New York State Public Health Association
Provisional 2023 Legislative Agenda
NYSPHA is the New York State affiliate of the American Public Health Association and serves as a statewide organization representing members from all disciplines of public health. NYSPHA’s mission is to promote and protect the public’s health through networking, professional development, advocacy and education.
NYSPHA’s Legislative Agenda is a combination of priorities for the state budget and priority legislation after the budget is passed. NYSPHA’s initial recommendations for the 2023-2024 state budget are contained in its October 21, 2022 Executive Budget recommendations letter to Governor Hochul (see above). In addition to specific budget recommendations, NYSPHA provides recommendations to for legislation to address the major public health issues of the day.
Legislative Priority #1: Support the Local Public Health Workforce:
The first priority of New York’s local health departments (LHDs) is to maintain the core public health services they are tasked to provide. These are problems that short-term increases in funding will not address. The public health infrastructure is built on people – local health officials, preparedness coordinators, epidemiologists, public health nurses, sanitarians, social workers, public health educators and support staff. To strengthen the public health workforce, NYSPHA supports:
- Restoration of the New York City Department of Health and Mental Hygiene’s Article 6 reimbursement to 36% beyond the base grant to align their state aid with what other counties in NYS receive.
- Increased funding to support the expanded mandate (current and/or future) into the Lead Poisoning Prevention program of the New York State Department of Health and distribute all funding necessary to the local health departments through existing grant mechanisms to support implementation of the expanded mandate.
- Provision of a 50:50 state:local match for counties investigating unattended deaths, including through Medical Examiners, to assure the early detection and full characterization of public health threats (services are currently 100% county cost).
Legislative Priority #2: Tobacco Prevention and Control
Tobacco use remains the leading cause of preventable premature mortality in New York State. Approximately 12% of New York adults still smoke and 28,200 New Yorkers are projected to die from smoking-related illness this year. It is imperative that New York’s enacted budget and legislation take aggressive action to prevent tobacco initiation and enable users to quit. Read our Memorandum of Support to strengthen tobacco control efforts, NYSPHA supports:
- Passed in the State Budget. Increasing the tobacco tax. Increasing the cigarette tax by $1 per pack, moving it from $4.35 to $5.35 per pack, is projected to generate significant public health benefits for New Yorkers. Among other health benefits, the new tax proposal would also have significant public health benefits including decreasing youth (under age 18) smoking by 8.2% and an estimated 44,800 adults who currently smoke quitting.
- Also increasing the tax on all other tobacco products (OTPs) that parallels the new cigarette tax rate to ensure that the state does not inadvertently promote one tobacco product over another to youth, who are more price-sensitive than adults.
- Ending the sale of menthol cigarettes and all other flavored tobacco products. Flavors are a marketing weapon used by tobacco manufacturers to target youth and young people to a lifetime of addiction. Almost half of youth who smoked cigarettes used menthol cigarettes (46.7 percent). Products with flavors like cherry, grape, cotton candy, mint and gummy bear are clearly not aimed at established, adult tobacco users and years of tobacco industry documents confirm the intended use of flavors to target youth. Menthol can mask the harsh effects of smoking, facilitating nicotine uptake. Tobacco manufacturers have aggressively and intentionally targeted communities of color and LGBTQ+ communities with menthol products, leading to an unequal burden of death and disease.
- $7.5 million increase in the State Budget. Increased funding for the NYSDOH Tobacco Control Program, including directing any increased revenues from tobacco tax increase to the program. Although the state receives $2.63 billion annually ($1.63 billion in tobacco excise taxes and $737.7 million in Master Settlement Agreement funds), it only spends $39 million (1.6%) on the Tobacco Control Program. This funding level is a 54% decrease from the Program’s peak funding level of $85 million in the 1990s. NYSPHA supports an increase in the state budget to $52 million as a down payment towards the CDC-recommended funding level for New York State of $203 million.
