Legionnaires' Outbreak: Lessons Learned in NYC

## Overview NYC Health + Hospitals (NYC H+H) is the largest municipal health care system in the United States, serving as a vital safety net for more than one million New Yorkers annually across all five boroughs of New York City[1][3]. The organization operates a comprehensive network that includes 11 acute care hospitals, five long-term care facilities, six diagnostic and treatment centers, over 70 community-based Federally Qualified Health Centers (Gotham Health), a certified home health agency, correctional health services, and the MetroPlus Health Plan—a managed care option for low- and no-cost coverage[2][4][6]. With a workforce of roughly 45,000, NYC H+H is committed to providing high-quality, culturally responsive, and equitable care to all, regardless of ability to pay, immigration status, or gender identity[1][3]. ## History Founded in 1969 by the New York State Legislature as a public benefit corporation, NYC H+H was created to operate and improve the city’s public hospitals, which had faced significant challenges in funding and quality in the preceding decades[1][5][6]. Its oldest facility, Bellevue Hospital, dates back to 1736 and has been a pioneer in medical education, psychiatric care, and trauma services[1]. Over the 20th century, the system expanded to meet the growing and diverse needs of New York City’s population, especially after the introduction of Medicare and Medicaid in 1965, which initially strained but later helped stabilize public hospital finances[1]. ## Key Achievements NYC H+H has earned national recognition for its commitment to health equity, ranking #2 nationally in health equity and #3 in pay equity[6]. Its hospitals are repeatedly recognized for trauma care, behavioral health, maternity services, and culturally competent care, including designations as LGBTQ+ Healthcare Equity Leaders and Baby-Friendly hospitals[2]. The system’s Gotham Health network focuses

## Overview and Mission The New York City Department of Health and Mental Hygiene (DOHMH) is one of the largest and oldest public health agencies in the world, with a mission to protect and promote the health of all New Yorkers, regardless of background or neighborhood[4]. Serving over 8 million residents across the five boroughs, the department operates with an annual budget of approximately $1.6 billion and employs more than 7,000 staff[4]. Its work spans a broad spectrum—from inspecting restaurants and issuing birth certificates to tracking disease outbreaks and managing mental health crises[4][5]. ## History and Evolution Founded over two centuries ago, DOHMH has evolved from a traditional public health department into a comprehensive agency integrating physical health, mental health, and social determinants of health[4]. The department’s roots in mental hygiene trace back to state-level reforms in the 19th century, but its current structure reflects a modern, integrated approach to health and wellness[2]. Today, DOHMH not only responds to immediate health threats but also works proactively to prevent illness and promote equity[3][6]. ## Key Achievements DOHMH has been at the forefront of numerous public health milestones, including the city’s response to the COVID-19 pandemic, where it coordinated disease surveillance, distributed medical equipment, and managed vaccination efforts in partnership with NYC Health + Hospitals[1]. The department also launched initiatives like Mental Health for All to address the surge in mental health needs during the pandemic[1]. Its public health campaigns—ranging from tobacco control to chronic disease prevention—have set national benchmarks[4]. ## Current Status and Notable Aspects DOHMH continues to innovate, employing a public health approach that emphasizes prevention, equitable access, and stigma-free care[3]. The department contracts with community-based organizations to deliver mental health, developmental disability, and substance use services, ensuring a decentralized yet coordinated response to complex health challenges[1]. It