Public Health Solutions (PHS) was first established as the Medical and Health Research Association of New York City (MHRA) by the New York City Department of Health and Mental Hygiene (NYC DOHMH) in 1957. We were created to foster research in the NYC DOHMH by providing more flexibility to seek grants and contracts from government and private sources. What began in 1957 as a city agency’s innovation in research administration has successfully evolved into a major public health organization. Today, we not only continue in our original mission to conduct significant research and assist NYC DOHMH, but also provide vital services that improve the health of low-income and high-risk families and communities throughout New York City.

The Early Years: Expanding our Role

In the early and mid-1960s, our research income increased almost tenfold. Projects were largely focused on disease prevention among underserved populations. Included was a project to increase participation in screening for cervical cancer in Harlem. Another study focused on the prevalence of obstructive pulmonary disease and the role of air pollution on health. During this time, the organization also expanded work beyond research, including a vaccination assistance program and the establishment of a training program for nursing home administrators.

1970s: Services for Women and Children

In 1974, near the height of New York City’s fiscal crisis, MHRA was transformed from a research organization into a major provider of health services for low-income women and children. Our annual revenue leaped from $1.1M to $26M in 1975, and staff grew from 65 to nearly 700. We were serving over 100,000 women who were pregnant or seeking to prevent pregnancy through 11 reproductive health centers and 29 hospitals.

We were also providing enriched pediatric services to thousands of low-income children throughout the city. Through the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), MHRA became the leading nonprofit offering community-based WIC programs to offer supplemental foods and nutritional education to pregnant and breastfeeding women and children who were determined to be at nutritional risk.

Additionally, we were awarded the NYC Information and Counseling Program for Sudden Infant Death Syndrome (SIDS). Through this program, we provided information and counseling to families whose infants had died of SIDS, and educated the community about SIDS prevention through the “Back to Sleep” campaign. Moreover, MHRA broke ground with the Prenatal Diagnosis Laboratory (PDL) to provide counseling and genetic testing for low-income pregnant women that helped to reduce risks of genetic neural tube defects and tested the insurability of these services in the private sector.

1980s: Shielding Programs from Budget Cuts

The 1980s was a decade of de facto budget reductions for most of the maternal and child health programs adopted by MHRA. The consequences of government cutbacks and changes in Title X of the Public Health Service Act during this time resulted in MHRA having to address these problems while attempting to minimize the reduction of services to populations in need.  At the same time, MHRA was beginning to focus on the AIDS epidemic.

1990s: The Addition of HIV/AIDS Care

In the early 1990s, MHRA was selected by the City to administer federal funds for the Ryan White CARE Act. We established the HIV Care Services Program to develop networks of care in health, housing, and social services for people living with HIV and AIDS in the city. Much of the Ryan White funding was for small, community-based organizations well-qualified to provide services, but limited in their administrative, accounting, and reporting skills. To address this, MHRA created technical assistance systems to provide the needed support services for good fiscal accountability.

We also collaborated with NYC DOHMH, the HIV Health and Human Services Council, and Columbia University to institute the CHAIN (Community Health Advisory and Information Network) Study to research the health status of HIV-positive individuals and how they received care. CHAIN, which continues today, has been instrumental to the national public health community in providing clear evidence about the impact of Ryan White CARE Act-supported services on the reduction on morbidity and increased length of life.

During these years, Medicaid coverage for women and children was expanding, and managed care became the predominant means through which services for low-income women and children were financed. The impact of these national changes and the rise in new public health opportunities during this time had a profound impact on our success.

We became a WIC Vendor Management Agency, responsible for training, licensing, and inspecting stores participating in the WIC program in Brooklyn, Queens, and in later years, Nassau County, Suffolk County, Orange County and Rockland County. MHRA started the Early Intervention Service Coordination Program (EISC), providing case management to 9,000 children with special healthcare needs. We collaborated with NYC DOHMH to develop All Kids Count, a citywide immunization registry that led to improved childhood immunization rates. We also partnered with NYC DOHMH and the Robert Wood Johnson Foundation to build a citywide immunization registry called All Kids Count, which led to improved childhood immunization rates.

