Introduction
The health of a population is dependent on the specific measures put in place at the community level to ensure that the common ailments are prevented before they occur. The desire to prevent diseases before they occur has led to the development of special healthcare departments in health institutions and government agencies that are dedicated to community diagnosis. Researchers estimate that more than half of the conditions that affect the population in an area can be prevented if effective measures are put in to diagnose the community and/or engage it in safeguarding its health. The determinants of a disease are first studied before they are controlled at the community level.
Over the past three decades, the Department of Health and Human Services (HHS) has developed a ten-year plan on how to advance the wellbeing of all the American populace (Healthy People 2020 Progress Review, 2011). The schema created by the department spans over a 10-year period. Targets are incorporated where the department can use to see whether there is any progress. The current Healthy People Initiative by the HHS is titled Healthy People 2020. According to Healthy People 2020 Progress Review (2011, p. 1), “it lays out the proposed agenda for the current decade, which will end in 2020”. The vision of this initiative is to ensure a society where people can live healthy for long. The mission that the initiative includes the establishment of priorities in health improvements, increment of public awareness of health and its determinants, provision of measurable health goals, engagement in various health stakeholders, and identification of the important research needed to improve the health standards (Leading health indicators for Healthy People 2020 letter report, 2011).
The borough of Queens is the largest municipality in New York. It consists of a multicultural community with an interesting history and special health determinants. This research paper focuses on the borough of Queens to describe the determinants of health in the community while providing a thorough community assessment in keeping with the Leading Health Indicators in Healthy People 2020. The paper takes a broad scale perspective on the concerns of a community. It also contains the following items concerning the whole community: the populations at risk, health concerns, resources, access to resources, the race and ethnicities in the community, levels of poverty, and a description of the community and its characteristics including its History. It also focuses on other determinants such as education, demographics, healthcare, environment, and the local economy.
Demographics
The borough of Queens is the biggest area in New York. Its global fame has attracted a number of races and ethnicities. There are over 170 languages spoken in the borough of Queens. Immigrants who have settled here represent more than 100 nations from all corners of the world. The region covers a total land area of 70,190.2 acres, which are equivalent to 109.7 square miles (United States Census Bureau, 2010). The population according to the 2010 census was 2,230,722 people. This figure was a change of 0.1% from the previous census where the population was 2,229,379 people (United States Census Bureau, 2010). The growth in population in Queens’ borough has resulted from immigrants from other parts of the world where they have come to look for employment and/or to do business.
The growth in population between 2000 and 2010 is insignificant compared to the 14.2% growth that was observed in the ten-year period between 1990 and 2000 (United States Census Bureau, 2010). The population during this period grew from 1,951,598 to 2,229,379. The factors that led to the growth of the population during this period included the lax immigration policies at the time and the well performing economy before the global economic crisis. Births in 2010 in Queens were 26,955, a reduction from the total of 27,050 births recorded in 2005 (United States Census Bureau, 2010). The birth rate was 12.1 births per 1000, with this rate remaining constant in the period between 2005 and 2010 (United States Census Bureau, 2010).
The second vital statistic, the death rate, in Queens was 5.4 per 1000 of the population in 2010. This rate was a decrease from the rate of 6.0 per 1000 that was recorded in 2005 (United States Census Bureau, 2010). The actual figures for the two periods were 12,155 deaths for 2010 and 13,298 deaths for 2005 (United States Census Bureau, 2010). The infant mortality was at 4.5 per 1000 in 2010, while it was 5.1 per 1000 in 2005. The distribution of people per square miles was 20,553.6 people in the 2010 census. The races represented in the borough included the white race that made up 39.7% of the population. 19.1% of the population was either black or African American. The Asians made up 22.9% of the population while the rest of the races made up 4.5% of the population (United States Census Bureau, 2010). The census also established that the population that was of Spanish origin, Hispanic, Latino, and other different races made up 27.5% of the population (United States Census Bureau, 2010).
