Assessment Paper for Community Health Nursing
Community Assessment of New York City
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Community Assessment of New York City
Different individuals and communities across the globe experience various issues based on their location, political, economic and social conditions as well as the availability or access to public support services. Community assessment defines the process conducted to identify the assets, strengths, needs and challenges of a specific community within a city or region (Smathers and Lobb, 2020). Assets, in this case, refer to the talents, skills, and abilities of different individuals and also resources that local institutions and organizations provide for the community. By assessing the community needs, an individual or a leader understands the sectors that should be improved and how and which area need more resources, whether it is the entire city or one neighborhood. It also helps to engage the community members and potentially establish new community partnerships. This case will focus on assessing the community needs, mainly health needs, in the community in New York City.
Defining the Community
New York City (NYC) or simply New York is one of the largest and most populous cities in the United States. By 2019, it had an estimated population of almost 9 million individuals, though this number has significantly dropped because of the coronavirus infections. The city occupies about 302.6 square miles or 784 kilometres squared. It is located in the Southern tip of U.S. state of New York and is at the centre of New York metropolitan area, the biggest metro area globally by urban mass. According to Kang et al. (2020), the city has five counties and 59 community districts, and demographics and health disparities vary significantly across the city. Some neighborhoods are wealthy with better houses and facilities, while some are poorly managed and developed. The city has been described as the financial, culture, and media capital worldwide profoundly influencing entertainment, commerce, technology, research, education, art, tourism, sports, and fashion. The headquarters of the United Nations is also in New York. The city has a diverse population with multiple ethnic groups with whites as the main residents in New York, with over 10 million individuals. Hispanics and Latinos are about 3.7 million, while African Americans are approximately 2.7 million (Duffin, 2020). There are also about 1.6 million Asians and approximately 42,000 America Indians.
Education in New York is provided in a vast number of public and private schools, where some schools offer scholarships to students from all over the world. It has some of the best schools, libraries, universities and research centres globally. These are many well educated with Bachelors and Masters degrees. Thus, they can get good positions in some of the biggest companies in the city. The birth rate in the city by 2016 was at 58.6 per 1,000 women between 15 to 44 years. There were 117,013 live births in 2017, according to the New York Department of Health and Mental Hygiene (2017). The death rates decreased from 575.4 to 545.7 per 100,000 individuals. Currently, the city is experiencing higher death rates because of Covid-19, especially among individuals between 45 to 74 years old (Elflein, 2020). A significant number of individuals in the city have health insurance as long as they have different documents such as social security members to show that they are residents in New York City and citizens of the United States of America. The city offers low-cost health insurance programs, including Medicaid for individuals and families with low income and Child Health Plus insurance for children under 19 years. There Qualified Health Plans is private insurance, for individuals in New York State who are not eligible for Medicaid. New York has a large population, and the minimality of resources could lead to various health problems for different individuals. The community assessment, in this case, aims to assess the health needs in the community in New York City. This assessment can be used to inform decisions made for the health sector in the city. The information will be obtained from online sources and also from research through windscreen surveys and focus groups.
New York City is one of the most expensive cities in the world where living standards and health costs are significantly high. Sales of homes in the United States has increased, especially in big cities such as New York. This leads to financial constraints for individuals with low incomes leading to many individuals not gaining access to certain health care services which results in more chronic illnesses and minimal functioning in the community. In essence, the environment in which individuals are born into, lives and works profoundly influences their health and overall life expectancy. The populations in New York contain some of the most marginalized groups most likely to experience poverty. Individuals living in poverty experience continued exposure to harmful substances which lead to cycle-driven health equity challenges and illnesses, including poor birth outcomes, diabetes, airways problems, heart diseases and hypertension.
