YOUR KEY TO AN AFFORDABLE HOME • RX WARNING: FOSTER KIDS ON DRUGS

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Beyond
the
Golden
Arches
Healthy eating comes
to the ’hood.
Plus: How your nabe’s
groceries stack up.

INSIDE:
THE HEALTH
COMMISH’S
SMOKING
BAN SEQUEL

 The
A ction
Diet

The food
justice
movement looks
to change more
than just what
New York kids eat.
By Tracie
McMillan
Photographs by
Margaret Keady

“IT HAS A BUTT CRACK!”
Vanessa Santiago, 18 years old, giggles as she peers at the object of her
glee: a garbanzo bean.
Tight jeans, a bomber jacket and a pink sweatband—Santiago
doesn’t look like the type of girl to contemplate the aesthetics of legumes.
But on this cold Saturday morning, she has come from Bushwick to
lower Manhattan to inspect a can of beans. Standing in the middle of a
commercial kitchen, Santiago and a half-dozen other teenagers cluster
around a steel table, a ragtag bunch of critics.
“This has a lot of sugar,” says Ronny Segura, 14, shaking his head disparagingly at a jar of sun-dried tomatoes. Segura and the other young chefs
slowly move through the pile of food on the table. Is the food good? How
can they tell? How much sugar is in it, and how much salt? Where did it
18

come from—another state, country? Is it in season? Is it in keeping with
“ancestral tradition?” Does everyone remember what “organic” means?
Once they’ve trudged through their ingredients, the group springs
into action. Ronny, a fan of Emeril on the Food Network, brandishes a
knife, dicing onions. Vanessa eagerly minces garlic. Jimmy, a big kid
from Chinatown, squeezes thawed spinach over the sink.
As the prep work drags on, kids begin to wander in and out, heading
downstairs to the lobby of the youth services organization housing the
project. Chris Williams strides into the kitchen with an Otis
Spunkmeyer danish. The sugary smell catches Vanessa’s attention; when
she finishes chopping, she slips out and returns with two cookies, two
Pop-Tarts, a cupcake and a handful of M&Ms. The two teachers
exchange looks as the sugar count mounts, but say nothing.
CITY LIMITS

 In her neighborhood, Bushwick,
Vanessa Santiago eats food from lots of boxes
and cans—and Burger King.

That teenagers are devouring fat and sugar isn’t shocking, but here it
has a special irony. These teenagers aren’t simply learning to cook. They’re
training to spread the word that healthy living—and healthy food in particular—isn’t too expensive or too difficult. These kids are being primed
to solve the obesity and health crisis among young people.

W

e possess far more information about the symptoms of the
American obesity epidemic than we do working ideas for
how to stop it. Obesity is, according to the U.S. Centers for
Disease Control and Prevention, rapidly gaining on tobacco as the country’s number-one cause of death. Its correlation with heart disease and
diabetes is well known; those two combined killed 26,000 New Yorkers
in 2002. Obesity is also linked to several cancers and asthma. And its

