The health status
of Panamanian Immigrants
in New York City:
An assesment

 

By Marcia Bayne-Smith, PhD
Prof. – Urban Studies Dept
Queens College – CUNY
Chair – Board of Directors
Caribbean Women’s Health Asso., Inc.

       Introduction
Any effort to assess the health status of Panamanian immigrants living in New York City has to begin with a careful examination of how well or how poorly Panamanians are doing in terms of maternal and child health measures which are generally regarded as key indicators in determining the health status of a community. Among maternal and child health measures, the infant mortality rate (IMR) in particular, is internationally considered to be a reliable indicator of the health status of any population group.

The universal acceptance of the infant mortality indicator is based on the recognition that infants are in many way, the most vulnerable segment of any population group in terms of susceptibility to health adversities in their environment. Therefore, if a group is unable to safeguard the health of its babies it is unlikely that they will take care of the health of adults. The international reliability of this indicator is also largely due to the fact that it involves birth and death statistics which every country collects and involves an “event” which, unlike the identification of various diseases, is unambiguous. However, the greatest power of the IMR indicator is its ability to act as a predictor of health status of any group because among groups where IMR is highest, invariably that group also faces high levels of additional health problems.

Reports from the National Center for Health Statistics point out that infant mortality decreased dramatically in the United States (U.S.) throughout the course of the twentieth century with declines as high as 55% for whites and 37% for blacks in the last 2 decades (National Center for Health Statistics [NCHS], 1998). While this improvement is indeed significant for the U.S. as a whole, it has not been consistent for everyone who resides in the U.S. For example, the 1991 US IMR of 16.5 for black infants was 2.2 times greater than the rate of 7.25 for whites. Ten years later, IMR information from the Centers for Disease Control and Prevention (CDC) indicated that the 2001 IMR of 14.0 for blacks was 2.6 times greater than the rate of 5.7 for whites, which emphasizes not only the persistence of racial health disparities but also that in the wealthiest nation in the world, black infants are more than twice as likely to die before their first birthday than white infants.
There are many explanations for the higher IMR risk among racial/ethnic groups and these include:
- higher incidence of low birth weight (LBW) and pre-term births for blacks, even
when controlling for education as a proxy for socio-economic status
- sudden infant death syndrome (SIDS) has been shown to play a role in higher IMRs
among American Indian and Alaska Natives,
- LBW has been identified as contributing to high IMR in Latinos/Hispanics, and Asian
Pacific Islanders as well.
While these explanations refer to birth outcome of the four major groups of color in the U.S., there are no explanations or studies that shed light on the current glaring IMR disparities found in specific racial/ethnic immigrant communities in New York City or elsewhere in the country. Let us focus for a moment on the situation in New York City (NYC) and of course on Panamanians.
New York City Department of Health (NYCDOH) released reports in 1998, with the claim that it had achieved a city-wide IMR average of 6.4 which was certainly lower than the national average of 7.2. Local community-based organizations (CBOs), hospitals and other health providers in Brooklyn, questioned the reports asked for a closer examination of data from a more comprehensive (1996-1999) period. Analysis of the larger data set revealed that there were significant racial differences in IMR in NYC, and much of those differences are concentrated among immigrant groups. Further, the data identified a dozen countries: ten in the circum-Caribbean Region, and two from Africa as the birth countries of immigrant mothers with the highest IMR. One of those countries from the circum-Caribbean countries is Panama.
Panamanian Immigrants in New York City
Data from New York City Department of City Planning (NYCDCP) indicates that while Panamanian immigrants to the U.S are found in all 50 states, New York City has the largest cluster. In New York City Panamanians are most numerous in North Central Brooklyn, an initial stop in their migration pattern, which is sometimes, but not always, followed by a secondary migration pattern away from the inner city to outer suburban areas of the City and to other states. Naturally, this data excludes the undocumented population as there is no “official” or reliable quantification of undocumented persons in the country. Nevertheless, it is estimated that for every 3 documented persons there is at least one undocumented person in the country and this flow of undocumented persons is expected to continue. It can be expected that these assumptions about the undocumented also hold true for Panama.
Given these characteristics of U.S. migration, the demographic profiles of Panamanians in the U.S. (Table I) and in New York City (Table II) are illustrated below:

The process of immigration and settlement is one that is naturally shaped by kinship networks. As a result, new immigrants to the City move into immigrant enclaves where there is an existing concentration of people from their homelands. According to data from NYCDCP, Table III shows the continuous concentration from 1990 to 2000 of Panamanians in Brooklyn and Table IV shows the specific Brooklyn neighborhoods where Panamanians tend to be clustered.

