Cooking, Healthy Eating, Fitness and Fun, Research Paper Example

Introduction

The Bronx, New York is one of the most impoverished cities in New York. There is about 570, 000 people living in the city. Eighty percent of the people living in the Bronx are of non-white ethnicity. Sixty-six percent of the population is of Hispanic origins. Over half of the population speaks Spanish at home as a first language (Brand, Horst, & Washington, 2013). The Bronx is considered a medically underserved area with a shortage in healthcare professionals. There is a high rate of poverty and the city is composed primarily of immigrants and minorities. Homeless rates are high and employment rates are low which equates to a low socioeconomic status (Brand, Horst, & Washington, 2013). There are many diseases (obesity, heart disease, asthma, diabetes, hypertension, and sexually transmitted diseases) prevalent to the Bronx that are linked to persons who live in low socioeconomic statuses.  The purpose of a community health assessment is to collect and analyze data in order to educate and mobilize communities. This will ensure that priorities are made and resources are garnered to plan an action to improve the public’s health.

Biophysical Considerations

The population of the Bronx is 1,332,650, or 17% of the total population of New York City. In the Bronx, the percentage of the population that is Hispanic (48 %) is substantially higher than in New York City as a whole (27%), while the percentage that is white (15%) is substantially lower than in New York City (34%). The percentage of the population that is African-American (31%) is somewhat higher than in New York City as a whole (25%), and the percentage that is Asian is substantially lower (3% vs. 10%). The age-adjusted death was somewhat higher in the Bronx than in New York City as a whole (847 vs. 737 per 100,000 population). The percent of persons living in poverty was somewhat higher in the Bronx (28%) than in New York City overall (19%). The percent of adults aged 25 and older without a high school diploma was substantiallyhigher in the Bronx (41% vs. 32%), and the percent of linguistically isolated households was somewhat higher (15% vs. 12%). The percentage of the population aged 25 years and less was somewhat higher in the Bronx than in New York City overall (40% vs. 34%), and the percentage aged 65 and older was somewhat lower (10.1% vs. 12%). (http://www.bronxcare.org/about-us/2013-community-health-needs-assessment/)

Psychosocial Considerations

The Bronx also faces many economic barriers, social issues, and special needs that are prevalent for such an area. The population of the Bronx is comprised mostly of a very young population. About one-third of the population is individuals under the age of 20 years old. About a third of the population is a recent immigrant from the Caribbean, South and Central America, and West Africa (Brand, Horst, & Washington, 2013). There is a significant unmet health disparity among these residences. These residences have many barriers that prevent them from accessing primary medical care. For example, many are not fluent English speakers and others have cultural factors that prevent them from receiving care. Also, many are uninsured. About 17 percent of the population is uninsured. In this area, more than 90 percent of the deaths are attributed to chronic illnesses. More than 36 percent of the population has no primary physician (Banquiran, Raymundo, Mayris, Webber, & Appel, 3002).

Sociocultural Considerations

The median household income in the service area is under the citywide level. In the Bronx the average household income is $22, 779 versus that of the surrounding is $49, 127. The proportion of households in the Bronx that earns below $25, 000 is 54 percent of the area versus only 28 percent of the city earns below that amount. In the Bronx, about 38 percent of the families are considered poverty stricken. While, only about 17 percent of the population in New York is labeled as poverty stricken. In the Bronx, 59 percent of the population is eligible to receive public assistance, including Medicaid. While another 17 percent have no health insurance. . The Bronx has the highest rates of persons on public assistance in New York. Many believe this is so because about 20 percent of the population has only a ninth grade education. 69.6% of the population 25 years and over in the Bronx had a high schooldegree or higher. About 43 percent of the population is unemployed. Yet, the Bronx’s low-income population lives less than a mile from agrocery store (Brand, Horst, & Washington, 2013). There are 871 fast food restaurants in Bronx County. There were 134 liquor stores in Bronx County. There were 43 recreation and fitness facilities andthe establishment rate of such facilities was 3.10 per 100,000 population. The Bronx Health REACH Faith-Based Outreach Initiative helps faith organizations (of all denominations) provide health programming around nutrition and fitness, diabetes prevention and management, and health disparities to their constituents. Through the Initiative, churches establish health ministries that distribute information and organize health activities such as:

• Fine, Fit, and Fabulous, a nutrition and fitness program.
• The Culinary Initiative, a healthy cooking course for culinary committee members.
• God’s Health Squad, a youth nutrition program.
• The Way, a support program for congregants living with diabetes.

To date, 47 faith-based organizations in the Bronx and Northern Manhattan participate in the Bronx Health REACH Faith-Based Outreach Initiative.

