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PubMed2026

The impact of non-native trees on galling and herbivory in New York City across space and time.

Cities and suburbs frequently plant native and non-native trees as foundation species, with non-natives cultivated in these areas for centuries while remaining non-invasive. Although previous research has found that native trees often host more arthropods, studies have not simultaneously looked across space and time to determine the consistency of tree origin on urban arthropods. We combined varied methods across spatial and temporal scales in New York City to test if native tree leaves consistently have more insect and mite interactions than long-established non-native trees, predicting stronger effect sizes for specialists (galling arthropods) than generalists (herbivory). We examined (1) congeneric species pairs, controlled for growing conditions and stoichiometry in an arboretum, (2) diverse oaks at a botanical garden, (3) community science records across Brooklyn, and (4) herbarium specimens from 1883 through present across the city. Across spatiotemporal scales, we found consistent results. Specialist interactions were striking: contemporary native trees supported numerous galling species, while only one congeneric non-native species hosted any galls. For generalists, contemporary native trees had equivalent to slightly greater herbivory. Over the last century, herbarium records showed that herbivory increased on non-native trees to nearly the level of natives, whereas native trees increased in gall abundance while non-native trees remained rarely galled. Our results demonstrate the impact of tree origin on tree-arthropod interactions in a real-world urban setting, with far fewer galls even when non-native tree species have been cultivated locally for centuries. Our findings will help city planners and property owners confidently choose native trees to promote arthropod biodiversity.

Trees↗
PubMed2006

Apheis: Health impact assessment of long-term exposure to PM(2.5) in 23 European cities.

INTRODUCTION: Apheis aims to provide European decision makers, environmental-health professionals and the general public with up-to-date and easy-to-use information on air pollution (AP) and public health (PH). In the Apheis-3 phase we quantified the PH impact of long-term exposure to PM(2.5) (particulate matter < 2.5 microm) in terms of attributable number of deaths and the potential gain in life expectancy in 23 European cities. METHODS: We followed the World Health Organization (WHO) methodology for Health Impact Assessment (HIA) and the Apheis guidelines for data collection and analysis. We used the programme created by PSAS-9 for attributable-cases calculations and the WHO software AirQ to estimate the potential gain in life expectancy. For most cities, PM(2.5) levels were calculated from PM10 measurements using a local or European conversion factor. RESULTS: The HIA estimated that 16,926 premature deaths from all causes, including 11,612 cardiopulmonary deaths and 1901 lung-cancer deaths, could be prevented annually if long-term exposure to PM(2.5 )levels were reduced to 15 microg/m3 in each city. Equivalently, this reduction would increase life expectancy at age 30 by a range between one month and more than two years in the Apheis cities. CONCLUSIONS: In addition to the number of attributable cases, our HIA has estimated the potential gain in life expectancy for long-term exposure to fine particles, contributing to a better quantification of the impact of AP on PH in Europe.

Air Pollution↗
PubMed2005

Floristics, performance and prognosis of historical trees in the urban forest of Guangzhou city (China).

Outstanding historical trees embedded in cities constitute pertinent environmental assets, yet they are widely threatened in third-world cities. Inadequate understanding of this valuable natural-cum-cultural heritage hinders proper conservation. A case study of Guangzhou in south China evaluated floristic composition, age profile and biomass structure of historical trees, assessed their performance in major habitats (institutional, park and roadside), and established a prognosis for future growth and management. The 348 historical trees examined belonged to only 25 species, vis-à-vis 254 trees in the entire urban forest, dominated by five species and native members. Roadside had more trees, followed by institutional and park, with merely the most common four species shared by all habitats. The limited commonality reflected tree-performance differentiation by habitats exerting selection pressure on species. The institutional growth-regime was more conducive to nurturing high-caliber specimens, whereas park is less capable. Individual species achievement by habitats, derived from tree-count ranking and relative-abundance indices, could inform species choice and tree conservation. Few trees exceeded 300 years of age in the millennium-old city, echoing a history of intense tree-city conflicts. Potential life-span, trunk and crown diameters indicated ample opportunities for further expansion of biomass and landscape impacts, which would be straitjacketed by the tightening urban fabric.

Biomass↗
PubMed2006

Access to revascularization among patients with acute myocardial infarction in New York City--impact of hospital resources.