- Closing loopholes and addressing enforcement issues with flavored e-cigarettes. New York’s 2020 e-cigarette legislation exempted products that have received a pre-market tobacco product authorization (PMTA) by the US Food and Drug Administration. In addition, loopholes that allow distributors to continue to carry and sell prohibited products to merchants as well as vagueness that allows retailers to claim they are selling products remotely undercut the effectiveness of the law. These loopholes need to be eliminated.
Legislative Priority #3: Support Immunizations.
NYSPHA is strongly committed to the reduction of vaccine-preventable illness, improving vaccine access, and supporting responsible investment in our state’s immunization infrastructure. The COVID-19 pandemic has underscored the profound impact that immunization has in preventing severe disease, hospitalization, and death. Despite this tremendous impact on public health and the countless lives that have been saved by vaccination, disinformation about vaccines persists and many communities still experience challenges with accessing vaccines. This unfortunate reality has dangerous consequences. There has been a disturbing backslide in routine childhood vaccination rates as organized efforts to undermine public confidence in vaccines continues. Diseases like measles and polio, once believed eliminated in the United States, have returned in New York. To strengthen the immunization infrastructure, NYSPHA supports:
- A requirement for reporting of all vaccinations given to individuals ages 19 years of age or older to the state and NYC immunization registries (NYSIIS/CIR), moving from an “opt-in” to an opt-out consent provision for reporting in New York. New York is one of only a handful of states or cities that require “opt-in” consent for adults to have their vaccines entered in the immunization registries. Robust immunization registries have numerous benefits. They ensure health providers have consolidated and accurate immunization records of their patients, prevent over-immunization, and provide State and local Health Departments with the tools and information to help control vaccine-preventable diseases through accurate vaccine tracking. Notably in New York State, all immunizations administered to children less than nineteen years old have been required to be reported to NYSIIS/CIR since 2008. The registries also allow immediate notification of patients and providers if a product recall is required.
- Increased investment in public health immunization infrastructure, including restoration of New York City’s reimbursement for public health to 36% above the base grant under Article 6 as mentioned above. Article 6 funding for vaccination work by local health departments ($60 million annually). Local health departments have played a critical role in the state’s COVID-19 vaccination efforts and are an important point of access for vaccines in our communities, routinely working with health care providers and schools to assure that children receive life-saving childhood immunizations and providing coordination for regional immunization efforts.
- Provision of additional state resources dedicated to a sustained public relations campaign around general vaccine promotion and education focused on the importance of vaccination for all New Yorkers and combatting disinformation efforts. The State’s strong #VaccinateNY campaign helped educate, build trust, and generate enthusiasm in the COVID-19 vaccines. We recommend sustaining and extending state resources to similarly encourage New Yorkers to receive all recommended vaccines throughout the year.
Legislative Priority #4: Cancer Prevention and Control
Cancer is the second leading cause of death in New York State. In 2023 there will be over 118,000 new cases of cancer and over 32,000 New Yorkers will die from the disease. More specifically, an estimated 17,800 women will be diagnosed with breast cancer while 870 women will be diagnosed with cervical cancer and an additional 8,950 men and women will be diagnosed with colorectal cancer. The NYSDOH Cancer Services Program (CSP) provides with free breast, cervical and colorectal cancer screenings, and diagnostic services for New Yorkers with no or limited health insurance. The CSP is currently able to reach only 18% of the eligible population because of its limited budget. That budget was cut 20% in 2017. To ensure that every New Yorker has access to breast, cervical and colorectal cancer screening, NYSPHA supports:
- $2.5 million increase in the State Budget. Restoration of the 20% lost in 2017 and dedicate $25.6 million to the CSP, expanding the availability of screening to low-income, under-, and uninsured residents. Additionally, New York State should establish a specific budget line item for operating expenses needed to implement the CSP and allocate $1 million in Fiscal Year 2023-24. These investments should be a down payment on a larger investment as part of New York State’s 2024-2029 Comprehensive Cancer Control Plan which is due to be released in 2023.