Health System Considerations

The Bronx-Lebanon Community Physician Liaison Program was initiated with the goal of strengthening the partnership between the community and physicians to improve the effectiveness of health care delivery in the area. The program leaders initiated In-Direct Admissions Programs, which connects those in need with primary care physicians. They also provide culturally appropriate care for those populations of immigrants.Through the Healthy Hearts Restaurant Initiative, Bronx Health REACH partnered with 23 restaurants to promote healthier food offerings that resulted in thousands of customers having the option of choosing a healthier meal. Some participating restaurants introduced healthier menu items including low fat milk, mixed greens, and whole wheat bread. In addition, five Annual Bronx Food Festivals offered approximately 3,000 community members an opportunity to learn about healthy eating and provided restaurants an opportunity to demonstrate their commitment to making healthier options available. Bronx Health REACH also promoted participating restaurants to local organizations and used them to cater meetings and events (Rodriguez, et al, 2013).

Mental Health/Substance Abuse

Mental health and substance abuse are two conditions that are rarely evaluated in conjunction until recent years. There have been links found between the two. Often a person with mental illness will turn to drugs as way to cope with the illness. Likewise, people who are dependent upon substances often develop mental illness as a result of the prolonged drug use. The Bronx Department of Psychiatry offers a comprehensive care program for those suffering for mental health and substance abuse. More than 200,000 patients are seen annually in the Bronx and its surrounding area. The Department of Psychiatry is one of the organizations that is providing innovative services that takes in account the whole patient. The center offers substance abuse treatment for alcohol detoxification, impatient rehabilitation, methadone maintenance treatment, two halfway houses, and a partnership with another center that provides outpatient chemical dependency services. (http://www.nyc.gov/html/hhc/downloads/pdf/community-assessment/hhc-chna-ncb.pdf)

Psychological Considerations

There are seven leading causes of death for adults aged 25-64-malignant neoplasm, heart disease, HIV, psychoactive substance abuse and accidental drug poisoning, diabetes mellitus, homicide, and cerebrovasucular disease. The leading cause of death among adults 65 years of age and older was heart disease and cancer. The deathrate in the Bronx from both causes was nearly identical to the comparable rate in New York Cityoverall. Diabetes mellitus was the third leading cause of death in this age group in the Bronx, butonly the fifth leading cause in New York City as a whole. The death rate from diabetes mellitus inadults aged 65 and older was substantially higher in the Bronx than in New York City (244 vs. 137/100,000). The death rate from essential hypertension and hypertensive renal disease (seventh leadingcause of death in this age group in the Bronx vs. eighth leading cause in New York City) was substantiallyhigher in the Bronx than in New York City overall (94 vs. 62/100,000). (http://www.nyc.gov/html/hhc/downloads/pdf/community-assessment/hhc-chna-ncb.pdf)

Target Illness

The Bronx has one of the highest incidences of HIV/AIDS rates in the United States. I chose this illness because it can be eliminated through education and screening. However, the majority of the population in the Bronx does not have access to regular health care. I believe this is an issue that should be targeted in the Bronx to help ensure that more lives are not lost to a preventable disease. The rate of Bronx residents living with HIV was 632.2 per 100,000 persons in 2009 and increased to 635.1 in 2010. The rate among Bronx residents was higher than the citywide and statewide rates in 2009-2010. In 2009 the citywide rate was 449.8 per 100,000 and in 2010 the citywide rate was 471.4 per 100,000. In 2009 the statewide rate was 249.6 per 100,000 and in 2010 the statewide rate was 255.6 per 100,000.  The rate of Bronx residents living with HIV was 632.2 per 100,000 persons in 2009 and increased to 635.1 in 2010. The rate among Bronx residents was higher than the citywide and statewide rates in 2009-2010. In 2009 the citywide rate was 449.8 per 100,000 and in 2010 the citywide rate was 471.4 per 100,000. In 2009 the statewide rate was 249.6 per 100,000 and in 2010 the statewide rate was 255.6 per 100,000.The rate of Bronx females living with HIV was 518.7 per 100,000 persons in 2009 and decreased to 510.1 in 2010. Overall, the rate of Bronx residents living with HIV increased from 2009-2010. The Bronxrate of residents living with HIV is significantly higher than the citywide and statewiderates. Among cases of Bronx residents living with HIV, male cases of HIV are moreprevalent than female cases. The Bronx female cases decreased over time as the Bronxmale cases increased.The rate of newly diagnosed AIDS cases among Bronx residents was 52.9 per 100,000persons in 2009 and decreased to 46.8 in 2010. The newly diagnosedAIDS cases in the Bronx were higher than the citywide and statewide rates from 2009-2010. In 2009 the citywide rate was 32.5 per 100,000 and in 2010 it was 28.5 per100,000. In 2009 the statewide rate was 17.6 per 100,000 and in 2010 it was 15.4 per100,000. (Chu, et al, 2010)