JULY/AUGUST 2004

impact on kids has been perhaps the most chilling: Already, one in three
born in 2000 is at risk of developing type 2 diabetes, according to the
CDC. In New York City public elementary schools, one in four children
is obese, and nearly as many are overweight.
The situation is most severe in poorer urban communities that share
grim common denominators. There’s an overabundance of fast food.
Supermarkets are sparsely located and many stock mediocre and expensive produce. Public recreational space is not only scarce but shrinking;
schoolchildren have lost significant playground real estate to portable
classrooms. Physical education is mandatory in New York State public
schools, but precious little class time is actually spent engaged in physical
activity. Where there are parks, many are still not safe to ramble in.
Beyond the infrastructual obstacles lay the practical ones. How to cook
healthy meals on low budgets and in short spurts of time, while pleasing the
palates of children. There are deeply ingrained cultural habits surrounding
food—using lard, heavily salting dishes, deep-frying—that have been passed
down for generations within families. And we all know one reason kids can’t
stay away from fast food: The marketing juggernaut is inescapable.
The problem’s complexity may be why the city Department of Health
declined to include obesity in its ambitious 10-point “Take Care New
York” health improvement plan, released this spring. City officials
defended its omission by arguing that science has yet to find a clear-cut
solution. “We don’t currently have an obesity prevention program per
se,” admits Candace Young, an assistant director of prevention in the
department’s Diabetes Prevention unit, which was founded in late 2002.
Instead, obesity and diabetes are both subsumed under point number
three, reducing heart disease. Most related programs are centered in local
organizations—hospitals, clinics, churches—and perform a combination of assessment, education and direct service. “We try to work as
much as we can to improve institutions,” says Young.
Bryant Terry is more interested in putting young people themselves
in the driver’s seat. Two years ago, Terry founded B*Healthy, the organization that’s teaching Vanessa and Ronny how to cook. His plan: Get
kids in the kitchen, grab their attention with cooking, and start to talk
to them about food—what’s healthy, why certain foods are available
instead of others, and what’s marketed to them. “That’s where you get
the buy-in,” says Terry. “You have to couple education with getting
young people involved in the preparation of foods.”
Every other Saturday, the class converges on the kitchen at the Door,
the youth services agency that houses the program, to cook a meal. Those
lessons are supplemented with weekly classes on a variety of food- and
health-related topics: body image, food marketing, how to select good
produce, when different vegetables are in season, yoga sessions. Bringing
together hippiefied organic cuisine, the Black Health movement, sustainable agriculture, and urban youth culture sensibilities, B*Healthy’s goal is
both simple and immense: to cultivate a cadre of young people with a
sophisticated understanding of food and nutrition, and who can go out
and spread the word. “This information is a lot more palatable coming
from a young person,” says Terry. He hopes to eventually have his students run workshops at after-school programs, at conferences, in front of
health and home-ec classes—anyplace where young people gather to
learn. Terry has supersize ambitions. “I like to think that we’re training
future food activists,” he rhapsodizes—leaders who will eventually transform the ways their communities consume food. “I brand them as trailblazers and revolutionaries, because the effort they’re putting in this is
going to be commonplace in 20 years.”
B*Healthy is unique in New York, but it is part of a “food justice”
19

 Supermarkets
Why we don’t have more of them.
In the battle against the bulge, easy access to a
wide range of quality, healthy food is front and
center. Supermarkets as a rule carry more
healthy food than smaller stores, and consumers will eat it: A 2002 study found that for
each additional supermarket located in a census
tract, fruit and vegetable consumption
increased by as much as 32 percent.

City Limits archives

But as millions of New Yorkers know, finding
decent produce and other healthy food is often
easier said than done. That’s true across the
country as well: The wealthiest neighborhoods
have more than three times as many supermarkets as the poorest ones, according to a 2001
study published in the American Journal of Preventive Medicine. The same study found the gap is even wider along racial lines, with white neighborhoods
having as many as four times the number of supermarkets as black ones.
By the early 1990s, the situation was so dire that the Local Initiatives Support Corporation started a subsidiary,
the Retail Initiative, to step in where private developers feared to tread: developing urban supermarkets. Even
when financing has been available, attempts to close the gap and get fresh food to greater numbers of poor
consumers in New York City have been frustrated by two things: Costs are too high, and revenue is too low.
The profit margin in the supermarket business is extremely small—about 1 percent.

movement that is thriving on the West
Coast. In Oakland, California, the People’s Grocery trawls neighborhood
streets in a converted milk truck outfitted with a booming solar-powered
stereo, selling affordable produce out its
back. Also in the Bay Area, Edible
Schoolyard, created by celebrity chef
Alice Waters, couples a student-run
organic garden with cooking classes at a
Berkeley middle school; it’s now slated
to expand to the entire district. Along
with grassroots activism, California has
a strong commitment to developing a
public policy framework for food and
health activism: The Prevention InstiRonny Segura joined
B*Healthy because he loved
Emeril, but never thought
he’d become a healthy-city
missionary.

