Serving the Whole Person in NYC

How do you lead 16 agencies and serve 8.2 million people without losing sight of the individual? New York City's Deputy Mayor of Health and Human Services Helen Arteaga shows what happens when a leader moves beyond the binary of efficiency vs. compassion, using data and local insights to get both right.

In this episode, you'll learn:

• Why a structured system for serving people from birth through end-of-life means better, consistent care.
• How to use neighborhood-level data and geographic targeting to serve people before they hit crisis.
• How to get the right processes in place before feeding data to an AI.
• The importance of early intervention with babies and children.
• Why ensuring equal access to good care is so personal for DM Arteaga, and how she honors her father's legacy by doing so.

Listen here, or wherever you get your podcasts. The following is a transcript of the conversation. 

Steve Goldsmith:

Welcome back. This is Steven Goldsmith from Data-Smart at the Bloomberg Center for Cities with another podcast. We're joined today by Deputy Mayor Dr. Helen Arteaga, who was recently appointed by the mayor as New York City's Deputy Mayor for Health and Human Services. That's quite a portfolio. Previously served as CEO of NYC Health and Hospitals Elmhurst, where she led one of the city's most vital public hospitals. Welcome, Deputy Mayor.

Deputy Mayor Helen Arteaga:

Hello, Steve. How are you doing?

Steve Goldsmith:

I'm fine. I'm so glad to talk with you. You spoke recently to our chiefs of staff of major cities, and the only problem with your presentation is you were rated more highly than me.

Deputy Mayor Helen Arteaga:

Well, that can't be possible. You are an expert in this world, and I'm assuming the week that they had with you, not only did they leave with amazing tools to make sure their cities are better, but they're left inspired to even do more.

Steve Goldsmith:

Thank you. Speaking of inspiration, I think your background is interesting. Your work at Elmhurst during COVID, which was a red zone for some of the most difficult challenges, probably shaped your current work. Tell us a little bit about your Elmhurst work and what relation it has to what you do now.

Deputy Mayor Helen Arteaga:

My work at Elmhurst basically started a long time ago with my dad. My dad was a community activist without really knowing what that word meant. He was a Christian man. We came here from Ecuador when I was 12, and he always believed in helping thy neighbor. And he made things, in a world that was so complex, he made it simple. He always said, "When someone asks us for help, that's when they're the most vulnerable."

And during that time in my community, HIV and AIDS, we were going through our epidemic there here in our community. And one of the major things that he was always saying, "We can't fix the world, but we can fix this one block. How do we help that neighbor? How do we keep the street clean?" My dad would talk to gang members all the way to fixing someone's plumbing. And he didn't know how to do any of that, but he believed in education. He believed in working together as a community, and I got that drive from him.

Unfortunately, we didn't know much about the healthcare system here in the United States. So when my dad got really sick, he ended up at Elmhurst Hospital. And when he got to Elmhurst Hospital, he was diagnosed with leukemia, stage 4. And the second question was like, "Where's your insurance?"

And of course, we had no idea what that was. In Ecuador, we have universal healthcare, so we thought the same thing here in this country. We thought we were assigned to Elmhurst. And unfortunately, my dad died that February waiting for his Medicaid application to get approved. And in that moment, not only did the birth and the fire of my public health advocacy was born, but indirectly, I guess my path to Elmhurst was always in the plans, I guess, if that makes any sense.

So to become its CEO of Elmhurst Hospital started with that 17-year-old girl seeing her dad die. And that's where the advocacy of my work came from, making sure everyone has access to healthcare, good healthcare, language access, inclusive healthcare, making sure social services and the wraparound services that an individual needs to thrive was born.

So when I took over Elmhurst during the pandemic, where the community was so scared, in my world, in my head, the way I address that again, is using data, holistic views, and then experience from being in that community and saying, "How do I help my community from a moment of so much fear and death at the same time?"

Steve Goldsmith:

That's such a powerful story. I think that context makes all the difference. People who don't understand the problems of folks in a daily existence have difficulty configuring the responses.

So now, you are a bureaucrat. No offense. I was one. I've been one forever. I don't even mean it in a pejorative sense. I mean, you run a very large organization.

Deputy Mayor Helen Arteaga:

Yes. It's like Elmhurst on steroids.

Steve Goldsmith:

Yeah. Right? It must be the largest portfolio in New York City, which is the largest bureaucracy public service in the country. How do you think about this rationing issue? In other words, if we take all of the challenges people face, how do you think about a system that is as effective as possible in terms of intervening at the right time for people who need it the most? You sit on a huge amount of data. How do you think about using the data to determine intervention strategies and ways to help people?