The total population by age for Queens as reported in the 2010 census was 5.9% for the under 5 years old, 5.5% for the 5 to 9 years old, 5.5% for the 10-14 years old, 6.2% for the 15 to 19years old, and 63.9% for the 20-64 years old. The population 65 years and over made up 12.8% of the total population (United States Census Bureau, 2010). For all these ages, the median age was 37.2 years. The distribution of the ethnicities according to the same census was 27.6% for non-Hispanic White, 27.5% for Hispanic, 22.8% non-Hispanic Asian, and 17.7% non-Hispanic Black or African-American (United States Census Bureau, 2010) as shown in the chart below.
Queens has a significant immigrant population, with the foreign-born population comprising 47.7% of the total population (United States Census Bureau, 2010). The proportion of this population born in Latin was 47.7%. 37.4% was born in Asia while 11.7% of the population was born in Europe. Moreover, 2.2% came from Africa while 0.3% was born in Northern America 0.04% born in Oceania. However, about 48.2% of the population was born in America. There was an observed increase of Latino or Hispanic population of 10.3% in the period between 2000 and 2010. This population stood at 613,750 in 2010 (United States Census Bureau, 2010). Queens also has the largest population of Colombians, Salvadoran, Ecuadorian, Guatemalan, and Peruvian population in New York City (United States Census Bureau, 2010).
In the last census, the Mexican population increased by 67.3% in Queens between 2000 and 2010. It stood at 92,835 people, with this figure making up the second largest population in New York City. The Asian population was New York City’s largest, with the number of Asians being 501,298 (49.3% of New York City’s total Asian population) (United States Census Bureau, 2010). The borough also had the largest population of other races such as the Chinese, Nepalese, Korean, and Filipino population (United States Census Bureau, 2010). The languages spoken here are different. The population above 5 years was reported to speak another language other than English at home. The exact percentage of this population was 57.4%, which represented an increase of 7.7% from the previous census (United States Census Bureau, 2010).
The median household income for the borough of Queens was estimated at $53,054 for 2010, with this information being collected through the census and other sources (United States Census Bureau, 2010). People who lived below the poverty line were 332,165 persons. The population represented about 15.0% of the population of Queens, thus accounting for 63,738 families. This number was 12.1% of all families represented in Queens at the time (United States Census Bureau, 2010).
Brief History
Some of the earliest settlers in Queens were Dutch in origin. They settled in Western Queens around 1637. However, they settled in the Rockaway Peninsula two years later. In 1643, Queens had its first share of English settlements although they did not last long after the natives drove them out of the original Maspeth area that they had settled. The English people later settled in Flushing, Newtown (currently Elmhurst) and Jamaican parts of Queens over the next ten-year period. These settlements were more successful than the previous one. Because of the growth in the number of British settlers in the area, the British took control of the borough from the control of the Dutch and proceeded to give it the current name of Queens after their Queen Elizabeth in their homeland.
The region was largely agrarian. There was farming until the 1800s when the industrial developments began to take shape. The industrial and residential developments in Queens started in the Western side of Queens. There was rapid development in the field of agriculture as mechanization began to be used (Profile for Queens, n.d). Queens began to expand in the 1800s, with Astoria being one of the areas that were incorporated (Profile for Queens, n.d). The borough also started experiencing residential developments in the areas of Long Island City, Maspeth, and the Corona, which also housed the area’s industries.
Areas beyond Western Queens also started having significant developments in the mid-19th century. There were new immigrants from Ireland and Germany around the same period who mainly settled in Astoria, Middle village, Jamaica, and Flushing (Profile for Queens, n.d). Some of the other areas that were developed around the same period included Woodhaven, Whitestone, and College Point. The area of Rockaway became a seaside resort for wealthy individuals and families. The population continued to increase in the 19th century to reach 30,329 by 1860.
In the periods after the Civil War, there was a considerable increase in the population of New York City, which contributed to the rapid growth of the borough of Queens, with the population reaching over 150,000 by 1900. Because of the rapid population growth, the neighborhoods of Queens such as Glendale Steinway, Morris Park, and Hollis started experiencing significant growth in the populations (Profile for Queens, n.d). Some of the factors that led to expansion in the areas include the addition of the superior rail lines. The borough of Queens was initially incorporated into the City of New York in 1898 where it constituted the largest borough.