“It’s tough to get high quality supermarkets into the ’hood,” says Alicia Glenn, vice president of Goldman
Sachs Urban Investment Group, which is participating in a federal incentive program to spur commercial
enterprises in low-income areas. To turn a profit, supermarkets must move large volumes of goods. To really
make the numbers work, says Glenn, “You need ground-floor, large-scale development, something that’s half
a city block.” And in New York, stores of that scale have to be built from the ground up.
Community development groups have helped lead the charge to bring supermarkets into urban areas. Pathmark’s Newark development is widely cited as a model for community supermarket development, as is the
central Brooklyn Pathmark developed with Bedford-Stuyvesant Restoration. Of eight supermarkets developed through the Retail Initiative, six were done with CDCs.
Not every partnership is successful. With the Retail Initiative’s help, the community development corporation Mid-Bronx Desperadoes (MBD) broke ground on a commercial project near Crotona Park boasting a Pathmark supermarket as its anchor tenant. MBD was an experienced housing developer, and the project was its
first foray into serious retail development. According to a developer associated with the project, that made
for a bumpy ride. The original contractor’s work was deeply flawed, delaying the project—originally set to
debut in 2002, the supermarket still has not opened. “It’s one thing to renovate an existing building. New construction is a new animal,” the developer says. “It would’ve been probably easier if they’d partnered with a private sector group to develop that site.”
There are logistical challenges unique to urban areas: restrictive zoning, parking shortages, proximity to public transportation, traffic congestion. Community opposition to chain retailers is also common. When Pathmark partnered with Abyssinian Development Corporation and the Retail Initiative to develop its mammoth
Harlem store, smaller local grocers organized opposition to the project, arguing that Pathmark would put
them out of business. The ensuing battle delayed the project for two years, and ultimately led the mayor to
reduce city financing available to the project before it finally opened in 1999.
The feds have stepped in to make the going easier. Looking to entice businesses to locate in high-poverty census tracts, the Clinton administration launched the New Markets Tax Credit in late 2000, offering developers
financial incentives. Still in its early stages, the program has left some developers skeptical that it will do
much to generate new retail development. “It sweetens the deal,” says the adviser on the Bronx Pathmark. But
unlike the Low Income Housing Tax Credit, which has helped produce millions of new homes, “it’s probably
not going to make or break a deal.”
Yet some previously underserved areas are seeing a surge in supermarket development. The force bringing in
the new stores is also a mixed blessing for poor communities: the boom of high-priced housing in formerly
marginal areas. “Some of the retailers are still scared of these neighborhoods,” says Glenn. “But we have to
get high-quality grocery stores, because why else are people going to buy these condos?”
—TM
20

tute, which gets funding from the selloff of California’s Blue Cross insurance
nonprofit, has worked to address the
problem of poor people’s inadequate
access to supermarkets.
What these efforts have in common is
a founding premise that bulging waistlines and unhealthy living aren’t just
symptoms of an individual’s lack of discipline, but of broader structural concerns:
food access, consumer culture, lack of
open space. And all of these organizations work with young people. They’re
betting that by starting kids on a path of
healthier habits, they’ll change not just
CITY LIMITS

 their immediate experience but their expectations as well. In a generation,
these young people and their friends could generate a surge in consumer
demand for better, healthier food. Healthy living—eating well, exercising
regularly—could become a right, not a luxury.

Farmers’ Markets
Abundant, but still far
from universally accessible.