Deputy Mayor Helen Arteaga:

For me, it's about geo-mapping a lot, but also understanding that the data is one part of the story. You got to dig deep at the data and remember that after every data point, there's a human being behind it, or every data point there's a cluster of data points, there's a community behind it. And then once you know that, you look deeper, what does that community look like? You start looking at demographic data. Then you look at what makes that community unique. Corona, Queens, we're like a mini Ecuador. But then you go to Jackson Heights, it's like mini Colombia. When you go to Harlem, it's a different type of community.

And again, for us, when I look at that and I look at the clusters and I look at the data points, I go back. And the way I intervene healthcare in Queens is very different on how I intervene healthcare in Brooklyn. And being Deputy Mayor of Human Services as well, I think for me, it's super important to make sure that that side of the world, all my not-for-profits, also see that healthcare is part of their work as well. They shouldn't do that in silo either. So I'm always putting little pebbles of healthcare in different pieces of my portfolio or what I call my service line.

Steve Goldsmith:

How do you think about helping your frontline workers access data that's in all sorts of different parts of the city for different purposes in order to help them help the people who present themselves? How do we get a complete view of the person when you're dealing with so many different data systems and benefit systems and healthcare components?

Deputy Mayor Helen Arteaga:

I think that's what we're trying to do here with the Mamdani Administration. We're trying to make sure that the word accountability and access and making sure affordability... We only get to that if we understand where we are. Using data demonstrating everything from a community health worker. Let's take that for example. If I give that community health worker, I'm like, "This is your patient and he has X, Y, and Z, and we need to get him to A, B, and C."

But if I don't show that community health worker the pathway of how to do that or the progress he or she or they is doing, how is that person going to feel motivated? How is that person going to feel like he or she or they has done something? And the same thing goes for the patient. And this is what's so exciting about healthcare right now is that we have so much data, but we got to make sure we use it wisely. We got to make sure that we create enough dashboards, enough one-pagers, one or two bullet points, let's not overwhelm everyone on a billion indicators or seven dashboards.

I remember at Elmhurst, they gave me a report and they said, "Oh, Helen, this is the dashboard of Elmhurst."

And I was thinking like a one-pager. It was 56 pages. I was like, "First of all, this is not a dashboard. It's a full-blown report."

And again, I went in there and I did the homework with the team and we did the work. I'm like, "Okay, what are the major things that's our North Star? What are the things that we need to make sure we're monitoring our North Star? And how do we explain that to the housekeeper or to the guy in the boiler room? How do I explain the data of making sure someone's cardiovascular disease is being monitored correctly to the guy in the boiler?"

And I'm doing the same type of methodology here in the city. I'm trying to make sure all New Yorkers understand what true access means to healthcare, but good data points for their communities to have. Each community is a little unique. So Queens could be like hypertension, but Brooklyn could be maternal death. So again, trying to figure out the uniqueness of data points for each of the boroughs.

Steve Goldsmith:

What role do you see for AI in your frontline workers, the caseworker in a social service agency or the intake worker in a hospital? Let's leave aside the potential abuses of AI for a second, but just in terms of positive, are you working on ways that AI can help those workers consume all that information to make better decisions?

Deputy Mayor Helen Arteaga:

Here at City Hall, one of the things what we're trying to do with AI is, again, trying to making sure that the data points it gives us, we're going to use it responsibly. We're trying to make sure that we have the right processes in place to make sure that it gives us the right data points that are both inclusive and again, operational. Because you can have all the data points from AI, but if it's not operational or aligned with the administration's goal, our own North Stars, it wouldn't make sense for us. But we are still trying to discover what that means for us.

Steve Goldsmith:

Just for a second, what all is inside your portfolio? I understand health. What's the human services? Do you have all of the human services of New York City?

Deputy Mayor Helen Arteaga:

I have all of them. I like to tell people I'm in charge. So we're a total of 16 agencies. We're the second-largest budget item for the mayor. So I like to say I'm also the most expensive for him at the DOE. I also tell him I'm the most fun.

So when you look at the life cycle of a human being from the moment of thought of life, through all the different cycles of an individual, I am in charge of. So if you think about the moment of thought of life, we take care of you in the hospital, give you birth, a lot of healthcare. We give you food. We make sure that you have enough housing. We make sure in case you fall on hard times, we provide shelter, we provide cash assistance, SNAP. At the same time, we make sure that there's a workforce. We provide afterschool childcare, even opening up restaurants in the business world.

And then as you get older, you become part of our aging community. We are in charge of aging. But sometimes we might join the military, so we're in charge of Veterans. And then at the same time, as we think about life, even in death, I'm in charge of you. So even in death, we are also making sure that you have access to the right healthcare. We're making sure that in death, you're also being honored for the life that you've given New York City.

Steve Goldsmith:

Your answers are so compelling.

Deputy Mayor Helen Arteaga:

It's because I love this work.

