Public Health Magazine: Winter 1995, Vol.5, No.1
Alumni Profile: Anne Nolon, '80

"Working in Peekskill, New York, is like working in a lab," she said recently. "It is like a microcosm of New York City with all the major urban area ills. But because it is not that large and the population is not transitory, you can see the positive impact of the health center in the community--in the health of people."

That community level impact has not gone unnoticed at higher levels. Recently, the Clinton Administration selected the Peekskill Area Health Center as one of three national demonstration sites for the National Service Program. Vista volunteers will work with local volunteers over two years to help address community needs including teen pregnancy prevention, immunization, intergenerational issues, health care for the homeless and migrant agricultural workers. Rather than providing direct services, the volunteers are expected to develop programs that can continue long after the Vista volunteers have moved on.

"The idea is to leave behind a system that doesn't depend on the person who created it," Nolon was quoted saying in The New York Times' coverage of the new program. "There's the same integrity and belief in community empowerment that we have here at the health center. It's a sign of respect for what we do in Peekskill that they've selected us."

Former Governor Mario Cuomo has also paid tribute to the health center, which is a private non-profit corporation originally created by grass roots volunteer effort. "It's a wonderful facility," Cuomo said during one of his visits to the center. "We should have these kinds of [community health centers] all over the country."

Strange Twist for Peekskill Location The new governor, however, is massively cutting the funding for community health centers, Medicaid, and other state health services, which puts Nolon in an awkward position because he is from Peekskill. Governor George Pataki was Peekskill's mayor, state assemblyman and then state senator before being inaugurated as governor in January. As a result, state health care leaders have turned to Nolon and asked if she can influence Pataki on the important work of community health centers, which are severely underfunded in his new budget.

"People think I have the ear of the Governor, but it's a long way from knowing him in the old days to impacting his thinking on Medicaid or budget cuts today," Nolon told the Chronicle. "George has been involved in our health center as a community resource board member and appears on our letterhead as such. He has been very supportive and comes to all our fund raising events. But now he's more concerned with budget cutting. Health care providers, Medicaid recipients and community health centers are high on his list of cuts."

In Nolon's view, budget cutting fervor has reached a dangerous senselessness. "When you are bottom line driven, you lose your policy direction," she said. New York state had been a leader in sound health care policy development, particularly on Medicaid managed care and infra-structure building. It had created and supported a system of essential community providers like community health centers throughout the state. According to Nolon, this entire system and the people who rely on it are vitally threatened. "It's going to be even worse than people think," she predicted. "And it's not going to be just people on Medicaid. Undermining the system for the poor, the uninsured and the elderly will jeopardize the health care of all New Yorkers."

Development of "Community Health in the Broadest Sense"

Now married and the mother of two children, Nolon started her health career as a Vista volunteer in Yonkers, NY, before attending CSPH. After a brief assignment in a child health program, the county health department put her in charge of the struggling Peekskill Area Health Center. At the time the center had one clinician and a $125,000 budget. Today's staff, which includes 20 clinicians, and a budget of $10 million are used on a wide array of programs throughout the Hudson Valley.

Although the primary mission is to provide comprehensive health care to people who cannot otherwise afford it, the center has taken an holistic approach. For the center, community health goes beyond the bio-medical approach to include a teen parent support group, a housing preservation corporation, a foster grandparent program, a truancy prevention program and a mentoring program for minority male youth.

Nolon sites two strong influences for this broad-based approach to public health: Jack Geiger, M.D., the founder of community health centers, and Columbia School of Public Health's Joanne Lukomnik, M.D., M.P.H. "They are my philosophical sounding boards as to what a community health center should look like," she said. "It's a vision of health in the broadest sense, but you have to be ready to change the vision. You have to continually listen to the community, always asking people what their needs are and then guide the organization in responding to those needs."

Now, Nolon must take her active approach and wade into the rapidly changing political currents. The Peekskill Area Health Center is well-prepared, for example, for New York state's mandate that all Medicaid beneficiaries must enroll in managed care plans. Although Nolon questions the wisdom of such mandatory enrollment, she is confident that community health centers can provide cost-effective managed care. "We have enrollees who are well cared for. We've experimented with cost-effectiveness as a provider who owns the health plan. We know it's a good relationship and it works," Nolon noted. "We're going to see 40 percent of our patients or more enrolled over the next few years because the system is changing so drastically."

Nolon also has some advice for her colleagues on how to respond to the new reality of shrinking governmental support. "By necessity," she said, "we all have to look at how cost-effective we really are and how we run our systems. We need to get ourselves even closer to the consumers and be more patient focused. One way you can do that is to slice out middle management and become more horizontal, rather than vertical. We have created silos of bureaucracies over our short lives based on old management models."

Nolon, however, is not only adjusting to the new politics but also has been busy testifying in government hearings against certain reforms which she cannot abide. "Our federal and state governments don't quite get it," she said. "For example, the block grants to states [now under consideration in Congress] build up just this kind of middle management between the federal government and the state and the county and the community providers. Block grants create a less patient focused, less consumer oriented approach. Why destroy the best public/private partnership going by inserting middle management, more cost, and more bureaucracy?"