The Health of the Latino Community in the Bronx

1
The Health of the Latino Community in the Bronx

• An Overview of the Health Status of Latinos in
  the Bronx
• Joann Casado
• Executive Director
• The Bronx Healthlink
• Prepared March, 2005

2
Mission and work of TBHL and the Perinatal
Information Network

• To identify and organize information about the
  service systems in the Bronx to improve perinatal
  health, which includes maternal and child health
  issues.
• Gaps in local services are addressed and
  opportunities for collaboration and cooperation
  are identified to maximize services and prevent
  duplication.

3
Organizational Structure of the TBHL Perinatal
Work

• The Infant Mortality Workgroup serves to
  facilitate Bronx-wide interagency collaboration
  to
• build partnerships dedicated to infant mortality
  reduction and reaching Healthy People 2010 goals
  of 4.5
• increase consumer awareness of community
  resources for infant health protection
• support these goals through data collection,
  analysis, and dissemination of findings and
  recommendations
• A designated planning committee for the New York
  City Department of Health Mental Hygienes
  Infant Mortality Reduction Initiative.

• The Outreach and education Workgroup functions
  Include
• Planning committee for Community Health Education
  Day and A Bronx-Wide Baby Safety Shower.
• Identifies professional skills needed to enhance
  community outreach and consumer education.
• Assess needs of providers and identifies
  resources for professional development.
• Identifies existing and emerging resources,
  coalitions, programs and services that will
  increase the networks capacity and enhance
  delivery of services to the perinatal population.

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How can we work together?

• Sharing information and resources related to
  local and national issues which impact the health
  of women of childbearing age and their families.
• Partnering to deliver staff and consumer
  educational sessions through the PIN staff and/or
  the PIN speakers bureau.
• Membership in the PIN.
• Participation in the PIN workgroup(s).
• Access the TBHL web site and join the web site.
• Join and come to the monthly meetings of the
  Bronx Planning Council.

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Limitations of presentation

• There is no clear source of data on Latinos,
  despite our growing presence in the United States
  and in particular, New York City and its
  boroughs, there is a dearth in the available data
  describing the health status of this community.
• For the purpose of most of the slides used in
  this presentation, communities are defined by the
  Community Profiles, thus
• The Central Bronx Bathgate, Crotona, Morris
  Heights, Mt.Hope, Tremont ( 10453,10457,10460)
• Fordham/Bronx Park- Bedford Park, Belmont,
  Kingsbridge, Norwood,University Heights (
  10467,10468, 10458)
• Highbridge/Morrisania ( 10452, 10458, 10451)
• Hunts Point ( 10454,10455,10474,10459)
• Kingsbridge/Riverdale (10463,10471)
• Northeast (Coop City,Eastchester, Wakefield,
  Woodlawn, Williamsbridge) 10455,10470,10466,10469
• Southeast ( Soundview, Parkchester,Castle Hill,
  Throgs Neck, and Country Club) 10461,10462,10472,
  10473

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Who is the Latino Community in the United States

• Hispanics or Latinos are persons of Cuban,
  Mexican, Puerto Rican, South or Central-American,
  or other Spanish culture or origin, regardless of
  race.  The federal government considers race and
  Hispanic origin to be two separate and distinct
  concepts Hispanic Americans may be any race.1
   According to the 2000 U.S. Census, Hispanics of
  all races represent 12.5 percent of the U.S.
  population, about 35 million individuals. The
  Census Bureau projects that by the year 2035
  there will be 75 million Hispanic individuals,
  comprising 20 percent of the population. Though
  Hispanic communities can be found throughout
  Florida, the Northeast, and other parts of the
  country, the greatest concentrations of Hispanics
  are in the southwestern states from Texas to
  California.  The states with the greatest
  concentration of Hispanics are New Mexico,
  California, Texas, Arizona, Nevada, Colorado, and
  Florida.2
• Though they share many aspects of a common
  heritage such as language and emphasis on
  extended family, Hispanic cultures vary
  significantly by country of origin. Hispanics
  tend to be younger than the white non-Hispanic
  population (except for Cubans, who have a higher
  proportion of elderly than other Hispanic
  groups). Their health profiles are also unique
  Puerto Ricans suffer disproportionately from
  asthma, HIV/AIDS, and infant mortality,3 while
  Mexican Americans suffer disproportionately from
  diabetes.4 Factors that contribute to poor health
  outcomes among Hispanics include language and
  cultural barriers, lack of access to preventive
  care, and lack of health insurance.5

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Who is the Latino Community in the Bronx

• The Bronx is home to
• The largest expatriate community of Puerto Ricans
  in the country.
• Dominicans, are the primary foreign born
  residents in 5 of the 7 communities designated in
  the NYCDOHMH profiles
• Mexicans ( because of their immigration status it
  is difficult to get accurate data on their
  numbers in the borough
• Hondurans Garifunas
• Undocumented Latin Americans many of whom will
  never be counted in Census data but who live,
  work, and die in the Bronx.

