Community Needs Assessment: South Bronx - Research Paper Example

Community Needs Assessment: South Bronx This work looked into the community situation of South Bronx, New York. The needs assessment focuseson the incidence of asthma in the area. The needs assessment covered an analysis of prevalence of asthma in relation to the other features of the community. The author concluded that asthma is indeed a priority problem in South Bronx. Further, the author also concluded that the problem of asthma in South Bronx is best addressed in relation with improving the quality of the environment in South Bronx and that, therefore, health programs on asthma must recognize and adjust to this fact. 1.0. Introduction The work of Maninno et al. (2002) has recognized that asthma is a major cause of school and work days losses in America since the 1980s. Maninno et al. (2002) found that between 1980 and 1996, the prevalence of lifetime asthma has increased in the United States. Related with this, the study of Manino et al. (2002) reported that school days and work man-days losses due to asthma have also increased. This needs assessment focused on the problem of asthma in South Bronx because this analyst believe that asthma is most likely a serious problem in the community given the reputation of South Bronx with regard to the family income of its residents. In addition to the usual objectives of needs assessment, the needs assessment was designed to develop insights on how a health program focused on asthma can best be developed for South Bronx. Thus, the author was keen on drawing data helpful to producing insights in that direction. To produce the community needs assessment, the author reviewed documents, news reports, and gathered a documented testimony from at least one community leader. 2.0. Community Description South Bronx is a community populated by low-income minority families in New York City. Figure 1 shows New York City on the left panel and South Bronx on the right panel. South Bronx is composed of localities labeled with numbers 1, 2, 3, 4, 5, and 9 on the right panel and colored yellow. The entire Bronx (colored as peach and yellow) on the right panel is the peach colored area in left panel. Figure 1. New York City, the Bronx, and South Bronx Source: Restrepo and Zimmerman, 2004, p.5 According to the Lehman College that is located in the Bronx area, census data indicate that the Bronx had a population of 1.4 million people as of 2008. A significant part of this population resides in South Bronx. Unfortunately, according to the college, around 30% of the South Bronx population refuse to categorize themselves into a racial category. The Lehman College pointed out that although South Bronx is described as a low-income community, there is a section of the population that is well off. There is good potential for closely working with residents in the area for better health and an improved environment. A self-help group exists and has recently achieved a modest legal victory over banishing odors and emissions from sewage facilities. The Community News Service (2010) reported that the New York City Department of Protections and “Mothers on the Move,” a community group of South Bronx, arrived at an agreement that the city will cease shipment of sewage sludge to the New York Organic Fertilizer Company for at least two years. The agreement came after “Mothers on the Move” complained for years the “health and quality of life problems associated with sewage odors and fumes in their neighborhood.” 3.0. Health Problems, Issues and Risks The United Health Foundation has identified South Bronx as community with a high prevalence of asthma and diabetes since 2004. Restrepo and Zimmerman (2004, p. 5) described South Bronx to have one of the highest asthma rates in the country and which “residents feel is one of the most pressing health issues in their community.” Serrano (2005) reported that 20 to 25% of schoolchildren in the South Bronx suffer from asthma. The South Bronx Asthma Partnership (2004), a “diverse group of organizations and individuals dedicated to reducing the high rates of pediatric asthma in the South Bronx” summarized the situation into something like this: one out of four children in South Bronx has asthma and this rate is one of the highest in the United States. Serrano (2005) pointed out that asthma is the number one cause of absenteeism among students of New York City. He emphasized that rate of hospitalization of children in the area is 250% higher than the rare of hospitalization for the other children of New York City and even 1,000% higher than the rate of hospitalization for the State of New York. The New York City Department of Health and Mental Hygiene have strongly recognized that South Bronx has one of highest childhood asthma hospitalization in the city (p. 3). A better health access for South Bronx residents is not only a health issue but it is also an issue of equity and race. It is an issue of equity because South Bronx has a reputation of being community in which the low income groups are fairly large. It is also an issue of race or racial equality because a significant portion of South Bronx is composed of non-whites. Rightly or wrongly, depriving South Bronx of adequate attention on its problem can readily transform into an equity and racial issue. 