.

Senator McGOVERN. The committee will be in order.

OPENING STATEMENT OF HON. GEORGE MCGOVERN, CHAIRMAN OF THE SELECT COMMITTEE ON NUTRITION AND HUMAN NEEDS

On Monday of this week, the select committee began a new series of hearings into environmental health. We heard witnesses from the Mississippi Delta who described in uncomfortable detail the terrible. conditions of housing, water, and sanitation under which many Americans still live. What they described is not confined to Mississippi but is, in fact, widespread throughout rural America. Today, we are going to hear about living conditions and their effect on health in the urban North, specifically in New York City.

We will start with our first witness from the Dr. Martin Luther King Neighborhood Health Center. Dr. Harold Wise is the project director. He is accompanied by Dr. Alan Harwood, Xavier Rodriguez, and Sonia Valdes.

STATEMENT OF HAROLD B. WISE, PROJECT DIRECTOR, DR. MARTIN LUTHER KING, JR., HEALTH CENTER; ACCOMPANIED BY ALAN HARWOOD, STUDY DIRECTOR; XAVIER RODRIGUEZ, HEALTH ADVOCATE; AND SONIA VALDES, DIRECTOR, COMMUNITY HEALTH ADVOCACY

Dr. WISE. Senator McGovern, I am Dr. Wise. Dr. Harwood and Mrs. Valdes will begin our testimony.

Senator McGOVERN. Fine.

(959)

Dr. HARWOOD. Senator, the Dr. Martin Luther King, Jr., Neighborhood Health Center is an OEO-funded ambulatory care facility affiliated with Montefiore Hospital in the Bronx, New York City. The health center is mandated to provide comprehensive, family centered medical care to the 45,000 residents of two New York City health areas located in a deteriorating section of the South Bronx.

Long deserted by an adequate supply of private physicians, the two health areas were clearly in need of medical service in 1967 when the health center first opened its doors. In that year the infant mortality in one of the health areas ranked fourth highest in the Bronx (41 per 1,000) and the TB rate ranked 10th (66.2 per 100,000). In the other health area the TB rate was even higher (82.3 per 100,000), placing it sixth in the county.

Similarly high were the rates of venereal disease for both health areas (fourth and fifth highest in the Bronx). The need for primary medical care in this target population was clearly apparent.

Yet the founding principles of the King Center looked beyond primary care. Consequently, the project's major components included a health careers training program to provide scarce technical personnel and to develop new kinds of health workers.

A second program of community development and health advocacy aimed to mobilize community interest around health issues and to develop more effective approaches to social medical problems.

A third program concerns research and evaluation.

Finally, the medical care program is organized around a health team, consisting of physicians, public health nurses, and family health workers, which is responsible for rendering comprehensive health care to families in the neighborhood. This comprehensive care includes not only the treatment of disease, but preventive programs as well. The center not only recognizes the family as the important unit in the delivery of health care, but at the same time sees the family as operating within a larger urban setting and seeks to apply a broad spectrum of health services to the target community.

Many of the founding principles of the health center are being realized. The center currently provides medical care to approximately 14,000 patients per month and has a total registration of 8,000 households. Eight medical teams are in operation, holding regular weekly conferences to examine the best ways of helping their assigned families with social as well as medical problems. Preventive immunization programs, testing for lead poisoning, and other case-finding methods have been initiated.

In spite of these achievements, however, the center is waging a losing battle, because the environment outside its doors only perpetuates the health problems which are treated medically inside. One of the most acute of these many problems in the neighborhood is housing. In the course of an ethnographic study of health beliefs and practices in the area, residents most often mentioned housing and drug addiction as their most pressing health problems.

This report will detail the housing problems in the King Center's target area as they relate to the objectives of the health program. It will also indicate some of the preliminary steps the center has either taken or planned in order to deal with the problem. These first steps,

however, have revealed difficulties in achieving results within present legal and bureaucratic structures. On the basis of these revealed difficulties, we shall in conclusion present recommendations for change.

HOUSING AND THE HEALTH PROGRAM OF THE HEALTH CENTEROUTLINE OF THE PROBLEM

The housing stock in the Martin Luther King Center's target area ranges from private dwellings to four and five-story walkups, large apartment complexes of 50 to 100 units, and the high-rise buildings of a city housing project. Most families live in the four and five-story tenements, which were constructed 50 to 70 years ago. These buildings accommodate between eight and 30 families, with a median size of 13 households. Private dwellings, housing two or three families, are commonly found nestled among the larger buildings.

THE DIMINISHING HOUSING STOCK

When the health center began operation in 1967, the target area contained about 11,862 housing units-4,190 in the city housing project and approximately 7,672 units outside it. Since that time, the number of units outside the project has declined steadily through fire, abandonment by landlords and dilapidation.

The New York City Planning Commission reports a net loss of 141 units in the target area during the first 11 months of 1969-a decline of 2 percent of the housing units outside the project. Our own survey of the Bathgate area (health area 24), which included only outwardly observable abandoned or gutted buildings, reveals a loss of 531 housing units between June 1967 and January 1970, a reduction of 15 percent in that one section of our target area alone.

In the Bathgate area not only housing but commercial property has declined. From fire alone Bathgate Avenue, once a bustling street of small shops and sidewalk stalls, has come to resemble a bombed-out disaster area. In the 2 years between September 1968 and today, nearly one-third of the stores have been demolished or abandoned.