Over the last century, the borough has had its share of large infrastructure projects, which have led to the development of the area. The population also increased significantly, with the area growing to be an important residential and industrial center. There were developments in bridges such as the Queens Borough Bridge that linked Manhattan to the area. The underwater tunnel that was built under the East River, the electrification of the railway and the extension of the elevated rail line, and the building of the subway were some of the developments in infrastructure that made Queens one of the successful areas in New York in the early 20th century.
The borough continued to develop throughout the 20th century, with the remaining open areas being developed for housing projects where residents and foreigners settled. In the First and Second World Wars, there were numerous projects for the veterans. There were also extensions of the subway. In the 70s, there was a net population loss in Queens and New York in general. However, this time marked the last period that saw negative growth in population, with growth being experienced in all other periods. The second half of the 20th century saw the immigration of people from Russia, China, South and Central America, Asia, and the other parts of the world, with the population growth making this area very metropolitan.
Education in Queens
The level of education in an area is an important determinant of health in the area since education determines the preventive measures put in place and the response to health issues among other things. Some of the important factors in education include the schools’ enrollment, dropout rates, teen pregnancy rate, SAT scores, college-bound students, and the teacher-student ratios. Parents’ involvement in the education of their children is also an important determinant. The city of New York has one of the highest numbers of graduates in the world, with most of its inhabitants having a university degree. However, the population is diverse, with many of the immigrants having little if any educational experience as it is reflected in Queens.
The graduation rate for the State was at 60.5% in the 2000 census, with the same figure changing to 70.8% for the census that followed in 2010 (United States Census Bureau, 2010). The population was also significantly high in the State of New York, with the people aged 25 years and above who had graduated from high school being 84.9% of the population (United States Census Bureau, 2010). This number was a considerable improvement from the previous value of 79.1% that was recorded in the 2000 census (United States Census Bureau, 2010). The population above 25 years with a minimum of a bachelor’s degree in the State of New York was 32.5% in 2010 as compared to the United States’ average of 28.2% (United States Census Bureau, 2010). This information is shown in the figure below.
Queens has several colleges and universities, with these admitting students from high schools that serve the population. The school enrollments stood at 95% in 2010, with the dropout rates decreasing throughout the years to stand at only 1.6% of the population (United States Census Bureau, 2010). The major problems that are facing the learning institutions are general to the State of New York and the USA. They include drugs, bullying, and the presence of gangs in the schools and in the neighborhood. The issue of teen pregnancy is also rampant in the borough. However, this case has been reducing over the last decade in line with special measures put in place by the State of New York. The number of girls between 15 and 19 years that got pregnant in 2010 was 72.6, which was a reduction from the number that got pregnant in 2001, which was 98.8 per 1000 of the girls in this age group (United States Census Bureau, 2010).
The average SAT scores for students in the borough are 499 for the verbal score, 564 for the math score and 538 for the writing score (Profile for Queens, n.d). This shows that the borough is well performing as compared to other parts of the US. These scores are significantly higher than the national averages for the same disciplines. The teacher-student ratios are high in Queensland, with the public schools being well staffed. However, private institutions are better staffed, with the average being better than that of the public schools. There is reportedly better parental involvement in education as compared to other parts of New York, with parents playing a significant role in the education of their children.
Healthcare in Queens
The healthcare in a specific area is mainly determined by the health institutions available in the area and the part they play in the development of health programs for the locals. The ownership of the health institutions is also a major area of concern. Public institutions are more involved in policy formulation. In the borough of Queens, the number of health institutions is rather small compared to the served population. There are 10 hospitals in the area, with the bulk of them being public institutions. All of these institutions accept Medicare. There are also smaller facilities and private clinics in the area. They provide basic services for the locals at competitive rates. Most of these institutions also accept Medicare.
