Alumni Profile: Mary T. Bassett’79

A Champion of Health Equality at the Helm of the NYC Department of Health

Peter Wortsman

| Photos by Ricky Owens

"We don’t believe in a back-seat approach to protecting public health,” said Mary T. Bassett’79 at the press conference on Jan. 16, 2014, at which New York City Mayor Bill de Blasio announced her appointment as commissioner of health and mental hygiene. Dr. Bassett went on to outline her plan of action: “Whether it is protecting a community facing the loss of a hospital or ensuring that all neighborhoods enable healthy choices as people eat, work, and play, we will meet New Yorkers where they live and ensure their health is protected.” 

She has since been true to her words, focusing on the neighborhoods most in need and, by most accounts, effectively juggling the myriad health priorities of the teeming metropolis. Her public profile soared in the spotlight of an Ebola scare in October 2014, during which she leapt into action, calmly and assuredly piloting what she proudly dubbed “the leading urban health department in the world,” all the while taking pains to keep the public informed. 

In a career spanning more than three decades, including 17 years teaching and directing AIDS prevention programs in Zimbabwe and eight years as NYC deputy commissioner of health promotion and disease prevention in the Bloomberg administration, spearheading such bold initiatives as a transfat ban and calorie labeling in the city’s fast food restaurants, Dr. Bassett has applied an unabashed activist vision of public health. “We’re trying to shift the paradigm from thinking of population health as driven by individual behavior to thinking about the decisions that are, in fact, available to people and trying to put healthy choices within everyone’s reach.” 

She made time in her busy schedule to talk with Columbia Medicine while looking back on her career and sharing her concept of public health. 

Honing her Vision at Harlem Hospital

Training in medicine from 1979 to 1983 at Harlem Hospital, where in her last year she served as chief resident, Dr. Bassett tried to balance the considerable health burdens of the community and the hospital’s scarcity of means during a difficult time. The confluence of the heroin epidemic, the beginning of the AIDS epidemic, an economic downturn, and housing abandonment, among other crises with an impact on health, made it a veritable trial by fire. She lauds the dedication of her colleagues, under the charismatic leadership of Harlem Hospital Department of Medicine chair Dr. Gerald Thomson’96 HON, the Samuel Lambert and Robert Sonneborn Professor Emeritus of Medicine at P&S. “We lacked supplies, we had very sick patients, the operating room would be shut down because they didn’t have air conditioning, and I remember the night they ran out of respirators. But in spite of those really daunting conditions, Dr. Thomson inspired us all by his example, generating standards, demanding quality of care, and commanding respect.” 

Another Columbia faculty mentor on staff at Harlem Hospital, the late Dr. John Lindenbaum, chief of hematology/oncology, was not only “a classic Socratic teacher,” but also “brought the example of being a topnotch physician-scientist to Harlem Hospital.” (In April 2015, Dr. Bassett returned to P&S to deliver the John Lindenbaum Memorial Lecture.)

“Yet as committed as the staff was to the needs of the community, it didn’t take me long,” she says, “to see that we were patching people up and sending them back out, that as hard as we worked in the hospital, the main things that determined their health were happening outside in their homes and on the street.” That realization prompted her to pursue a master’s degree in public health at the University of Washington in Seattle. 

A Child of the ’60s 

“My goal has always been to be of use, to have a positive impact,” she says. A child of the ’60s, her consciousness was raised and shaped early on by her parents, the late Dr. Emmett W. Bassett, a chemist who held a PhD in dairy technology from Tuskegee Institute, the first African-American investigator in the field, and Priscilla Bassett, a dedicated librarian who venerated learning. “Together they made an incredible team.” Both were activists in the civil rights and peace movements. “They taught us children the importance of commitment to community, to family, and the fact that many people paved the way for us and our opportunity for advancement.” She remains haunted to this day by childhood visits to her father’s native Virginia, where interracial marriages remained against state law until the law was invalidated by a U.S. Supreme Court ruling in 1967. During those visits, Dr. Bassett had to pretend that her mother, who was white, was not her mother. “I remember being tormented by the idea that I could get it wrong,” she still recalls with a catch in her throat, “when, of course, I knew it was society that was getting it wrong.” 

