Issues of public health, infrastructure and the environment are inseparable from one another. The Bronx has long been victimized by infrastructure projects that benefit the rich at the expense of marginalized communities, and the Cross Bronx Expressway is the quintessential example.’

Adi Talwar

A view from the Grand Concourse of Jerome Avenue with its elevated 4 train, the Cross Bronx Expressway ramps and 174th Street.

“The Bronx can’t breathe,” Congressmember Ritchie Torres (NY-15) declared, standing in front of a crowd of community leaders, elected officials, and reporters at a Parkchester press conference on a sunny April morning. “I spent most of my childhood in three places,” Torres continued, “my house, my school, and the emergency room, because I was repeatedly hospitalized for asthma.” 

Congressmember Torres convened this press conference along with Assemblymember Karines Reyes, a former nurse at Montefiore, to call for “capping” the Cross Bronx Expressway, or covering exposed portions of the highway with park space. In the Bronx, where asthma rates are the highest in the nation and air pollution levels exceed that of any other borough, a project like this would have major health and environmental impacts. It would reduce exposure to toxic fumes released by the 175,000 vehicles traveling the Cross Bronx each day, connect neighborhoods split by the highway, and create more green space for recreation, exercise, and housing.  

A couple of medical students from the Albert Einstein College of Medicine were in the crowd, too. We were inspired to join efforts to #CaptheCrossBronx by Nilka Martell, founder of #LovingtheBronx, which aims to increase green spaces in the borough. Nilka – whose neighborhood is adjacent to the Cross Bronx Expressway – experienced the devastating health impacts of the highway firsthand when her newborn son had his first asthma attack. She brought her idea to cap a small portion of exposed highway running through her neighborhood to city officials, citing the health effects of breathing in toxic fumes. Unfortunately, her proposal wasn’t taken seriously at first.  

Determined to make her case, Nilka discovered a report by Dr. Peter Muennig, a physician and public health researcher at Columbia University, who was also in the crowd that day. Dr. Muennig’s paper examined the cost-effectiveness of covering the Cross Bronx Expressway with a park. His model showed that the project would reduce pollution, increase opportunities to exercise, reduce pedestrian car accidents, and improve mental health. In doing so, the project would pay for itself in reduced healthcare costs and increased property values. With Dr. Muennig’s report in hand, Nilka had the scientific evidence she needed to support her proposal, and policymakers at the city, state, and federal levels started to listen. 

Since then, the momentum has continued to build. Earlier this month, Assemblymember Karines Reyes met with Senate Majority Leader Chuck Schumer to advocate for securing federal funding from the American Jobs Plan to cap the Cross Bronx Expressway. Reyes also launched a petition (sign it!) that calls on President Joe Biden and U.S. Secretary of Transportation Pete Buttigieg to explicitly fund this project in their infrastructure plan.  

The success of #CaptheCrossBronx was due in large part to unprecedented collaboration between community leaders like Nilka, physician-advocates like Dr. Muennig, and elected officials like Torres and Reyes. Unfortunately, other medical and public health professionals remain conspicuously absent from advocacy around transforming the Cross Bronx Expressway, despite the clear link to public health. Dr. Muennig was the only physician at the #CaptheCrossBronx press conference. Yet, every policymaker who spoke that day cited their own struggles with asthma as motivating their efforts to secure funding to cap the Cross Bronx Expressway. 

As physicians-in-training, we believe the kind of participation and collaboration Dr. Muennig exemplifies should be the norm, not the exception. Physicians and public health professionals working in the Bronx need to see environmental justice as central to public health policy. 

Issues of public health, infrastructure and the environment are inseparable from one another. The Bronx has long been victimized by infrastructure projects that benefit the rich at the expense of marginalized communities, and the Cross Bronx Expressway is the quintessential example. Its architect, Robert Moses, used federal funding to design the most expensive one-mile stretch of highway ever built at the time, without soliciting community input. The result was a 6-lane expressway bound for Long Island and Connecticut that divided the Bronx in two, displacing low-income families and communities of color who continue to bear the burden of the highway’s environmental and health consequences today. Moses also placed two other major highways in the Bronx, the Major Deegan and Bruckner Expressway, and numerous companies – exiled from wealthier boroughs with more political power – built their industrial facilities in the South Bronx. 

In our clinics and hospitals, we bear witness to the negative health consequences that mega-highways and industrial centers inflict on our patients. In addition to asthma, studies have linked air pollution with heart disease, diabetes, and other chronic conditions – all of which are extremely prevalent in the Bronx. A growing body of research has also found associations between exposure to air pollution and death from COVID-19. It is no coincidence that the Bronx was ground zero for the pandemic, with the highest death rate in the city. Looking at these disparities, it is clear that keeping our patients healthy requires reversing historical acts of environmental racism and injustice, and heeding the calls of community leaders like Nilka Martell to build back better. 

Capping the Cross Bronx is one example of how we can begin to do this, and opportunities to promote health through infrastructure and environmental projects abound. The Green New Deal, introduced in 2019 by the Bronx’s own Alexandria Ocasio-Cortez (NY-19), offers a 10-year plan to curb climate change while reducing inequality and rectifying a legacy of systemic oppression. Parts of the Green New Deal focus on policies that directly address climate change, while other parts propose “non-climate” policies like universal health care, education and job training. Why? Because as we’ve seen, environmental justice is inextricably linked to health, racial, and economic justice. The Green New Deal offers a path forward for the Bronx to tackle health and economic inequities through sustainable infrastructure projects. But enacting these proposals requires buy-in and further advocacy from leaders in medicine and public health.

As Bronx-based physicians and public health professionals (both future and practicing), we have a unique opportunity to collaborate with local advocates and politicians in the creation of health policies that align with the Green New Deal. The patients we care for and the communities we serve elected leaders who are committed to this mission and are calling us in. When Ocasio-Cortez released the Green New Deal resolution to Congress in 2019, she explicitly asked for community engagement, describing the Green New Deal as a “call for proposals.” As healthcare providers in Ocasio-Cortez’s congressional district, and in the districts of other Green New Deal champions like Ritchie Torres and Jamaal Bowman, physicians and public health leaders need to answer this call.

There are numerous avenues for us to do this. Physicians and public health researchers can generate data and speak to the health impacts of past and future infrastructure projects – just like Dr. Muennig has done for capping the Cross Bronx. Healthcare providers like nurses and physician assistants can use their platforms to tell policymakers how the built environment impacts the patients they see and care for every single day. Or, they can run for office themselves, like Karines Reyes did. 

Our group of medical students comprising the Bronx One Policy Group has partnered with community organizations to identify a suite of transportation and infrastructure policies that stand to reduce chronic disease and improve our patients’ ability to attend their medical appointments – ranging from capping the Cross Bronx Expressway, to improving bus and subway routes, to expanding bike lanes. We will be presenting these proposals to hospital systems in the Bronx, and urging them to add their support for one or more of these proposals. 

No matter what form it takes, health professionals have a crucial role to play in advancing environmental and infrastructure policies that impact public health. It’s time for us to start lending our voices to these calls. Our patients’ lives and the communities we serve depend on it. 

The authors are members of Bronx One Policy Group, comprised of first and second year medical students at the Albert Einstein College of Medicine who work with community leaders to advance policy efforts that impact health and healthcare delivery in the Bronx. The Bronx One Policy Group also produces The Healthy Bronx Podcast. This op-ed was also developed in collaboration with Nilka Martell of #LovingtheBronx, an advocacy organization founded to advance community building, development, and organizing around social and environmental issues through the use of parks, open spaces & waterways in the Bronx.