Timely revascularization can improve survival in patients with acute myocardial infarction. Identification of factors associated with increased use of revascularization in appropriate patients could improve outcomes. Using New York City hospital discharge records for 1988-1992 and 1998-2002, we determined revascularization rates for patients hospitalized with MI by neighborhood. Odds ratios for revascularization were estimated using a spatial model adjusting for neighborhood sociodemographic characteristics, while accounting for similarities in the rate of revascularization among geographically adjacent neighborhoods. Only 16 out of 112 New York City hospitals performed coronary revascularization. They were located in 14 of 41 neighborhoods. In general, patients living in neighborhoods with higher percentages of patients admitted to hospitals capable of revascularization service were more likely to be revascularized than those in neighborhoods with low percentages of patients admitted to hospitals with revascularization resources. This was true regardless of neighborhood availability of revascularization, after accounting for neighborhood socioeconomic characteristics and patients' clinical status. Revascularization rates in New York City increased from 1988-1992 to 1998-2002 in every neighborhood and as a whole from 103 to 326 per 1,000 hospitalized AMI patients. This increase was not explained by the addition of new revascularization services. Thus, in New York City, where only certain hospitals can perform revascularization, efficient delivery of patients to hospitals with these resources appears to increase the likelihood of revascularization performance among AMI patients without increasing the number of new hospitals capable of revascularization.

Health Services Accessibility↗
PubMed2006

Assessing the impact of VOC-contaminated groundwater on surface water at the city scale.

This study is believed to be one of the first to assess the impact of urban VOC-(volatile organic compound) contaminated groundwater on river-water quality at the city scale. A network of riverbed piezometers was used to study the 7.4-km urbanised reach of the River Tame that flows across the groundwater-effluent unconfined Triassic sandstone aquifer underlying the city of Birmingham (UK). Aquifer groundwater contained significant chlorinated VOC contamination due to the city's industrial heritage. Chlorinated VOC-contaminated baseflow was widespread along the reach with trichloroethene (TCE) dominant. VOC concentrations in riverbed piezometers were in the range 0.1-100 microg/l with typical regulatory limits occasionally exceeded by an order of magnitude. Although anaerobic biodegradation products such as cis-dichloroethene were widespread, they were unlikely to have formed in the generally aerobic riverbed. The lack of anaerobic conditions was ascribed to insufficient accumulation of low-permeability, organic-carbon rich riverbed sediments in this medium-high energy river. Assumptions a priori that natural attenuation of chlorinated VOCs will occur via reductive dechlorination in urban riverbeds are likely in error, particularly where deposits of medium-high permeability exist transmitting much of the baseflow. Surface-water quality impacts were nevertheless still low with in-river TCE increasing by just 2 microg/l over the 7.4-km reach. Agreement of baseflow contaminant flux estimates based on five flow-concentration product methods was achieved to within an order of magnitude with 22-200 kg/yr of TCE estimated to discharge to the 7.4-km reach (equivalent to 0.8-7.5 mg/d/m2 of riverbed). Such uncertainty was not regarded as unreasonable when the large measurement scale and geological and chemical heterogeneities are considered. Improved flux estimation methods and greater monitoring densities are nevertheless warranted. Considering Birmingham's long industrial history and known incidence of VOC-contaminated groundwater, the city-scale impact of VOC-contaminated groundwater upon surface-water quality was judged to be relatively modest.

Aerobiosis↗
PubMed2005

Groundwater contamination by nitrates in the city of Konya, (Turkey): a GIS perspective.

Groundwater is an essential drinking water source in the city of Konya, Turkey. Approximately 75% of the city's water consumption has been supplied from 198 groundwater wells for the last six years. Nitrate (NO(3)(-)) is one of the important water quality parameters and was measured in the water samples taken from 139 wells in 1998 and from 156 wells in 2001 within the study area of 427.5 km(2). To evaluate the nitrate data, a vector-based GIS software package ArcView GIS 3.2 was used. A hardcopy map of the city was digitized in the UTM projection system. The locations of the wells were obtained by a hand-held Global Positioning System (GPS) receiver. According to the maps produced, nitrate concentrations generally tend to increase in the city center, the average concentrations being 2.2 and 16.1mg/L for the years of 1998 and 2001, respectively. A statistical correlation procedure was also applied to well depths and nitrate concentrations. As a result, correlation coefficients of 0.259 and 0.261 were obtained for data collected in 1998 and 2001. It is concluded that the distribution of nitrate concentrations is not correlated with well depths within the study area.

Cities↗
PubMed2003

Air quality data from large cities.