Panamanian Neighborhoods in
Brooklyn 1990 - 2000

• Williamsburg D Bushwick
•Bedford Stuyvesant
•East New York
•East Flatbush - Flatbush
•Canarsie - Flatlands

IMR Rates Among Panamanian Immigrants in NYC.
The highest IMR in NYC is concentrated among immigrant women from 10 Caribbean countries and two from Africa. Table 5 describes the highest IMRs in NYC by maternal place of birth for 1996-1999, Panamanian women as a group, have the third highest infant mortality rate among immigrant groups in NYC.

A summary report of vital statistics from NYCDOH for year 2000 provides information on IMR by borough and by specific neighborhoods. (See Figure V, NYC – Residents, 2000) This figure indicates that the infant death rate for NYC as a whole was 6.7 per 1000, which is better than the goal of 7 established by the Federal Healthy People 2000 (HP2000) program but above the target of 4.5 for 2010 that has been set by the Healthy People 2010 (HP2010) goals. It is also evident from this data that IMRs are not uniform throughout the city as it is clearly lower in Manhattan (5.0), Staten Island (6.1) and Queens (5.8), than the city average of 6.7. However, the overall NYC IMR of 6.7 in 2000 was surpassed by two boroughs of which Brooklyn is one (6.9). Further, the highest rates in Brooklyn are in the neighborhoods of: Bedford Stuyvesant-Crown Heights (10.8), East Flatbush-Flatbush (9.8), East New York (8.9), and Canarsie-Flatlands (8.7) which are all neighborhoods with concentrations of Panamanians.

Health Status Implications
The long standing reliability of the IMR indicator to suggest the presence of other health problems in a given population demands that we look at the implications of high IMRs among Panamanians living in NYC, by exploring the incidence of three selected health indicators: Asthma, HIV/AIDS and Prostate Cancer, in neighborhoods where Panamanians reside. Table 7 shows that asthma in children 0-14 in Brooklyn is highest, in most (four of the five) of the same neighborhoods where IMR is also highest.

Three of the five neighborhoods in Table 8 with an adult/adolescent AIDS case rate in Brooklyn of more than 4000 cases are ones in which large numbers of Panamanians reside.

Data was obtained from NYCDOH on the 1992-1995 Prostate Cancer Rates by neighborhood for men 45-64. Table 9 shows unusually high rates of prostate cancer in those same neighborhoods.

Conclusion
Given the preceding discussion on the high IMRs, among immigrant mothers in NYC who were born in the Republic of Panama and its attendant impact on health status, it is important for Panamanians to be aware that we have a unique set of health care needs and concerns that we must now focus on addressing. First there is a lack of readily available health care services in our communities. Many of the health professionals who provide health services to us are grossly negligent of who we are, our culture or how we utilize health services. There has also been a palpable inattention by health service providers in our communities, to the development of culturally sensitive models of service delivery that are best suited for addressing health disparities for Panamanians.

Of equal importance is the absence of reliable data without which any group is hard pressed to argue its case for the need for better care. With regard to the issue of data, the City has not instituted any uniform measures for collecting all health data which means that there is inadequate coordination of data related to the health needs of Panamanians or any other racial-ethnic group. Without access to uniform data, it will be extremely difficult for us as a group to advocate for the services we need to decrease the incidence of HIV/AIDS, cancers, drug and alcohol use, chronic diseases, and poor birth outcomes, particularly IMR, in our community.

Therefore the health care goals for the Panamanian community in NYC must include:
- The development of a broad network of bilingual health   care providers.
- Efforts to increase awareness of Panamanian culture among health professionals so that they might better provide culturally sensitive services
Encourage health related research targeting the Panamanian
Increase the number of Panamanian professionals in a broad range of health care professions.
Inform and educate the Panamanian community in order to diminish and eliminate behaviors that promote the spread of disease.
Address immigration-related issues restricting access to care.
Many challenges lie ahead as we begin to take hold of our health and our health care needs. We must bear in mind that the struggle for optimum health is not only personal but also, it is indeed a larger struggle in which we much first acquire the skills and resources needed to take on the struggle. Then, we must become fully cognizant of the kinds of changes we will have to make, personal and political, knowing that ultimately we must assume responsibility for our own destiny.

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