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Tracking Health: Boro Leads City Fight On Diabetes, But Also Lacks Insurance, Flu Shots
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| Percentage with no health insurance by neighborhood, NYC Community Health Survey 2004.
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By MATT HAMPTON
A study released Oct. 26 by the New York City Department of Health and Mental Hygiene takes broad strokes toward improving the lives of New Yorkers by identifying specific health risks, broken down locally across the five boroughs.
The study, using neighborhood definitions established by the United Hospital Fund, concentrated on health topics deemed most urgent by “Take Care New York,” the DOHMH’s citywide health initiative. The most recent release is an update and improvement of community health research started in 2003, compiled and kept as current as possible to help healthcare officials stay on top of community health issues across the city.
In the study, Queens was the site of some benchmark improvements, but also showed some troubling tendencies. While Queens was among the most favorable when it came to asthma and up-to-date HIV testing, there was a troubling lack of insurance coverage, particularly in Western Queens. As well, many Queens residents admitted that they were behind on flu vaccinations, an important issue as the flu season moves into full swing.
The study itself was done as random-dial information survey, and a cross section of 10,000 residents were interviewed citywide. For urgent health issues, data was compiled for each neighborhood and the results were then color coded and represented on city maps.
Each neighborhood was given its own profile, highlighting the positives and negatives of healthcare by community. At the most fundamental level, the community health profiles allow residents of every community to know where they are at risk, and how to take action to protect themselves.
Lack of Insurance
One of the most basic forms of protection is completely forgotten in parts of Queens, as numbers of uninsured residents were startlingly high. According to the study, Western Queens neighborhoods like Long Island City, Astoria and Sunnyside had higher-than-average percentages of uninsured New Yorkers. West Queens, including Corona, Jackson Heights, Woodside, Elmhurst and Maspeth, had 33 percent of respondents saying they were uninsured, the most in New York City.
As well, the study showed that residents enrolled in Medicaid, the federal assistance medical program, were often 10 percent lower than areas of Brooklyn and the Bronx.
The reason for these extremely low numbers probably lays in the rates of foreign born adults in the areas, according to Bonnie Kerker, Assistant Commissioner of the Bureau of Epidemiology Services.
In Addition,“65 percent of adults in West Queens are foreign born, as well as 52 percent in Northwest Queens,” Kerker said.
These numbers of foreign born residents feed into a larger figure of the Community Health Profiles that says foreign born residents are three times as likely as U.S.-born residents to lack health insurance.
These residents often don’t know they can seek healthcare, either through an employer or through the federal government, which leads to gaps in healthcare coverage.
To make matters even more grave, more than one in four residents in these neighborhoods also classified themselves as being in either fair or poor health. The Community Health Profiles value a personal assessment of health almost as much as a doctor’s visit, because a resident’s personal health perception is often an extremely accurate portrait of their physical health.
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| Percentage who received influenza vaccine in last 12 months by neighborhood, NYC Community Health Survey 2004.
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Queens Fights Diabetes
New York City has come under attack in recent years by Diabetes, an affliction that has touched an estimated 800,000 people in the five boroughs, according to the DOHMH. The Community Health Profiles indicate that while the highest occurrences of the disease are in the Bronx and Brooklyn, no part of New York City is immune to its influence.
In Queens, however, new tools have been implemented to help manage the disease, which does not have a cure.
For five years, Queens and Elmhurst Hospitals have been using an electronic registry to track the health and progress of Queens patients with Diabetes. Recently, the NYC Health and Hospitals Corporation expanded the program to eleven New York City Public Hospitals.
The program, which will allow hospitals to track up to 50,000 New Yorkers with Diabetes, provides doctors, nutritionists, and other health experts with what the program classifies as a “health status snapshot” that paints a clear picture of how a patient is managing the disease.
By monitoring glucose levels and blood pressure, along with other factors, the e-registry helps health care professionals take action to prevent the kidney failure, blindness and heart trouble all associated with Diabetes.
During the testing phase of the registry, 9,000 Queens residents were monitored, nearly half of whom recorded an improvement in glucose levels.
“We like to see them at least every three months,” said Dr. Rand David, Elmhurst’s Director of Ambulatory Care. David stressed the importance of exercise and having regular check-ups for Diabetes patients, but stressed that patients also “need to learn about self-management.”
According to David, the National Committee for Quality Assurance in Health Care estimates 50 percent of adults with Diabetes nationwide do not keep the disease under strict control. Among patients at Elmhurst, David said, “it’s more like 16 percent.”
“The epidemic is probably still growing,” David was quick to add. “We have to get to the epidemic of obesity.”
Obesity is the leading modifiable risk factor in the development of Diabetes.
Jamaica, the district in Queens with the highest rate of obesity, according to the Community Health Profiles, was also a district that had higher than average deaths, hospitalizations and amputations due to Diabetes.
Behind on Flu Vaccines
Another important health factor is being overlooked in Queens, as more than 50 percent, and sometimes two-thirds of residents say they do not keep up with flu shots.
“People don’t understand that flu can be deadly,” said Jane Zucker, assistant commissioner of the Bureau of Immunization. “That’s a large part of it.”
Zucker continued to say that people are consistently surprised by the number of yearly fatalities at the hands of the common flu.
“36,000 people die every year in the United States from the flu,” Zucker said, and added that over 3,000 dead, more than 1 in 12, were New Yorkers.
The Bureau of Immunization, campaigns every year during flu season, in an effort to make sure New Yorkers, in particular those over 65, stay up to date, but it isn’t always easy.
“Some neighborhoods have fewer services for people,” Zucker said. “We go where the people are who need shots.”
Zucker admitted that in some areas, there was a disparity along racial lines of those who were and were not up to date with flu shots. Areas of the city that had a higher percentage African American population often had larger gaps in flu vaccine coverage.
This can be attributed to any number of factors, according to Zucker, including a willingness to treat more ailments with home remedies, and a general distrust of government sponsored services.
Zucker was still hopeful, however, that residents would protect themselves this flu season.
“The easier you can make it for someone, the more likely they are to get a flu shot.”
The health of Queens residents, and all New Yorkers, ultimately depends on the services available at the local level. The Community Health Profiles represent an important step in improving health care for the entire city of New York, allowing medical professionals and the people they serve to have the most comprehensive and up to date information.
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