More precisely, according to the Centres of Disease Control and Prevention (CDC), 2019), heart disease and cancer are some of the leading causes of deaths in the population in New York followed by accidents and chronic diseases including diabetes and hypertension. In 2017, 44,092 individuals died from heart disease while 34,956 died from cancer (CDC, 2019). More individuals also die from stroke, pneumonia, Alzheimer’s disease and septicemia. Currently, the leading cause of deaths is the coronavirus with thousands dying from the disease every day. Nevertheless, the United States had been working on the Healthy People 2020 initiative, which aims to improve and build a healthier nation (Centres for Disease Control and Prevention, 2018). This initiative could help to solve some of the leading health issues in New York.
One of the airways or respiratory issues experienced by the people in New York is asthma. Asthma is also chronic and affects about 170,000 children in the city (DiNapoli, 2014). It is the leading cause of inpatient admissions. Nonetheless, there are barriers to treating asthma, especially among homeless or undocumented individuals. Mental disorders are also common health issues in this community caused by genetic or environmental factors such as trauma and stress. As a highly developed and expensive urban area, some of the common problems contributing to the increased mental health issues include poverty, discrimination due to gender, race, or socioeconomic status and noise and air pollution. There are over one million individuals with mental illnesses, collective of general anxiety disorder, schizophrenia, bipolar disorder, major depressive disorder, and obsessive-compulsive disorder. These issues significantly affect the health, lives and overall wellbeing of the community. Increased stress and poverty levels have also driven many New Yorkers to abuse drugs and alcohol. This behavior has increased homelessness, poverty, violence both at home and on the streets and various substance use disorders.
Additionally, more than a third of the overall adult population in New York has pre-diabetes or Type 2 diabetes, and the numbers increase yearly. This health problem is common in the city due to the increased number of the aged population, obesity and inadequate physical activities among New Yorkers (Thorpe et al., 2018). The disease is most common among Hispanics and Blacks who pay little attention to their lifestyle, mainly their eating behaviors. Another health concern is the rapidly increasing ageing population in New York. By the age of 65, most of the individuals in this group have chronic illnesses which increase the risk for mobility and cognitive decline. Older individuals also experience other complexities around their financial and living situations that may significantly impact their health. The above health concerns create the need for the city and community to develop strategies to improve the overall health of individuals and reduce mortality rates in the city. Public health agencies in the U.S. find it challenging to allocate funding and resources in different cities and neighborhoods. Resource allocation is crucial to public health policy since it involves managing and improving the health of individuals. It is even more difficult for bigger cities like New York, where funds are minimal but more health concerns. According to Kang et al., 2020), the NYC Department of Health and Mental Hygiene (DOHMH) uses a local approach to address public health concerns at the neighborhood level. The above data and severity of specific health concerns inform on the allocation of resources in the community districts.
Assessed Community Health Needs
The increasing aging population continues to be a health concern for the community in New York City as it leads to other issues including diabetes, hypertension, decreased mobility, cognitive decline and other physical conditions that hinder individual normal functioning. As illustrated above, other health concerns in New York City include heart diseases, obesity, alcohol and substance abuse disorder, cancer, asthma, diabetes, stroke, accidents, pneumonia, hypertension, diabetes, Alzheimer’s diseases, mental disorders and septicemia. Though birth rates are relatively high, death rates are much higher due to the increased health problems and different kinds of accidents that cause injuries and death. Also, populations in New York experiencing most of the health problems are adolescents and youths, individuals with food insecurities, domestic violence survivors, homeless individuals, immigrants with no insurance or access to health care services, incarcerated individuals and gender variant individuals facing discrimination in the community. The city must address the above issues impacting the lives of individuals in the community to improve the overall health in the community. Facilities such as the NYC Health + Hospitals can help to identify and address the health issues experienced in the community.
