Community Health Centers: A Movement and the People Who Made It Happen

Chapter 5: New York: Health Care Is a Right

A golden day in Central Park, sun shining on autumn leaves. Enormous medieval pennants hang over the Bethesda Fountain plaza. The rainbow of people includes roller bladers, acrobats, families on outings, dog walkers, and one lone reader sitting yoga style on a glacial rock. The lake is full of boats and the boathouse full of rich tourists sipping $7 Bloody Marys. Those with less money line up for the cafeteria . A hassled maître d’ gripes to no one in particular: “How soon do they expect a table when I have to deal with Spike Lee and the Wall Street Journal?” I’m returning to that thick stew of charm and chutzpah, guts and heart, that was my home for fifteen years, my North Star for much longer. I moved to New York in 1960, convinced it was the center of the universe. I came of age here and made the transition from observer to activist, swept up in a deepening commitment to civil rights, my own search for community, and involvement with electoral politics. Things are different now, but on days like this the festival of street life brings some of it back. The Sixties Happened Here The sixties happened in many places, but surely they happened here: Hare Krishna dancers, street music, people at card tables hawking not wares but ideas. Depending on which corner of Eighty-sixth Street and Broadway you stopped at, you could sign up to register voters, boycott grapes, or march for peace. And yes, support your local health center. My old neighborhood, the Upper West Side, is home to the William F. Ryan Community Health Center, largest in Manhattan, and now operating sites in the Lower East Side and the midtown Chelsea-Clinton area as well. 91 Chapter 5 New York: Health Care Is a Right The story of the Ryan center, like so many others, is one born of need and opportunity, followed by a struggle to gain independence from the hospital where it was first established. It’s also a saga of survival, growth, entrepreneurship , the ups and downs of network development and managed care, wheeling and dealing in the New York political scene, preservation of consumer governance , and commitment to community needs. One health services researcher who interviewed patients from numerous New York centers says: “Ryan is the one place they claim as their own.”1 The Upper West Side extends from Central Park to the Hudson River, bordered by Fifty-ninth Street on the south and Harlem on the north. Some streets boast turn-of-the-century castles, high-ceilinged apartments with six or seven bedrooms, renovated brownstones, and subsidized housing for lower-middleincome residents. In the sixties, more often than not, each middle-class block had its own pockets of poverty—crowded “old law” tenements and once-proud hotels turned to warehouses for welfare recipients, full of drugs, sickness, and crime. The residents were just as varied—blacks and old-line WASPs; secondgeneration Jews and Irish; first-generation Puerto Ricans, Haitians, and Cubans. There were academics, artists, writers, mothers, merchants, and laborers. The checkered condition of the 268,000-person Riverside health district, which encompassed most of the area, brought the infant mortality rate up to nearly 33 deaths per 1,000 live births, compared with citywide and national averages of 26.2 Some people struggled to give their children a decent life when the smallest mishap could mean eviction, worldly goods in the gutter, a downward slide into disaster. Others just gave up. But the neighborhood was also home to dozens of clubs and organizations and hundreds of causes, and an incubator for civil rights and community action even before the national awareness of the sixties. Now it was fertile ground for the new programs coming out of Washington. A Time of Hopefulness “Think about the idea of a national war on poverty,” says Paul Torrens, who came to New York as a young internist just out of the navy and the Harvard School of Public Health. “Or the concept of health care as a right. It was a time of hopefulness, but it wasn’t completely naive.” During his stint at Harvard, Torrens had spent some time at the New York City Department of Health. He got to know the commissioner, who recruited him in 1962 to help St. Luke’s Hospital reach out to its West Side community. “How does an old-line Episcopalian institution affiliated with Columbia Medical 92 Community Health Centers [18...