Surveillance to Monitor the Impact of the Trump Administration on the Health of New York City Residents

Context: The Trump administration has enacted or proposed many policies that could impact public health. These include attempts to dismantle or repeal the Patient Protection and Affordable Care Act (ACA), restricting funding for women's health care, and loosening of environmental regulations. Objective: To develop a surveillance system to monitor the public health impacts of the Trump administration in New York City. Design: Epidemiologic assessment. Public health surveillance system. Setting: New York City. Participants: New York City residents. Main Outcomes Measures: We identified approximately 25 indicators across 5 domains: access to care, food insecurity, reproductive health, environmental health, and general physical and mental health. Sources of data include the New York City Department of Health and Mental Hygiene's (DOHMH's) health and risk behavior telephone survey, vital statistics, emergency department visits, DOHMH sexual health clinics, Federally Qualified Health Centers, lead and diabetes registries, Medicaid claims, Supplementary Nutrition Assistance Program enrollment, Women, Infant, and Children program enrollment, and 311 call records. Data are collected monthly or quarterly where possible. We identified measures to stratify indicators by individual and area-based measures of immigration and poverty. Results: Since April 2017, we have compiled quarterly reports, including establishing a historical baseline of 10 years to account for secular trends and encompass the establishment and enactment of the ACA. Indicators are interpreted within the context of changes in programming or local policy that might explain trends. Conclusions: We have successfully established an adaptive surveillance system that is poised to rapidly detect changes in the health of New York City residents resulting from changes by the Trump administration to public health policy. The development of such systems is a critical function for health departments across the country to play a role in the current political and policy environment.