The Immigrant Health Project
DEVELOPING A STRATEGIC PLAN FOR MEETING THE HEALTHCARE NEEDS OF THE GROWING IMMIGRANT POPULATION IN NEW YORK’S SUBURBAN AND URBAN COMMUNITIES
New York Medical College School of Public Health
This project is designed to address the challenges faced by New York State’s Lower Hudson Valley healthcare systems in meeting the health needs of its growing immigrant population. It is a collaboration of the New York Medical College School of Public Health, the health officers of the seven Hudson Valley counties (Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester), and healthcare providers and other community organizations in the seven counties. We are working to obtain information necessary to identify recently arrived immigrants’ unmethealth needs. Thisinformation will be used by the county health departments with support from the School to develop an action plan to meet those needs. The project will also publish and distribute a manual describing the project methods to allow replication by others.
An action plan is essential at this time as the region is currently experiencing one of the largest waves of immigration in its history. Approximately 122,000 immigrants settled in the Lower Hudson Valley during the period 1990-2000. These immigrants came primarily from Mexico, the Caribbean (Jamaica, Dominican Republic, and Haiti), South America (Ecuador, Colombia, and Peru), Central America (Guatemala, El Salvador, and Honduras), Asia (India, China, and Philippines), and Africa. While urban centers have historically been the residential location of choice for newly arriving immigrants, more recently suburban and rural areas across the country are experiencing large new immigrant settlements (Salvo, 2004).
The public health community and healthcare providers in the Lower Hudson Valley need to address the health consequences resulting from the marked increase (56%) over the past ten years (compared to 43% nationally, Camarota, 2001) in the area’s foreign-born population. The issues that have been identified as most pressing are: poor access to health care, use of the ER for primary care, lack of adequate immunizations, need for screening of infectious diseases and parasites, HIV/AIDS, sexually transmitted diseases, poor nutrition, substance abuse, and mental health disorders.
In addition, language ability and cultural acceptability of the health care provided are issues of particular relevance for recent immigrants. Lack of cultural acceptability of proposed treatment often creates clashes between immigrants and our healthcare system. The degree to which the healthcare provider is culturally sensitive can influence the patient’s willingness to follow treatment recommendations, to continue care, and to have a sense of satisfaction. Language issues can cause poor communication, translators can breach confidentiality, and misinterpretation can lead to medical errors.
Our project accomplishments thus far are significant. Phase I, initiated by the convening of a major introductory conference in March, 2001, Developing a Strategic Plan for Meeting the Healthcare Needs of the Growing Immigrant Population, was completed in December 2003. Working with the New York City Department of City Planning we then developed a comprehensive immigrant demographic profile for each zip code in the Lower Hudson Valley Area. Those zip codes with the greatest concentration of immigrants (N=21) were then identified for careful review. From these, the 12 target zip codes that will be the focus of Phase II – the community needs assessment - were selected by the county health officers with support from project staff. These zip codes in combination closely reflect the distribution of immigrant populations in the Lower Hudson Valley. We informed the general public in the selected communities about the project and solicited their cooperation at our August 12, 2003 conference, Asking the Right Questions: Responding to Immigrant Healthcare Needs in Our Community.
The Community Needs Assessment (CNA) phase of the strategic planning project began in the Fall of 2004, while the methodology was piloted during the summer of 2004 in Orange County. This phase includes the following: a) interviews with primary care providers, key community informants and recent immigrants; b) a catalog of initiatives that address immigrant health issues; c) a health indicator profile; and d) a manual describing the project methods to allow replication by others.
Currently, the project has completed 130 interviews with providers and key informants and 70 interviews with immigrants for all seven counties.
Analysis of the data from the CNA will identify the key health issues and unmet health needs of this population. A catalog of available initiatives that address immigrant health issues similar to those in the Lower Hudson Valley will be developed based on a literature and internet search. The county health departments, working with the project staff, will integrate the information collected during the CNA into their community health assessments and strategic planning process. NYMC School of Public Health will continue to work with the county health officers as they develop their action plan.
The field portion of this study (phase II) was supported by grants from: Fidelis Care of New York, The New York Community Trust, and the Westchester Community Foundation.