Mary Bassett grew up in Washington Heights, where her parents were a driving force for the establishment of the Community Advisory Board at Presbyterian Hospital and several neighborhood health clinics. In 2014, the stretch of 162nd Street between Edgecombe and St. Nicholas avenues, where her parents lived for decades and where they planted trees that have since grown tall, was renamed Emmett W. Bassett Street in her father’s honor. 

It was in the course of a high school summer job as a census taker in West Harlem that she decided to study medicine. “I was given the privilege of going into people’s homes, seeing what they put on their table for dinner, sitting down, and taking information about their lives,” she says. “I wanted to do more than just register statistics.”

As a student at Radcliffe College, where she earned a BA degree cum laude, with a major in history and science, she made time to volunteer at the Black Panther Party Franklin Lynch Free Health Center in Roxbury, Mass., one of Boston’s predominantly black, low-income neighborhoods. She scheduled doctors’ appointments, “badgering, bullying, and cajoling” physicians from Harvard-affiliated hospitals to pitch in, and helped screen residents in the city’s housing projects for sickle cell anemia, a genetic disorder with a relatively high incidence among African-Americans but largely overlooked at the time by most biomedical researchers. (Another distinguished P&S graduate, the late hematologist Helen Ranney’47, first elucidated the genetic basis of the disease.) 

Back Home in Washington Heights

Gerald Thomson HON’96 and Mary T. Bassett’79 

She decided to study medicine in her old stomping ground, Washington Heights. Yet though she cherished interactions with Dr. Thomson and other members of the Columbia faculty, including the late Dr. Harold Neu, an internationally recognized authority on infectious diseases, and the late Dr. Mervyn Susser, a South African-born epidemiologist at the Mailman School of Public Health known for emphasizing connections between disease and social conditions, her four years at P&S were by and large not a happy time. One of only three African-Americans, and the only black woman in her graduating class at P&S, she recalls “a climate laden with the expectation that black students would perform poorly.” Getting involved with the Black and Latino Student Organization (BALSO), she and fellow students tried to make a case with the administration for improving the diversity of the student body. She winced, meanwhile, at certain residents’ off-handed derisive remarks about poor patients, many of whom were black and Latinos from the neighborhood. And although she maintained a stellar academic record, she recalled one professor’s “prognosis” that “black students have trouble with academic subjects, but do much better in later clinical years ‘because they have good people skills.’” It was not an isolated attitude. 

While much progress still remains to be made, the cultural climate at P&S has since changed for the better. The Class of 2019 includes 38 underrepresented minorities—24 percent of the class of 161, one of the highest percentages among peer medical schools. 

From Harlem to Harare

Her training at Harlem Hospital was a real eye-opener. As a first-year intern, she made home visits on her own and came to realize that “the main drivers of Harlem’s excess mortality were not ‘ghetto’ behaviors and diseases, but the common killers that affect everyone in industrialized countries: cardiovascular disease and cancer,” she wrote in a short memoir “From Harlem to Harare,” included in the book “Comrades in Health: U.S. Health Internationalists, Abroad and at Home,” 2013, edited by Anne-Emanuelle Birn and Theodore M. Brown. “I liked the practice of medicine, and you could not find a more committed group than the Department of Medicine at Harlem Hospital,” she wrote, “but I suspected that if my goal was to make people healthy, I wasn’t accomplishing much.”

After earning an MPH, she accepted a position as a junior lecturer in the Department of Community Medicine at the University of Zimbabwe, in Harare, where she initially expected to spend a year or two but stayed 17 years and raised two daughters. It was a heady, hopeful time for the country previously known as Rhodesia, in which the black majority cast off the yoke of minority white rule. 

“The thing that really strikes me,” she says, looking back, “was how young the leadership was of the Zimbabwe Ministry of Health, the people who were really leading the charge to improve conditions in the country following independence.” She was greatly impressed by their “practical and ambitious agenda to promote primary health care, which doesn’t just mean primary medical care, as we see it in the U.S., but also means paying attention to food security, water and sanitation, environmental approaches to diseases like malaria, and providing everybody access to a primary care facility.” The ministry achieved remarkable results. “A massive expansion of rural health centers placed roughly 80 percent of the population within eight kilometers of services. Before independence,” she wrote in her memoir, “infant mortality was an estimated 120 to 150 deaths per 1,000 live births; by 1990 it was down to 60 deaths per 1,000 births.” And contrary to WHO recommendations, the ministry’s insistence on use of a simple home-based sugar-salt solution for oral rehydration of children suffering from diarrhea helped stem fatalities. WHO officials later recognized their own error and the ministry’s effectiveness.

