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DEPUTY BOROUGH YVONNE GRAHAM'S REMARKS FROM DIRECT FROM D.C. - THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES: ACCESSING RESOURCES FOR YOUR COMMUNITY CONFERENCE

Let me offer a warm Brooklyn welcome to all of you, and say how delighted I am to have the opportunity to partner with the Greater Southern Brooklyn Health Coalition in convening this tremendously important conference.

New York City is undoubtedly a microcosm of the world and continues to be the mecca for new immigrants from every corner of the globe. This blend of people from every country and race adds to the rich cultural and economic fabric of the city, making it like no other. While cultural diversity brings enormous benefits and opportunities, it also brings needs and challenges.

Health care policy makers and providers continue to struggle with finding ways of reducing and/ or eliminating health disparities among racial and ethnic groups.

The literature is replete with information establishing the fact that health care is certainly not a “one size fit all” and that in order to address the multiple needs of at-risk communities, a broad-based and coordinated approach must be used. It also supports the notion that partnership between government, the private sector, health professionals advocacy groups, the media and community-based organizations (CBO’s) is essential in health services delivery.

Historically, for many racial and ethnic groups, particularly immigrants, community-based organizations and faith-based institutions were a necessary response to the failure of government and large institutions to meet the needs of those groups. Partly because they are in a position to break down many of the barriers that prevent communities from accessing health care in a way that mainstream organizations simply cannot.

As our communities become more diverse, we have witnessed the proliferation of small grassroots, CBO’s and increased involvement of faith-based organizations in health care and social services delivery. Their major identifying characteristic is that they define health from a community perspective and, by so doing, they focus on cross-cutting prevention strategies, involving everyone in the community. They also serve to advocate for, increase access to, and/or provide health, social support and immigration-related services to their constituents. In this capacity, they are a critical link between the constituents they serve and the larger service delivery institutions.

In these times of fiscal constraints, many of these community-based organizations are now operating in a crisis mode, some have closed their doors, and others are on the verge of closing.

One of the pivotal aims of this conference is to highlight the role of CBO’s as essential partners in the spectrum of health care delivery and the challenges they confront, and to call for a shift in paradigm to allow for more innovative approaches to strengthen their capacity to help reduce health disparities.

My task this morning, is to provide some selected demographic, socio-economic and health-related data on New York City’s population, selected health indicators, and some information on community-based organizations, with the hope that it will serve as a contextual framework for the workshop discussion.

After seeing this data, the logical questions to ask are:

What are some of the reasons for these disparities?
What models of service delivery are most effective in reducing the disparities?

There are some well known risk factors associated with poor health such as:

Alcohol and substance abuse
Lack of access to health care
Insufficient physical activity
Poor nutrition
Poverty
Low levels of educational attainment
Violent and abusive behaviors
Unsafe sexual behavior and the like

But, there are also some persistent consumer and systems related barriers that impact on access to care - among them are an interplay between:

Consumer -Related

Economic issues resulting in inability to pay for care
English language proficiency
Cultural differences in seeking, accepting and using health care services
Immigration-related issues restricting access to care

Systems-Related

Untimely and inadequate statistical data to plan and develop effective interventions.
Lack of comprehensive, continuing and individualized care.
Unmet need for primary care.
Funding disparities in racial, ethnic and immigrant groups for culturally targeted programs.
Lack of a culturally competent public health workforce.
Punitive restrictions in immigration laws.

In a 1996 report from New York State Department of Health on opportunities to improve the health of New Yorkers, the department outlined some guiding principles for reduction in health disparities. A major priority area was the involvement of local communities based on the premise that neighborhood organizations and local communities are best suited to intervene in the causes of poor health.

Recognizing that local communities have long played a role in addressing the health of their constituents and are best suited to do so, it makes perfect sense for us to learn about:

The model they use
What are some of their best practices
What lessons can we learn from them
What challenges do they face, and
What tools and resources do they need to make them more effective

Reports and experiential information from CBOs show that:

CBOs have been successful in developing a model of care that meets of their constituents. This model is neighborhood-based and population specific, holistic, family oriented. The services are also culturally competent, confidential and immigration sensitive, and available at convenient hours.

