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As 2025 approaches, the New York City Department of Health and Mental Hygiene faces a slew of daunting public health challenges.
The fallout of the Covid-19 pandemic persists, while fears grow about the potential spread of bird flu. A second Donald Trump presidency looms, bringing with it the possibility of steep funding cuts for federal health agencies and a sharp reorientation of the nation’s public health agenda.
For Dr. Michelle Morse, the Health Department’s acting commissioner, the problems are manifold — but the solutions are at hand.
An internal medicine physician, Morse stepped up to lead the Health Department in October, following the abrupt departure of her predecessor, Dr. Ashwin Vasan. In 2021, Morse became the Health Department’s first-ever chief medical officer, tasked with bridging the city’s public health and health care systems. Now she’s at the helm of one of the world’s largest public health agencies, steering a department with a roughly $2 billion budget and thousands of employees.
Advancing health equity has been a throughline in Morse’s varied and accomplished career. She cut her teeth in global health equity with Partners in Health, in Haiti and Rwanda, and more recently, has received national recognition for her work to end racist algorithms in clinical medicine.
Amid the challenges ahead for the Health Department, Morse told Healthbeat that her charge remains clear: “My focus as acting commissioner is going to be on equity and stability.”
This interview has been edited for length and clarity.
What do you see as the critical public health issues facing the city, and how are you thinking about tackling them?
What we have going for us as a field, and as a discipline, is that we’ve shown over several hundred years that public health interventions work and protect lives and save lives. Whether that is clean water or tobacco policies or vaccination, we have a track record for really protecting the health of the public at scale.
The things I’m prioritizing as acting commissioner are, number one, looking at chronic disease and chronic disease prevention very closely. Many of our health care partners talk about the fact that we have a sick care system: We spend a lot of money on health care and not enough on prevention. As a public health agency — as the largest local health department in the country — we see chronic disease prevention as a huge priority.
The second big thing I would focus on is birth equity. And within birth equity, protecting the health of women and pregnant people, also reproductive justice and access to abortion care and family planning. Then third is looking at our overdose epidemic and really addressing the racial inequities in it. That’s a huge priority for us. The final big thing that I’ll mention is preparing for the new federal administration. The [Centers for Disease Control and Prevention] is a very close partner to us. We work very closely with them on a number of issues. We receive a lot of funding from the CDC, and so we’re really doing a lot of planning around understanding the potential implications of this new federal administration.
Undergirding all of that is HealthyNYC. That is our city’s framework for extending life expectancy for New Yorkers beyond 83 years by 2030. That’s in large part because we lost significant longevity during 2020 and 2021 in the midst of the Covid pandemic. We had tons of preventable deaths. We want to get us back on track to extending life expectancy in New York City, and doing so in a way that ensures gains across all racial and ethnic groups.
Many local health departments were already confronting reductions in federal money from the expiration of the COVID-19 public health emergency, and now the incoming Trump administration has signaled budget cuts for the CDC and other key federal health agencies. Are you preparing for potential reductions in federal funding, and how could that affect the day-to-day work of the department?
There’s a lot of planning we need to do. We’ve known for some time that some of the Covid-related emergency funding would be expiring, and so there was already some planning around that. This also gets to the boom-bust cycle in public health, unfortunately, where there’s a flood of funding when there’s an emergency, and then quite significant underfunding in between emergencies, which makes it hard for us to continue to prepare and plan and do the preventive measures.
We had already been doing some planning around the Covid-related federal funding cliffs. And now we are really thinking about what the new federal administration and what the new HHS and CDC perspective is going to be on public health values and science. For vaccination and other core public health issues, from our perspective, no matter who the president is, that work continues. We have 7,000 people in the New York City Health Department who are on the frontlines every day trying to protect the health of New Yorkers. That doesn’t change with the new federal administration.
But we are, of course, trying to understand better what the priorities of this new administration are going to be, where there might be alignment, and how we can do our best to protect the funding we do have from the federal government so that we can continue our core functions.