The access to healthcare in the borough of Queens is better compared to that of other areas in the country. However, there are is a significant population of citizens that are uninsured having no access to the health institutions. This population mainly constitutes the unemployed immigrants who are relatively new in the area and the black and Hispanic races that are of lower socioeconomic status. Some of the latest findings in Queens indicate that the bed capacities in the health institutions are not enough to cater for the health demands of the population. There is projected growth in the population of the elderly patients in the borough. This growth is associated with high demand for in-patient services in the area.
Some of the health institutions that served the population of Queens have closed over the years, hence contributing to the burden of disease on the existing populations. Some of the residents are reported to be leaving the borough to other parts of New York and the US to seek medical care because of the existing gaps in healthcare. Tertiary care is one of the most neglected in Queens, with the western part being the worst affected. The western side of Queens also has the least access to care in the borough. A large percentage of the people here are considered leaving for other boroughs to seek specialized and more affordable care.
The other issue affecting the healthcare system in the borough is the deficiency in primary healthcare physicians, with this problem mainly affecting the westerners (Profile for Queens, n.d). There is a reported negative operating margin in the borough of queens, with the loss in revenues for the health institutions being attributable to the number of patients seeking care elsewhere. There is a reduced number of specialized medical practitioners in the borough, with the population served by these specialists being considerably high. The ratio of doctors to the total population is low in the area. However, this situation can be attributed to the high population density. Some analysts have said that if the borough were considered an independent city, its high population of over 2.3 million people would make it the fourth largest in the USA.
Transportation to the health facility in the borough of Queens is not a problem for most of the residents. The emergency service department is specialized to respond adequately to most of the emergencies in the borough. The main modes of transport to the health institutions are the private cars, with a large number of the population driving into these facilities. A large population also uses the public transport means to get to the hospitals. They use the subways, the train system, and buses. The ambulances also transport a large population of patients to the hospitals especially for the emergency cases.
Local Economy
The local economy in Queens is diverse, with many industries and economic activities. The borough has the largest economy of the New York boroughs apart from Manhattan. The employees work in industries such as health, manufacturing, transportation, film and television, construction, and retail trade. Some of the factors that have brought concern to the business owners in the area include the recent recession and the super storm Sandy that was experiences lately (Profile for Queens, n.d). The main factors working to the advantage of Queens’s economy include the proximity of the borough to Manhattan and the advanced and intricate transport network in the area. The major airports in the area are located in Queens. They provide a link between New York and the rest of the world.
The employment in Queens is mainly in the private sector, with the jobs available here being 486,160 in 2012 (United States Census Bureau, 2010). The borough was also second only to Manhattan in the total number of jobs available for the same year. The jobs in the private sector have also been on the increase, with the jobs being noted to increase by about 11% over the last decade. The largest employer in the borough is the healthcare and social assistance sector. For 2012, there were 108,000 jobs in this sector, which represented one in five jobs available in the borough (United States Census Bureau, 2010). There were also growths experienced over the last decade in the sector. The second largest employer in the borough is the warehousing and transportation sector, with the jobs available in the sector being 59,390 in 2012. More than half of them were available in the air transportation sector (United States Census Bureau, 2010). The distribution of the various jobs in the borough is shown in the figure below. The “all other” category represents areas such as repair services, education services, beauty services, and wholesale services among others.
The unemployment rate in the borough of Queens is considerably lower than other parts of New York. It has remained low for the past decade. It is reported that the unemployment rate in the borough was 8.3% in 2010, which was lower than the national average of 9.2% (United States Census Bureau, 2010). The median income for the households represented in Queens was $53,570 in 2011. This figure was relatively high in relation to the entire US’ average of $49,460 for the same year (United States Census Bureau, 2010). The poverty levels in Queens have remained lower for the past decade compared to most of the other boroughs in New York City levels. Despite the levels remaining lower than other parts of New York, the poverty has been increasing as observed in other parts of the city.
The city poverty levels were 20.7% in 2011, with the same index being at 16% for the borough of Queens, which was a considerable increase from that recorded in 2005 at 12.1% (United States Census Bureau, 2010). The majority of workers commute to work using the public transport system. Most of the owners of these companies where the employees work are multinationals and private institutions as stated above. The economy is strong and is able to support the local wage bill.
