Nullary Care: Activating East Harlem

What if "unhealthy" communities didn't need doctors?

Photo of Abraham Haggerty
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Founding Story: Share a story about a key experience or spark that helps the network understand why this project got started or a story about how you became inspired about the potential for this project to succeed.

East 96th Street, separating the Upper East Side and East Harlem (EH), is a meaningful border: people in EH live 9 years fewer on average. Why, when same air, same water? Wealth is a key driver of health disparities. Good news: despite almost $100K less median family income, EH has a wealth of assets: free clinics, CBOs, gov't services, etc. Nullary Care increases families' use of resources and creates agency. Families own their health and become leaders of community transformation.

Which categories describe you? (the answer will not be public)

  • White (for example: German, Irish, English, Italian, Polish, French, Caucasian)


Nullary Care, Inc. operates as

Location: Where is your organization headquartered? [State]

  • New York

Location: Where is your organization headquartered? [City]

New York City

Location: Where is your project primarily creating impact? [State]

  • New York

Location: Where is your project primarily creating impact? [City]

East Harlem neighborhood of NYC

Problem: What problem is this project trying to address?

Difficult problems are not hopeless problems, but their solutions are often obscured by habitual practice. Child health disparities are tragic because they can be solved by empowering families, uniting stakeholders around best practices to change the conditions that cause morbidity, and iteratively evaluating impact. Cada Paso is an example of "nullary care" in that families are empowered to use the community space as the platform for promoting self-determined of health. Families directly address gaps in care through health education and resource utilization, and proceed to address root causes of disparities by changing their environment. Our families have reached parity in terms of access to care, and are now delving deeper to improve the political and economic conditions.

Children's health depends on families' health; supporting families means responding to their self-identified needs for their children and, further, providing opportunities for community leadership to eliminate the root causes of disparities. 

Cada Paso is a family walking program that integrates health education with access to relevant neighborhood health resources.  Along with the physical fitness of walking, we endorse healthy habits (eating fresh fruit, drinking NYC's finest tap water, composting our waste in community gardens), we strengthen our social network and we provide informal time with volunteer allied health providers.  Our families utilize visited health resources 40-70% of the time compared to under 5% if a resource is mentioned, but not visited on a walk.

But health does not ultimately reside in a medical facility. The roots of health are planted in the neighborhood space.  Beyond responding to immediate child health needs, we promote active engagement with community initiatives, including improvements to the built environment (development of a city-sponsored walking trail, renovating a community garden to grow our own food), policy (endorsing environmental policies to reduce the health burden on our families), and economic opportunity (developing community wealth strategies with partner agencies, legal services for work visas).  

The health disparities confronted by our families constitute injustice.  Activating the local assets can alleviate the disparities.  Our families are architects of a community that generates health for their children.

Is your model focused on any of the following traditionally underserved communities?

  • Communities of color
  • Low-income communities
  • Other

Does your model work within any of the following sectors?

  • Child and Family Services
  • Community Development and Empowerment
  • Education
  • Mental Health

Year Founded


Project Stage

  • Established (the solution has passed the previous stages, and has demonstrated success)

Example: Walk the network through a specific example of what happens when a person or group engages with your solution.

Our families are primarily recent immigrants from Mexico and Central America, isolated by barriers of poverty, immigration status, language and culture. Based on iterative needs assessments, we facilitate access to care for self-identified child health topics. E.g. our dental health walk starts with teaching and demonstration of dental hygiene in a local playground, followed by walking and talking en masse with volunteer health providers, and stopping at a community garden for fresh fruit. We visit a local health clinic for a tour in Spanish and sign families up for insurance and appointments on the spot. Families report added benefit from socialization and neighborhood familiarity, all while walking as a family unit.

Impact: What was the impact of your work last year? Please also describe the projected future impact for the coming years.

Cada Paso bundles several benefits into the program. Adult participants have walked over 1700 miles in 23 walks, averaging about 25 adults and 40 kids per walk. We've activated use of dozens of resources, including clinics, community gardens, parks, CBO's and local government programs. Follow-up surveys reveal successful utilization of resources: a clinic visited on a walk is used again 40-75% of the time compared to the same clinic only being talked about without a visit (<5% return use). Aside from the children's appointments, adults make appointments for themselves and refer friends. Further, parents are transformed into agents for change: they lead walks, uncover new resources to share, and participate in community activities to engender improved conditions for all. The next generation of EH residents will be living as long as their Upper East Side counterparts.

Organization Type

  • nonprofit/NGO/citizen sector

Annual Budget

  • $10k - $50k

Financial Sustainability Plan: What is your solution’s plan to ensure financial sustainability?

A diverse revenue stream incorporates not just grants, as we’ve relied on to date, but private contributions and fees for services. Specifically, we are developing our social media network in preparation for crowd-funding, and we are developing sponsorship arrangements with our community partners. We anticipate working with CMS to demonstrate the cost savings for our healthy population.

Unique Value Proposition: How else is this problem being addressed? Are there other organizations working in the same field, and how does your project differ from these other approaches?

One of the strengths of Cada Paso is the "meta" nature of the program: we facilitate access to the existing resources in East Harlem. We've developed a network of partners all addressing different facets of the systematic disparities. Our role is to coordinate utilization. And this includes the transformative resources: DOH, City Council and community programs to transform the built environment and change food security and environmental health policy. Our families are now architects for changing the conditions for the whole neighborhood.

Reflect on the Field and its Future: Stepping outside of your project, what do you see as the most important or promising shifts that can advance children’s wellbeing?

Eliminating wealth disparities will alleviate health disparities. Poverty is a prominent contributor to toxic stress, which limits the potential for children to live long and productive lives. Empowering families with economic assets would seem to be appropriate. As demonstrated by the Nurse-Family Partnership, breaking the cycle of health disparities can have multi-generational effects. A poverty-specific, community-wide intervention that promotes personal success and communal resources may succeed in that way.

Source: How did you hear about the Children’s Wellbeing Challenge? (the answer will not be public)

  • Email


Join the conversation:

Photo of Jessie Mandle

Great program! Who facilitates the walking tours? Thanks for sharing your model- I think this is a terrific way to connect families with each other and resources!

Photo of Abraham Haggerty

Thanks for the kind words Jessie, we coordinate Cada Paso through our non-profit, in partnership with a local health service CBO.  Happy to tell you more if interested.  We try to be as transparent and open-source about our program as possible.

Cappy Collins, MD, MPH

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