A Wish List for 2025

It's become a December tradition for me to share a wish list for how New York can be a healthier place in the upcoming year. As 2024 winds down, here's what I'm wishing for in 2025:

1. A shot in the arm for primary care. This one stays on the list for another year. Primary care has the best return on investment of any type of health care service - a rare "win-win" associated with both better health outcomes and lower costs. Yet, we chronically underinvest in primary care, spending only 5-7 cents of every health care dollar in this area. We can and should do better, by devoting a greater share of total health spending to primary and preventive care. Doing so wouldn't require spending more; it would mean spending in smarter and better ways.

I'm optimistic we will get there. New York was selected to participate in the Centers for Medicare & Medicaid Services' AHEAD Model, designed "to curb health care cost growth; improve population health; and advance health equity by reducing disparities in health outcomes." States participating in AHEAD must set a specific target for primary care spending, giving New York the perfect opportunity to rebalance our health care spending. Let's take advantage of this unique moment to get more bang for our health care buck.

2. Preservation of core public health functions. In a column about investing in the public health infrastructure in the wake of COVID, I wrote, "Too often in the U.S., we take for granted that we have safe drinking water, that our kids are protected from lead poisoning, that disease outbreaks can be monitored and contained." Now, we cannot take those things for granted.

The President-elect's key health nominees are unconventional contrarians, with histories of promoting misinformation and opposition to life-saving vaccines. Robert F. Kennedy Jr.'s misguided opposition to community water fluoridation has fostered skepticism about its safety. And just last week, it was reported that RFK's lawyer has asked the Food and Drug Administration to revoke approval of the polio vaccine. Rough seas are ahead for public health. (Some ideas on the table could be promising - cracking down on pesticides and food additives and improving the quality of school meals - but it's unclear how those might play out.)

Given the atmosphere at the federal level, New York State needs to protect the gains we've seen in childhood vaccination rates, community water fluoridation, and basic public health monitoring and data reporting. We've largely put COVID in the rearview, but chances are we'll see another public health crisis before too long - and we've got to be ready for it.

3. Sustained, more equitable progress addressing the overdose epidemic. Here's some good news: the State Health Department's latest data show a decrease in opioid-related overdose deaths and emergency department visits statewide. Overdose deaths in New York dropped by more than 20% between July 2023 and July 2024, according to the Centers for Disease Control & Prevention. Sustained efforts - making naloxone widely available, expanding access to substance use treatment, and establishing the nation's first Overdose Prevention Centers in New York City - are starting to pay off.

But the fight's not over. On nearly every measure related to opioid use and overdose statewide, Black and Latino New Yorkers fare worse than their white counterparts. In New York City, residents of the Bronx and Staten Island; Black and Latino residents; and those living in neighborhoods with very high rates of poverty are most likely to die of an overdose. Even as rates of overdose declined among white New York City residents between 2022 and 2023, rates among Latinos increased - so in some cases, disparities are widening rather than shrinking.

4. Finish the job on healthy school meals. Free school meals improve physical health, mental wellbeing, and academic performance. And when meals are free to all, the stigma and shame associated with school lunch decreases and participation increases.

We are so close to healthy school meals for all. The State's budget includes $145 million for free school meals, which means that more than 80% of New York public school students are getting the food they need to be healthy and learn well. But close is not complete. We are not done until free school meals are truly universal, so that every public school student can participate, regardless of where they live.

Just wishing doesn't make things come true. Success will take hard work, persistence, coordination, and some luck. Let's be ready to work together to make these wishes a reality in 2025. And please share your own wishes for the new year in the comments.

My final wish: a healthy and happy holiday season for you and your loved ones.