JULY/AUGUST 2004

David Goschfeld

D

eep into Red Hook, an asphalt lot traced with the outlines of
faded baseball diamonds gobbles up an entire block, ringed
with chain link fencing. Inside sits one of Brooklyn’s two working farms (the other is the Wyckoff Farm, which dates back to 1652).
A sunny spring Saturday finds a handful of teenagers crouching over
three raised garden beds, digging shallow furrows and dispensing seeds
into them. At the end of the beds, a greenhouse—built of heavy plastic
stretched over aluminum tubing—holds another four young farmers,
planting seeds in starter containers. Two of the farmers, Jasmine and
Caridad, hail from B*Healthy and trekked here with their teachers to
work with the organization that runs the farm, Added Value.
Ian Marvey never
intended to be an agricultural missionary. He cofounded Added Value in
2000 based on a simple
observation from his
work with young offenders at the Red Hook
Community Justice Center. These kids were
working off their community service sentences
by cultivating a community garden. To Marvey’s
surprise, many kept tending their plots even when
they no longer had to.
Seeing how passionate
young people were about
growing things, Marvey
and a colleague, Michael
Hurwitz, decided farming was a natural business
enterprise for teenagers.
When the neighborhood’s only supermarket
closed down in 2001, the group opened a farmers’ market across the
street from the old store.
Marvey and Terry have brought their groups of kids together to learn
from one another—to expand their view of how food is grown, sold and
consumed, and to understand how their work is interconnected. It seems
to be catching on. Denia Cuello, 15, of Added Value nods toward Jasmine as they both set seeds into starter pots. “The things that we plant,
they cook,” she says. “We grow organic food, and they cook organic
food.” Hurwitz explains to the young farmers and cooks that their simple acts mean much more than they may realize. “We’re all trying to
make sense of a world that doesn’t always do things the right way, ” he
counsels. “And we’re trying to learn to do it in the right way.”
Terry and Marvey both work hard to connect their kids with other food
movement groups. This spring, Terry traveled to Boston with some of his
students for workshops with the Food Project, an exchange program that

Allyson Bennett is on a mission. “Alfred, you got my apples?” she calls
out, marching purposefully to a farm stand in front of Brooklyn’s Borough Hall. Bennett has trekked here from East New York on foot—the
hike took her about two hours, she says—to purchase two boxes of Fuji
apples from Wilklow Orchard, staffed this morning by Albert Wilklow, a
sixth-generation farmer from upstate (Bennett, he laughs, never gets his
name quite right). Bennett makes her purchase before heading to the
chem lab at New York City Technical College, where she is a student.
Recovering from a long illness, Bennett pursues a diet high in fruits and
vegetables, with a special focus on fresh juice.
Though open-air markets like this one, nestled on a sunny plaza lined with
gardens, connote bourgeois urban living, many of the city’s 63 farmers’
markets are vital conduits for bringing fresh produce into the kitchens of
lower-income households. That’s in large part due to two federal nutrition
programs: WIC and food stamps.
The Women, Infant and Children program offers coupons for purchases at
farmers’ markets. Food stamps—which Bennett uses to pay for her apples—
can also be used at some markets.
WIC coupons, distributed as part of the Farmers’ Market Nutrition Program
(FMNP), are widely considered a success. Redeemable only at farmers’ markets, the coupons offer pregnant women and mothers of young children $24
per season, in $2 increments. This is virtually the only allotment for fresh produce under WIC. Nearly 90 percent of FMNP recipients in a 2002 survey said
they would eat more fresh produce year-round because of the coupons;
more than three-fifths said they used their own cash in addition to the
coupons. For Wilklow, FMNP represents a significant amount of his sales at
the city’s farmers’ markets, his primary outlet. “A good chunk of it is WIC,”
says Wiklow. “It does bring us a lot of business we wouldn’t otherwise get.”
Food stamps, however, are barely trickling into the farm stands. When New
York eliminated the old coupons and switched to electronic benefit transfer cards in 2001, farmers didn’t have the technology to process them. A
few vendors at markets around the city have since joined a federally
funded pilot program testing wireless terminals that can process the cards.
But the prospects for expansion remain limited: Most people receiving
food subsidies don’t live near a year-round farmers’ market [see “Where to
Grab a Bite,” p. 24-25] and don’t have the time to make a trek.
—TM