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Population Data by Community

• The Central Bronx
• 199,530 residents
• 62 are Latino
• 30 are foreign born
• Fordham/Bronx
• 250491
• 54 Latino
• 35 foreign born
• Highbridge/Morrisania
• 189,755
• 57 latino
• 30 foreign born
• Hunts Point
• 122,875
• 73 Latino
• 25 foreign born

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Population Data by Community

• Kingsbridge/Riverdale
• 88,989
• 32 Latino
• 30 foreign born
• Northeast
• 185,998
• 20 Latino
• 33 foreign born ( Jamaica, Guyana)
• Southeast
• 290,052
• 45 Latino
• 23 Foreign born

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What is health

• Health is a state of complete physical, mental
  and social well-being and not merely the absence
  of disease or infirmity.
• Preamble to the Constitution of the World Health
  Organization as adopted by the International
  Health Conference, New York, 19-22 June, 1946
  signed on 22 July 1946 by the representatives of
  61 States (Official Records of the World Health
  Organization, no. 2, p. 100) and entered into
  force on 7 April 1948.

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How do Bronx residents rate their health

• The New York City Department of Health and Mental
  Healths survey of adult residents throughout
  the city provides a self reported measurement of
  health status. The options included Excellent,
  Very Good, Good, Fair and Poor.
• In the Southeast Bronx, 24 rated their health as
  poor
• In the Central Bronx, 35 rated their health as
  poor
• In the Fordham/Bronx Park section, 26 rated
  their health as poor
• In Highbridge, 35 rated their health as poor
• In Hunts Point/Mott Haven, 35 rated their health
  as poor
• In Kingsbridge, 20 rated their health as poor
• Finally, only in the Northeast Bronx did 14 of
  the residents rate their health as poor.

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Status of Women in New York City

• The health of women in New York City has greatly
  improved over the past decade, but some groups of
  women - particularly black, Hispanic, and
  low-income women - still experience poor health.
  -- And some more specific stuff-- Women in New
  York City's poorest neighborhoods have a life
  expectancy 5 years shorter than those who in the
  highest income neighborhoods. Black women have a
  life expectancy almost 5 years shorter than white
  women.Among the poorest neighborhoods in New
  York City, the Bronx has 4 communities, namely,
  the Central Bronx, Highbridge, and Hunts Point
  Mott Haven with poverty rates over 40, and only
  one ( Riverdale) out 7 communities listed in the
  Community Profile reported a poverty level lower
  than the city average
• Latinas and women with low incomes are less
  likely than most other women to have health care
  coverage. -- Black women are more than twice as
  likely as white women to die from
  pregnancy-related complications. -- Among women,
  27 of years of potential life lost are due to
  cancer, while cancer is responsible for only 17
  of the years of potential life lost among men.
  -- Nearly one-quarter of women age 40 and older
  have not received a mammogram in the past two
  years fewer than half of women age 50 and over
  have ever had a colon cancer screening and 1 in
  5 women have not had a Pap test in the past three
  years. Asian women are least likely to receive
  colon cancer screenings and Pap tests. -- The
  rate of new AIDS diagnoses is 11 times higher
  among black women than white women and the rate
  of AIDS deaths is 7 times higher.

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The context of health in the Bronx

• The socio economic status of a community affects
  access to care and quality of care.
• In the Bronx, many of the communities have high
  levels of poverty.
• According to data in the Community Profiles
  developed by the NYCDOHMH, out of the 7
  designated Bronx communities, three have poverty
  levels over 40.