This paper presents an assessment of the air quality for the principal cities in developed and developing countries. Part of the vast and widely dispersed information on air quality that is available at this time on the Internet was compiled, thus making possible a comprehensive evaluation of the tendencies that emerged at the end of the 20th century. Likewise, these values are compared to the air quality thresholds recommended by two international organizations: guideline levels of the World Health Organization (WHO) and limit values of the European Union (EU), in order to determine air quality concentration levels in large cities around the world. The current situation of air quality worldwide indicates that SO(2) maintains a downward tendency throughout the world, with the exception of some Central American and Asian cities. NO(2) maintains levels very close to the WHO guideline value around the world. For particulate matter, it is a major problem in almost all of Asia, exceeding 300 microg/m(3) in many cities. Ozone shows average values that exceed the selected guideline values in all of the analyses demonstrating that it is a global problem. In general, the worldwide trend is to a reduction in the concentrations of pollutants because of the increasingly strong restrictions which local governments and international organizations impose. However, in poor countries and those with low average incomes, concentrations of air pollutants remain high and the trend will be the elevation of their ground levels as they develop, making the problem even worse.

Air Pollutants↗
PubMed1996

The molecular epidemiology of tuberculosis in New York City: the importance of nosocomial transmission and laboratory error.

SETTING: During the 1980s, New York City experienced a rapid increase of tuberculosis cases, more than 40% of which were human immunodeficiency virus (HIV)-associated. OBJECTIVE: To better define the molecular epidemiology of tuberculosis in New York City. DESIGN: We collected an isolate from every patient in New York City with a positive culture for Mycobacterium tuberculosis, including both incident and prevalent cases, in April 1991. Restriction fragment length polymorphism (RFLP) analysis using IS6110 was performed and the clinical, demographic, epidemiologic, and drug susceptibility patterns of patients were correlated with RFLP results. RESULTS: Of 441 patients, 12 (3%) had laboratory, clinical, and RFLP evidence of falsely positive cultures. The remaining 429 patients had 252 distinct RFLP patterns. Patients with clustered 1-3 band isolates did not share demographic or drug susceptibility patterns. Eliminating these patients from the analysis, 344 patients remained, of whom 126 (37%) belonged to one of 31 clusters ranging in size from 2-17 patients (median cluster size = 3). Clustering was more common among patients with multidrug-resistant isolates (53%), African Americans (44%), and the homeless (49%), but was not associated with HIV infection or acquired immune deficiency syndrome (AIDS), Multidrug-resistance, being African American, and homelessness remained independently associated with clustering in multivariate analysis. Of 79 patients in clusters of > or = 4 patients, 25 (32%) had identifiable epidemiologic linkages; 17 (74%) of these patients, and 6% of all cases, were documented to have been nosocomially associated. CONCLUSION: A small but non-negligible proportion (3%) of New York City patients had falsely positive cultures for M. tuberculosis as a result of laboratory error. More than one third of all patients and most patients with multidrug-resistance in April 1991 had clustered RFLP patterns, suggesting recent transmission of M. tuberculosis. Homelessness, multidrug-resistance, and being African American independently increased the risk of clustering. Most of the identified epidemiologic linkages and 6% of all cases resulted from transmission in hospitals.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Y2K medical disaster preparedness in New York City: confidence of emergency department directors in their ability to respond.

OBJECTIVES: To study the preparedness New York City for large scale medical disasters using the Year 2000 (Y2K) New Years Eve weekend as a model. METHODS: Surveys were sent to the directors of 51 of the 9-1-1-receiving hospitals in New York City before and after the Y2K weekend. Inquiries were made regarding hospital activities, contingencies, protocols, and confidence levels in the ability to manage critical incidents, including weapons of mass destruction (WMD) events. Additional information was collected from New York City governmental agencies regarding their coordination and preparedness. RESULTS: The pre-Y2K survey identified that 97.8% had contingencies for loss of essential services, 87.0% instituted their disaster plan in advance, 90.0% utilized an Incident Command System, and 73.9% had a live, mock Y2K drill. Potential terrorism influenced Y2K preparedness in 84.8%. The post-Y2K survey indicated that the threat of terrorism influenced future preparedness in 73.3%; 73.3% had specific protocols for chemical; 62.2% for biological events; 51.1% were not or only slightly confident in their ability to manage any potential WMD incidents; and 62.2% felt very or moderately confident in their ability to manage victims of a chemical event, but only 35.6% felt similarly about victims of a biological incident. Moreover, 80% felt there should be government standards for hospital preparedness for events involving WMD, and 84% felt there should be government standards for personal protective and DECON equipment. In addition, 82.2% would require a moderate to significant amount of funding to effect the standards. Citywide disaster management was coordinated through the Mayor's Office of Emergency Management. CONCLUSIONS: Although hospitals were on a heightened state of alert, emergency department directors were not confident in their ability to evaluate and manage victims of WMD incidents, especially biological exposures. The New York City experience is an example for the rest of the nation to underscore the need for further training and education of preparedness plans for WMD events. Federally supported education and training is available and is essential to improve the response to WMD threats.