21

 Community
Supported Agriculture
Farmer co-ops put down fresh roots.
Genevieve Richards needs fresh vegetables. The home health aide,
well into her fifties, has dangerously high cholesterol, and her doctor
has her on a strict regimen of lean meats and veggies. But in East New
York, where she has lived for 25 years, the produce available at the
local market can be “kind of terrible,” laments Richards.
That’s why Richards chose to join the East New York Community Supported Agriculture Project (CSA). A group of consumers team up with
a local farmer, paying for food up front and then collecting it weekly
throughout the growing season.
In some ways, it’s an ideal model to bring quality food into lowincome neighborhoods. CSAs are relatively easy to establish, capable
of scraping by with a few committed volunteers and a church basement. They bring farm-fresh produce directly into the neighborhoods
where people live, and charge about $15 a week for a heap of food. But
while they offer quality produce at low prices, CSAs have had to struggle to open up access for low-income members.
“In a traditional arrangement, you pay the farmer in January and you’re
assured a share from June to November,” explains Ruth Katz, executive
director of Just Food, a New York–based nonprofit that coordinates the
city’s CSAs [see “Where to Grab a Bite,” p. 24-25] and advocates for a
stronger local food distribution system. Because one household’s CSA
share typically costs around $350, Just Food has coordinated fundraising
to subsidize low-income memberships, including grants from the New
York Community Trust and United Way. Richards is a beneficiary: She gets
a reduced price and pays for her food every other week, instead of a
lump sum up front. Just Food has also learned how to do the paperwork
to accept food stamps, which Katz says are now accepted at about half
of the city’s CSAs. “That initially is kind of a pain for folks,” she concedes.
“But once they do it, it’s done and people can use their food stamps.”
CSAs are part of a growing sustainable agriculture movement that
argues for localized food production, building connections between
farmers and consumers, and generally encouraging community built
around wholesome food. As a CSA member, “You’re kind of forced to
think about how to use what’s available,” says Sarita Saftary, a Just
Food staffer who coordinates the East New York CSA. Saftary admits
that some members have a hard time adjusting to simply taking whatever the farmer brings them, but that, she says, is part of the point:
“It gives people a much stronger connection to agriculture and to the
idea of not having whatever you want, whenever you want, in whatever quantity you want, at the expense of whatever else.”
At a recent cooking class held for the members of East New York’s CSA,
the menu featured a salad of fruit and organic quinoa, oven-fried chicken
with a red pepper coulis, and lacinato kale cooked with sun-dried tomatoes. The ingredients, confesses Saftary, were bought at the Park Slope
Food Coop, six miles from East New York. “The preseason classes are to
educate people about nutritious foods,” explains Saftary, “and to introduce them to foods they might not be familiar with. So it was a lot of stuff
you can’t find in East New York.” Saftary notes there’s been talk among
CSA members about trying to start a food co-op in East New York.
Richards is looking forward to the produce, but she’s also pleased with
the focus on farming. “They have the agriculture thing, which I like—I
grew up with that,” the Antigua native remarks. In the midst of cleanup
before she sits down to her quinoa salad, Richards pauses at the sink.
“Probably I can learn something too.”
—TM

