Featured Story from the Field

Chinatown NORC Program Partners with New York City on Colon Cancer Screenings

Overview
The Chinatown Neighborhood NORC program in lower Manhattan, comprising 24 of New York City’s densest residential blocks, was in its infancy in 2007. With state funding, an advisory council was in place, community partners were involved, and staff had started to identify seniors likely to benefit from participation. But the NORC program had not yet found a defining issue around which to rally, and the partners were still thinking about how best to bring people together and keep them engaged.

Meanwhile, the city’s Department of Health and Mental Hygiene (DoHMH) was looking for new opportunities to expand its cancer prevention initiatives. Increasing the rate of colonoscopies was a key focus because colonoscopies are more than just a screening tool – they also find polyps that can be removed before they have a chance to become cancerous. When the health department formed its Citywide Colon Cancer Control Coalition in 2003, just 42 percent of the city’s residents reported having a colonoscopy in the past ten years. The department wanted to improve that citywide figure to 80 percent.

The overlap between these agendas was not readily apparent. But the Chinatown NORC program and the health department found common cause in the recognition that Asians were far less likely than any other racial or ethnic group in the city to have had colonoscopies. The story of how their collaboration came together and evolved offers a model for others to consider.

The Chinatown Community
Manhattan’s Chinatown has one of the highest concentrations of seniors in the city and the greatest number living in poverty. Based on U.S. Census data from 2000 (the most recent data available), the Asian American Federation of New York offers this overview:

  • From 1990 to 2000, the number of elderly people in Chinatown grew by almost one-third, compared to an 11 percent growth rate of the community as a whole.
  • Chinatown is a singularly poor neighborhood: 39 percent of its elderly population live below the poverty line, compared with 24 percent of Asian elderly citywide.
  • More than half the Chinatown community is foreign-born, and almost three-quarters of the elderly residents have limited proficiency in English.
  • Almost 2,000 senior residents live in the 24-block area included in the neighborhood NORC.

Launching the Initiative
The Visiting Nurse Service of New York (VNSNY), which has a long history of providing home health services in Chinatown, received funding from the New York State Office for the Aging in 2006 to serve as lead agency for the development of the neighborhood NORC program. Five other partners were formally involved:

  • The Chinese Consolidated Benevolent Association, an umbrella group of 60 business, social service and community organizations in Chinatown.
  • New York Downtown Hospital, which provides inpatient services to a significant portion of the Chinatown community.
  • The Chinese American Planning Council, founded in 1965 as the first social service agency in New York City to specifically target the Chinese-American community.
  • University Settlement, a multi-service agency that has historically served new immigrants and more recently has served the range of diverse populations living in lower Manhattan.

Working with the United Hospital Fund (UHF), the fledgling Chinatown program used the Health Indicators in NORC Programs process, which surveys seniors about their health status and measures the effectiveness of targeted health interventions. All 54 NORC programs in New York State have participated in the first phase of Health Indicators, administering a 75-question survey to a total of more than 6,300 seniors.

As the Chinatown NORC program was collecting baseline data about its community’s health, DoHMH was looking for opportunities to increase the use of colonoscopies. At UHF’s suggestion, health department representatives made a presentation to directors of five New York City NORC programs describing the importance of colon cancer screening, the barriers to its use and the education, resources, and supports available to promote wider testing. The idea caught the attention of the neighborhood NORC program, which had learned from its Health Indicators data that colonoscopy rates among its predominantly Asian clients were low.

“It became a way to mobilize our partners – both our formal partners and others we worked with in the community,” said Karen Bassuk, manager of program development for VNSNY. “We could say, ‘Look, we have the data, this is a real issue, it makes sense to come together to look at this.’”

“We developed our most robust partnership with the Chinatown NORC program,” said Marian Krauskopf, director of the DoHMH’s Cancer Prevention and Control Program. “We are accustomed to working in citywide coalitions, but we had not previously worked to micro-target a community.”  Continued...


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