Their employees reflect the characteristics of the population they serve, and understand the lay of the land.

Their programs are designed, developed, implemented and evaluated with consumer input.

They tend to take ownership of the problem and interest in the solution.

They compliment the mainstream service delivery system and are cost-effective.

Among the challenges they face are:
Limited organizational
Competing interests from larger institutions
Obliteration when there are shifts in policies and resources
Lack of long term government investment in programs which affect their ability to continue to provide needed services

The good news is that these are all problems that can be fixed if there is commitment form all sectors of our society to improve the quality of life for the underserved. This commitment involves helping CBO’s to address their most acute needs are such as:

Developing their leadership
Building capacity in order to maintain a competitive edge
Maximizing and leveraging resources to achieve self-sufficiency
Strengthening their capability to assess organizational and community needs, plan strategically and evaluate program outcomes.

That is why we have come together today, and I hope that during the course of the day, as CBO’s highlight their strengths, needs and challenges, our colleagues in government will see opportunities to partner with them to address the needs of our society’s most vulnerable. I firmly believe that by working together, there is nothing we cannot accomplish.

Population by Nativity
• The foreign-born population in New York City increased from 2.1 million in 1990 to 2.9 million in 2000, a new peak. The native born population, however, declined 2 percent, to 5.1 million in 2000.

• The share of the foreign born also increased to 35.9 percent of the city’s population in 2000, up from 28.4 percent in 1990.

• Of the city’s foreign born, over one-third lived in Queens, and another one-third in Brooklyn. Manhattan and the Bronx were home to 16 percent and 13 percent of the foreign-born respectively, while 3 percent lived in Staten Island.

Region of Birth of Foreign-Born
• Those born in Latin America and the Caribbean numbered over 1.5 million and comprised 53 percent of the foreign-born population. The Asian born were the second largest group constituting 24 percent of the foreign-born, while those born in Europe accounted for 19 percent of the foreign-born population. The African-born nearly doubled in size but accounted for just 3 percent of the foreign-born population.

Ancestry of NYC Residents
• Most European ancestry groups saw a decline in population. Those of Italian ancestry, for example, dropped 17 percent in the last decade, but remained the largest ancestry group, numbering 690,000 or nearly 9 percent of the city’s population. Those of Irish ancestry dropped by one-fifth, totaling 422,000 in 2000.

• In contrast, the population of those with West Indian ancestry grew from 392,000 in 1990 to 550,000 in 2000, an increase of 40 percent and were the second largest ancestry group in the city. Those of Sub-Saharan ancestry more than doubled in size to reach 122,000 in 2000.

English Language Proficiency
• Of the population 5 years and over, 48% spoke a language other than English at home, compared to 41 percent in 1990. Nearly one-half of those who speak a language other than English at home are not proficient in English.

Educational Attainment
• Of the population 25 years and over, 27.7% had no high school diploma; 24.4% had a high school diploma only; 15.2% had some college; 5.2% had an associate degree; 15.8% a bachelor’s degree and 11.6% a graduate or professional degree.

• By borough we see that Staten Island had the greatest percentage of high school graduates, followed by Manhattan, then Queens. These were higher than the city average. However, Brooklyn and the Bronx were below the city average.

• Looking at college graduates, Manhattan had the greatest percentage far above the city average. This is followed by Brooklyn, Queens, Staten Island and the Bronx which were below the city average. Bronx had the lowest percentage of both high school and college grads.

Employed Persons
• The number of employed persons reported in the Census remained about the same in 2000 as in 1990, a pattern that is replicated over the five boroughs.
• However, there was an 8% increase of persons 16 years and over and the stagnation in employment. As a result, labor force participation declined from 62 to 58 percent in the city. There were also declines in each borough.

• Median earnings for full-time, year round workers rose 5% for women but declined 4% for men. Median earnings stood at $32,900 for women and $37,400 for men.

Income and Poverty
• After adjusting for inflation, the median household income for New York City declined by about 2% in the 1990’s with family income down $3,000 or almost 7%.
• By boroughs we see that median household income was up over the decade in Manhattan, but the same or down in other boroughs.

