Sunday, January 08, 2012

Brooklyn's fractured demographics, as seen in a new report on health care

A report from the state Department of Health, At the Brink of Transformation: Restructuring the Healthcare Delivery System in Brooklyn (see Greater NY Hospital Association comments), aims to restructure Medicaid, but also offers some broader perspective on Brooklyn's fractured demographics and deep disparity between progress and need, a backdrop to the Atlantic Yards debate.

Brooklyn is the state's most populous county, and it has big problems. (Crain's is sponsoring a discussion 1/11/12 on Solving Brooklyn's Hospital Crisis.)

From the report's Executive Summary:
Today, Brooklyn is grappling with high rates of chronic disease and a healthcare delivery system that is, in many areas, ill-equipped to address them. High rates of preventable hospital admissions and avoidable emergency department visits indicate deficiencies in primary care and inefficient use of high-cost resources. Further, while there are several fine hospitals in Brooklyn that are well-managed and financially-stable, Interfaith Medical Center, Wyckoff Heights Medical Center and Brookdale Hospital Medical Center are experiencing financial crises. At the same time, great opportunity presents itself in new models of patient-centered care, focused on prevention, and supported by technology and appropriate reimbursement incentives... With Brooklyn’s high rates of obesity, high blood pressure and diabetes, and 1 million Medicaid beneficiaries among its [2.5 million] residents, the state has a strong interest in the quality, accessibility, efficiency and viability of healthcare in the borough.
Neighborhoods

The report draws a set of Brooklyn neighborhoods. To understand Atlantic Yards, consider the contrast between prosperous, mostly gentrified Northwest Brooklyn, and needier Central Brooklyn:
To describe geographic variation in health and socioeconomic status and access to care in Brooklyn, this report uses the neighborhoods defined by the United Hospital Fund for the purpose of research and planning studies. UHF drew 42 neighborhoods across New York City based on boundaries consisting of adjoining zip code areas. These neighborhood designations provide clear and consistent boundaries for the unique demographic, economic, health and delivery system characteristics of small geographic areas. In Brooklyn, the UHF neighborhoods are: Greenpoint, Northwest Brooklyn, Central Brooklyn, East New York-New Lots, Sunset Park, Borough Park, Flatbush, Canarsie-Flatlands, Southwest Brooklyn, Southern Brooklyn, and Bushwick-Williamsburg.
The demographic/health contrast between Northwest Brooklyn and Central Brooklyn


More demographics: race

From the report:
Nearly 20 percent of Brooklyn’s population is Hispanic or Latino, 36 percent is Non-Hispanic White, 32 percent is Non-Hispanic African American, and more than 10 percent is non-Hispanic Asian.9 Brooklyn’s neighborhoods vary based on the distribution of races and ethnicities among their residents. In Central Brooklyn, Bushwick-Williamsburg, Flatbush, and East New York- New Lots, for example, more than 85 percent of the residents are African-American or Hispanic. By comparison, in Greenpoint, Borough Park, and Southwest Brooklyn, more than 50 percent of the residents are White. Sunset Park has the highest percentage of Asian residents at 29 percent.

More demographics: economics

From the report:
Socioeconomic factors, such as income, health insurance, and education affect health needs and access. In 2010, 23 percent of Brooklyn residents had incomes below the federal poverty level ($22,350 for a family of four, or $11,100 for a single person). This compares to 20.1 percent citywide and 14.9 percent statewide.11 Nearly 15 percent of Brooklyn residents had no health insurance in 2010, compared to  nearly 12 percent statewide.12 Almost 1 million Brooklyn residents, or forty percent of the total, are covered by Medicaid. This compares with 4.7 million and 24 percent statewide.