4.0. Problem Analysis and Relevance Based on “Healthy People 2010” The presence of the United Health Foundation in South Bronx since 2003 indicates the seriousness of the health problems in South Bronx as well as the priority status of the area for the community’s health needs to be addressed. The foundation has declared thorough its official website that it is the foundation’s policy to help the poorest communities in the United States acquire access to health care. The foundation has been assisting only our sites in the United States and one of these four sites is South Bronx (the other communities that the foundation assists are in Overtown, New Orleans, and Anascostia). South Bronx is a priority community for assistance because based on the records of the United Health Foundation, homeless families are present in the community. This implies that families most vulnerable people to health problems, the homeless, resides in the community. In his report, Serrano stressed that the health conditions of the South Bronx residents are partly attributable to the air quality in the area as the area is situated along roads where vehicular traffic is heavy. Serrano (2005) specifically focused on diesel trucks that are “omnipresent” in the area which, according to him, have been linked to the severe asthma attacks in the area. Serrano (2005) also reported that South Bronx residents have abnormally high rates of other respiratory illnesses, infant mortality, and immune deficiency conditions “while living in unhealthy conditions and having poorer access to healthcare.” Barbara Warren (2007), registered nurse with masters degree in Environmental Health Science and a leader of the “Sustainable South Bronx,” a community-based environmental justice organization, asserted in her testimony before the New York State Department of Health that “environmental degradation contributes to the high prevalence of asthma and the high incidence of asthma exacerbations.” Warren (2007) further explained that in the case of South Bronx, “large numbers of people have no reasonable access to health services and this problem disproportionately affects minority groups, those with limited incomes and those with mental health problems that impact their ability to obtain services.” Warren (2007) complained further that, “in the past few years, I have not heard a single outcome from hospitalization that was absent a major error or complication.” This implies that the health problems in South Bronx are more than those that are immediately visible to the eye. Complications in health hospitalizations do not usually appear in health statistics of government agencies. Thus, this particular portion of the Warren (2007) testimony must be taken into account to appreciate fully the nature of the health problems of South Bronx, New York City. The Warren (2007) testimony imply that other than addressing health problems head-on, there is a need to review how health services are being conducted in Health Bronx and find out if the people of South are receiving quality health services. There is also a need to find out if the people of South Bronx are being deprived not only of specific health services but also of quality treatments and hospitalizations. Unfortunately, the state of quality of health services does not always show up in morbidity and mortality statistics. Figure 2. Peak hour traffic in South Bronx Source: Restrepo and Zimmerman, 2004, p.14 The concerns of Serrano (2005) and Warren (2007) have a good scientific basis. The study of Restrepo and Zimmerman (2004, p. 8) found the concentrations of nitrogen dioxide, carbon monoxide, and sulfur dioxide are significantly high in the South Bronx although the concentration of particulates in the South Bronx area are only consistent with the concentrations found in New York City (Restrepo and Zimmerman, 2004, p. 8). Most likely, figure 2 that identifies the areas with peak hour traffic (marked in red color) defines that part of the South Bronx with the worst concentration of particulate pollutants. At the same time, figure 2 probably defines that part of the population of South Bronx most vulnerable to asthma, respiratory diseases, or ailments associated with pollutants. Particularly vulnerable are that part of the neighborhood that are exposed to high particulate pollution levels. Figure 3 shows the areas with the highest pollution levels. The extent of particulate pollution is color-coded and the codes are on the right side Figure 3. The colors that are on the topmost part of the right side of Figure 3 correspond to colors associated with high particulate pollution levels. Research conducted by the University of Cincinnati (UC) and Columbia University Mailman School of Public health indicate that exposure of mothers to chemical compounds created from the incomplete combustion of fuels in vehicles in heavy traffic areas is linked not only with cancer but with asthma as well (Science Daily, 2009). According to the research, pre-natal exposure to polycyclic aromatic hydrocarbons results into an “epigenetic” alteration in the gene ACSL3 thereby resulting into genetic vulnerability to asthma (Science Daily, 2009). The Science Daily elaborated that based on the research of the universities involved, “epigenetic programming” results from “an organism’s genes interacting with the environment” (2009). The “epigenetic alteration” leads to airway inflammation or asthma later in life (Science Daily, 2009). Figure 3. Pollution levels in the eastern part of South Bronx Source: Restrepo and Zimmerman, 2004, p.20 Addressing asthma is consistent with goal 1 of the document Healthy People 2010 (U.S. Department of Health and Human Services, 2010, p. 8). Goal 1 of the document declares that it is US health policy to help individuals of all ages increase his or her life expectancy and improve his or her quality of life. Naturally, addressing asthma will help much to make life comfortable, eliminate time loss, and expenses from medical bills. In particular, the Healthy People 2010 document recognized that asthma can also be “triggered or worsened by exposure to ozone and ETS” (U.S. Department of Health and Human Services, 2000, p. 41). ETS is environmental tobacco smoke According to the US Department of Health and Human Services, mortality from asthma increased by 57% by 1993 from 1980 and for children the mortality figure increased by 67% during the same period. Other than vehicle exhaust, a significant factor that promotes asthma is second hand smoke among nonsmokers (U.S. Department of Health and Human Services, 2000, p. 41). Related to need to improve health care quality in South Bronx, the need is highly relevant based on goal 2 of Healthy People 2010. Goal 2 of Health People 2010 is the elimination of health disparities (U.S. Department of Health and Human Services, 2010, p. 11). An