Environmental Concerns
The main environmental concern in the borough of Queens is the pollution that is produced by the transport system and the industries in the area. Sources of pollution in the area are many, with the amount of greenhouse gases emitted increasing over the past decade. The City of New York has had significant success in reducing pollution over the past decade. The City was also hit by a major storm in the recent past causing massive flooding and destruction to property. The main agenda that has dominated the political, social, and public health area is the rise in pollution in the city, specifically in the borough of Queens.
The administrative authorities manage water supply in the area. They are also involved in the collection of waste in the area and the provision of waste management services. The surrounding water sources are largely polluted, with the city departments being involved in clean up exercises. The pollution in the area is also due to the high population density in the borough. The services provided by the public administration are hardly enough to see the cleaning of the area. Another source of major concern in Queens is toxic leaching. There are also undefined electromagnetic hazards in the area because of the technological innovations and applications in the borough, thus leading to a large concentration of electromagnetic activity in the borough. The air quality is better than most of the other boroughs in the City. However, the quality is worse than most parts of the rural countryside. The pollution is occasioned by the large traffic, the large industries, and other activities, which are mainly mechanized in the area. The high air traffic in the area is also a contributor of the remarkably high air pollution. The airports also produce significant noise pollution.
Community Health Plan
The analysis of the above information concerning the borough of Queens is adequate to provide a community plan based on the Leading Health Indicators in Healthy People 2020 guide to the interventions. The health improvement priorities are in the reduction of non-communicable diseases that are a common observation in the borough. The region needs to invest in more health institutions to ensure that citizens have more access to healthcare provision. There are improvements that are needed in the delivery of specialized care so that the inhabitants of Queens are able to access services in their own area. Although the health sector constitutes the biggest employer in the borough, there are still people who have little if any access to the health services. They are the priority for any program that seeks to improve the health of the people.
The Healthy People 2020 guide has the mission of increasing the awareness of citizens on the determinants of health and disease. In the borough of Queens, there is the need to create awareness through the existing structures such as the learning institutions, which are a significant source of interactions with the society. The public awareness should be carried out as a function of the public health department in the borough. This awareness should integrate other services that the city provides for its residents.
One of the health concerns that are evident in Queens as demonstrated with the personal interactions with some of the residents is the use of illicit drugs in the learning institutions. The available resources that can lead to the reduction in the problem include the learning institutions, the health institutions, and the administrative organs located in the borough of Queens. The main interventions that can be used to reduce this problem include the introduction of primary healthcare education in the learning institutions and the development of teaching schedules for people attending the healthcare centers. The community also needs to be educated on the determinants of health and modes of reducing pollution. There is also need to provide health objectives that are measurable and achievable at the local level. Besides, the residents should be involved in the formulation of these health objectives.
The other area of healthcare concern is the environmental pollution in the borough of Queens. The active air transport, the large number of motorized vehicles, and the natural organic waste contribute to the pollution in the region. To ensure that the population is safe from the health risks associated with the pollution, the government and the local council need to put in place measures aimed at reducing this pollution such as the increased use of more efficient transport systems. The existing industries in the borough need to be evaluated on how well they are using the health regulations. This strategy will be important as a primary prevention measure.
There is also need to engage many stakeholders in the primary prevention of diseases. The local health department should call for a constitutive committee that oversees the health policies for the borough. Some of the sectors that need to be brought on board in the primary preventive measures include the transport sector stakeholders, the health industry stakeholders, and the industrial sector. They should develop a policy that binds them and/or encourages them to participate in measures that are aimed at environmental protection. There is also need to carry out research on the determinants in the borough, with this strategy being targeted to the explanation of the main health risks in the population, the best ways of dealing with them, and how to develop a wider reaching solution.