When the AIDS crisis hit Zimbabwe, Dr. Bassett saw countless patients suffering from the disease. Wanting to have a more widespread effect, she turned her focus to epidemiological studies, education in rural high schools, and prevention programs to reduce mother-to-child transmission. She became increasingly interested in the social determinants of health. 

Back to the Big Apple

In 2002, following a one-year stint as associate director for health equity at the southern Africa office of the Rockefeller Foundation, she was invited to take the position of deputy commissioner of health promotion and disease prevention in the NYC Department of Health and Mental Hygiene, under the direction of fellow P&S alumnus Thomas Frieden’86. 

In an effort to combat obesity, then as now one of the most pressing public health problems in the city and throughout the country, she helped push through calorie postings in fast food chains and the ban on trans fats in all New York restaurants. But the department’s drive to cap the serving size of high calorie sugary drinks, pursued after she left the department, was challenged in court and effectively blocked by the soft drink industry. A June 2014 decision effectively ended the health department’s authority in this area.

Accused by some of promoting a “nanny state,” she insists on the need for government to level the playing field. “To frame chronic disease risk as a consequence of ill-conceived personal choices,” she was quoted in an article in Capital New York, “is a modern day version of hand washing to prevent cholera. Not wrong but tragically misguided. Government at all levels should use its regulatory tools to limit tobacco use, end the glut of salty, sugary, high calorie food, and increase physical activity.” In addition, “It should be bolder in seeking to check advertising that promotes tobacco use and consumption of high calorie and low nutrient foods, especially those ads directed at children.”

Dr. Bassett served from 2009 to 2014 as program director of the African Health Initiative and Child Abuse Prevention Program of the Doris Duke Charitable Foundation until taking on the reins of the NYC Department of Health in January 2014. For the record, she is the fourth woman and the second woman of African-American descent to hold the position. 

Promoting a Neighborhood-Based Approach to Health

Building in many areas on the work of her predecessors, Thomas Frieden’86 and Thomas Farley, she has pivoted from their largely centralized approach to promoting neighborhood-based solutions to pressing public health concerns, a lesson she learned from her time in Zimbabwe.

"In an ideal world, I would, of course, like to eliminate poverty. It would really do wonders for health, but we can do better at delivering health to our population even within the context of poverty."

“Anybody who has ever worked in Sub-Saharan Africa will tell you they are organized by district structures,” she says. “We brought this neighborhood lens and this idea that a neighborhood is a valid unit of intervention in urban public health to our work in New York. We recognized that there are certain neighborhoods with a higher disease burden than others. These neighborhoods are disproportionately poor, predominantly black or Latino. They do not suffer from exotic diseases but from the same things that kill all New Yorkers and all Americans: heart disease, cancer, etc.” Zeroing in on pressing local needs, she has directed more intensive efforts at community health offices in such hard hit neighborhoods as East and Central Harlem, Central Brooklyn, and the South Bronx. 

She also has sought and fostered dialogue and engagement with the community. “You need to have a supportive policy environment, but its sustainability is often based on the fact that the people who are the intended beneficiaries embrace it.”

When word spread in 2014 that a Columbia physician, Craig Spencer, who had volunteered with Doctors Without Borders in West Africa, was diagnosed with Ebola upon his return to New York City, Dr. Bassett made sure, among other top priorities, to allay fears and stem panic by getting word out to the public on how the disease is and is not transmitted and how unlikely it was to spread in the city “and to let the West African communities in the Bronx and Staten Island know that we were committed to protecting them from stigmatization.” 

Homegrown Health Solutions and Lessons Learned from the Developing World

Cognizant of “how poorly we were doing in managing many chronic diseases,” including asthma and diabetes, and influenced in part by community health worker strategies effectively employed in Latin America, the health department under Dr. Bassett’s guidance restored the practice of “public health detailing,” sending advisers out into the community “to support doctors in their practice and help them engage with their patients.” The department also provides brochures and posters for doctors’ waiting rooms and health clinics and educational materials, including a kit for people with diabetes demonstrating what an ideal calorie allotment should look like, with half the plate heaped with vegetables. 