Steve Goldsmith:

I can tell. I can tell. You've recruited one of the country's most talented social service individuals in Erin Dalton who was the Allegheny commissioner. And she spent a lot of time over there trying to link together social service systems so that she can make the right intervention. You've got this great opportunity here because you have health and social services. How do you think about identifying the needs of a person, say domestic violence or they don't have a job, or they have a health problem early? How do you identify where to inject help? Cities are notoriously bad at failing to intervene when it's low cost and waiting until it becomes really a serious, expensive problem. Do you think about that sort of return on investment?

Deputy Mayor Helen Arteaga:

So one of the things I love spending time with our Commissioner Dalton, talk about brainstorming and figuring out what we want to do, and dream how we create data, and how do we use data to really do three things. How do we manage the crisis that whatever we're dealing with? Right now we were dealing with Code Red and how do we use data for that? Then how do we work on prevention? And at the same time, how do we work with the 86,000 individuals that are in our shelters? So we've got to manage those three pillars.

And Erin Dalton, the way her brain works along with data is not only inspirational, but she's able to give practical solutions. Perfect example, we just finished our Code Red. We had the heat wave here in New York City, five days of extreme heat. It was 105 degrees the other day. It got to the highest of 112, which felt like 125. So what she did is that she divided the five boroughs into clusters. Because we had all these outreach workers going everywhere, working on the most vulnerable. We had a workbook. We were calling on 311.

So she had this idea of like, "Well, let's make zones or clusters." Because if you think about data points, you can make trends out of them in clusters. So she was like, "Based on data, let's make these zones or clusters. And then let's get the right teams to be in those zones and clusters. Then these teams become experts of zone 25 or zone 16."

This is going to be interesting. Again, an unsheltered individual in Staten Island is very different from an unsheltered person in Manhattan. And what are the teams that we need to make sure they address those needs? So we did that. We had over 100 different teams in the five boroughs. And I'm happy to report we had over 400 plus placements and over 9,000 engagements during a Code Red. That was something I've never seen any other administration do.

Steve Goldsmith:

That's terrific. As you work through this at the end of your term in New York City-

Deputy Mayor Helen Arteaga:

Which hopefully will be eight years!

Steve Goldsmith:

I thought it was going to be 12 or 16, I'm confused! Eight years, how will the system be different if you're successful? And I can tell from just talking with you, it'll be more empathetic. The people will work, they'll be more empathetic. But other than that, how do you think the system will have changed?

Deputy Mayor Helen Arteaga:

Well, I think I will be very proud. I'm very proud of the work we already have been doing in the last six months, but I think if I need to look back after my four years, that's what I know I have for sure, if I could look back after my four years and say that I've indicated healthcare access in most of my nonprofit sectors, I think I've done my job. Because if you think about it, if you don't have good access to good healthcare and your body's not healthy, you can't go to school, you can't go to work, you can't think of the goals that you need to do. You can't live to your fullest life. And if I could do that for 8.2 million individuals in the world of HR1, I would be very proud of that day. I would be like, "Okay, high five, Mayor."

Steve Goldsmith:

That's a great answer. How about in terms of prevention? What would be the most important preventive acts the city could take? We're involved in a project at Harvard with some of your team on heat mitigation, the effect of heat on health. What preventative actions do you think would make the most difference?

Deputy Mayor Helen Arteaga:

We got to start working with the individuals at an early stage. Not saying that my older adults and my adolescents are not important, but there's a lot of rework that we got to get done, a lot of changing behaviors that we have to get done. But if I can get that 2-year-old or 1-year-old to eat a little bit more vegetables or just go to their doctors or just get vaccinated, right? By the time you're 2 years old, you should be 100% following in your vaccine schedule. That is not the case in New York City. And if you look in Black and Brown communities, that is definitely not the case.

And when you think of a child that's not fully vaccinated, that child's more at risk and has more sick days than a child who has been vaccinated. It starts as early as that. Again, because if you're not healthy, you're not going to go play. If you're not healthy, you're not going to learn new words. If you don't feel nice and healthy, you're not going to want to learn how to read or be social. And that is the beginning of the development of the mind and also of the human being. And we want to make sure that their future starts strong.

Steve Goldsmith:

Dr. Arteaga, let me just close with both a compliment and a thanks. Your commitment to your job, your insights into the needs of folks and potential of folks who present themselves for help is unique. Your motivation of your team is terrific. We look forward to watching your results over four and/or eight years and seeing how much healthier the New Yorkers will be as a result. Thank you for your time today.

Deputy Mayor Helen Arteaga:

Oh, no, thank you so much, Steve. And I look forward to having you as a partner for the next four or eight years.

Steve Goldsmith:

We're eager to do so. Thanks so much!

Deputy Mayor Helen Arteaga:

Yes, have a great day!