Many people living in New York lack available access to primary healthcare. Numerous communities across New York have an inadequate capability to meet the health care needs of their residents be it current or future. For such an environment, it is, therefore, critical that the State has a plan based on data to help health care centers build their capacity and expand their availability to all residents.
The first plan identified methods to expand capacity from the centers that do exist by increasing productivity and employing more staff to work in the centers. The Department of Health did a report and identified opportunities that would be able to expand capacity by enlarging the system. This could be done by building new health centers by constructing new sites and also using mobile medical vans to access virgin areas. There can also be the development of which type of patients to be served.
Some parts of New York State have never had health care centers. These are the areas where demand for healthcare exceeds the available capacity. There are about 16 centers out of 22 that have the highest need for support of new health care centers. With such kind of data, the plan enables the health sector players across the State to invest so as to achieve the required health care efficiency for the States residents (Community Health Profiles, 2015).
A poorly maintained housing characterizes Bronx County. This has adverse health outcomes such as respiratory and mental illnesses. Fordham and University Heights lead with the highest number of homes that have maintenance defects in the city (Community Health Profiles, 2015). This is one of the major neighboring conditions that the district faces. Air pollution is also another problem. Although air quality in New York is improving, there are still harmful pollutants contributing to illnesses.
More than half of the population in the Bronx speak languages other than English as most of them are immigrants. This poses both cultural and regulation challenges to health care access. The huge problem being the inability to access government benefits programs. They also lack safety on the streets. The costs accrued for medical care also act as hindrances to the prevention and disease management of the affected people. The cost of living is high in New York, and even the working poor find it difficult to qualify for Medicaid. Community members, as well as providers, consistently experience a huge time difference for hospital visits as well as long time for their medical attendance. Consequently, the possible need for multiple visits such as for tests or specialist services, discourage the efficient use of services and for many makes the emergency department a rational choice for one time visits. Also, funding and regulatory agencies have very different requirements. They may limit the continuation of care for patients who have multiple needs. High demand for organizations that work with multiple systems is hence seen. Funding for high demand services is limited because the salaries for such positions are very minimal (Community Health Profiles, 2015).
There is also the necessity to improve the economic status of Bronx residents. It is known that poverty hinders healthy living and hence making it hard to access healthcare services. Thus, it becomes hard to prevent illnesses. Poverty is often caused by unemployment that in turn leads to cases of unaffordable housing. Houses that are rather deemed affordable often have poor health conditions. At least one in every five adults who live in University Heights and Fordham is unemployed and spend more than a third of their income on rent (Community health profiles 2015, Brooklyn Community District 5, 2015). This is the highest rate reported in the city. Comparing death rates among neighborhoods helps to see the effect on income on the health of the residents. On the social pillar, education is also an important factor. Most adults have not completed high school or have never attended college. This affects their lifestyle choices through income received as it not sufficient.
Drug and substance abuse or alcohol-related illnesses are also prevalent in the Bronx. This combined with poor dieting and physical inactivity cause risk to the body and may lead to diseases such as high blood pressure or diabetes. In 2012, data shows that an estimated 639.2 per 100,000 who visited emergency rooms were due to illicit drugs. Adult drinking is also high. This implies that behavioral health issues as one the factors that hinder adequate primary healthcare as well as prevention. According to residents, survival is the most important thing and not necessarily seeing a doctor for medication. Resources allocated to cater for behavioral health are inadequate. The system is fragmented with a poor integration of behavioral and physical health. Behavioral health services are regulated by agencies such as Office of the Mental Health that restricts patient care according to funding.
Bronx residents also face a huge health hazard due to inaccessibility of health care. Quality health care in its deficit leads to adverse clinical outcomes. These may result in death due to illnesses which would have rather been avoided. In Fordham and University Heights, one in every four adults does not have health insurance. The rate is even higher where some go without medical care at all. This also includes late or no prenatal care at all (Community health profiles 2015, Brooklyn Community District 5, 2015).
The leading causes of death within the county are heart-related diseases as well as cancer. HIV-related deaths are also three times that of the entire New York Citys rate (Community health profiles 2015, Brooklyn Community District 5, 2015).
Heart-related diseases were the highest ranking leading cause of death for both males and females in all four boroughs and New York City as a whole. It was also the primary cause of premature death for males and the second leading cause for females in the Bronx. Furthermore, it was the second highest leading cause of premature death in both males and females in Brooklyn, Manhattan, and Queens (Community health profiles 2015, Brooklyn Community District 5, 2015).