Recent HealthyNYC data showed a rise in New Yorkers’ life expectancy overall, primarily from a drop in Covid-19 deaths, but still some persistent racial inequities, including in cardiovascular disease and diabetes mortality. Why have those particular types of mortality proven intractable?
We’re very encouraged by the fact that there was about a year in gain, in life expectancy, in our 2022 data. But as you said, we remain quite concerned and have a lot of work to do, in those seven drivers of life expectancy.
In Covid, what we saw is we had very high rates of Covid-related mortality in 2020 and 2021, and it decreased by 48% in 2022 data. That’s a whole-of-government response, led by the data and the kind of prioritization framework that we use in the Health Department. I want to highlight that example of success, because that, in many ways, is the blueprint for how we’re then going to need to tackle cardiometabolic disease, cardiovascular disease, diabetes, etc.
Our goal is to reduce cardiometabolic-related mortality by 5% by 2030. This is a hard one. This has always been incredibly challenging. Part of the reason is the way that funding priorities happen. A lot of funding of public health goes to disease control, partially because those are the roots of public health history over many, many decades. Chronic disease prevention also requires multi-sectoral coordination and coordination with the health care infrastructure. And because of the way our payment policy for health insurance, Medicare, Medicaid works, the resources in many ways are targeted toward taking care of people once they’re sick — instead of the preventive measures that we know work.
Part of how we want to get to that goal of 5% by 2030, is shaping the food environment. There’s three main areas of work that we’re proposing to get us to that goal. The first is around addressing material needs. That means, people need housing, people need access to education, transportation, those social, anti-poverty measures like guaranteed basic income. The second area of focus for us is commercial determinants of health. How do corporations facilitate, or not, healthy choices and access to healthy things? The third is healthy living and healthy behaviors. And that’s where some of our more traditional public health programs, like Health Bucks, Groceries to Go — these programs that get healthy food into the hands of all New Yorkers, regardless of their ability to pay. As we know, it’s often more expensive to buy healthy food than it is to buy food that we would consider less nutritious.
Pivoting to your global health work, how do your experiences in places like Haiti inform how you think about health issues in New York City? And touching on community health workers, how do you reflect on the role that they play in New York?
For 15 years or so prior to coming to the Health Department as the inaugural chief medical officer here, I really had focused quite a bit on building health systems and strengthening the workforce in the Global South, in Haiti, Rwanda, and other places. New York City is one of the most global cities in the world and is part of the reason that I was very excited and honored to start here.
I’ve learned so much from Haiti. In fact, the first-ever model of community health workers that I witnessed when I was in training was in 2009 in rural Haiti, and I was accompanying community health workers who were doing directly observed therapy for tuberculosis and were doing health education and vaccination campaigns. Their approach is being from the community that they’re serving, knowing what messages work, knowing how to build relationships. In that community, they are the people who are saving lives; it wasn’t doctors or nurses, really, from what I saw. It was community members who themselves were often directly impacted, who were able to really bring information and access to places that had been, in many ways, forgotten, or just de-prioritized.
That was my model for community health workers, and has been for over 15 years. Coming to New York City, we had the honor of launching the Public Health Corps during the pandemic. The Health Department’s piece of the Public Health Corps is really the community-based side. Our community health workers are not placed in clinics; they’re placed in communities, supported by community-based organizations and Health Department staff, to be those trusted messengers.
That model, to me, is one of the reasons we saw a massive drop in Covid-related mortality from 2020 to 2022, and is one of our most effective interventions. I’m very excited to see the future of community health workers in New York City, particularly the community-based side, which we do in the Health Department.
I do think that the recent Clade I mpox case that was identified in California is a great example of why we have to continue to focus on global health equity. We are all interconnected. And in fact, if there had been investments and a more rapid mobilization of vaccines and prevention measures in Central Africa, not only would it have saved lives in Central Africa — which is a primary concern — but it also would have ensured that there’s more protection for populations all around the rest of the world from impacts.
That issue of vaccine equity and global health equity, and making sure that resources to protect the public health in places in the Global South that have never been prioritized, quite frankly, is part of the way that we can be successful in public health in New York City as well.
Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .
