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Bronx Health Disparities

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Submitted By sandranaka
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Health Disparities in the Bronx and New York City
A.H. Strelnick, MD
Department of Family & Social Medicine
Albert Einstein College of Medicine
(These slides were provided by Dr. Jane Bedell, Assistant
Commissioner, South Bronx District Health Office,
New York City Department of Health & Mental Hygiene)

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, 1948
(the Definition has not been amended since 1948)

What is Public Health?
Public health is the science and art of preventing diseases, prolonging life, and promoting health through the organized efforts of society.

Smoking Prevalence in the Bronx, 2002
35

Healthy People 2010 Goal: 12%

30

25

25

29

25

25
22

20

20

17

15
10
5

NY
C

Br on x

Br on x h So ut Pk

rd ha m
-B
ro nx Fo

Pe

lh a m
-T
h

ro gs Ne c k

ge sb rid
Ki
ng

NE

Br on x

0

NYC Smoking Reduction 2002-2004
6.2%

10.0%
5.0%

-5.1%

-15.0%
-20.0%
-25.0%

-18.7%

-18.9%
-23.1%

Staten
Island

Queens

Manhattan

-10.0%

Brooklyn

-5.0%

Bronx

0.0%

2002-2004 decline

Cancer Screening in the Bronx vs. NYC, 2002
Bronx
100

NYC

Healthy People 2010 Goal: 90%

80

85
78

80

77

60
50

49
40

20

0
Colon Screening

Mammogram

PAP Smear

HIV & AIDS Cases in the Bronx, 2003
25000

20000

19504

15000

10000

5000
774
0
# Living w/HIV & AIDS

Figures as of 9/30/2003

# New HIV Diagnoses

Rates of People Living w/HIV & AIDS in the Bronx vs. NYC vs. US, 2001
18

17.0

17.0

15.6

16

Rates per 1,000 Population

14
12

11.1

10.7

9.2

10
7.9

8
6

5.1
3.9

4

3.2

2

Figures as of 12/31/01

S
U

YC
N

ro nx B

lh rd am ha m
-B
ro nx C
Pk
ro to na
-T
re m on t H un ts
Po
in t H ig hb r id ge Fo

Pe

Br on x
E
N

K

in g sb rid ge

0

Rates of New HIV Diagnoses in
The Bronx vs. NYC vs. US, 2001
2.5

2.3
2.1
1.9

Rates per 1,000 Population

2.0

1.5

1.3

1.2
1.0

0.8

0.8
0.6

0.5

0.3

0.1

Figures as of 12/31/01

S
U

YC
N

ro nx B

lh rd am ha m
-B
ro nx C
Pk
ro to na
-T
re m on t H ig hb r id ge H un ts
Po
in t Fo

Pe

Br on x
E
N

K

in g sb rid ge

0.0

Obesity Prevalence in NYC
2002, by UHF District

Percent of Overweight NYC Residents
(BMI > 25), by Borough, 2003
% Overweight (BMI > 25)

70

64

60
50

52

53

Queens

Staten
Island

57

53

44

40
30
20
10
0
Manhattan

Brooklyn

Bronx

NYC

Percent of Obese NYC Residents
(BMI > 30), by Borough, 2003
% Obese (BMI > 30)

30
25

23

20
15

18

24

19

19

14

10
5
0
Manhattan

Queens

Staten
Island

Brooklyn

Bronx

NYC

Percent of Overweight Bronx Residents
(BMI > 25), by UHF District, 2003
70

62

68

63

62

64

60

53

49

50
40
30
20
10

h ou t

YC
N

ro nx B

B ro nx

k
P
S

E
N

rd ha m
-B
ro nx Fo

el ha P

B ro nx

k
N
ec ro gs

m
-T
h

in g sb ri d

ge

0

K

% Overweight (BMI > 25)

80

Percent of Obese Bronx Residents
(BMI > 30), by UHF District, 2003
30
23.0

25.0

24.0

23.0

19.0

20
15.0

15
10
5

Fo

YC
N

ro nx B

Br on x h So ut Br on x
E
N

in g sb rid ge rd ha m -B ro nk
Pe
Pk lh am
-T
hr og s
Ne
ck

0

K

% Obese (BMI > 30)

25

27.0

Prevalence of
Diagnosed Diabetes in NYC
2002, by UHF District

Percent of NYC Residents with Diagnosed
Diabetes, by Borough, 2003
14
12.0

% w/Diagnosed Diabetes

12
10
8.5

9.1

9.7

9.0

8
6

5.6

4
2
0
Manhattan

Staten
Island

Queens

Brooklyn

Bronx

NYC

Percent of Bronx Residents w/ Diagnosed
Diabetes, by UHF District, 2003
20

18.0

16
14
12

11.0

10.0

10

12.0

11.0

9.0

8
5.0

6
4
2

YC
N

ro nx B

Pk

Br on x h So ut E
N

rd ha m
-B
ro nx Fo

lh a Pe

Br on x

k
Ne
c ro gs

m
-T
h

in g sb rid ge

0

K

% w/Diagnosed Diabetes

18

Percent of All Bronx Adults Who Report One or More Binge Drinking Episodes, 2003
>5 Drinks per Month (by UHF District)
16
14.0

14
12

11.0
9.9

9.4

10

11.0
9.7

8
6

5.0

4
2

lh a m
-T
h

YC
N

ro nx B

ro gs Ne c k

Pk
Pe

rd ha m
-B
ro nx Fo

Br on x h So ut sb rid in g K

N

E

Br on x

ge

0

Hospital Admissions
Related to Mental Disorders
Age adjusted rates per 10,000 population, excluding alcohol-related, by UHF Neighborhood, 2000
Hospitalization Rate per 10,000 Population