- Support legislation to require health insurance to cover biomarker testing. Progress in improving cancer outcomes increasingly involves the use of precision medicine. Biomarker testing is important step for accessing precision medicine including targeted therapies that can lead to improved survivorship and better quality of life for cancer patients. Nearly 60% of all cancer drugs approved in the last 5 years require or recommend biomarker testing before use. Biomarker testing is increasingly important for cancer care – and for the treatment of other diseases including arthritis, other autoimmune conditions and rare diseases, and possibly diseases like Alzheimer’s in the future. Not all communities are benefiting from the latest advancements in biomarker testing and precision medicine. Communities that have been excluded including communities of color, individuals with lower socioeconomic status, rural residents, and patients receiving care in non-academic medical centers are less likely to receive biomarker testing. Improving coverage for and access to biomarker testing across insurance types is key to reducing health disparities.
- NYSPHA Biomarker Testing Letter to NY Legislators Final.pdf
Legislative Priority #5. Behavioral health, drug use and suicide prevention.
- Increased funding for Local Governmental Units for staff to support and maintain the essential services they provide their county residents to respond to the opioid crisis, mental health challenges, and risk of suicide. Specifically, a full-time mental health and suicide prevention coordinator within each New York County is critical to support the suicide prevention coalitions. Funding is also needed to support suicide prevention coalitions that do not receive federal funding like substance use and opioid task forces.
- The implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for alcohol and other drug use in schools and primary care settings so that risk is identified across a continuum and brief intervention is provided to reduce risk before consequences become more severe.
- Investment in the provision of Question, Persuade, Refer (QPR) suicide prevention training so that it is readily available free-of-charge across the state
- Investment in the routine delivery of universal screening and brief intervention for depression and suicide risk in primary care settings and ensure county and organizational leadership have the information and tools they need to develop and implement a comprehensive approach to suicide prevention.
- Funding support to promote the use of 988 (National Suicide Prevention Lifeline) across New York State and among underserved communities, to provide training and support to 988 operators and call centers, to provide incentives to increase the crisis care workforce, and to provide training, technical assistance, implementation support, and quality control of community-based crisis services including the delivery of suicide risk screening, safety planning, follow up and monitoring, and transitions to outpatient care so they are equipped to provide services to those referred by 988.
Legislative Priority #6: Mental health programs for students and schools
Schools are in significant need of funding to support the mental health of students following their return to in-person schooling in the wake of the COVID-19 pandemic. The U.S. Surgeon General declared a mental health crisis among youth; youth are struggling after losing almost a year and a half of in-person schooling and connections with their peers and school staff. To address these mental health needs, NYSPHA supports:
- Funding to schools to implement depression and suicide risk screening and intervention and the evidence-based Sources of Strength program to build trust between students and adults, promote help-seeking, create a positive school climate, and prevent suicide.
- Funding for a psychologist and social worker in each school, universal screening for mental health issues as described in A6636, and mental health parity for student insured through CHIP as described in A343.
- New York State providing additional funding and guidance to schools on the adherence to state laws around mental health education in schools and training for school staff. First, mental health is as important as physical health, so mental health education should be provided at the same level as standard health classes, not only one class. Second, schools should be provided guidance on specific evidence-based mental health and suicide prevention trainings and should invest in the provision of these trainings to schools including offering incentives for staff to complete these trainings annually. These trainings include Youth Mental Health First Aid; Question, Persuade, Refer (QPR); Applied Suicide Intervention Skills Training (ASIST); Suicide Safety Training for School Staff (SST); and Helping Students At-Risk for Suicide (HSAR).
Legislative Priority #7: Address Rural Health Disparities
The Rural Health Network Development Program and the Rural Health Care Access Development Program. Both programs are designed to address the disparities in healthcare access and health outcomes that rural communities experience. Funding for these important rural health programs has been significantly reduced over the past several years. As recently as SFY17, the funding for these two programs totaled $16.2M; in SFY23, the funding was $9.41M. NYSPHA supports:
- The restoration of funding for the RHND and RHCAD programs to $16.2M. This will help address achieving health equity for rural people in rural places and reduce disparities in healthcare access and health outcomes as a function of rurality.