Attitude of Health Personnel↗
PubMed2000

Children and the city: a summary of recent environmental psychology research.

The environmental psychology literature is reviewed as it focuses on children's needs and experiences of towns and cities. Children are, we argue, the unacknowledged outsiders in the planning and management of urban areas; yet their enjoyment of and contribution to these areas is ignored at our peril. We discuss the importance of place attachment in the child's developing personal identity; and the rich affordances of towns and cities for the child's well-being and development, alongside an assessment of the evidence about the social and physical dangers that are more frequently stressed in popular discussions: these range from strangers and street crime, to traffic and pollution. Other related topics reviewed include: children's favourite places and their role in the child's self-regulation; the role of exploration of the local area as part of the child's widening social and cognitive world; gender differences in patterns of exploration, and whether these might be changing; and examples of children's involvement at more than a token level in the planning of their communities. The role of children as consumers in the local economy, and their use of public places, malls and plazas, has often been discussed as if they were inevitably socially problematic, and that their presence inevitably led to conflicts with adult users: yet we argue for a view of cityscapes which bring the different strands of society together. We conclude by discussing those Continental European city designs which foster the participation of children in the city's social life.

Child↗
PubMed2004

Does increased general schooling protect against HIV infection? A study in four African cities.

BACKGROUND: The association between educational attainment and risk of HIV infection varies between populations and over time. Earlier studies in sub-Saharan Africa have found that those with more education are at increased risk of HIV infection. METHODS: We investigated the associations between general schooling and both HIV and herpes simplex-2 (HSV-2) infection using data from the multicentre study on factors determining the differential spread of HIV in four African cities. Cross-sectional general population studies were conducted in 1997-1998 in Cotonou (Benin), Yaoundé (Cameroon), Kisumu (Kenya), and Ndola (Zambia), including about 2000 adults in each city. RESULTS: There was no association between schooling and HIV infection in men or women in Kisumu or Ndola. Women in Yaoundé and men in Cotonou, with more schooling, were less likely to be HIV positive. These associations persisted after adjusting for sociodemographic factors. Similar trends in men in Yaoundé and women in Cotonou were not statistically significant. Increased schooling was associated with significantly decreased risk of HSV-2 infection in women in Kisumu and Ndola and men in Cotonou. In all the cities those with more education tended to report less risky sexual behaviour. CONCLUSIONS: There was no evidence of an increased risk of HIV infection associated with education as seen in earlier studies. In each city there was some evidence of lower HIV or HSV-2 infection rates and less risky sexual behaviour associated with increased education levels. The most educated may be responding more readily to health education programmes. The challenge is to extend this to the rest of the population.

Adolescent↗
PubMed1996

Tuberculosis, AIDS, and death among substance abusers on welfare in New York City.

BACKGROUND: In New York City, the incidence of tuberculosis has more than doubled during the past decade. We examined the incidence of tuberculosis and the acquired immunodeficiency syndrome (AIDS) and the rate of death from all causes in a very-high-risk group--indigent subjects who abuse drugs, alcohol, or both. METHODS: In 1984 we began to study prospectively a cohort of welfare applicants and recipients 18 to 64 years of age who abused drugs or alcohol. The incidence rates of tuberculosis, AIDS, and death for this group were ascertained through vital records and New York City's tuberculosis and AIDS registries. RESULTS: The cohort was followed for eight years. Of the 858 subjects, tuberculosis developed in 47 (5.5 percent), 84 (9.8 percent) were given a diagnosis of AIDS, and 183 (21.3 percent) died. The rates of incidence per 100,000 person-years were 744 for tuberculosis, 1323 for AIDS, and 2842 for death. In this group of welfare clients, the rate of newly diagnosed tuberculosis was 14.8 times that of the age-matched general population of New York City; the rate of AIDS was 10.0 times as high; and the death rate was 5.2 times as high. There was no significant difference in the rate of new cases of tuberculosis between subjects with positive skin tests and those with negative skin tests at examination in 1984. CONCLUSIONS: Among indigent alcohol and drug abusers in New York City, the rates of tuberculosis, AIDS, and death are extremely high. In this population, a single positive or negative skin test does not predict the development of tuberculosis, probably because both anergy and new infections are common. If programs to control tuberculosis and AIDS are to be effective in groups of indigent substance abusers, health services must be integrated into the welfare delivery system.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Hospitalization costs associated with homelessness in New York City.

