Health Needs Assessment
by Christina Shat
(Community Relations Coordinator)
Today, Philadelphia’s Chinatown, occupying 20 square blocks in Center City, is a growing community of 4,000 residents, more than 110 businesses, a wide range of human services and influential religious institutions. It is our community, our neighbor, located approximately four blocks away. As Hahnemann seeks to fulfill its mission, we understand that the Chinatown community has unmet health care needs that we believe we can help address. To better serve Chinatown, Hahnemann is endeavoring:
- To develop a deeper understanding of the health care needs;
- Offer programs and services to address these needs;
- Offer services in a way that the Chinatown community will access them; and
- Above all, conduct outreach and provide services in a culturally sensitive manner in conjunction with the health care professionals already serving the community.
To begin this process, a needs assessment was conducted by Tina Shat, M.S.W., Community Relations Coordinator for Hahnemann’s Chinatown outreach and also for the Philadelphia Chinatown Development Corporation (PCDC). 377 questionnaires on health status and services were collected from those who live and come through Chinatown. PCDC also worked in collaboration with the Philadelphia Health Management Corporation (PHMC) to conduct ten key informant interviews and three focus groups, which supplemented the quantitative findings of the questionnaire. This assessment will present:
- Demographic information;
- Information on the current resources in the community;
- Data collected from the questionnaires, interviews and focus groups; and
- An outline of needs in the community.
Chinatown is represented by the zip code 19107 in Census Tracks 2, 126 and 127. While Census 2000 figures records 1,420 Asians in those tracks, we believe that the number is closer to 4,000 based on the number of housing units and average number of occupants. In the City of Philadelphia, Census 2000 data indicates that there are 17,783 Chinese out of a total of 74,435 Asians. Out of the total population of 5.1 million in the Delaware Valley, almost 200,000 are Asian, including 40,000 Chinese. Chinese and Asians beyond Chinatown were included in this assessment, because on the weekend, approximately 75,000 people come through Chinatown, which serves as a cultural center and a hub of services for Asians in the Delaware Valley.
The number of Asians has grown by at least 50% each decade since 1970, and the trend is expected to continue. Nationally, Asians are the fastest-growing minority, increasing in New Jersey 76% and in Pennsylvania 62%. The Asian population at present tends to be younger than all races/ethnicities combined with a greater increase of Asians 45+ years old expected between 2000-2005. The ratio of males and females is about 1:1. 38.4% of women are of child-bearing age, 14-44 years old. 18.6% are younger than 18 years old.
Analysis using the available 1990 Census data indicates that the Chinatown community is at a socioeconomic disadvantage. 61.5% of Asian households in Chinatown are living below the poverty line, while all races of households in Chinatown and Philadelphia are at a 49.0% and 20.3% poverty rate, respectively. The median household income was $8,170 in 1990, and the median family income was $14,740.
21% of Asian residents are unemployed in Chinatown, while 58% are underemployed. With closing of garment factories, entry-level positions have become more scarce. No other industry has been identified to replace these entry-level jobs. Furthermore, only 22% are homeowners, which is well below that national homeownership rate of 67%. With a steady stream of new immigrants settling in Philadelphia, more and more are living and relocating to South Philadelphia, where housing is more affordable.
Health Needs in the Community
The needs assessment identified some key needs in the community. 40.2% report fair/poor health. 27.9% of the respondents did not have a regular source of care. Also, when asked how medical services were paid, 33.2% either paid out-of-pocket or received free services, which may indicate a lack of insurance or inadequate coverage. PHMC’s household survey reported that 41.9% of Asians did not have prescription coverage as compared to the 19.6% of the overall population, and that 44.9% of Asians did not have dental coverage as compared to the 29.5% of the overall population.
Providers in Chinatown believe that the needs of Chinatown residents are adequately served by them. Most elderly residents of the On Lok House also have adequate care. However, there is a need for specialty services. Those who work with children report a high percentage of children without health insurance who are eligible. They believe that the parents have difficulty completing application forms because they are unable to show proof-of-income and do not receive paystubs in cash jobs. Dental care for children is particularly poor. Parents may believe that cavities do not need to be treated because adult teeth will soon replace the baby teeth. Some are also concerned about the growing number of children who are overweight and obese, due to a sedentary lifestyle.
Furthermore, the physical health of the community may be improved with more regular preventative care and health education. According to PHMC, a larger percentage of Asians in comparison to the overall population reported that they were less likely to have had their BP read within two years and that the last time that almost a quarter of the Asians had gotten a physical was more than 2 yrs. According to National Asian Women’s Health Organization, Asian American women have one of the lowest early detection screening rates for breast and cervical cancer. Several Asian American ethnic populations have incidence and mortality rates for breast cancer comparable to Caucasian women, and Vietnamese women have the highest rates of cervical cancer in the country.
Interestingly, only 13% of respondents reported using only Chinese medicine or using Chinese medicine more often than Western medicine. Another 14% report using Chinese and Western medicine equally. While there are still some who prefer to use Chinese medicine, it seems that as immigrants become more acculturated, the more they use Western medicine and are able to access the American health system. This is also dependent on their English language proficiency. Some will use Chinese medicine for minor ailments or complaints such as coughs, colds, stomachaches and minor aches and pains, while seek Western care for more serious illness. A common use of Chinese medicine is for chronic pain. If Western medicine fails to effectively treat the ailment, some will seek alternative medicine, and vice versa, if they typically use Chinese medicine first.
Some of the major disorders found in the Chinese community are:
- Heart disease
- Hepatitis B
Smoking and gambling also significantly affect the community. Domestic violence is a growing concern, while mental illness, which are often exhibited psychosomatically, is a taboo subject. In general, Chinese patients tend to not seek any medical treatment until the problem is quite severe.
Goals to Consider to Improve the Health of Chinatown residents:
- Increase health education.
- Improve preventative health care and screening.
- When ill, access treatment earlier rather than waiting for status to become acute.
- Address mental health concerns and illness.
- Integrate traditional medicine with Western approach
 This position is jointly funded by Hahnemann and PCDC, as it is mutually beneficial.
 The number of residents who have limited English proficiency (LEP) and/or wary of their immigration status may account for the difference in population totals.
 Based on 1990 U.S. Census projections.
 The poverty line is at a household income of $17,050 for a family of four.