Legislative Priority #8: Combating Climate Change
The 2019 Climate Leadership and Community Protection Act (“CLCPA”) created a Climate Action Council (“the Council”) and requires New York to reduce state- and sector-wide greenhouse gas emissions 40% by 2030, and at least 85% from 1990 levels by the year 2050. The Council’s Scoping Plan, in which it laid out an initial framework for achieving the CLCPA’s objectives, included strategies for reducing emissions from the State’s agricultural sector, which is a sizable contributor to greenhouse gas emissions and is also vulnerable to the impacts of climate change. In addition, steps are needed to develop additional renewable energy sources and to move the states building and transportation infrastructures onto electricity. NYSPHA supports several proposals in this area to reduce climate change, protect the public health, alleviate racial and socioeconomic inequities, and build up local economies.
- The Good Food New York bill would permit local governments to adopt values-based standards for food procurement based on the national Good Food Purchasing Program (GFPP). These standards include benefits to local economies, environmental sustainability, valued workforce, animal welfare, nutrition, and racial equity. Currently, New York State food procurement laws require that local governments and institutions choose the lowest responsible bidder without considering other criteria.
- The Greenhouse Gas Emissions Standards bill would require that NYS OGS and DEC establish a methodology for state agencies to estimate the greenhouse gas emissions that occur through the life cycle of all food and beverages purchased by said agency. The bill also requires that the OGS establish best practices for sustainable food procurement, and that state agencies give preference to food and beverage procurement practices that achieve the goal of reducing greenhouse gas emissions.
- Promote Clean Buildings and Reduce Reliance on Natural Gas. The following steps will reduce pollution from our buildings that drives climate change:
- Affirming the critical importance of meeting the emissions and equity goals of the Climate Act,
- Adopting policies that prioritize energy efficiency and electrification in buildings as the primary strategies to replace fossil fuel combustion, especially phasing in code requirements prohibiting on-site combustion of fossil fuels in new buildings over a 2024-2027 period;
- Adopting zero-emissions appliance standards, while working with the relevant state agencies to ensure equitable and effective implementation of these rules;
- Supporting a planning process to begin scaling down the utility gas system that maintains affordable, safe, and reliable utility service while protecting ratepayers, utility workers, and New Yorkers in the transition from fossil fuels.
Legislative Priority #9 Improving Access to Healthy Foods
- $134 million increase in the State Budget. Healthy School Meals for All. Last June, federal COVID waivers ensuring every student in the nation had access to free school meals expired. As a result, more than 726,000 New York students lost access to free school meals. One in 7 kids in New York experience hunger, disproportionately impacting Black and Latinx children. Existing programs in New York leave far too many behind, including families struggling to make ends meet while hovering just above the income limits for free school meals and kids who qualify, but hesitate to eat, due to stigma and shame associated with providing free meals to only certain students. NYSPHA supports state funding to allow 2000 additional schools in the state to be able to provide universal free school meals for all students.
- Healthy Food Service Guidelines (S4644C/A5682C) The Healthy Food Service Guidelines for New York Act would direct the Department of Health to develop standards for healthier foods and beverages in all state facilities and state-supported programs. The bill mandates that food standards be consistent with the most recent federal Dietary Guidelines for Americans, prohibits the offering of sugar-sweetened beverages, and encourages the purchase of plant-based whole foods.
- Food Donation and Food Scraps bill (S9562) expands the State’s food donation and food scraps recycling program by gradually scaling down the annual average tonnage of food scrap generators that are required to join the program, and by removing exceptions regarding recycler capacity. Food scraps, often perfectly edible, end up in landfills where they decompose and release even more greenhouse gases in the form of methane emissions. Meanwhile, millions of New Yorkers face food insecurity and inadequate access to healthy foods.
- Community Gardens Bill (S629) would amend the agriculture and markets laws to direct the community gardens task force to determine whether New York community gardens located on public land qualify for designation as Critical Environmental Areas (CEAs) under state law. The bill builds on S3152A/A735, which required the Commissioner of Agriculture and Markets to convene a task force to assess the state of and promote the expansion of New York’s community gardens.
- NYSPHA Memo of Support Healthy Food Service Guidelines_2023.docx