Dr. Bassett is an advocate of free lunches in public schools following sound nutritional guidelines. She also endorses Shop Healthy, a program originally devised in Philadelphia. The program “supports the establishment and retention of stores that sell fruits and vegetables” in areas that she has labeled “food deserts,” where healthy choices are otherwise unavailable. “The program is really about redesigning the retail environment, changing the offerings at the deli counter,” she explains. “It has been a learning experience for us in the Department of Health, working not only with shopkeepers, but also with wholesalers and distributors.” She cites the case of one bodega owner who spoke at a press conference: “‘Look, I’m a businessman,’ he said, ‘but I can’t help but notice that people are just too heavy. I wanted to give this a try, and I’m happy to report I’m helping and making more money in the process.’”

Dr. Bassett hopes to enlist the presidents of public and private hospitals to become institutional sponsors of healthy food choices in their neighborhoods. 

She is a firm believer in incubating creative new ideas at community health offices and then, if they prove successful, applying them elsewhere. Health Bucks, an innovative program developed in the Bronx, provides qualifying individuals with subsidies in the form of vouchers to buy healthy foods at local farmers markets. She sees it as a two-pronged effort to encourage the consumption of nutritional foods and bolster the economy. The city currently leverages $650,000 worth of healthy purchases. She hopes to up the commitment to $1 million. 

When Dr. Bassett was deputy commissioner, the Department of Health experimented with a program, used effectively in Mexico and Brazil, called “Condition Cash Transfer.” The idea was to offer cash subsidies to the poor, conditioned on the accomplishment of certain actions, like putting healthy food on the table, making regular visits to the doctor, and ensuring that children attend school. Though the program’s initial trial run in New York had problems, she believes the department can learn from the problems and modify ideas that work abroad. “We are a part of the globe and we have things to learn from the developing world,” she says, “just as we have much to offer.” 

Black Lives Matter

In a much cited perspective piece in the March 19, 2015, New England Journal of Medicine, titled “#BlackLivesMatter—A Challenge to the Medical and Public Health Communities,” written in response to the widely reported wave of police killings of young black men, Dr. Bassett stated unequivocally: “As New York City’s health commissioner, I feel a strong moral and professional obligation to encourage critical dialogue and action on the issue of racism.” But she insists on a broader view of the insidious effects of racism. 

“The burden of race,” she argues, “extends beyond the burden of violence and even beyond the burden of police violence. We have an obligation to lower that risk. I don’t question the desire for justice. Violence plays an outsized role in the black population, but it doesn’t account for most of the deaths that occur prematurely. The cost of racism has to be measured in lives cut short. A bigger view of justice would take into account the outsized toll of heart disease, stroke, diabetes among African-Americans.”

Kenneth A. Forde’59, P. Roy Vagelos’54, Mary T. Bassett’79, Dean Lee Goldman, and Paul Maddon’88 MD, PhD

Proud to Serve under a “Public Health” Mayor

“In an ideal world, I would, of course, like to eliminate poverty. It would really do wonders for health, but we can do better at delivering health to our population even within the context of poverty,” she insists. “I’m proud to serve under Mayor de Blasio, who has really made addressing the growing income inequality a centerpiece of his administration. And though I don’t know if he would describe himself as a public health mayor, he most definitely is. Pre-K education, affordable housing, and living wage, among other key priorities, all are important platforms for health. And while the health department can’t do all these things, I can lend my voice as health commissioner to stressing the link between these initiatives and the health of our people.” 

Dr. Bassett was one of the prime movers behind the city’s “Talk to Your Baby” campaign, encouraging parents to talk, read, and sing to their babies to bolster brain development, a program in which the city’s first lady, Chirlane I. McCray, has taken an active interest and at one promotional event famously burst into song.

Apropos of singing, while not herself inclined to a capella performances, Dr. Bassett is an avid jazz fan, in her scarce spare time slipping off to attend a concert at one of the city’s many venues. 

Looking Back and Looking Forward

Reflecting on her career before a group of students in 2014, Dr. Bassett said: “I feel enormously privileged to have had the opportunity to work in various settings at home and abroad. And I feel privileged to have come of age in the ’60s, a time when the legislative landscape offered opportunities to the broadest population.” As for the course of her career, she reflected, “When you’re living it forward it’s considerably less planned than it might look in hindsight. Looking back, I only wish I hadn’t worried as much.

“I remain totally thrilled to serve as health commissioner for New York City, the absolute best job in public health, as far as I can tell.” 

What lies ahead?

“To do my best to help make every neighborhood a healthy neighborhood, at least that’s
the plan.”