Early 2000s:  An Expanded and Stronger Role

During the early 2000s, our organization’s strategic planning and the terrorist attack on the World Trade Centers provided the impetus for important program changes to more effectively respond to the city’s new and emerging public health needs. During this time we built new programs on our existing bases, and at the same time expanded and improved our long-standing programs. The 9/11 terrorist attacks and the intended distribution of anthrax through the mail resulted in new federal funding for emergency preparedness. We were named the administrative agent for the city’s bioterrorism grant from CDC, which was part of NYC’s public-private model that has been highlighted by the General Accounting Office (GAO) as the most effective and efficient bioterrorism model in the country.

Our roster of services through the Ryan White CARE Act had grown substantially by this point. In 2001, the NYC DOHMH transferred the responsibility for regranting HIV prevention funds, making our organization the Master Contractor of Ryan White managing $132M, including 343 contracts and 133 community-based organizations.

The rising number of immigrants in NYC also significantly affected our work. While there was a broader eligibility of Medicaid, many who were eligible for services were unaware of their availability. During this time, we took steps to make services more accessible to those who needed it most. Our Health Insurance Enrollment Program, which was demonstrated to be effective in enrolling low-income families at WIC centers, was enhanced to assure that services were language, literacy, and culturally appropriate. During the same period, we strengthened Healthy Families Bushwick (formerly Bushwick Bright Start) and added Nurse-Family Partnership®, both evidence-based home-visiting programs for young and first-time mothers in Brooklyn and Queens high-risk communities. MHRA also continued to tackle the problem of childhood obesity through the addition of a WIC farmer’s market and nutritional training program.

MHRA’s internal research programs were growing with the realization that our directly-operated programs with large numbers of constituents could serve as natural laboratories for quickly mounting studies about urban public health and for testing interventions. For instance, we were able to survey our WIC recipients about confusion regarding access to public health services. This research led to wide-scale efforts to improve outreach to immigrants across the city.

2005-2015: A New Name and Expanded Outreach

In 2008, we changed our name to Public Health Solutions (PHS) to more accurately capture the essence of what our organization had grown to be, and to better define our role in New York City’s public health environment. Much of our work during this time focused on expanding both our direct service programs and expanding our contracting and management services into other public health issues and the innovation of video-interactive projects.

PHS became the leading organization of School Food FOCUS, a nationwide program working with school districts, community and private partners, and all levels of government to bring healthier and more sustainably produced food to urban school children. We were also continuing to lead NYC Coalition for a Smoke-Free City (now NYC Smoke-Free), a coalition which works to protect the health of New Yorkers through tobacco control policy, advocacy, and education. Our combined efforts were instrumental in encouraging the passage of the 2003 NYC Smoke-Free Air Act.

PHS also introduced CoMadres, a major place-based initiative in high-risk and mostly immigrant neighborhoods in Queens to help improve maternal infant health. PHS, which has long enrolled New Yorkers in health insurance, became a Navigator agency for the Affordable Care Act. Through this program, our navigators enroll New Yorkers in all five boroughs, and Nassau and Suffolk Counties in Long Island.

On the research front, PHS launched a series of research-based video-interactive projects. HIV Is Still A Big Deal video series encourages and motivates gay men to make safer choices in their sex lives. The series was developed in response to the continuing HIV epidemic among gay men. It features relatable characters in compelling stories who deal with dating, sex, HIV testing, disclosure of HIV status, and the use of PrEP. PHS also developed, a contraceptive decision-making tool which asks a series of questions about a patient’s history and needs, and then identifies the most effective forms of birth control for her to discuss with a medical professional. A randomized control trial shows that patients make more effective birth control choices after viewing the module.

Today: Thought Leadership, Champion of Public Health, and Excellent Partner

Today, PHS is the largest public health nonprofit serving New York City. We improve health outcomes and help families thrive by providing services directly to the city’s most vulnerable populations, publishing groundbreaking research that moves public health policy and practice forward, and supporting over 230 community-based organizations through our long-standing government partnerships. We are a leader in addressing crucial public health issues, including food and nutrition, health insurance access, maternal and child health, reproductive health, tobacco control, and HIV/AIDS prevention. PHS has a strong focus on health equity to ensure NYC families have the basics for a healthier life.