Flushing and Whitestone Disease Prevention Plan

Introduction

New York City comprises several distinct neighborhoods, each defined by its diversity, vast historical background, and unique population. However, prolonged and gradually increasing income inequality, coupled with a history of racial segregation, has given rise to striking health disparities between neighborhoods. There is a tendency for deteriorating health outcomes to concentrate in areas where people of color reside and where many people live in poverty. The purpose of this paper is to present a disease prevention plan for the neighborhoods of Flushing and Whitestone.

Within this area, the most prevalent cause of premature death is cancer, with a likelihood of 24 percent, followed by heart disease at 21 percent. Other causes constitute 42 percent and include accidental incidents (5 percent), HIV-related deaths (3 percent), homicide (3 percent), and suicide (2 percent). It is important to note that these causes of premature death affect both men and women, particularly those between 45 and 64 years of age. For individuals aged 65 and older, the leading causes of death are cancer and heart disease (New York City Department, 2002). Among men, prostate, lung, and colorectal cancers are the primary causes of death, while among women, lung, breast, and colorectal cancers are the main causes. Additional causes of premature death among individuals aged 65 and older include injuries from falls (Ashpole et al., 2013).

Community Setting and Role

The preceptor in this context is a senior clinical staff member at Flushing Hospital Medical Center. Taking into account the demographic characteristics of its primary service area, Flushing Hospital has identified key concerns within the community it serves and is committed to reducing disparities in healthcare access in order to improve the health status of all populations. Accordingly, mortality rates and data representing characteristics from each of the ten most significant areas identified by New York City's Take Care New York (TCNY) 2016 initiative are outlined for Flushing Hospital's service region, with comparisons made against neighboring areas such as Queens and New York City overall.

The population of the region spans over 255,000, comprising 52% of individuals of Asian descent, 28% White, 17% Hispanic, 2% African American, and 2% other. Approximately 57 percent of the people in the region were born outside of the United States, and 47 percent are not proficient in English. According to the community data profile, roughly 70 percent of residents rated their own health as excellent, very good, or good, with a life expectancy of 83.6 years (NYC Health, 2015).

Several factors prevent members of the target community from fully utilizing the healthcare system. These include cultural barriers, particularly those associated with religious beliefs, as well as a lack of health literacy and familiarity with the existing healthcare system. There is a significant need for religious leaders and the broader community to work together to promote healthcare maintenance and increase awareness of the prevalent causes of death and illness within the community. For instance, one approach is to emphasize the importance of maintaining heart health and the value of early detection and treatment of various cancers. Two of the most common contributing factors to heart disease among community residents are high cholesterol and high blood pressure; screening residents and establishing management programs are therefore essential steps (Ashpole et al., 2013).

The educational attainment of residents in the target community varies. The majority of community members have earned either a high school diploma or some college education, at 28 percent and 42 percent respectively. An additional 23 percent of residents aged 25 and older hold a college degree. Reports also indicate that approximately a quarter of area residents lack health insurance. Overall, 20 percent of adults in the population do not have a primary care provider, a figure that roughly meets the TCNY target, suggesting that residents have relatively better access to healthcare, which corresponds to lower rates of emergency department visits (Ashpole et al., 2013).

Target Population

The primary issue of concern is linked to the health status of minority groups within the target population. Adults and children from minority groups with low-income status experience a disproportionate burden of chronic illness, utilize hospital emergency room services more frequently, have poorer health status, and face higher rates of premature death. According to FHMC (2012), lower-income minority populations are also more likely to lack access to healthcare and to develop mental health problems, including substance abuse, stemming from high psychosocial stressors such as job loss and financial hardship.

Within Queens, there is a noticeable disparity in premature birth rates: Black non-Hispanic women experience higher rates of premature births compared to White non-Hispanic women. This disparity is also apparent when comparing premature birth rates for Hispanic and White non-Hispanic mothers between New York State and Queens, with Queens showing higher rates (FHMC, 2012). Furthermore, the neighborhoods reflect high rates of risk factors for low birth weight and preterm births, including births to Medicaid recipients, African American and Latina women, and low-income women.

Low birth weight and premature births increase the likelihood of medical complications — both in the newborn period, such as brain bleeding and patent ductus arteriosus, and later in life, including heart problems. The neighborhoods have shown comparatively low percentages of preterm births and low birth weight occurrences. The low birth weight rate is 6.51 percent, below the Healthy People 2020 target of 7.8 percent. Approximately 11.1 percent of births in the area zip codes were premature, meeting the Healthy People 2020 objective of reducing the rate of premature births to 11.4 percent or lower (FHMC, 2012).

Concerning numbers of hospitalizations due to falls, gaps in insurance coverage, low immunization rates, and insufficient HIV screening all require attention. Statistics indicate that roughly 15 percent of residents live below the federal poverty level. This is compounded by a 9 percent unemployment rate, with over 50 percent of residents spending more than a third of their monthly gross income on rent. However, school absenteeism among elementary-aged children is low, with only 8 percent of students missing 20 or more school days. Approximately a quarter of adults lack health insurance, 9 percent went without needed medical care, and 9 percent received late prenatal care or no prenatal care at all (NYC Health, 2015).

The prevention measures for the target population operate at the primary, secondary, and tertiary levels. Primary prevention measures include health education provided by nurses and immunization programs. Secondary prevention encompasses early diagnosis, appropriate illness screening, case identification, and prompt treatment. Tertiary prevention focuses largely on falls among the elderly, offering alternative housing options, physical therapy, and Direct Observed Therapy (Rector, 2018).

A substantial effort is required to implement the plan of care effectively. To engage the community, public health nurses can communicate with local council members, the community board president, and community leaders through conferences, assemblies, and presentations. These interactions will foster community learning and raise awareness about key health concerns. The need for expanded health insurance coverage, free STD and HIV screening clinics, and increased health education must be addressed. Similarly, the importance of regular physician visits and health screenings should be emphasized through community health initiatives.

The aging population may require services such as assisted living, home health aides, or telehealth technology. Maximizing the use of community resources and health programs would allow residents to gain meaningful health education and participate in disease management, thereby producing positive changes. While there are many community concerns that a public health nurse can address, the high prevalence of falls in the area is particularly troubling. As a result, the health concerns selected for focus include fall risk, hazardous medication use, and unsafe home environments (Ashpole et al., 2013).

Conclusion

Healthy People 2020. (n.d.). 2020 topics and objectives. Retrieved March 27, 2018, from

New York City Department of Health. (2002). New York City neighborhood health profiles: Brooklyn, 2000 (Rep.). Retrieved March 27, 2018, from

NYC Health. (2015). Community health profiles 2015: Flushing and Whitestone.

Centers for Disease Control and Prevention. (2013, October 29). Older adult falls publications. Retrieved March 27, 2018, from

Rector, C. (2018). Community and public health nursing (9th ed.). Wolters Kluwer.