Running head: WINDSHIELD SURVEY 1
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Health Promotion and Disease Prevention in Vulnerable and Diverse Populations
WINDSHIELD SURVEY 2
This paper addresses the question of diversity in health care by focusing on the health
risks and health care needs of those living in East Harlem, New York. The paper will first
provide an overview and statistical information about the population demographics of the East
Harlem community. It will then discuss the findings from a recent windshield survey of the
community. From this information, the demographic changes for the minority population in the
community will be explained. This will be followed by a description of health risks and health
care needs for the minority population and an examination of the prevalence and impact of
different illnesses on the same population. Finally, there will be an explanation of the health
disparities and the social determinants of health that can affect the vulnerable population in this
An Overview of East Harlem
East Harlem, also called Spanish Harlem or El Barrio is home to many immigrant
communities including one of the largest Hispanic communities in New York City with a
population of nearly 120,000. It also has a small Italian-American population. The majority of
the population is Hispanic (50%), and the rest of the population consists of African-Americans
(31%), whites (12%), and Asians (6%). The median age in the East Harlem community ranges
from 25–44 years. Around 22% of the population is between 0 and 17 years of age, and 12% of
the population is more than 65 years old. The average life expectancy of people in this
community is 76 years.
Surveillance Survey of the East Harlem Community
A windshield survey will provide a detailed picture of the people living in the area (New
York City Department of Health and Mental Hygiene [NYCDOHMH], 2015).
Comment [A1]: Great intro! This lets the reader know exactly what to
expect in the paper.
Comment [A2]: You did a nice job of describing the overall
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Housing. Around 76% of the homes in East Harlem are renter-occupied homes with one
or more maintenance defects; that include water leaks, the presence of mice or rats, cracks and
holes in the wall, inadequate heating, peeling paint, and toilet breakdowns. The community
consists of residents from a low socioeconomic background and cannot afford better housing.
Open Space. According to a study by the group New Yorkers for Parks, East Harlem has
1.2 acres of open space for every 1,000 residents, which is less than the recommended minimum
of 2.5 acres. Adequate open space allows children to play and exercise and offers parks for
relaxation which can improve the physical health of children and aging seniors.
Pollution. Unfortunately, East Harlem has a high concentration of fine particulate
matter—one of the harmful air pollutants in New York City. Air pollution is a leading cause of
health issues for people in East Harlem, especially among children, senior residents, and those
with preexisting health issues such as asthma and other respiratory ailments (NYCDOHMH,
Education. The neighborhood has many private, public, and charter schools. However,
an acute lack of resources in school and poor family life cause a majority of children to drop out
of school at an early age. Therefore, East Harlem consists of a substantial section of adults (26%)
who have not graduated from high school.
Culture and religion. From the first wave of Italian immigrants in the 19th century to
the tidal wave of musicians in the “mambo era,” East Harlem has set the stage for arts and
culture for over a hundred years. Because of its Italian-American population, East Harlem is still
influenced by southern Italian food, tradition, and ceremony. East Harlem has residents who are
followers of different religions ranging from Christianity and Islam to Scientology, and they have
their own places of worship in the area.
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Health services. East Harlem has several health centers in its community. Even with the
presence of these health centers, the residents of East Harlem do not have easy access to health
care primarily because they come from low-income families and lack health insurance.
Transportation and businesses. East Harlem has a wide range of business institutions,
one of the most famous being the East Harlem Chamber of Commerce. East Harlem is also
known for its well-run public transit system.
Hispanic Culture in East Harlem
East Harlem is a predominantly Hispanic neighborhood, due to immigration of Puerto
Ricans, Latin, South, and Central Americans. About a third of the Hispanic populations in East
Harlem are college graduates, while approximately 26% of the population has not finished high
school. These subgroups face barriers due to lack of language fluency. This language barrier can
lead to miscommunication and prevent Hispanic populations from accessing important health
education material and regular medical care, which in turn make them a vulnerable population
Demographic Changes in East Harlem
Hispanics and black residents comprise 81% of the population in this area, with about a
quarter of the residents being foreign-born. Around 31% of the residents in East Harlem live
under the Federal Poverty Level, making it the twelfth most underprivileged community in New
York. One out of eight East Harlem residents aged 16 and above is unemployed. More than half
the residents use nearly 30% of their overall income on rent.