The life expectancy in the borough is said to be improving just like in other states in the US. With growth in the population of the elderly, there is a need to increase the number of beds available in the borough to take care of the non-communicable conditions that are likely to manifest in this group. This move will be an important one in realizing the first overarching goal of the Leading Health Indicators in Healthy People 2020. The populations should have better quality of life free of preventable diseases. Queens has one of the most diverse populations of any part of the world, with almost all the nations of the world having a significant population settled or working there. The figures provided above show that there is no dominant race or ethnicity. The second overarching goal of Healthy People 2020 is the achievement of health equity in the USA, with elimination of all disparities that may exist in the provision of healthcare (Healthy People 2020 Progress Review, 2011).
The provision of health for this diverse population of people requires the participation of all races. The borough has an opportunity to ensure equity. The main ways that the borough should ensure health equity is through the provision of cheap healthcare for the inhabitants so that some of them are not forced to seek health services from outside the borough. Primary prevention involves the prevention of diseases or health conditions before they occur. The borough of Queens should ensure that the immunization is appropriately carried out to all children born to all races. The high growth rate in the area may also expose it to many conditions that are not known in the area. People should be screened for the risks of some of the known conditions that may be fatal.
Primary prevention should also involve the creation of environments, both social and physical, that promote good health according to the Healthy People 2020 guide. Queens has many parks and natural vegetation as compared to other parts of New York. However, it is also dogged by the problem of air and noise pollution. The measures to reduce these issues are discussed above. The secondary prevention measures that are necessary in the borough include early diagnosis and treatment of conditions as they occur. There is the need to increase the public health facilities and the number of people in Queens that have health insurance. This move will ensure that people can afford the services offered in these institutions and that they can manage to get the required services in time.
Tertiary preventive measures are aimed at preventing the development of complications or the reoccurrence of a condition after the primary one has been dealt with. In the borough of Queens, there is also a need to ensure that the prevention of non-communicable diseases is possible. This strategy will be important in preventing the complications. The main way that the borough can ensure tertiary preventive measures is the provision of education to patients in the health institutions. One of the ways in which the Healthy People 2020 to guide encouraged the promotion of health is through the promotion of quality of life. The goal is to have the overall quality of life for the population increase in the next decade. A way of achieving this goal is improving the employment status of the people in the area. There is the need to ensure that more people in Queens are employed. They will be able to afford the basic commodities that are essential for good health including a balanced diet.
The promotion of healthy behaviors is also an objective in the Healthy People 2020 to guide. One way in which this goal can be achieved as with many of the other objectives above is health education. This education should be offered to all ages in the borough, with special attention to the women who are recognized as a major influence on the health of all other groups. The population needs to be educated on the need to perform physically demanding jobs or daily physical activities to ensure that they stay healthy. There is also need to open more centers dedicated to the provision of primary care services, including the institution of community-based nursing programs.
The community health nurse (CHN) plays a role in all the three levels of prevention in healthcare. At the primary prevention level, the CHN is trained to offer education to the public on the ways that can be used to prevent diseases. For example, the nurse can teach the public how to avoid hypertension through exercising and maintaining a healthy diet. At the secondary prevention level, CHNs can monitor the treatment of patients and report adherence to the recommended medication and doses. In tertiary prevention, the role of the CHN is the provision of information to the patients on how to prevent complications, how to remain healthy, and to rehabilitate them back to the society.
Conclusion
In conclusion, the community assessment of the borough of Queens provides important information regarding the health of the people, the structures in place, and the necessary health measures. The Leading Health Indicators in Healthy People 2020 are used as a guide to the interventions that are suggested to the main health problems. The paper looked at the demographics of the area, a brief history of Queens, the education in Queens, healthcare and health services offered, the local economy, and the environmental concerns. These aspects led to the development of a community health plan for the borough of Queens. The plan has been discussed in detail in the paper.
Reference List
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Healthy People 2020 Progress Review. (2011). Healthy People 2020. Web.
Leading health indicators for Healthy People 2020 letter report. (2011). Letter Report. Washington, DC: National Academies Press.
Profile for Queens. (n.d.). Queens, New York Borough Information. Web.
United States Census Bureau. (2010). New York City Census. Web.