22

takes young urban gardeners to farms and brings rural youth to the city.
Ronny Segura ran a workshop there asking the other kids to think critically
about the way fast food is marketed to them. More B*Healthyites will go to
Olympia, WA, this summer to attend a national conference of youth organizations working on food systems and sustainable agriculture. Piece by
piece, the New York groups are trying to build local and national networks.
Funders see the potential, too. Since starting B*Healthy three years ago,
Terry has been awarded the Open Society Institute’s Community Organizing Fellowship and won substantial support from the New York Foundation.
Terry’s goal of encouraging healthier eating wasn’t what won him the grants;
it was the fact that he intended to spark a movement. “Looking at food as a
way to encourage social justice was brilliant,” says Alvin Starks, who was the
program’s initial progam officer at OSI. “The important piece to understand
here is the organizing part. It’s not about whether Bryant parachutes in with
‘Eat this organic fruit!’ What Bryant has to do is challenge the cultural component of food, which in low-income communities can be very difficult
because [unhealthy food] is affordable.”
Under Terry’s guidance, Theodora Rodriguez, a young mother, became
enchanted with organic foods and healthy eating, and
she helped him start a nutrition project for other mothers at the Door. She now works as a tutor for City Year, Bryant Terry, center,
a service organization. When each volunteer in her pro- brings his teen
trainees into contact
gram was given space to run a program for third-graders,
with other agricultural
one worker chose community, and another chose multiactivists, including
culturalism. Rodriguez chose nutrition.
young urban farmers
Bryant is convinced that one reason B*Healthy
in Red Hook.
alumni are carrying the healthy-diet message forward is
that he never shoves it down their throats. He and the
two teachers who help run the program avoid recommending very specific changes in habits and make clear
that participants are welcome to heed or ignore their
advice. “You have more likelihood of a person maintaining a healthy diet that works for them,” says Terry.
“It has to be incremental steps.”
Terry’s laissez-faire philosophy stands in stark contrast
to the Black Health movement. Black Health adherents
promote vegetarian and organic diet choices as part of an
extreme lifestyle change. Celebrities like rapper Common,
singer Erykah Badu and entertainer Ben Vereen swear by
the work of healers like Queen Afua, a holistic food and
health icon based in Crown Heights. A strong advocate of
vegetarian—and preferably liquid—diets, Afua says that
she mostly works with adults who’ve encountered serious
health problems and are looking to make a profound
change in their diet. “I advocate that they become complete vegetarians, but
of course everyone has a different level,” she concedes. “I meet them where
they are and try to move them gradually to a more holistic lifestyle.”
Her public persona tends to be far more militant. At a community
event held at Medgar Evers College last fall, an audience member asked
Afua whether, as someone who was not willing to become vegetarian, it
was worthwhile to switch to organic meats. “It will still kill you,”
responded Afua tersely.
While Terry appreciates the longstanding contributions of healers like
Afua, he’s not sold on the zero-tolerance approach. “Dude, how impractical and elitist is that?” he says. “It’s like saying, ‘Don’t go to school
unless you go to an Ivy League college.’”
Following his students for a few months, one can see the changes in
CITY LIMITS

 attitudes unfold. “I’m not going to change the way I eat,” declared
Ronny Segura, the Food Network fanatic, last October. “I’m just going
to take a different view.” Six months later, he’s been eating more fruit
and less fast food—just once a week by his estimate, and he’s narrowed
it down to french fries. While his mother still cooks mostly traditional
Dominican foods—rice and beans, fried plantains—he’s convinced her
to switch to olive oil and favor herbs over salt.
For now, Terry has to accept that these incremental gains are the most
he can expect to see. His kids can’t decrease the sodium and fat content
in their school meals, make their local parks safer, or open a supermarket. “I’ve been thinking about how city government might be involved
with that,” he muses.

A

fter sitting on the sidelines while the bad news about food and
health kept mounting, government is finally beginning to wake up
to the high stakes of how people eat. Medical costs stemming from
obesity have ballooned to an estimated $75 billion nationwide, about half
of which is borne by public spending through Medicaid and Medicare.

activity a part of people’s lifestyles.”
The department has two initiatives in full swing. One trains teachers
in public schools, day care and after-school programs to keep kids moving—encouraging activities that involve every student, for example,
instead of having 30 kids taking turns dribbling a ball. (Right now, 41
percent of the city’s elementary schools do not even provide regular physical education classes to all their students, according to a 2000 report
commissioned by the New York Community Trust.) A second, run
through community health offices in low-income neighborhoods, sponsors family-friendly physical activity events in local parks.
On the food front, school lunch is getting an overhaul through a
“School Food Revolution” announced in May by the Office of School
Health. School meals are being reconfigured to lower fat and sodium,
emphasize whole grains, vegetables, fish and plant-based proteins, and
reduce processed food. Every student—not just poor ones—is now
offered free breakfast, to ensure that they’re eating right. The City Council has done its part, too, banning doughnuts, hard candy and soda from
school vending machines (though cookies and potato chips—along with

“This is fast and easy to get to,
and it fills you up,”
explains Vanessa as she stacks
onion rings inside her
Whopper’s bun. Then she
smothers it all in ketchup.