A windshield survey refers to an informal survey where health professionals drive around a specific community they are researching and record their observations. A windshield survey was used to collect relevant data on the growing and already developed neighborhoods in New York City. From the observations, there are many ongoing construction sites within the city, with new neighborhoods, apartments and homes being built. Buildings, including office and apartment buildings, are closely built in modern styles and materials such as glass and bricks. The streets are well maintained, but some neighborhoods have more wastes, mainly near manufacturing industries, hospitals and factories. Burning these waste materials have led to air pollution, causing asthma. There are also liquor stores and food trucks within the city. Thus, how can individuals experience healthy changes when they are only exposed to alcohol, bad quality food and cigarettes.
From the observations, there are more wheelchairs on the driveways than bicycles. This means that at least one individual in a home uses a wheelchair due to deteriorated health or from aging. Lack of enough exercises through running and cycling has also led to poor health in the community. The city is also densely populated with many unemployed and homeless individuals seen sleeping on the streets and shelters. Most of these individuals cannot afford health care costs, leading to more chronic and mental health cases from stress and unhealthy diets. The survey showed that there are multiple health care facilities, including general hospitals and private clinics. Nonetheless, health care is costly, and the many low-income families cannot afford it worsening their health conditions. These facilities, however, greatly helps to improve the overall health of the community through charity programs and accepting low-cost insurance programs, including Medicaid.
The research used focus groups of seven individuals from different neighborhoods within the city to get clear insights into the issues affecting the community and how the authorities have responded to those issues. From the findings, about 50% of the participants complained of being in poor health in most time of the year. The research shows that some of the significant health issues include obesity in youths and adults, which leads to other problems such as diabetes and heart diseases. Hence, many individuals are using canes and walkers by the time they reach 60 years. Many children are also obese, which significantly affects their health and functioning. About 70 percent of the participants in the focus groups complained of the increased asthma cases in the city caused by air pollution from increased construction sites and waste gases from the factories. Asthma patients are treated in the hospitals and discharged, but when they go back home, they are exposed to dust and other triggers, making the condition even worse. Also, economic pressures experienced by many New Yorkers from job loss leads to stress and other mental issues and ultimately violence and family breakdown since the household cannot keep up with the increasing living expenditures and expensive housing. The participants claim that they have seen their neighbors becoming homeless after losing their jobs. Homelessness is also another factor that substantially influences the health of individuals, mostly psychologically or mentally and emotionally.
New York City is one of the biggest cities, not only in the United States but also the world. Although there have been great advancements in the health of New Yorkers, not all individuals or groups have access to quality health services, leading to poor health outcomes in the overall community. Some of the common problems affecting the community include heart disease, asthma, hypertension, diabetes, obesity, substance use disorders, mental illnesses, cancer and different kind of accidents. Nevertheless, these conditions can be prevented and managed to improve the community’s health outcomes. The city should raise awareness on the importance of maintaining healthy lifestyles to avoid health issues such as obesity and diabetes. Also, it should provide free health care services to enable homeless and low-income families to gain access to quality health care services to reduce the occurrence rates of chronic illnesses to reduce the mortality rates in the city. In a time when the city is highly affected by coronavirus disease, the public health facilities backed up by the CDC should provide sufficient protective gears such as face masks to minimize the spread of the virus. Fundamentally, the state should develop better strategies to improve the health of individuals from different neighborhoods within the city regardless of their socio-economic backgrounds or ethnicity.
Centres for Disease Control and Prevention. (2018, October 31). Healthy people 2020. Centres for Disease Control and Prevention. https://www.cdc.gov/dhdsp/hp2020.htm
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DiNapoli, T. P. (2014). The Prevalence and Cost of Asthma in New York State. New York State Comptroller.
Duffin, E. (2020, September 15). New York: Population, by race and ethnicity 2019. Statista. https://www.statista.com/statistics/306042/new-york-population-ethnicity-race/
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Thorpe, L. E., Kanchi, R., Chamany, S., Rodriguez-Lopez, J. S., Chernov, C., Freeman, A., & Perlman, S. E. (2018). Change in diabetes prevalence and control among New York City adults: NYC Health and Nutrition Examination Surveys 2004–2014. Journal of Urban Health, 95(6), 826-831.