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Introduction
Good health is a necessity for all individuals because it determines their quality of life and productivity. The government takes necessary measures to ensure that the community has healthy living. Nevertheless, health disparities among communities living in New York, a city that contributes significantly to the American economy, continues to be a persistent problem. The government needs to have adequate information about the communities living in the city to plan and implement evidence-based health programs to improve residents wellbeing. Structural racism has been a contributing factor for the development of impoverished neighborhoods with limited access to health-promoting resources. Therefore, policy makers need to have communities health profiles to address the disparities and dismantle unjust plans and practices that lead to poor health. Health assessment of New Yorks Chinatown can help identify a problem affecting the community and discuss resources and possible interventions.
New Yorks Chinatown is a community dominated by people from South Asia, including Chinese. The neighborhood was selected because it is one of those who experience various health inequalities in NYC. Additionally, dominant residents are one of the minority groups in the United States, comprising individuals, some of whom are unregistered immigrants. Further, the community is prone to various social, economic, and health issues. Different streets are used to explain New Yorks Chinatown location, including Essex Street and Lafayette Street to the east and west, bordering Lower East Side and Tribeca, respectively. To the north, the community reaches Grand Street, overlapping or bordering Little Italy. At the same time, southeast and southwest limits are East Broadway and Worth Street, touching Two Bridges and Civic Center.
The community health assessment will focus on the adult population that has a significant role in the community because they engage in income-generating activities to pay rent, healthcare services, transportation, and buy food and clothes. The assessment will help collect the communitys information about their health status, problems, and needs. The information gathered through the community assessment will serve as an instrumental tool for developing a health improvement plan. It will also justify the allocation of a specific amount of resources to a particular area to optimally meet the communitys needs.
Demographics of New Yorks Chinatown
Social and Economic Conditions
Education, economic stress, violence, and helpful neighbors are essentially social and economic conditions that influence individual and community health. According to NYC Department of Health and Mental Hygiene (2018), NYCs Chinatown comprises 36% Asians, 30% whites, 25% Latinos, 7% African Americans, and 2% others. Moreover, 87% of the population are more 18 years and 24% of adults aging 25 years and above have not reached high school. Those who have reached school and attained some college education are 28%, while college graduates are 48%. The rate of those who never completed high school in the community is higher than NYCs average rate of 19%. Thus, more adults in the community are at risk of poor health.
Poverty, unemployment, and rent burden are important factors that define the communitys economic stress. The data from NYC Department of Health and Mental Hygiene (2018) indicate that 18% of NYCs Chinatown residents live in impoverished neighborhoods, limiting their healthy options and access to health-promoting resources and quality health care. Additionally, the communitys unemployment rate is approximately 9%, similar to the average level in NYC, and households use more than 30% of their income to pay rent. Most of them may not afford better health care, clothing, and healthy food. Further, the rate of assault-related hospitalizations is low in the community at 42 per 100,000 individuals. Conversely, 66% of residents believe that their neighbors are helpful, indicating strong social connections that positively impact health. Therefore, rent burden is a significant issue impacting health of the NYCs Chinatown.
Housing and Neighborhood Conditions
The environment is one of the essential factors that determine whether individuals lead healthy lives or not. According to NYC Department of Health and Mental Hygiene (2018), air pollution in NYCs Chinatown is 8.9 micrograms/cubic meters, higher than the average rate of 7.5 in New York City. Moreover, housing quality is the community is poor because 64% of rented homes are not adequately maintained. They have different defects, such as cracks, heating breakdowns, peeling paints, and holes. Equally, 36% of the residents report seeing cockroaches in their houses. The community is at increased risk of contracting respiratory-related illnesses.
Pedestrian and bicycle lanes and food environments are also components of neighborhoods that influence community health. The NYC Department of Health and Mental Hygiene (2018) note that 36% of NYCs Chinatown has well-established bicycle and pedestrian lanes, which is higher than the average rate of 10% in New York City. Residents have more comfortable and safer access to these lanes, reducing pedestrians number because of injuries. Additionally, NYCs Chinatown hosts four of the citys farmers markets, and supermarkets ratio to bodegas is 1:18. Therefore, the community has easier access to healthy food options at affordable prices.
Healthy Living
Physical activity, self-reported health, smoking, and diet comprise factors that define healthy living. According to NYC Department of Health and Mental Hygiene (2018), the communitys adults who report having good health are 70% compared to the average 78% rate in NYC. Moreover, approximately 77% of adults in NYCs Chinatown engage in at least one physical activity within 30 days. Additionally, 88% of the residents take at least one serving of healthy foods such as fruits and vegetables. Further, 16% and 20% of the adults consume at least one 12-ounce sugary drinks daily and are current smokers, respectively. The rate of adult smokers in the community is higher than the NYC average rate of 14%. Therefore, smoking is one factor that increases the communitys risk of health conditions like cancer.