120
99.3

100

87.5

99.5

90.5

80
60

55.8

52.9

69.4

62.5

66.5

40
20

YC
N

ro nx B

on rd t ha m
-B
H ro ig nx h
B
Pk rid ge
-M
H or un ris ts an Po ia in t-M ot tH av en ro to na
-

Tr em Br on x
N

sb rid in g K

E
C

Fo

Pe

lh a m
-T
h

ro gs Ne c k

ge

0

Teen Pregnancy in NYC, 2000
(by UHF Neighborhood)

NYC Teen Pregnancy Rates
1996-2000, by Year & Borough of Residence per 1,000 females age 15-19

200

150

100

50
1996
Manhattan

1997
Bronx

1998

1999

2000

Brooklyn

Queens

Staten Isl.

Adolescent Pregnancy Rates in the
Bronx, U.S., and Europe
150

137.2
79.8

100
50

20.2

16.1

8.7

France

Germany

Netherlands

0
Bronx

United
States

Rate of pregnancy per 1,000 w om en ages 15 to 19

Too Few People are
Getting Flu Shots, 2003

Influenza Immunizations in Past 12 Months
*only people aged 50 and over
Healthy People 2010 Goal: 90%

100

60

56

53

48

46

56

52

48

40
20

YC
N

ro nx B

Pk

rd ha m
-B
ro nx h

sb rid in g K

So ut ge

k
Ne
c

Br on x

Fo

Pe

lh a m
-T
h

ro gs E

Br on x

0

N

% Immunized

80

Flu and Pneumonia Vaccinations by Bronx Neighborhood, 2003
*only people aged 50 and over

Flu vaccinations in past 12 months 80

% Immunized

100

Pneumonia vaccinations in lifetime 56

60

56
42

46

40

53

48

40

39

35

52

48
37

32

30

20

lh a YC
N

ro nx sb rid in g K

B

ge

k
Ne
c

m
-T
h

ro gs Br on x h Br on x
E
N

So ut Pe

Fo

rd ha m
-B
ro nx Pk

0

Gender and Racial Disparities in
Vaccinations, Bronx, 2003

Influenza Immunizations in Past 12 Months
*only people aged 50 and over
100

Healthy People 2010 Goal: 90%

% Immunized

80

60
49

53

55

59

42
37

40

20

0
Male

Female

White

Hispanic

Black

Asian

Gender and Racial Disparities in Vaccinations, Bronx, 2003

Pneumococcus Immunizations in Lifetime
*only people aged 50 and over
100

Healthy People 2010 Goal: 90%

% Immunized

80

60
44
40

35

39

38
31
24

20

0

Male

Female

White

Hispanic

Black

Asian

Trends in NYC Asthma Hospitalizations
Rates per 1,000 persons, 1990-2000, All Ages
Rate per 1,000 Persons

6
5.1

5
4
3

4.6
4.0

4.3

4.6

4.6

4.7
4.3
3.7

4.0

3.4

2
1
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Asthma Hospitalizations in The Bronx
Hospitalization rate of children under age 15, per 1,000 population, by UHF neighborhood, 2002

14
11.7

12
10

9.0

8.8

10.0

9.4

10.1

9.7

8
6.0
6

4.8

4
2

B

YC
N

x ro n
B

on t re m on aT ro t C

rid ge -M or ri sa ni a Pk ig h
H

Fo

rd ha m

-B

ro n N

Pe lh am

-T

hr og s

tH t-M ot
P
un ts H

x

ec k av en ro nx B
E
N

K

in g sb ri dg e 0

11.69

12

10.05

10
8
6
4

8.98

6.02
3.08
1.72

2

Hunts
Point-Mott
Haven

High
BridgeMorrisania

CrotonaTremont

(excluding NYC)

NYC

NYS

0

US

Rate per 1,000 Population

Asthma Hospitalization Rates in Children
Aged 0-14 in NYC, US, and South Bronx
(2002)

Hospitalization rates for children in South Bronx (ages 0-14) have gone down over the past 5 years rate per 1000 children

25
20
15

22.49
18.53
16.16
11.69

10

10.05

8.98

9.43
6.02

5
0
CrotonaTremont
27.2% decrease

High Bridge- Hunts PointMorrisania Mott Haven
45.7% decrease

60.1% decrease

NYC
36.2% decrease

1997
2002…...

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Health Disparities Summary

...     "What are the differences in quality of care between the U.S. free markets based system as compared to the universal health insurance program offered in Canada?" Introduction A little over five decades ago, Canada and the United States had very similar health care systems. Today however, they are very much different but rapidly growing closer in similar views and a universal health system. The Canadian system is more than ninety percent publicly financed, whereas the U.S. is funded primarily through private vectors. What is less clear is whether the two different health care systems produce differences in the quality of care for their respective populations. Quality of care is the fundamental goal of health care, yet it is difficult to define. It is a concept that health care policy and programming strives for, and that many have attempted to elucidate. Given its many components and manifestations, defining and quantifying quality of care, in the context of health, is extremely difficult. (Rhee, 1987, p.11) Canada has a universal system that insures every citizen yet there lies disparities within a common group, the Aboriginals.  The U.S. has a free market health system that only provides to those citizens covered yet the U.S. spends almost double on health care than Canada; noted that health disparities among U.S. citizens are among the worst in the nation.  Studies show that the quality of care in the U.S. rank higher than the quality......

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