BACKGROUND: Homelessness is believed to be a cause of health problems and high medical costs, but data supporting this association have been difficult to obtain. We compared lengths of stay and reasons for hospital admission among homeless and other low-income persons in New York City to estimate the hospitalization costs associated with homelessness. METHODS: We obtained hospital-discharge data on 18,864 admissions of homeless adults to New York City's public general hospitals (excluding admissions for childbirth) and 383,986 nonmaternity admissions of other low-income adults to all general hospitals in New York City during 1992 and 1993. The differences in length of stay were adjusted for diagnosis-related group, principal diagnosis, selected coexisting illnesses, and demographic characteristics. RESULTS: Of the admissions of homeless people, 51.5 percent were for treatment of substance abuse or mental illness, as compared with 22.8 percent for the other low-income patients, and another 19.7 percent of the admissions of homeless people were for trauma, respiratory disorders, skin disorders, and infectious diseases (excluding the acquired immunodeficiency syndrome [AIDS]), many of which are potentially preventable medical conditions. For the homeless, 80.6 percent of the admissions involved either a principal or a secondary diagnosis of substance abuse or mental illness -- roughly twice the rates for the other patients. The homeless patients stayed 4.1 days, or 36 percent, longer per admission on average than the other patients, even after adjustments were made for differences in the rates of substance abuse and mental illness and other clinical and demographic characteristics. The costs of the additional days per discharge averaged $4,094 for psychiatric patients, $3,370 for patients with AIDS, and $2,414 for all types of patients. CONCLUSIONS: Homelessness is associated with substantial excess costs per hospital stay in New York City. Decisions to fund housing and supportive services for the homeless should take into account the potential of these services to reduce the high costs of hospitalization in this population.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Analysis of PM2.5 and PM10 in the atmosphere of Mexico City during 2000-2002.

During the last 10 years, high atmospheric concentrations of airborne particles recorded in the Mexico City metropolitan area have caused concern because of their potential harmful effects on human health. Four monitoring campaigns have been carried out in the Mexico City metropolitan area during 2000-2002 at three sites: (1) Xalostoc, located in an industrial region; (2) La Merced, located in a commercial area; and (3) Pedregal, located in a residential area. Results of gravimetric and chemical analyses of 330 samples of particulate matter (PM) with an aerodynamic diameter less than 2.5 microm (PM2.5) and PM with an aerodynamic diameter less than 10 microm (PM10) indicate that (1) PM2.5/PM10 average ratios were 0.42, 0.46, and 0.52 for Xalostoc, La Merced, and Pedregal, respectively; (2) the highest PM2.5 and PM10 concentrations were found at the industrial site; (3) PM2.5 and PM10 concentrations were lower at nighttime; (4) PM2.5 and PM10 spatial averages concentrations were 35 and 76 microg/m3, respectively; and (5) when the PM2.5 standard was exceeded, nitrate, sulfate, ammonium, organic carbon, and elemental carbon concentrations were high. Twenty-four hour averaged PM2.5 concentrations in Mexico City and Sao Paulo were similar to those recorded in the 1980s in Los Angeles. PM10 concentrations were comparable in Sao Paulo and Mexico City but 3-fold lower than those found in Santiago.

Aerosols↗
PubMed2005

Effect of liquefied petroleum gas on ozone formation in Guadalajara and Mexico City.