Health Care
The rate of adult residents in NYCs Chinatown without health insurance cover is significantly high. According to NYC Department of Health and Mental Hygiene (2018), 11% of adults have no health insurance cover. Additionally, 8% of adults go without necessary medical care for 12 months. These rates do not differ much from the average prevalence of 12% and 10% in the city. However, the number of avoidable and fall-related hospitalization among the community adults is higher at 1207 and183 that 1033 and 1604 per 100,000 individuals in NYC. Conversely, the rate of vaccination against diseases such as influenza among adults in the community is 47%, 4% higher than the average rate in NYC. Thus, appropriate measures are necessary to reduce the number of avoidable and fall-related hospitalization in the community.
Health Outcomes
The communitys health outcomes can be defined by the prevalence of hypertension, diabetes, obesity, psychiatric hospitalization, binge drinking, and premature death. According to NYC Department of Health and Mental Hygiene (2018), the rate of obesity and hypertension is 10% and 22%, lower than NYCs average prevalence. However, diabetes among adults is 11%, similar to the average rate in NYC. Additionally, Psychiatric hospitalization among adults is 632 per 100,000 individuals, and binge drinking is 23%in the community NYC Department of Health and Mental Hygiene (2018) adds that cancer causes most premature death, followed by heart disease among the community and NYC. The rate of premature death due to cancer among adults in NYCs Chinatown is approximately 421 per 100,000 people. The main types of cancer contributing to these deaths are liver, lung, and colorectal ones. Indeed, cancer is a health problem in this community and can be associated with smoking and binge drinking.
Cancer as the Communitys Health Problem
Cancer is a health condition that affects any part of the body. It starts when abnormal cells grow faster than normal ones, making it hard for the body to function as it should. Successful cancer treatment is possible if the therapy commences at the diseases early stages. There are different types of cancer, named depending on the part of the body affected, such as breast, lung, and colon (American Cancer Society, 2015). Although all cancers are alike, they differ significantly in the way they grow and spread. Some types of the illness grow and spread faster than others. Moreover, cancers respond to treatment differently, where some require a simple surgical operation, chemotherapy, and other combinations of more than one therapy.
Causes, Symptoms, Stages, and Treatment of Cancer
Cancer is associated with numerous possible causes, including carcinogens, genetics, environmental factors such as exposure to a hot sun, and lifestyle habits. For instance, lifestyle habits such as smoking and binge drinking are possible causes of liver, colon, and lung cancers that affect NYCs Chinatown community. Cancer stages are defined by how far the disease has spread from where it started. The stages can be 1, 2, 3, or 4, and knowing the disease phase helps doctors decide the appropriate treatment (American Cancer Society, 2015). If clinical tests reveal that the cancer is at a lower phase, that is, stage 1 or 2, it means that the disease has not spread very much. The higher phase (stage 3 or 4) is an indication that the disease has spread more and affected other body organs.
The common symptoms of cancer include unexplained weight loss, unexplained lumps, night sweats, irregular bowel patterns, unexplained pain, and fever. Radiation, medicines, and surgery are the common treatments involved in cancer therapy. Doctors can use more than one type of treatment, depending on stage and type of cancer (American Cancer Society, 2015). Different types of drugs, such as hormone and target therapy, immunotherapy, and chemotherapy, are used to kill or limit cancerous cells growth. Radiation treatments such as X-rays are also effective in killing cancerous cells.
Effects of Cancer on the Communitys Health
Cancer hurts individuals and families wellbeing from point of diagnosis to the entire process of treatment. Cancer patients can suffer from psychological conditions such as depression and anxiety disorders when told they have the disease. They may have difficulties executing their daily activities, including exercise and eating healthy food, which can lead to deterioration of their health. The pain associated with cancer can also have adverse effects on patients well-being (Okamoto et al., 2012). Additionally, cancer treatments have side effects such as fatigue, vomiting, and pain, affecting patients health and quality of life. Okamoto et al. (2012) add that families psychological wellbeing is affected due to distress associated with caregiving roles. Yabroff et al. (2011) indicate that economic burden because of cancer treatment costs decreases families ability to buy healthy food and seek appropriate healthcare services. Indeed, the communitys well-being and economic status can deteriorate if prevalence of cancer is not contained and reduced.
Resources Available to Help the Community Deal with Cancer
Cancer treatment centers, cancer control and prevention, educational, and cancer screening programs are resources available in NYCs Chinatown to help deal with the disease. The government provides resources in collaboration with private and community organizations. Mount Sinai Doctors Chinatown, 168 Center Street, NY10013 and Advanced Oncology Chinatown, 139 Center Street, NY 10013 are critical healthcare facilities that provided the community cancer care. For instance, Advanced Oncology offers early as well as progressed stage treatments for cancer and holistic primary care.