Housing loss has naturally meant a loss of population as well. In the Bathgate area alone approximately 2,700 people have been displaced in the last 22 years. A number of the families that were in treatment at the health center have disappeared into other areas of the city, and the program of health care that was initiated with these families cannot be continued.

The investment in manpower and medicine already made on these families, while certainly not wasted, can now never yield its full return, however, since comprehensive care must also be continuous and nonsporadic if it is to realize its goals fully. Thus the decline in housing and the consequent steady loss of families from treatment contravenes the fundamental comprehensive-care goals of the health center.

QUALITY OF HOUSING AND MOBILITY

Housing losses, however, are only the end result of a process of continuing neglect of the housing stock of the area. In the course of

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ethnographic research, in which the unit of study was the tenement building, the research department of the health center observed housing conditions in nine buildings within the target area over a period of approximately 1 year. The study buildings were chosen at random and reflect the state of the four- and five-story tenements, the most prevalent type of housing in the area. (Not represented in the sample were private dwellings or large apartment buildings.) Community residents, trained in research methods, visited the nine buildings almost daily to gather various kinds of health information from residents and at the same time recorded data on housing conditions.

Twice during the course of the year's observations, researchers rated the buildings to which they were assigned with regard to: (1) state of the plumbing, electrical fixtures, plaster, windows and other structural features; (2) cleanliness and maintenance of public areas; and (3) presence of vermin. In addition, researchers kept a constant record of tenant turnover in the buildings under observation.

An important finding of the research effort is that the turnover rate among tenants is directly correlated with the condition of the building the more dilapidated the building, the greater the turnover.

This finding has implications for the Martin Luther King health program, because of high mobility, and thus its correlate, poor housing, is antithetical to the provision of comprehensive, continuing medical care. A family that is constantly on the move cannot be followed for the children's immunizations. Such a family, as it moves from team area to team area or outside the health center's target area altogether, will not become well known personally to health center staff; followup treatment after hospitalizations or for chronic illnesses will be virtually impossible with such families. In short, poor housing with its correlated high mobility works directly against the kind of medical service the Martin Luther King program is designed to deliver.

Poor housing has a second effect on the Martin Luther King program. As residents move up into positions with adequate, reasonably steady incomes, they understandably move to areas with better housing. There is thus a steady loss from the area of the stable income residents who could be effective agents of change in the community.

THE DETERIORATED CONDITION OF TENEMENT BUILDINGS

Mobility is an effect of poor housing which influences health care only secondarily. Much more directly affecting the community's health is the actual condition of buildings in the area. The randomly selected buildings provide a sample of the tenement housing stock which can be generalized to the entire tenement building population in the area-some 25,000 people.

Leaks. All study buildings had deficient plumbing, ranging from leaky faucets to bathtubs and toilets which drained into the apartments below. In two buildings leaky pipes had been unattended, and as a result the surrounding walls had deteriorated to the point where tenants could look from one apartment to the next. In one of the buildings tenants living in an apartment on the top floor had to carry an umbrella to the bathroom when it rained, and in another building

beds had to be moved periodically to keep them dry during rainstorms. In yet another building the leaks, coupled with frayed interior wiring, caused periodic short-circuits.

In all cases the landlords' response to these problems, when forthcoming, was to plaster damaged walls or around leaky pipes, but to leave the basic plumbing malfunction unattended. As a consequence, the superficial problems only recurred.

Lead-base paint.-The flaking plaster associated with leaky plumbing affords children easy access to bits of potentially harmful pigment. Tests of the composition of the paint in eight of the nine buildings under study showed that five buildings (62.5 percent) had lead-base paint on apartment walls.

Extrapolating to the entire tenement population of the health center's target area, this means that approximately 4,000 families in our area live surrounded by this lethal substance. In the last 3 months alone the health center hospitalized seven children with lead poisoning. However, no medical cure for this condition can be effective if the child ultimately returns to an apartment with chips of lead paint within easy reach. As a result, children wait in the hospital, occupying much-needed bed space, until necessary repairs can be made in the apartments.

Heat.-Between December 15, 1968, and April 30, 1969, researchers kept records on the provision of heat to eight of the buildings in the ethnographic study. Only one of these buildings (12.5 percent) had constant service during this period, and the rest (87.5 percent) had no heat from between I percent to 11 percent of the time.

If we extrapolate from this sample to the entire area, we must recognize the chilling fact that some 17,000 people in our target area have no heat during part of the winter. In approximately half of the buildings in the area the heat that tenants do receive is persistently insufficient, since it is on only a few hours each day.

To exacerbate this situation, every building under study had at least one apartment in which a broken window remained unrepaired throughout the winter, and all had broken windows in the halls.

To alleviate the cold, tenants in study buildings boiled pots of water on the stove all day or, if they could afford a heater, kept it in use until the inadequate wiring in the building would overheat and cause a short.

Vacant apartments. In two of the buildings under study there were vacant apartments which became hangouts for drug addicts. Since the electricity in these apartments was turned off, the addicts used candles for light and in one building started a fire which spread to the hall until it was ultimately extinguished by the regular tenants. People in both buildings feared going in and out of their apartments and were constantly prey to robbery attempts.

Project this figure of two out of nine sample buildings, which serve as havens for addicts, to the health center's entire target area and we find some 107 buildings housing 1,300 families living in ever-present jeopardy of fire and theft.

The repercussions of living in one of these semiabandoned buildings is demonstrated by what happened to one of the families in our study population. This family experienced several burglaries attempted from