Leakages of liquefied petroleum gas (LPG) are suspected to contribute greatly to ozone (O3) formation in Mexico City. We tested such a hypothesis by outdoor captive-air irradiation (CAI) experiments in the two largest Mexican metropolitan areas: Guadalajara (GMA) in 1997 and Mexico City (MCMA) in 2000. O3 was monitored in each city for 20 days (8:00 a.m.-6:00 p.m.) in smog chambers containing unaltered morning air or morning air enriched with either commercial LPG or LPG synthetic mixture 60/40 (propane and butane). Tested additions of both components were 35% (by volume) in GMA and 60% (by volume) in MCMA. The addition effects on O3 (max) were compared with effects from diluting LPG components or total nonmethane hydrocarbons (tNMHCs) by 50%. Diluting tNMHCs had the greatest absolute effect at both cities: it lowered O3 (max) by 24% in GMA and 55% in MCMA. Adding commercial LPG increased O3 (max) by 6% in GMA and 28% in MCMA; whereas adding LPG synthetic mixture 60/40 caused a similar increase in O3 (max), 4 and 21% in GMA and MCMA, respectively. Compared with dilution of tNMHCs, dilution of LPG-associated compounds had a smaller decreasing effect on O3 (max), only 4% in GMA and 15% in MCMA. These results show that commercial LPG and LPG synthetic mixture 60/40 affect O3 formation to a lesser extent than estimated previously.

Air Pollutants↗
PubMed1994

Estimation of the prevalence of cryptococcal infection among patients infected with the human immunodeficiency virus in New York City.

Cryptococcal infections are not reportable illnesses, and there have been limited attempts to estimate their incidence or prevalence. This study estimates the prevalence of cryptococcal disease in New York City in 1991 among human immunodeficiency virus (HIV)-infected patients who were at risk. Numerator data were generated by surveying all hospitals in New York City to determine the number of patients with cultures positive for Cryptococcus neoformans as well as the number of patients with positive cryptococcal latex agglutination tests in 1991; 517 culture-positive patients were identified, and 1,277 patients were estimated to have a positive cryptococcal latex antigen test. Of these cases, 96% were estimated to be related to infection with HIV. Denominator data were generated via an active surveillance program of the New York City Department of Health. The annual prevalence of cryptococcosis among HIV-infected patients at risk in New York City is estimated to be 6.1%-8.5%.

AIDS-Related Opportunistic Infections↗
PubMed1986

Stomach and colorectal cancers in Puerto Rican-born residents of New York City.

Colorectal cancer incidence and mortality rates for Puerto Rican-born residents in New York City (PR-NYC) for 1975-79 were about two times those for Puerto Ricans living in Puerto Rico (PR-PR) and one-half to almost two-thirds those for other whites in New York City. From 1958 to 1979, colon cancer mortality rates for PR-NYC increased dramatically (i.e., 212% in males and 54% in females), whereas in PR-PR, male rates increased only slightly and female rates remained constant. For stomach cancer, incidence rates for male and female PR-NYC were slightly, but not significantly, higher than those for male and female PR-PR. In contrast, stomach cancer mortality rates for PR-NYC were lower than those for PR-PR throughout the survey period, and mortality decreased substantially in all racial-ethnic groups in New York City and Puerto Rico from 1958 to 1979. Results of this study indicated that the changes in colorectal and stomach cancer incidence and mortality in Puerto Rican-born residents after migration to New York City, although not as dramatic as in migrants from Japan and Eastern Europe, were comparable to those observed for Hispanic migrants to New Mexico and Los Angeles.

Adult↗
PubMed2001

Partnering with communities to improve health: the New York City Turning Point experience.

Concurrent with the New York City Department of Health's reorganization efforts, the Robert Wood Johnson and W.K. Kellogg Foundations launched Turning Point, a national initiative designed to strengthen the nation's public health system. The Turning Point initiative has emphasized broad-based partnership building and planning as key prerequisites for improving public health practice. In response to the foundations' request for proposals, the department formed a New York City Public Health Partnership, which in turn applied for and was granted a Turning Point planning grant. This funding allowed New York City Turning Point to initiate a public health planning process, part of which involved convening forums in each of the five boroughs. With over 1,100 community participants, these forums provided both a starting point for establishing public health priorities and an interactive setting for sharing health and demographic data. Included among the issues that emerged as priorities were: access to care, environmental health, mental health, housing, asthma, education, and dietary issues. Building on the forum outcomes, the New York City Public Health Partnership developed a public health system improvement plan. The goals delineated in this plan are: (1) to create and support public health partnerships at the community, borough, and citywide levels; (2) to identify community health concerns and develop strategies responsive to these concerns; and (3) to develop policies to support and sustain a community health approach to improve health status. This article also discusses possible roles for local health departments in promoting a community health approach to address public health concerns.

Community Health Planning↗