Whether for cultural reasons, misinformation, or mistrust of the medical system, minorities too often resort to emergency medicine instead of preventive medicine. To combat the deleterious effect of this practice on the health of the community around it, the State University of New York at Downstate Hospital in Brooklyn is building and nurturing relationships with local African-American, African, Caribbean and Latino populations through initiatives in churches, beauty parlors and barbershops, and health fairs. “The key to a healthy community is the proper dissemination of information from the medical institutions that surround it,” says Dennis P. Andrulis, director of the Social Health Landscape of Urban & Suburban America project at SUNY Downstate, which documents the social and health improvements and challenges in the nation’s 100 largest cities and their suburbs.
Downstate president John C. LaRosa says 50 percent of the hospital’s patients are on Medicaid and many are uninsured, which makes efforts to combat emergency medicine even harder. “Many of our patients come in when the diseases are progressing and we have to treat [not only] that particular illness, but also the complications that arise from a delayed diagnosis,” he says.
Andrulis, who has a doctorate in educational psychology and a master’s in public health, argues that the good or bad standing of the nation’s economy has a strong correlation to the health of minorities of color. “The major issues for urban health are infant mortality, sexually transmitted diseases and HIV, combined with the long-standing effects of poverty. Across the country we see improvement in treating these illnesses when the economy is good,” he says. “But these numbers may be overtaken during a slow economy [that affects poor communities harshly].”
He notes that diabetes in children is competing with asthma and heart disease in the inner city, and that obesity and Type 2 diabetes have reached epidemic proportions in urban America. According to the American Diabetes Association, African-Americans experience higher rates of at least four serious complications of diabetes: cardiovascular disease, blindness, amputation and end-stage renal disease [kidney failure]. The association also reports that African-Americans are 1.6 times more likely to have diabetes than non-Hispanic whites; 25 percent of African-Americans between the ages of 65 and 74 have diabetes; and one in four African-American women more than 55 years of age has diabetes.
With research showing that communities of color increasingly are being serviced by teaching hospitals, relationships like those being fostered by Downstate are even more imperative. “We have become more culturally sensitive to the communities we serve,” says Maria Yomtov, R.N., director of the Center for Community Health Promotion and Wellness at Downstate. “The relationship with churches and community leaders allows us to show them how to take baby steps toward changing their diet habits, proper use of medication, decrease of alcohol [use] and smoking, and consciousness about exercising and practicing preventive medicine,” she says.
Aside from its health initiatives, Downstate also serves as an economic engine for the community, providing badly needed jobs and spurring a slew of business services. LaRosa, who is a medical doctor, considers this dual role a great opportunity for the development of the community and for growing future scientists. “I feel that in order to make real progress in fighting these epidemics [diabetes and heart disease], studies need to be performed in areas where you have a high-risk population,” he says. “Doing a study in a suburban middle-class community will have no effect on low-income, minority communities where there is a higher probability for the disease.”
The hope is that new studies and stronger emphasis on educational programs tailored to individual communities will have a positive impact on the state of urban health, he says.