New York tops out state Medicaid spending on obesity at $3.5 billion.
Last fall, Governor Pataki signed into law Childhood Obesity Prevention legislation. It calls for a comprehensive program to combat the problem, coordinating between local governments, schools, and health professionals to develop nutrition and physical activity programs. It also prescribes media campaigns to promote healthy lifestyles and establishes a unit
to track health data and develop policies. But don’t expect to see action anytime soon—there’s no money in the state budget to fund any of this.
(Assemblymember Felix Ortiz did try—he introduced a bill that would
have imposed a 1 percent tax on junk food, video games and movie rentals.)
New York City government has been taking some initial steps.
“Obesity is not rocket science,” says the health department’s Young.
“The math is that people are taking in more calories than they are burning. A lot of this is about changing social norms and making physical
JULY/AUGUST 2004

controversial Snapple juices—are still available).
Simply changing what’s available worries Terry. “You have to couple
education with that,” he says—tangible, experiential learning. “If people
aren’t aware of the benefits of vegetables and whole grains, it doesn’t matter. I don’t think a lot of these young folks are aware of the impact of diet
on their health.”
The schools are just starting to get involved in the kind of hands-on
teaching Terry promotes. The nonprofit Community Food Resource
continued on page 37

Next Page: What’s your neighborhood eating?
City Limits’ map of food in the boroughs
23

 The Action Diet
continued from page 23

Center launched Cookshop, a program that teaches elementary-school
students basic cooking skills and works with the school food office to
bring the program to a wider audience.
But what does it take to spark a genuine turnaround in how kids eat?
Vanessa Santiago is still figuring that one out. She is aware of the benefits of vegetables and whole grains. For the fall and winter, she regularly
attended the B*Healthy classes, diligently participating in workshops
about food selection, nutrition information, and food marketing and
advertising. “I believe in the seasonal stuff,” she confides. “The way they
take vegetables that aren’t even ready yet, and bring in stuff that’s not in
season—it messes up the cycle of the way things should go.” And she’s
making some adjustments to her diet, though perhaps not as intensively as her teachers might like.
On a frigid Saturday in February, Vanessa steps out of her grandparents’ Bushwick apartment and heads to Burger King. “This is fast and
easy to get to, and it fills you up,” she explains, opening her Whopper’s
bun to stack onion rings inside before smothering it with ketchup. After

A Clean Start
continued from page 31

of community members to advise the health
department on AIDS—which he handpicked
and which meets behind closed doors. (Clear
sits on the panel.)
Frieden apologizes for none of this. Activists
may be concerned about the Office of AIDS Policy’s oversight role, but he’s focused on its responsibility for preparing the city’s annual application
for federal funding. With that process under the
health department’s control, he points out, the
city got an $18 million boost this year. “I kind of
wish people would focus on the substance,” he
says, “rather than the symbolism.”
Moreover, even Frieden’s critics agree that
he has been more visible and accessible than
any health commissioner in memory. He’s met
with every HIV community planning body in
the city—usually nodding respectfully as they
light into him. But critics say he’s not much of
a listener. “It’s refreshing to have a very smart
guy who doesn’t feel like a politician,” says
Keller. “But the problem is that the way he
comes off is, ‘I know best. I’m the expert. And
I don’t care what you think.’”
Frieden sees this all as a diversionary conversation about style rather than what matters:
lowering HIV infection. “I’m really blunt
about things,” he shrugs, “and you have groups
that have created large organizations that are
very wedded to one model of doing things.”
The lingering question is whether Frieden’s
impatience with the give-and-take of commuJULY/AUGUST 2004