Over the last decade, East Harlem has observed a large wave of gentrification, a process
of renovation and reconstruction of an area leading to an influx of affluent families in that area.
The impact of gentrification takes place through increased rent burdens instead of direct
Comment [A3]: You did a good job of discussing East Harlem and the
transportation, health services, culture,
religion, education, housing and
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displacements—rents have increased by more than 40% in East Harlem. This has resulted in a
deeper class divide between the rich and poor (Florida, 2016).
Health Risks and Health Care Needs in East Harlem
Due to poor diets, a serious health risk faced by residents of East Harlem is obesity,
which is a leading cause of diabetes and heart disease. Cancer and heart disease are the leading
causes of death for people in East Harlem. Smoking is the main cause of preventable death in
NYC and also the cause behind many illnesses including stroke, heart disease, lung cancer, and
emphysema. More than 25% of East Harlem residents smoke, which puts its residents at a higher
risk of suffering from cancer and heart diseases than any other community in the state of New
Substance use is a major social and health issue in low-income neighborhoods due to
their inability to cope with their low quality of life. Limited educational, housing, and
employment opportunities combined with the availability of drugs contribute to drug and alcohol
addiction (NYCDOHMH, 2015).
Two other health risks in this neighborhood are asthma among children and HIV. East
Harlem has the sixth-highest rate of asthma hospitalization among children aged 5 to 14 in the
state of New York and death due to AIDS in East Harlem neighborhood is thrice as high
compared to the rest of New York City.
While there are several challenges, health care in East Harlem can be improved by
providing cultural competency training to health care professionals in language skills, cross-
cultural communication skills, and health literacy strategies which will help them earn the trust
of the population (NYCDOHMH, 2015).
Comment [A4]: Very nice job in this section. You described the
demographics very well and also
identified the reasons for the change.
Comment [A5]: There seem to be many health disparities in East Harlem.
The prevalence of various diseases
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Health Disparities and the Social Determinants of Health in a Diverse Population
According to the World Health Organization (WHO), the social determinants of health
(SDH) are defined as circumstances within which persons live and work (World Health
Organization, n.d.). The financially deprived residents struggle to meet their basic needs; have
scarce occasions to achieve constructive goals; experience more undesirable life events such as
marital trouble, joblessness, and monetary loss; and must deal with discrimination,
marginalization, segregation, and helplessness. Owing to these stressors, people with low
socioeconomic status are at a higher risk of obesity, diabetes, substance abuse issues, violence,
The existence of disparities in access to health care has been recognized for a while in the
United States. Recently, the U.S. government has started many initiatives to address the social
determinants of health. Medicaid, a government insurance scheme for the underprivileged, has
also developed several initiatives that relate health care to wider social needs. An important
project under this initiative is the Harlem Children’s Zone (HCZ), which aims to improve the
health of the Harlem community through a wide range of social, health, and family programs.
This project has reported a 92% acceptance rate for its programs (Heiman & Artiga, 2015).
East Harlem is known for its diverse population and rich cultural history. However, given
that most of the residents in the area are poor and come from marginalized backgrounds, they
face different health risks and have difficulties accessing health care. Reducing these health
inequities requires policymakers, health professionals, researchers and community groups to
work together for systemic change. Framing health policies with the help of the social
determinants of health will enable the poor residents of East Harlem access better health care.
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Florida, R. (2016). Where New York is gentrifying and where it isn’t. The Atlantic
Heiman, H. J., & Artiga, S. (2015). Beyond health care: The role of social determinants in
promoting health and health equity. The Henry J. Kaiser Family Foundation. Retrieved
New York City Department of Health and Mental Hygiene. (2015). Manhattan community
district 11: East Harlem. Retrieved from
New Yorkers for Parks. (2012). East Harlem open space index. Retrieved from
World Health Organization. (n.d.). Social determinants of health. Retrieved from