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Neighborhoods Most in NeedHarlem, So. Bronx,
Central Brooklyn
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Leading causes of death in New York City

• Total Number of Latino deaths in NYC in 2003 was
  8802, 4957 were of Puerto Rican ancestry, and the
  remaining 3,845 were Latinos of other ancestry
• Cancer was the cause of death in 802 case.
• HIV claimed 490 Latino lives in 2003
• Of the 294 total citywide deaths associated with
  use and accidental poisoning with psychoactive
  substances, almost 27 were Latinos( n-258)
• Homicide claimed 161 latino lives or 25 of the
  total number of homicides reported in 2003

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Latino Deaths in the Bronx, 2003
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Cancer in the Latino Community

• According to SEER data for the period between
  1988-1992, Latinos had a slightly lower incidence
  of prostate cancer than whites (89.0 versus 134.7
  per 100,000). However, Latinos were almost twice
  as likely to die from the disease.
• The average time between mammography results and
  follow-up was 7 weeks for Hispanic women,
  compared with 4 weeks for non-Hispanic White
  women.
• Latino women are less likely to be aware of Pap
  tests.
• Cervical cancer mortality rates for Latino women
  have increased an average of .2 per year.
• Overall, lung cancer is the leading cause of
  cancer death among Latinos.
• Lung cancer deaths are three times higher for
  Latino men than for the women.
• Of all ethnic/racial groups in NYC,
  Hispanic men and women less than 40 years old are
  the highest users of tobacco.
• The smoking prevalence among NYC Spanish-speaking
  females over 40 years is substantially higher
  than rates in Spanish-speaking women over 40
  nationwide.
• From 1991 to 1997, the prevalence of current
  cigarette smoking among high school student
  increased 32.
• Current cigarette smoking increased 34 among
  Hispanic students, versus 28 among white
  students.
• Source Center for Immigrant Health NYU School
  of Medicine

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Cancer Screening inThe Bronx vs. NYC
HP 2010 90
19
Rates of People Living w/HIV AIDS in The Bronx
vs. NYC vs. USCalendar Year 2001 Rates per
1,000 Pop.
Figures as of 12/31/01
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Rates of New HIV Diagnoses in The Bronx vs. NYC
vs. USCalendar Year 2001 Rates per 1,000 Pop.
Figures as of 12/31/01
21
Percent of Overweight Bronx Residents (BMI gt 25),
by UHF District
A woman 54 tall is considered overweight at 146
lbs. A man 510 tall is considered overweight at
174 lbs.
22
Percent of Obese NYC Residents (BMI gt 30), by
Borough
A woman 54 tall is considered obese at 175
lbs. A man 510 tall is considered obese at 209
lbs.
23
Diabetes Prevalence in NYCBy Borough, 2002
Healthy People 2010 Goal 2.5
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Percent of Bronx Residents w/ Diagnosed
Diabetes, by UHF District
25
Percent of All Bronx Adults Who Report One or
More Binge Drinking Episodesgt5 Drinks per Month
(by UHF District)
26
Live Births,Infant Death, and IMR
27
HP2000 Goal 7.0
NYC Avg. 6.1
HP2010 Goal 4.5
28
NYC Teen Pregnancy Rates1996-2000, by Year
Borough of Residence
29
Asthma Hospitalizations in The BronxHospitalizati
on rate of children under age 15,per 1,000
population, by UHF neighborhood, 2000
30
Gender and Racial Disparities in
VaccinationsNYC, 2001 Influenza Immunization Data
Healthy People 2010 Goal 90
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Health Literacy

• The degree to which individuals have the capacity
  to obtain, process and understand basic health
  information and services needed to make
  appropriate health decisions.
• DHHS, Healthy People 2010

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What are the consequences of limited Health
Literacy

• Limited participation in medical decision making.
  People with low health literacy are more likely
  to be disempowered during a clinical encounter
• More medication and treatment errors are possible
  because individuals cannot read the labels
• A higher rate of non adherence to medication
• Ineffective communication between the consumer
  and the provider can lead to misdiagnosis because
  consumers may not be able to explain and
  effectively communicate what they are feeling

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Conclusion

• The health status of the Latino community in the
  Bronx should alarm all of us community
  resident, provider, activist - ALL OF US!
• Because a large segment of the Latino community
  is in its childbearing years, it is a community
  in need of the full spectrum of primary care
  health services including family planning, pre
  natal care, child and adolescent health. Services
  must be provided in a manner that is culturally
  and linguistically appropriate.
• Efforts at targeted and specific health
  promotion, risk reduction and disease prevention
  for the Latino community must be developed,
  implemented and maintained.
• Culture, folk health beliefs, traditional health
  practices, language and acculturation all affect
  health therefore must be considered when
  addressing the health issues affecting the
  Latino community.
• Efforts must address how to improve access to and
  use of the health care system by the Latino
  community in the Bronx as a means of improving
  their health outcomes.