services measures are ambulatory care visits, emergency department use, inpatient insurance status, and numbers of physicians by specialty. Also presented are data on characteristics of the population and the community that can influence health. Among these are ethnic distribution, immigration status, household composition, per capita income, adult educational attainment, primary school reading and math scores, and crime rates.

For many measures, the report shows that Washington Heights/Inwood has relatively good health status. This population-based perspective is a valuable counter to the impressions that many medical center clinicians had developed from caring for those residents who are sick. The relatively positive findings also raised questions about why risk factors usually associated with poor health outcomes had a less adverse effect in this neighborhood. Possible explanations include greater household stability than might be expected among a predominantly immigrant population and the availability of informal employment to offset some of the “official” unemployment. The neighborhood is not without health problems, however. Of particular concern are violence, AIDS, and teen pregnancy.

The report has been a way to bring information about the community 's health to many interested groups that did not have such information and has been helpful in dispelling myths about the community. The report's neighborhood focus, which differs from the city health department 's program-based organization, has encouraged greater contact among the program managers in that health district. Columbia Presbyterian Medical Center has found the report valuable for orientation programs for students, interns, and residents. Clinicians have also been able to use specific pieces of information in preparing grant proposals. It seems too soon to tell whether the report has stimulated greater interest in population-based research.

A variety of groups in the community have been able to use the report and also have contributed additional insight into some health and health care issues. Schools, for example, have been able to reveal that many adolescents miss classes because they must take relatives to the doctor. This suggests that access to care may be affected by factors such as transportation or language barriers. Many other absences are pregnancy-related. Churches are seeing the impact of some of the circumstances documented in the report such as lack of insurance. To assist their members, churches have taken on an important community role in facilitating access to health services.

Discussion at the workshop of some of the differences between immigrant communities in California and New York highlighted the importance of understanding local conditions. In contrast to patterns seen in California, the Washington Heights/Inwood population were less likely to return to their country of origin for care when they were ill, were less likely to seek care from traditional healers, and were less likely to be deterred from seeking mainstream care by concerns about documentation of their immigration status.



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