Top death causes and rates (per 100,000 people)
DISEASE AND RANK DEATH TOLL DEATH RATE
BRONX/ NEW YORK
HEART ILLNESSES 680 172.3/ 202.6
CANCER 615 137.4/ 156.7
HIV 165 27.0/ 8.4
FLU 142 37.4/ 27.4
DIABETES 112 26.7/20.6
STROKE 105 25.7/ 18.8
DRUG RELATED 103 16.3/ 8.6
RESPIRATORY 102 23.8/ 19.8
NYC DOHMH, Bureau of Vital Statistics, 2009-2013
It can be observed from the table above that death rates are higher than the rate in the wider New York area. This shows that there is a need for better healthcare in Bronx County.
Infant mortality and premature deaths are also prevalent in the Bronx. As such, there is a general decrease in these across aspects the city. However, Bronx still has five times the rate of the city. There are also differences in premature death among neighborhoods. Premature deaths refer to the death of individuals less than 65 years old. According to Community Health Profiles of 2015, premature deaths are three times more in the Bronx than in the Financial District. This shows the need for proper healthcare in the county. The percentages of adults who are obese were higher in the Bronx and Brooklyn than in New York State, and compared to the New York State Prevention Agenda 2017 (NYS PA) target. The percentage of children and adolescents who are obese was higher in all four boroughs than both the New York State and the NYS PA 2017 target. The Bronx and Brooklyn also had the highest obesity rates according to self-reported height and weight (Healthy people 2020, 2010).
Infant Mortality Rate (per 1000 live births)
FORDHAM AND UNIVERSITY HEIGHTS UPPER EAST SIDE
NYC of Vital DOHMH, Bureau Statistics, 2011-2013
Premature Mortality Rates
FORDHAM AND UNIVERSITY HEIGHTS FINANCIAL DISTRICT
NYC of Vital DOHMH, Bureau Statistics, 2011-2013
Both tables show that the mortality rates are higher in the Bronx than in the general New York City and its neighboring districts.
Healthy People 2020 goals
This is a tool that is meant for the management by the public, government and private sector parties. It has a mission, vision, and goals that guide it for achieving its objectives. The goals offer the areas that require emphasis by the government of the United States to attain sustainable health come the year 2020. The Healthy People 2020 was developed under the collaboration of the Department of Health and Human Services of the U.S government as well as other federal agencies and the Advisory Committee. It contains a list of objectives used to evaluate the health progress of specific populations. It aims at ensuring long lived and healthy lives (Healthy people 2020, 2010).
One of the missions of the HP 2020 is to identify health improvements and priorities across the nation. The framework also aims to increase public awareness on diseases and health as well as help to understand the determinants of health. It should also provide for objectives and goals that can be measured and applied to all levels of the government. The Healthy Population 2020 also seeks to engage various sectors to be able to take action that will enrich policies that will hence develop practices controlled by the best pieces available to knowledge. It should also identify research that is critical and help in the evaluation and collection of data needs (Healthy people 2020, 2010).
The Healthy People is a set of goals and objectives with 10-year targets designed to guide national health promotion and disease prevention efforts to improve the health of all individuals in the United States (Healthy people 2020, 2010).
The Healthy People 2020 document has a set of goals that help attain high-quality healthcare. This will help eliminate health differences across the counties and federal government and also improve the health of all populations involved. To achieve this, there will also be the creation of physical and social environments that will promote quality health to all.
The mission, vision, and goals provide a framework and guidance for attaining the objectives. They are general but offer specific and critical areas that require emphasis so that action is taken if the government is to achieve better and sustainable health come the year 2020. Developed under the artistry of the Federal Interagency Workgroup (FIW), the framework is the result of an extensive collaboration process among federal agencies, public stakeholders, and the advisory committee and the U.S Department of health (Healthy people 2020, 2010).
The relevance of using health determinants to health care is critical to disease prevention. Behavioral health is often characterized by various factors at different levels such as psychological factors at institutional or policy levels. Interrelationships exist between the various levels among determinants of health. It is this that makes it useful to address all levels of determinants for interventions to be effective. In the past, many fields have focused on individual levels of health and health determinants as well as responses. The 2020 objectives should thus expand their focus to enhance health through physical and social environments. Additionally, the inclusion of education is critical for prevention (Healthy people 2020, 2010). There also arises the importance of health information technology for health communication. These are integral parts of the implementation of the Healthy People 2020.
Healthy People 2020 also aims at attaining a higher quality of health. This is one of the problems that affect the Bronx County with the 2020 goals. Higher quality of health can be achi...
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