a few bites, she begins to crack open the half-dozen creamers she scooped
up from the condiments island, squirting their contents into her mouth,
washing it all down with Hi-C lemonade. The entire meal, costing less
than $6, was in her hands in less than a minute; when she’s short on cash,
she’ll head for the dollar menu. She concedes that there are ways to eat
healthy—there’s always rice and beans, or apples and bananas—but it’s
hard for her to resist the lure of burgers and fries. “The
commercials…you know the food is bad for you, but your mouth is just
watering. You want it so bad.” Vanessa says she eats fast food about three
times a week; that’s a marked improvement since she started the program.
“I used to eat McDonalds every day,” she admits.
Terry says he’s not fazed by stories like Vanessa’s. “I like to joke about
getting discouraged, but it makes me happy that they can even be critical
[about food],” he says. “Even the fact that she’s aware of what she’s eating.
She’s reducing risk. She don’t get the gold medal, but she gets the consolation prize because that’s improvement. And this is after being in here for
four months, so two years from now, we don’t know where she’ll be at.”
And, notes Terry, young people often don’t take the most direct route
to their destinations. “When I was in high school, yeah, I went to Taco
Bell and drank Cokes and Sprites and all that stuff,” he says. “It’s like
William Blake wrote: ‘The road of excess leads to wisdom,’ and some
folks have to go through that. I think the seeds are planted.”

nity politics is actually preventing him from
achieving the bottom-line results he seeks. In
the end, can you really take the politics out of
public health—and should you? Harm-reduction veterans say the final plan for the Long
Island City needle exchange is a shadow of
what it could have been if the department had
started by building support within the community it planned to target. “It’s wonderful to
have a commissioner that’s so supportive of
syringe exchange and wants to put himself out
so far,” says Keller. “But I think what’s missing
is, you need bottom-up as much as you need
top-down.”
Keller’s speaking from experience. Like
Afterhours, her group is one of a few that are
mobile. CitiWide works in apartment buildings that contract with the city to house poor
people living with HIV. But when buildings
leave the program, CitiWide finds itself stuck,
because going into a new building means first
getting community board approval in that
neighborhood. Over the years, the group has
lost all four of the buildings it once served in
the Bronx, and to make up for that gap it
decided to add an exchange at its office near
The Hub.
CitiWide began reaching out to the surrounding community in the fall of 2001, and
spent the next year and a half locked in a punishing political campaign. They took the fight
directly to their most obvious foes, like the
police precinct and the parents’ groups—meeting individually with the most hostile board
members—and hashed out all the usual ques-

•

tions. They rounded up local users and had
them meet with those in opposition, to explain
for themselves why the program was needed.
And, in the end, they got one of the city’s most
expansive exchange sites. It operates five days a
week, 12 hours a day. “We managed to turn it
on its head,” Keller brags. “Now we’re like the
darling of the community.”
This is the sort of process AIDS activists
would like to have seen Frieden and AIDS
Center of Queens County engage in Queensbridge and Long Island City. The battle that
ensued in those neighborhoods was nothing
compared to the controversy needle exchange
is likely to stir in Jamaica and Far Rockaway.
Marshall has taken on a more prominent role
in the community outreach process, and
meetings have already begun in Jamaica. But
the stakes go up there, too: Jamaica boasts
more people diagnosed with AIDS than do
19 states. AIDS activists are waiting on edge
to see if Frieden learned something in
Queensbridge about how to play the community game.
Gioia just wants the health commissioner to
see a broader point about policymaking, and
the politics that inevitably accompany it. “I
hope the lesson they learned from this is that
you can’t take people for granted,” he says. “A
flawed process is a flawed result.”

•

This article was produced under the George
Washington Williams Fellowship for Journalists
of Color, a project sponsored by the Independent
Press Association.
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