Educational programs about cancer are provided in healthcare facilities by community health workers. These programs focus on sensitizing the community about the importance of cancer screening, risk factors, and preventing the disease through a healthy lifestyle. The screening programs are sponsored by the government and non-government organizations to facilitate early cancer diagnosis and commencement of treatments. Additionally, it helps identify individuals with late-stage cancer and recommend appropriate treatments.
Cancer services program (CSP) and cancer consortium are examples of government and community-sponsored resources that help address the problem of the disease in the community. CSP offers free diagnostic and screening services for different types of cancer to eligible residents in the community. The services are provided through local health centers, clinics, hospitals, and doctors offices in Chinatown. Conversely, cancer consortium is a voluntary network comprising more than 200 organizations and individuals in New York ( New York State Cancer Services Program , 2016). Cancer consortium helps develop and support the implementation of a cancer control plan to reduce the diseases burden in the community. The organization also shares with the community essential information about cancer control and prevention activities.
Recommendation for Cancers Primary, Secondary, and Tertiary Level Interventions
Education about risk factors for cancer and healthy living is an essential intervention at the primary level. The government should develop more education programs in NYCs Chinatown to ensure that the community knows various cancer risk factors for cancer such as smoking and alcoholism, among others, and how they can avoid them. Notably, smoking and excessive alcohol drinking are critical contributors to lung, liver, and colon cancer in the community. Equally, the programs will help the community learn healthy lifestyles, such as exercising and eating nutritious foods to minimize risks and manage them.
Secondary level interventions necessary to deal with the health problem are regular screening tests and exams in public places and follow up programs for patients diagnosed with cancer. On the one hand, the screening program targeting public areas will ensure that many vulnerable individuals who otherwise would not have been tested are reached. The program will increase the number of cases detected at early stage and help prevent adverse effects and costs associated with advanced cancer stages. On the other hand, follow-up programs will help community health nurses ensure that patients diagnosed with illness adhere to medications, diet, and exercises to prevent further spreading of the disease or develop new types of cancers.
Recommendable tertiary level interventions are the development and implementation of cancer management programs and establishing support groups. The management programs should focus on patients with advanced-stage cancers to help them relieve pain and live a comfortable life. The programs should integrate different stakeholders to provide patients with treatments, psychological, emotional, and spiritual support. Support groups will comprise cancer patients and survivors, allowing share their experiences and strategies to live well with the disease. The groups make patients feel that they are not alone, and someone else is in a similar situation, minimizing risks for depression and anxiety disorders.
Role and Responsibility of Government, Families, Individuals, Health Systems, and Educational Facilities
The governments role and responsibility are to provide the community with public healthcare facilities and equipment. A significant number of NYCs Chinatown cannot afford to seek cancer care services from private hospitals. Therefore, the government ensures that the community has accessible public healthcare facilities. Additionally, it equips these facilities with screening and testing kits, medicines, as well as machines for radiotherapy and surgical procedure treatments. The government also creates an environment that reduces tobacco use, promotes healthy nutrition and physical activities through regulations, support, and education programs (Brawley, 2017). Health systems primary role and responsibility are to assess community needs and develop and implement intervention plans, targeting vulnerable and affected population. Health systems provide cancer screening, treatment, and prevention interventions to the community.
Individuals have to go for regular cancer screening to ensure the diagnosis of the disease. Those diagnosed with cancer have to adhere to medication to manage the disease and prevent its spreading effectively. Equally, vulnerable individuals should lead a healthy lifestyle and avoid things that increase their cancer risks, such as carcinogenic products, smoking, and excessive drinking of alcohol. Families are instrumental in supporting patients diagnosed with cancer. They provide the patients with moral support, take them to hospitals, remind them about medication and adherence to a healthy lifestyle, and help them do their daily activities. Educational facilities teach the students about cancer, risk factors, and their impacts on individuals, families, society, and the economy. Moreover, the facilities teach them strategies for minimizing risks for cancer.
References
American Cancer Society. (2015). What is cancer? Cancer.org. Web.
Brawley, O. W. (2017). The role of government and regulation in cancer prevention. The Lancet Oncology, 18(8), e483- e493.
New York State Cancer Services Program. (2016). New York State Department of Health.
NYC Department of Health and Mental Hygiene. (2018). Manhattan community district: Lower East Side and Chinatown [PDF document]. Web.
Okamoto, I., Wright, D., & Foster, C. (2012). Impact of cancer on everyday life: A systematic appraisal of the research evidence. Health Expectations, 15(1), 97- 111.
Yabroff, K. R, Lund, J., Kepka, D., & Mariotto, A. (2011). Economic burden of cancer in the United States: Estimates, projections, and future research. Cancer Epidemiology Biomarkers & Prevention, 20(10), 2006- 2014. Web.
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