The following are some additional key socioeconomic indicators for Brooklyn:
• Median household income for all of Brooklyn is $42,143 in 2010.
• The 2010 unemployment rate for Brooklyn was 10.5 percent, compared to 9.3 percent statewide.
• Of the total population 25 years and older, 12 percent has less than a 9th grade education, 29 percent has attained a high school diploma or equivalent and 29 percent has a Bachelor’s or higher degree.
The neighborhoods in Brooklyn with the highest poverty rates are: Greenpoint, Bushwick-Williamsburg, Central Brooklyn, and East New York-New Lots, where more than 30 percent of households live below the federal poverty level. By comparison, the poverty rate in Canarsie-Flatlands is 14 percent, in Southwest Brooklyn 16 percent, and Northwest Brooklyn 20 percent.
More demographics: language, area of origin

From the report:
Fully 38 percent of all current Brooklyn residents are foreign-born. Of those foreign-born residents, 45 percent are not US citizens.18 The majority of immigrants residing in Brooklyn are of Latin-American origin, with 52 percent from South American countries. European and Asian immigrants make up 20 percent and 25 percent of the remaining immigrant population respectively.

All of Brooklyn’s neighborhoods have high percentages of foreign-born residents. More than one-third of the residents are foreign born in Borough Park, Canarsie-Flatlands, East New York-New Lots, Greenpoint, Flatbush, Southern Brooklyn, Southwest Brooklyn, and Sunset Park.

The large foreign-born population in Brooklyn naturally leads to a significant percentage of residents with limited English proficiency and a wide variety of spoken languages. Of the total population living in Brooklyn over 5 years old, 46 percent speak a language other than English at home and 25 percent state they speak English ‘less than well.’
Health problems

From the report:
Brooklyn faces daunting population health challenges. High rates of chronic disease and premature death exact human and economic costs. On all of the following indices, Brooklyn residents exhibited worse results on health status indicators than New York City residents as a whole:
• 26 percent of adults in Brooklyn were obese in 2009;
• 11 percent of adults had diabetes in 2009;
• 31 percent of adults had high blood pressure in 2009.22
Likewise, rates of hospitalization and premature death were higher in Brooklyn than citywide. In Brooklyn, 47 percent of residents who died did so prematurely (before age 75) between 2007 and 2009, as compared to 45 percent citywide.
It's especially tough for black and Hispanic Brooklyn:
Specifically, Black non-Hispanic Brooklyn residents experience a disproportionately high rates of negative health outcomes, including:
• 62.3 percent of Black non-Hispanic residents who died did so prematurely (before age 75), between 2007and 2009 -- double the rates for White non-Hispanic Brooklyn residents;
• Black non-Hispanic residents experienced the highest rates of obesity (31.8%) and high blood pressure (35.0%) and second highest rate of diabetes (13.2%) as compared to other race/ethnic groups in Brooklyn during 2009;
• Black non-Hispanic children in Brooklyn were hospitalized for asthma at a rate of 70.0 per 10,000) -- almost ten time the rate of their White non-Hispanic (7.6 per 10,000) counterparts.
Hispanics also experiences a disproportionately poor health outcomes compared to other racial and ethnic groups residing in Brooklyn. Between 2007 and 2009, in comparison with other racial and ethnic groups residing in Brooklyn, Hispanic Brooklyn residents had the:
• Highest percentage of premature deaths (62.5%)
• Highest prevalence of diabetes (15.5%) and asthma (11.0%);
• Second highest rates of obesity (29.3%) and high blood pressure (31.3%).
Compounding the problem 

The report notes how health problems are compounded:
High rates of chronic disease are compounded by socioeconomic barriers to health care, such as lack of health insurance, limited English proficiency, and poverty. Large segments of the population in several neighborhoods live in extreme poverty, have low levels of educational attainment, and are linguistically isolated.39 Fully forty percent of Brooklyn residents are on Medicaid and 15 percent are uninsured.

The inpatient payer mix of Brooklyn hospitals is dominated by Medicaid, which paid for 42 percent of the discharges in 2010. Medicare covered 33 percent, and commercial insurance covered 17 percent. The remaining 8 percent are considered “self-pay” patients, who typically include primarily uninsured and charity care patients. With high percentages of patients covered by Medicare and Medicaid (75 percent in 2010), Brooklyn hospitals are particularly vulnerable to the effects of the state and federal budgets.
Wondering why the percentage of those using commercial insurance seems low? Because better-off Brooklynites go to Manhattan.

A map of health professional shortage areas

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