Rapid Responses to:

FEATURE: Karen McColl New York’s road to health BMJ 2008; 337: a673 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Is this what New Yorkers want?

Monica M Mercieca   (6 August 2008)

Is this what New Yorkers want? 6 August 2008
Monica M Mercieca, Student of Public Health@ Monash University Dandenong Hospital Send response to journal: Re: Is this what New Yorkers want?	New York’s Road to Health. Article published 8/7/08 BMJ Response: Should we applaud or cry when we discuss how appropriate is it to provide cash incentives for people to look after their health? Opportunity NYC ( Pilot Project through The Rockefeller Foundation)certainly is well backed by a number of leading private organizations and is attempting to alleviate the poverty cycle, but to what extent should they alleviate a national government’s responsibility with respect to health provision ( which they state is a response to a lack of federal government action)and access for all? Jennie Popay (2008) Professor of sociology and Public Health, suggests we are creating further stigmatization and isolating poor people from society. The Australian Health System offers universal healthcare coverage. One of the underlying Health Systems Principles we have is that health care must be accessible and based on health needs and not the ability to pay. ( Duckett S 2007) Any form of health inequality must be addressed beyond such existing programs as identified above, and requires action that will further influence political policy makers to respond and recognize the needs of marginalized groups. According to Braveman et al (2003) a community’s response to any measure which is attempting to address inequality is linked too learned behavior. How individuals respond to changes in their health system will most likely be influenced by their physical and social circumstances, opportunities and their environment. Empowerment and better decision making in these areas will not only be valued if there is a sense of shared responsibility where participation is freely engaged in, but also where the community can make informed decisions through their access to health information. By equity in health we also mean equal opportunity to be healthy and this can’t be separated from the concept of equal rights to health. This has been clearly identified within the Universal Declaration of Human Rights where it is stated that “the attainment by all people of the highest possible level of physical and mental well being “. If communities are to respond effectively to these principles, then access to health should not be dependant on a fee for service for those who have money, nor should there cash incentives provided for rewards. Everyone should have equal access and incentives should pertain to the attainment of healthy lifestyles. (Parry et al 2003) Health access must be a national issue, and the goal is to address ways to ensure that there is equal access for all, if social disparities are to be reduced in health. A commitment needs to come from everyone if there is to be a positive change in health behavior. References: 1. Braveman, P et al. (2003) Defining equity in health. Journal of Epidemiology Community Health, 57, 254-258. 2. BLOOMBERG, M. (2007) Mayor Bloomberg announces first Incentive payments to families in Opportunity NYC, The nation's first conditional cash transfer program.http://www.rockfound.org/about_us/news/2007/1217oppty_nyc.shtml 3. DUCKETT, S. J. (2007) The Australian Health Care System. 4. PARRY, J. (2003) Health impact assessment and the consideration of health inequalities. Journal of Public Health Medicine 25, 243-245. 5. POPAY, J. (2008) Should disadvantaged people be paid to take care of their health? No 10. British Medical Journal, pp: 673. Competing interests: None declared