Welcome to the Mailman School of Public Health!

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The Mailman School of Public Health is one of the most prestigious public health schools in the country. With most students and faculty dedicating themselves to the study of health across populations and communities, it seemed like the perfect place to begin to discuss the health patterns in our neighborhood and patient population in comparison to New York City overall. Here we can also begin to discuss how the characteristics of our community affect their health on a larger scale and start to investigate the possible etiologies of these trends.

The Numbers

Let's look at the prevalence of different health issues and health indicators here in WaHI and compare it to the rest of New York City.

Chronic Illness

Overall, chronic illness in WaHI is higher than in New York City. Both high cholesterol and depression are significantly higher in our community. Hypertension and BMI are comparable across WaHI and NYC, with WaHI being only slightly higher.(24)

The most prominent difference on this graph is the much higher prevalence of diabetes in our community: 13.8% in WaHI as compared to 9.3% in NYC. For comparison, the overall prevalence of diabetes in the United States is 8.3% according to the American Diabetes Association. Following this statistic, slightly more than 1 in 8 adult patients seen in our center suffer from this disease.(25, 2)

Taken together, our patients are more likely to have chronic illness than if we practice in another part of the country, let alone another area of NYC. As medical students who will be caring for this population, it is important to not only know these statistics but to discuss reasons why these numbers are so high and how we as health care providers can intervene.

In 2006, the NYC Department of Health started a city wide initiative called Take Care New York. It served to assess health indicators in relation to health goals based on nationwide guidelines. Each neighborhood had a health assessment and they then compiled community profiles. What they uncovered in WaHI may be a partial explanation for our higher rates of chronic disease. About 1 in 3 WaHI residents do not have a regular doctor (32%). In 2006, 20% of the WaHI was uninsured as compared to 18% of NYC. In 2010, the uninsured population in NYC went down to 16.7% while in WaHI , 27.3% of residents were now uninsured.(30)

What do these three statistics have in common? They reflect the access our patients in WaHI have to healthcare. Access to healthcare helps to prevent disease through screening, early diagnosis and early intervention. Having insurance is often times a barrier to care, particularly in communities with high immigrant populations such as ours. Once a patient has insurance, having a "medical home"-a regular doctor and usual office to get care, is imperative to preventing chronic illness. When patients do not have insurance or a regular doctor, the ED is where they often times will receive care. Not only does this lead to a disproportionate number of patients in the ED with primary care complaints, but when patients do present for true emergencies, they are often preventable through regular primary care. This is reflected in the fact that 1 out of 10 residents in WaHI sought care in the ED when they were sick or needed advice.(30)

These statistics help to explain why our patient population has such a high burden of chronic disease. What we can do as medical students is be aware of these statistics and advocate for our patients and our community. Helping to seek social services for our patients when we see them in the hospital through case managers and social workers is a great way to improve the overall health of our patients. Also, volunteering at organizations that help to provide care to the uninsured is another way to bridge this gap our community. You can read more about these opportunities at the P&S Club stop.

Exercise and Nutrition

Olson et. al, 2010

In this chart we can again start to see that WaHI has worse exercise and nutritional health indicators than greater NYC on average. WaHi residents eat less fruits and vegetables, despite the area having a walkable commute to fruits and vegetables and several farmer's markets in the area. They are also more likely to add salt to their food at the table, presumably hinting at increased salt intake which has been linked to hypertension . The most significant finding on this graph is the difference between NYC and WaHI in terms of sugary drink consumption. About a third of people in NYC have 1 or less than 1 sugary drink a day while in WaHI this number drops to 22.5%. Sugary drinks have been independently linked to poor diet quality, weight gain, obesity, and type 2 diabetes. Its link to diabetes is particularly concerning in our patient population, where diabetes prevalence is already very high. Overall, this chart seems to highlight characteristics of our community's behavior and diet as contributors to chronic disease burden.(25, 7)

These diet characteristics are helpful to know as providers because it can serve as a framework for nutritional counseling that is a common part of primary care visits. Knowing the prevalence of sugary drink consumption in our community can guide a question regarding our individual patient's soda or juice consumption. Being familiar with close by farmers markets and other accessible low cost fruits and vegetables can come in handy when a patient needs help accessing the food you are recommending they eat more of. To learn more about our local farmer's markets visit our next stop. Also, in order to make reasonable recommendations to our patients about what to change in their diet, it is important to know what that diet is. For instance, if you have a Dominican patient who is diabetic, perhaps instead of recommending they cut rice out of their diet (a main staple of Dominican cuisine), you may instead recommend they switch from white rice to a healthier brown rice. To learn more about typical Dominican food visit Margot Restaurant.

Another consideration to keep in mind is the socioeconomic situation our patients are in. We learned at the NYC Public Library that 31% of our community lives at or below the federal poverty level. Taking the example above, recommending brown rice instead of white is a great idea but depending on your patient's income, it may be out of their financial reach. Brown rice is 10-20% more expensive than white rice and harder to find in bulk. A more appropriate recommendation may be to prepare the food they already have in a healthier way (boil or steam vs. fry) and to moderate their portions.

We can help our patients by pointing out healthier and attainable food options while discouraging sugary drink and excessive salt consumption.

Preventative Measures

Olson et al, 2010

In this chart we are seeing a different overall trend than in the other two we have discussed. Here we see that when it comes to preventative screening measures, WaHI is comparable if not better than the rest of NYC in many of these categories. Pap screening is on par with the rest of NYC and breast cancer screening and HIV testing are actually better (25). What is happening in these areas that is giving our patients better access to these types of tests?

These numbers are likely attributable to many positive forces of change in this community in the last two decades. The AVON Foundation for Breast Imaging Center has been providing uninsured women in our community free mammograms and pap smears since 2006. Knowing that many members of the WaHI community are uninsured, this resource helps to take away this barrier to accessing appropriate care. Free HIV testing is provided by several different agencies in the area including the Department of Health Chest Center located on the corner of 168th and Broadway and the Washington Heights Corner Project in collaboration with Alianza Dominicana, a community based organization, and CUHRON .

These collaborations between national foundations, state-wide and local institutions, and community based organizations and clinics can lead to positive health outcomes and community growth. When these collaborations are between academic institutions like CUMC and community based organizations they are known as community academic partnerships. Through this type of symbiotic relationship, both community and academic centers stand to benefit and reach common goals, like improved health of our overall community. A great example just such a collaboration is the CHALK initiative!

Next Stop: Community Academic Partnerships