The Bronx, which has a dominant African American population, has an average age of 34 years with 53% of the population being female. Most of the inhabitants are indigenous to the region with a very small amount having moved from a different state or county. The education attainment is low since a larger percentage of the population only studied to high school with around half of this proceeding to obtain a bachelors degree. Improvements in security have seen to it that employment through private companies has increased in the area, especially from health sectors, retail and social assistance. Additionally, retail trade is the most predominant industry in the region followed by real estate, eateries and then health care. The Bronx also has the lowest overall household income in the New York State with high unemployment and par city medical insurance cover in percentage.
Regarding health, there is less concern about the health care access (as this is relatively positive) and more in the quality of service and the linkages (like poverty and drug abuse) that affect the service and the access of health care (New York City Health, 2019). The Bronx is rated the least healthy county in New York State and also leads the tally in the percentage of premature deaths due to prevalence in AIDS, diabetes and heart and respiratory complications.
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Major health issues facing the Bronx have been closely related to household poverty and low level of education in the community. Similarly, poor health habits (like physical activities, diet, sexual practices and smoking habits) have also contributed to the state of health in the county. Some of the common ailments afflicting the county are HIV/AIDS, COPD and diabetes.
HIV infection in the Bronx is largely sexually transmitted due to the initiation of the syringe exchange program, that saw transmission through infected syringes decrease dramatically (previously, there was a 54% infection rate among fiends) (New York City Health, 2019). HIV infection was also perpetuated by childbirth and breastfeeding. Diabetes can either be genetically acquired or due to poor lifestyle and health habits. Poor dieting and inactivity are a leading cause of obesity, which acts as a gateway of multiple chronic illnesses, with the most notable being diabetes. Ignorance to the effects of poor lifestyle habits has not helped prevention as some still believe infection is purely genetic (Golden et al., 2017). Chronic obtrusive pulmonary disease (COPD) is a family of diseases that cause breathing related problems and also disability. It is the 3 rd leading death causing illness (New York City Health, 2019). Industrial and domestic air pollution, smoking habits, genetic factors and respiratory infections are the major causes of the disease. All these health issues are seen to be causes of poor social conditioning and health habits.
HIV/AIDS is the fourth leading cause for premature deaths in the Bronx, with an incidence percentage rate that is higher than the overall New York City infection rate. There is a large racial imbalance in the prevalence rate with African American accounting for the larger percentage (four times higher than Whites) followed by Hispanics (two times higher than Whites), then Whites. Transmission among drug injecting users has significantly dropped due to the syringe exchange program, which ensures access to clean syringes. In place, sexual transmission is the leading cause with 70% of patients who are above 19 years receiving syphilis screening.HIV/AIDS patients experience reduced immune protection and a high susceptibility to further infections (New York City Health, 2019). If a patient does not engage in HIV care, then they expose themselves and the community health by acquiring infections and spreading the virus, decreasing the overall community health.
The diabetes epidemic is increasing steadily across the United States .The diabetes composite (for the Bronx) is superior to that of New York City and the New York State, with the area population being concerned with diabetes as their main health concern (New York City Health, 2019). Nearly one in every three individuals in the Bronx suffers from diabetes, with Hispanics accounting for majority of the patients followed by African Americans, then Asians. Diabetes related complications, including death, are higher due to the substandard economical stance of most patients in the Bronx which limits their access to adequate and quality health care (Golden et al., 2017). Further effects like amputation, kidney failure and blindness are likely to worsen the implications on resources of the patients and the county.
Of the adult population in the Bronx that suffers from OCPD, the infection is highest in people with disabilities, followed by smokers. OCPD results in increased airflow limitation and deteriorated mental and physical status. Individual health suffers pain and incontinence coupled with slower movement, which is the first sign of disability development (Ambrosino, & Bertella, 2018). It is also noted to be more prevalent among white females and individuals with lower than a high school education. Infection rates also decrease with increase in the annual household income and increase with a patient’s advancement in age. The disease mainly affects the lungs but it has also been shown to cause weight loss, alter muscle functioning and affect heart-related diseases.
Patients who are HIV positive are receiving appropriate viral load suppression which is important in reducing HIV transmission while maintaining proper health in the affected. A key program is the Medicaid plan (New York City Health, 2019). There is a geographic situation between patients, who are Medicaid Beneficiaries in HIV service consumption, and the location of HIV/AIDS resources. From patients who have been diagnosed with AIDS, 91% are involved in care. Furthermore, 69% of patients are engaged in viral load monitoring and syphilis screening. HIV funding is prioritizing the resources spent on medical management rather than the supporting services. This has received backlash since the medical complications and chronic illnesses caused by HIV infection also seem to be neglected due to focused funding.
Lifestyle interventions before the diabetes onset are shown to lower the diabetes risk. Furthermore, this is the only way to counter diabetes infection alongside awareness of prediabetes by the stakeholders. The National Diabetes Prevention Program helps people with prediabetes to participate in affordable high quality lifestyle change that reduces the risk of type 2 diabetes (Schellenberg et al., 2013). Automated decision support reminders and chart audits coupled with individual feedback have been adopted into the management strategy for type 2 patients (Golden et al., 2017). Due to the financial nature of the inhabitants of the Bronx, universal screening for diabetes in African American between 45 -54 years and intensive statin therapy coupled with intensive glycemic control were effective since they were cost effective.
Toward the management of COPD, prevention of exacerbations is the main concern. This may be achieved through vaccines, like influenza and pneumococcal. The influenza vaccine is available annually (and as an annual dose) and it goes a long way in preventing exacerbations caused by the same in COPD patients (Ambrosino, & Bertella, 2018). Smoking cessation has also been a primary concern due to the role it plays in the advancement toward COPD development. Nicotine replacement therapy, electronic cigarettes (since they support quitting smokers) and behavioral change have been at the forefront of the charge. Similarly, educating the public about air quality and the adoption of cleaner fuels and its advantages is being taken from many fronts. Patients (and the general public since they are all at risk) are encouraged to exercise regularly and increase lungs activity.
The illnesses and conditions covered by this article show how both social and individual habits and conditions play a vital role in good health. Good habits, in relation to dieting and exercise, should be adopted by patients as well as the uninfected who wish to remain that way. Similarly, county and state level health authorities should be keen to provide information and enforce practices that improve the health standards of the citizens.
References
(2019). Retrieved from https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_applications/docs/st_barnabas_hosp_dba_sbh_health_system/3.4_st_barnabas_cna.pdf
Golden, S. H., Maruthur, N., Mathioudakis, N., Spanakis, E., Rubin, D., Zilbermint, M., & Hill-Briggs, F. (2017). The case for diabetes population health improvement: evidence-based programming for population outcomes in diabetes. Current diabetes reports, 17(7), 51.
Schellenberg, E. S., Dryden, D. M., Vandermeer, B., Ha, C., & Korownyk, C. (2013). Lifestyle interventions for patients with and at risk for type 2 diabetes: a systematic review and meta-analysis. Annals of internal medicine, 159(8), 543-551.
Ambrosino, N., & Bertella, E. (2018). Lifestyle interventions in prevention and comprehensive management of COPD. Breathe, 14(3), 186-194.
