Introduction and Aims
Have you wondered why people living in impoverished communities are sicker? It’s not as simple as not being able to reach a hospital; and it’s certainly not a personal failing when these communities have increased prevalence of obesity, diabetes, heart disease, and other illnesses. A number of environmental factors, termed social determinants of health, predispose poor individuals to worse health. Social determinants include education, employment status, wealth, and access to health services [1]. To identify the social determinants of health that affect low-income Hispanic communities, I conducted a community health needs assessment in the town of Bienvenido, an impoverished batey* community located on the southern coast of the Dominican Republic.
I visited the Niños Primeros en Salud (NPS) pediatric clinic in Bienvenido, a medical center directed by the Children’s Hospital of Philadelphia Global Health Center, to better understand the scope of medical services offered to the Bienvenido population. I then traveled to Bienvenido where I collaborated with the Bienvenido Project, a local nonprofit organization that offers nutritional and educational programs to children in the community. Along with Mariel Pierre Dide, Manuela Duran, and Bernarda Paul from the nonprofit, I surveyed residents in their homes to identify the primary health challenges and concerns of the Bienvenido population. We interviewed 145 adults and adolescents to evaluate four main spheres of health: demographics, personal and family health, community health, and maternal health. An additional, more involved questionnaire was used to interview community leaders in order to gain a more detailed understanding about the main health disparities within Bienvenido.
Results
The study identified five main focus areas of the NPS clinic: anemia, deworming, breastfeeding, immunizations, malnutrition (Table 1). Survey results also revealed the most prominent health problems affecting the Bienvenido community: HIV/AIDS, skin diseases, cold/fever, sexually-transmitted infections (STIs), chickenpox, tuberculosis, hypertension, diabetes, teenage pregnancy, diarrheal diseases, amoeba infection, dengue, and pneumonia. (Table 2). Finally, we identified likely social determinants of health and possible interventions (Table 3):
Lack of health insurance (as most residents of Bienvenido are of Haitian-migrant descent and do not have proper documentation to apply for public insurance).
Lack of employment opportunities in the community.
Lack of medications at the local pharmacy.
Poor quality/range of services at the Centro de Atención Primario (community health center).
Limited amount of vaccines and birth control available.
No specialized maternal or pediatric services or providers.
Lack of contraception (condoms, birth control) and consistent sexual health education.
Physical environmental factors that contribute to disease: contaminated water, stray animals, tropical climate (transmission of tropical diseases via mosquitos).
Absence of sanitary practices/conditions at home (improper waste disposal, washing hands).
Lack of exclusive breastfeeding practices (6 months) among mothers.
Table 1. The five primary focus areas of the NPS clinic.
Table 2. The most prominent health conditions facing the adult and adolescent populations in Bienvenido.
Table 3. Social determinants of health facing Bienvenido residents and potential interventions.
Conclusion
The results of the Community Health Needs Assessment in Bienvenido suggest that optimal health involves a combination of treatment and preventative healthcare services. In addition to medical services, specific educational talks — or “charlas” — were recommended by residents to enhance the understanding of disease prevention and health promotion within the community (e.g. sexual health, comorbidities, hygiene, adolescent mental/behavioral health). The information acquired from this pilot research study will be utilized to support future health projects in Bienvenido and will contribute to an important collection of scientific literature addressing social determinants of health in low-income, Hispanic communities around the globe.
Acknowledgments
I would like to give my sincere thanks to my mentor, Terri Lipman; the CHOP Global Health Center; the Class of 1971 Robert J. Holtz Fund and the Harnwell College House Research Fellowship; and lastly, to my friends and family in Bienvenido, especially Laura Collazo and Veronica Taveras, Founder and Director of the Bienvenido Project. Gracias por todas las oraciones y amor, nos vemos pronto (Thank you for all the prayers and love, see you soon).
*Batey community: a town made up of settlements located near a sugarcane plantation. Most migrant workers raise their families within these communities and work on the sugarcane fields year-round.
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