important source of disparity or inequity of access to health is income and race/ethnicity. South Bronx is largely populated by American blacks and low-income families of America. Maintaining and expanding a focus health assistance on South Bronx will contribute strongly towards improving the access to health services among Black and low-income Americans. Healthy People 2010 noted that there seems to be disparities based on health. Some of the manifestations: heart disease death rate is 40% higher among African Americans than among whites; death rate for all cancers is 30% higher for African Americans than among blacks; death rate from HIV/AIDS is more than seven times among African Americans than among blacks; and deaths from prostrate cancer is twice among African Americans than among whites (U.S. Department of Health and Human Services, 2010, p. 12). Meanwhile, while the poverty rate among children below 18 years old is around 10%, it is very close to 40% among African Americans. 5.0. A Community Need of South Bronx At the moment, the Division Public Health Office (DPHO) of South Bronx has an ongoing program in working with elementary school nurses and daycare personnel to improve the management of asthma among the afflicted. The South Bronx DPHO program involves encouraging families to take their medicines to schools, ensuring the proper treatment of children with poorly controlled asthma and referring children to community case management and heatlh care services (South Bronx Division Public Health Office, 2010). The DPHO of South Bronx also work with all health care providers and clinics in the community to improve asthma management. Working with the said groups cover discussing asthma treatment strategies and familiarizing all those concerned with appropriate use of medications. The DPHO also coordinates with community organizations in South Bronx with regard to health action initiatives on asthma. Thus, it seems that there is a perfectly working health program or initiatives on asthma. However, what is sorely lacking is the need to combine awareness on asthma management and treatment with a more proactive approach. In particular, given the increasing recognition of the link between asthma and air quality, there is a now an urgent need to translate that awareness into viable initiatives. For instance, one such initiative is to raise people’s awareness in the area on the likely link between air quality and asthma. Such an awareness can lead people to take actions or preventive measures on how they can minimize their exposure to fuel pollutants that result to children that are most vulnerable to asthma. Unfortunately, based on documents from the Division Public Health Office of South Bronx that are immediately available to this analyst, Division Public Health Office initiatives against asthma does not yet include a strong public awareness program on the link between air quality and asthma. Whether this link is actual or fictitious (evidence supporting the view that the link is actual appears strong), there seems to be benefits that can be realized if the public are made aware on the existence of the said link. For one, even if the gene altering effect of fuel pollutants is not confirmed, it has been established that asthma is also a type of allergy and, thus, minimizing one’s exposure to allergens can go a long way towards minimizing asthma attacks. Of course, the gene altering effects of fuels and their impact on a person’s vulnerability to acquire asthma is likely true but we just have to let scientific research verify the matter. In summary, there is a need to integrate into the various health education programs on asthma the link of the ailment with environmental quality, particularly air quality, so the community members of South Bronx can take preventive action and minimize their exposure. Minimizing the incidence of asthma can be likely enhanced by introducing additional policies that can improve the environment but, for the meantime, we can let that be one of the results of a stronger public education program on asthma that points out that link of the ailment with environmental quality. Bibliography Environment News Service. (2010, July 2). Community legal victory banishes South Bronx sewage smells. Retrieved July 20, 2010, from http://www.ens-newswire.com/ens/jul2010/2010-07-02-091.html Manino, D., Homa, D., Akinbami, L., Moorman, J., Gwynn, C., and Redd, S., (2002). Surveillance for asthma: United States. Surveillance Summaries, 51 (1), 1-13. Lehman College. (2010). Discovering the Bronx. Retrieved July 25, 2010, from http://www.lehman.cuny.edu/deannss/bronxdatactr/discover/oldbxtext.htm Matte, T., Ellis, J., Bedell, J., Selenic, D., Young, C., and Deitcher, D. (2007). Obesity in the South Bronx: A look across generations. New York City: Department of Health and Mental Hygiene. Restrepo, C. and Zimmerman, R. (2004). South Bronx environmental health policy study: Final report for Phase II & III. Submitted to the U.S. Environmental Protection Agency. Science Daily. (2009). Pollution-related asthma may start in the womb. Retrieved July 29, 2010, from http://www.sciencedaily.com/releases/2009/02/090214082110.htm Serrano, J. (2004). Clearing the air. Retrieved July 20, 2010 from http://www.gothamgazette.com/feds/serrano_092004.php South Bronx Asthma Parthership. (2004). Who we are. Retrieved July 29, 2010, from http://www.webmoose.com/portfolio/sobrap/ South Bronx District Public Office. (2010). Controlling Asthma. A brochure of the South Bronx District Public Office, South Bronx. United Health Foundation. (n.d.). Supporting increased access for our communities. Retrieved July 25, 2010, from http://www.unitedhealthfoundation.org/access.html U.S. Department of Health and Human Services. (2000). Healthy people 2010: Understanding and improving health. Washington: U.S. Government Printing Office. Warren, B. (2007). Testimony before the public hearing on the New York City Universal Health Care. New Yorker Hotel, New York City: New York State Department of Health and the New York State Insurance Department. Read More