Behavioral Considerations

According to the NYCDOH Community Health Survey (2012), 36.7% of Bronx men were classified as overweight but not obese, less than the New York City rate for men, which was 38.6%. The Bronx was the borough with the second lowest male overweight, butnot obese population. The male obesity rate in the Bronx, however, was 26.2%, making it the second most obese borough for men in New York City and significantly greater than the overall New York City male obesity rate of 20.7%.The percentage of women in the Bronx who were overweight but not obese was 30.5%, much higher than the New York City rate for women of 25.6%. For women, the Bronxrepresented the borough with the highest percentage overweight, but not obese. TheBronx was also the borough with the highest female obesity rate at 36.8%, almost 10% higher than the overall New York City female obesity rate of 27.2%. Bronx teens reported engaging in physical activity for at least 60 minutes per day. This was lower than the 20.3% ofNew York City teens who reported engaging in physical activity for at least 60 minutes a day. The rate of Bronx girls who engaged in physical activity was 12.8%, lower than the 15% of New York City girls who reported the same. However, at 27.1%, the rate of Bronx boys who reported engaging in physical activity was greater than the 26.4% of New York City boys who reported engaging in physical activity. The Bronx had the highest rate of adults who had not engaged in physical activity in the past 30 days of all of the boroughs at 24.7%. 22.2% of all New York City adults had not engaged in physical activity in the past 30 days. 23.8% of Bronx males had not engaged in physical activity in the past 30 days, compared with 20.9% of New York City males. 25.5% of Bronx females had not engaged in physical activity in the 30 days, compared with 23.4% of New YorkCity females. Likewise, 76.5% of individuals reported consuming few fruits orvegetables. According to the NYCDOH Community Health Survey (2012), 20.5% ofindividuals in the Bronx consumed no servings of fruit and/or vegetables per day, 73.2% of individuals consumed 1-4 servings, and 6.3% consumed over 4 servings. The Bronx had the lowest fruit and/or vegetable consumption of all of the boroughs, with the highest percentage of individuals consuming no servings of fruit and/or vegetables per day and the lowest percentages of individuals consuming 1-4 servings and greater than 4 servings per day. About 48.8% of adults in BronxCounty are alcohol drinkers and 15.8% of adults in theBronx reported being current smokers (Rodriguez, et al, 2013).

What We Can Do

A total of 96, 707 New Yorkers are reportedly diagnosed with HIV or AIDS. The number of persons living with AIDS has climbed steadily in recent years. In the early 1990s there were about 30, 000 persons in New York with HIV/AIDS. Although t hat number is up greatly today, that means that less people are dying from the disease. In 2001, HIV diagnoses are down by one-third, AIDS diagnoses are down by one-quarter, and AIDS deaths are down 18%.  Also, HIV testing has increased 20% over the past two years. There are many disparities in diagnoses and reporting of AIDS in African Americans and Latinos(Rodriguez, et al, 2013). There are several things that must be done to ensure that the number of deaths due to HIV/AIDS continue to decline. First, we must help to increase testing in the Bronx area. Although routine testing is voluntary and cost effective, it is not occurring often enough. Only about a third of person who have had more than three sex partners have been tested. To increase this, incentive programs should be in place to entice them to get tested. Linking persons to primary key is the key to get them tested. Maybe communities and medical facilities to offer a free primary care visit to a certain percentage of persons who come in to be screened for HIV/AIDS. Next, early diagnosis is so crucial to the fight against the disease. Early detection is key to effective treatment and access to social services needed. Early detection will prolong life by preventing drug resistance. Prevention is also important. We must expand prevention programs to revitalize public health. One way to do this is through condom distribution. Condoms have been proven to reduce the transmission of HIV. Often, sexual encounters that are high risk are completed without protection. In order to prevent this, condoms can be made available to persons in high risk areas. For example, areas that are frequented by drug use and prostitution. People who participate in these activities are at a higher risk for contracting the virus. Communities can have clean needle depositories where drug addicts are able to get clean needles for free. Finally, accountability is the key. The fight against the virus is an American fight. The collaboration of community and county officials is needed. Collaboration at the state and national level is a must as well. The funding for HIV/AIDS testing should be funded just like disaster relief. A national policy that has clearly defined missions and allots a certain amount of money for treatment, testing, education, and other control most be enacted.

Works Cited

Baquiran, Raymundo S., Mayris P. Webber, and David K. Appel. Comparing Frequent And Average Users of Elementary School-Based Health Centers In The Bronx, New York City. Journal of School Health 72.4(2002): 133-137.

Brand, Horst and Washington, D.C. Bureau of Labor Statistics (DOL). The New York Puerto Rican: Patterns of Work Experience. Poverty Area Profiles. Regional Reports: Bedford-Stuyvesant; Central Harlem; East Harlem; South Bronx 19.

Chu, C., et al. HIV-Infected Patients And Treatment Outcomes: An Equivalence Study of Community-Located Primary Care-Based HIV Treatment Vs. Hospital Based Specialty Care In The Bronx, New York. AIDS Care 22.12(2010): 1522-1529.

Rodriguez, Jacqueline, et al. Cooking, Healthy Eating, Fitness And Fun (Cheffs): Qualitative Evaluation Of A Nutrition Education Program For Children Living At Urban Family Homeless Shelters. American Journal of Public Health 103.S2 (2013).