Percent Below Poverty
• Poverty increased throughout the city according to the Census; However, the group that historically had the highest poverty levels (children under 18) showed no change. This implies that poverty increased among married couple families.

SELECTED HEALTH INDICATORS
The Leading causes of death in NYC are heart diseases, cancers, influenza and pneumonia. However, among the conditions that show the greatest disparities among racial and ethnic minorities are:
1. Asthma
2. Infant Mortality
3. HIV/AIDS
4. Prostate Cancer
5. Diabetes and cardiovascular disease

The following slides highlight disparities in Asthma hospitalizations, infant mortality, HIV/AIDS and prostate cancer throughout the City.

Asthma
• When we look at asthma hospitalization rates among children aged 0-14 years, we see a definite decrease in hospitalizations in 2000 compared to 1997. This is good and is a result of aggressive intervention. However asthma continues to be a major problem and hospitalizations were more excessive in primarily communities of color.

• Among all Boroughs, the Bronx showed the highest rate of hospitalizations.

• By neighborhoods we see for example In the Bronx, there were higher rates of hospitalization in High Bridge-Morrisania, Hunts Point-Mott Haven and Fordham-Bronx Park.

• In Brooklyn, Williamsburg-Bushwick, Bedford Stuyvesant-Crown Heights and East New York.

• In Manhattan East Harlem and Central Harlem showed the greatest rate by far.

• And in Queens, Jamaica and the Rockaways.

Infant Mortality
The infant mortality rate for New York City in 2000 was 6.7 deaths per 1,000 live births a historic low for the city as a whole. However, we continue to see marked disparities in infant mortality rates again in communities of color and among immigrants in all boroughs, with the Bronx and Brooklyn showing rates above the city average. By neighborhoods we see that:

• In Manhattan the neighborhoods of Lower Manhattan, East Harlem and Central Harlem showed rates of 11, 9.6 and 9.0 respectively, compared to Gramercy Park and the Upper West side with 1.7 and 1.9 respectively.

• In Staten Island Stapleton-St. George had an infant mortality rate of 10.8 compared to South Beach-Tottenville with 3.6.

• In the Bronx Kingsbridge-Riverdale showed a rate of 10.8 compared to Pelham-Throgs Neck with 4.4.

• In Brooklyn, the neighborhoods of Bedford Stuyvesant-Crown Heights, East Flatbush, East New York and Canarsie-Flatlands had rates of 10.8, 9.8, 8.9 and 8.7 respectively.

• And in Queens the Rockaways showed a rate of 10, South-East Queens 9.4, and Jamaica 9.3 compared to Ridgewood-Forest Hills with 1.7 deaths.

HIV/AIDS
Adult and Adolescent Case Rates

• In Brooklyn, which has become the epicenter of the epidemic in NYC, we see higher rates in the neighborhoods of Williamsburg/Buskwick and Bedford Stuyvesant.

• In Manhattan, Chelsea-Clinton, Union Square, the Upper West side and Central Harlem.

• In Queens, West Queens and Jamaica and

• In the Bronx, Crotona-Tremont, Highbridge and Hunts Point.

• In Staten Island, Stapleton and Port Richmond.

Cumulative Adults/Adolescents with AIDS by Sex
Clearly, males comprise the larger portion. However, in certain neighborhoods AIDS is increasing among the female population. For example, Brooklyn alone has 9, 407 females diagnosed with AIDS.

Cumulative Adults with AIDS by Ethnicity
• In NYC the leading ethnic and racial groups with AIDS are Blacks and Hispanics. Among Blacks, nearly one-third of those diagnosed are female.

PROSTATE CANCER
• Three of Manhattan’s neighborhoods (Washington Heights, Central Harlem and Murray Hill)
• Two of Brooklyn’s neighborhoods Bedford Stuyvesant-Crown Heights and East Flatbush
• And South-East Queens revealed elevated rates of prostate cancer among men aged 45-64. These are predominantly black neighborhoods and Black men in New York State are one-and-a-half times more likely to get prostate cancer and twice as likely to die from it than white men.