Wit Paper – Rosetta Howell Sang
Understanding Your Population: Improving the Health of East Flatbush through Cultural Awareness
Rosetta Howell Sang
Author Note
Rosetta Howell Sang, Department of Nursing, Baccalaureate Program
Abstract
The zip code of 11203 comprises the entirety of the neighborhood, East Flatbush. I have lived in East Flatbush for the past 22 years. East Flatbush is located in the borough of Brooklyn, New York, which is also referred to as Kings County. East Flatbush is a large neighborhood comprised of smaller communities including Farragut, Flatbush, Remsen Village, Rugby, and Erasmus. Like the borough it is situated in, East Flatbush’s history is one of Dutch history. The Dutch settled in Breucklen, what we know now as Brooklyn, in the 1600s where they established six villages – Bushwick, Brooklyn, Flatbush, Flatlands, New Utrecht, and Gravesend (New York City Department of Environmental Protection, 2007). Flatbush was one of the six original Brooklyn towns. The word flatbush in the Dutch language translates to V’lacke Bos which means a flat plain with woods (Benardo & Weiss, 2006). When the Dutch settled in Flatbush the geographical area was covered heavily with woods (Benardo & Weiss, 2006).
East Flatbush: 11203
East Flatbush is a large neighborhood that spans 3.4 square miles (NYC Planning, 2018). As the name indicates, East Flatbush is located in the central-eastern section of Brooklyn and is bounded on all sides by different neighborhoods. The northern border of East Flatbush is bounded by Crown Heights at Empire Boulevard. The western edge of East Flatbush is bordered by Prospect Lefferts Gardens at Bedford Avenue and mostly by Flatbush at New York Avenue. The southern end of East Flatbush borders Flatlands along Farragut Road. The northeastern section of East Flatbush is bordered by Brownsville along Remsen Avenue. To the southeast, East Flatbush is bordered by Canarsie.
There are ten hospitals and clinics in East Flatbush, three of which are the area’s main hospitals (NYC Planning, 2018). These hospitals are Kings County Hospital, SUNY Downstate Medical Center, and Kingsbrook Jewish Medical Center – the hospital where I have been a nurse for the past 13 years. These three hospitals and their affiliated specialty clinics, are all clustered together in the north of East Flatbush. Kingsbrook Jewish Medical Center is 0.7 miles away from Kings County Hospital and SUNY Downstate Medical Center is 0.1 miles away from Kings County Hospital (Google Maps, 2019).
Geography
As the etymology of the name Flatbush expresses, the geographical features of East Flatbush were flat woodlands. The plentiful woodlands the Dutch had settled in the 1600s, are now primarily filled with residential buildings (NYC Planning, 2018). Residences comprise close to 89% of the land use of Community District 17, with the majority being single- and two-family homes. The rest of the land use if mostly split between manufacturing buildings at 7% and commercial buildings at close to 4%. Finally, less than 1% of park space in my district is for parks at 0.6% of the land use (NYC Planning, 2018). The natural woodlands of East Flatbush are not present today, with the last remaining adjacent woods, Paerdegat Woods, developed into residential homes in the 1940s (Benardo & Weiss, 2006). The closest remaining natural asset is the neighboring Paerdegat Basin, the longest inlet in Jamaica Bay which up until the 1920s was fed by a freshwater creek in East Flatbush (Brownstoner, 2016). While East Flatbush may not be full off forests in the present day, the geographical feature of the plains remains today. Since 11203 is a landlocked neighborhood, the plains in Community District 17 are not affected by the floodplain such as in neighboring Canarsie or Flatlands (NYC Planning, 2018).
Community District 17 is included in the Jamaica Bay Watershed Protection Plan. (NYC DEP, 2007). As a remaining natural asset, the Jamaica Bay watershed spans approximately 71,000 acres from the southern end of Brooklyn to Queens to northern Nassau County (NYC DEP, 2007). Eight tributaries feed into the Jamaica Bay, including the nearby Paerdegat Basin (NYC DEP, 2007). According to the Köppen climate classification, the most widely used climate classification, Brooklyn’s climate is a humid subtropical climate known as Cfa. (Brittanica, 2019). Regions with this climate type are characterized as having relatively warm temperatures throughout the year with hot and humid summers, mild winters, and stable amounts of precipitation all year long. Brooklyn’s average annual temperature is 54.8°F, with the July being the warmest month on average at 76.6°F and January being the coolest month on average at 32.5°F (NYC DEP, 2007). The average annual precipitation in my region is 45 inches (NYC DEP, 2007). The average annual snowfall for my region is 29 inches (NYC DEP, 2007).
According to the United States Department of Agriculture (USDA) Plant Hardiness Zone Map, East Flatbush lies in zone 7b (United States Department of Agriculture, 2012). The USDA hardiness zone guide describes climate conditions under which plants can grow and survive. The USDA developed 13 hardiness zones according to average annual extreme minimum temperature, to be used as a guide for caring for flora (2012). Since East Flatbush is classified as zone 7b, it means that the flora in this neighborhood can withstand a minimum temperature of 5 °F to 10 °F (USDA, 2012).
In addition to the once plentiful forests, the present-day flora and fauna of East Flatbush can be found in the nearby, Jamaica Bay Watershed. The most common native vegetation found in the area are the black cherry plant, sea lettuce, salt meadow cordgrass, and red maple trees (NYC DEP, 2007). Due to the heavily urbanized and residentially-developed nature of my neighborhood, the fauna that exist here include domesticated animals, rodents, and birds that have adapted to human-made environment. Common mammals and rodents found in East Flatbush are the Grey squirrel, Norway rat, and raccoons (NYC DEP, 2007). Common birds found in the area are the rock pigeon, European starling, and the common grackle (NYC DEP, 2007). Due to the proximity of Paerdegat Basin and the greater Jamaica Bay Watershed, migratory and native birds such as the Herring gull, Ring-billed gull, and the House sparrow (NYC DEP, 2007).
Human-made environment
In 11203, land use can be divided into four categories – residences, manufacturing, commercial use, and parks (NYC Planning, 2018). As previously mentioned, most of 11203 is zoned for residential use. The majority of homes in East Flatbush are one- and two-family homes which comprise all most half of the land use at 44.53% (NYC Planning, 2018). Multifamily walk ups comprise 18.59% of the residential land use (NYC Planning, 2018). In the manufacturing sector, 3% of the land use is for industrial and manufacturing and another 3% is used for transportation and utility purposes (NYC Planning, 2018). Almost four percent of the land in my community district is used for commercial and office space at 3.58% (NYC Planning, 2018). Another 5% is used for mixed residential and commercial purposes (NYC Planning, 2018). The third largest land use in community district 17 is for public facilities and institutions at 7.14%, including 465 facilities and institutions (NYC Planning, 2018). Open space and outdoor recreation areas such as parks comprise 5.74% of the land use in my community district. The open space and recreation areas include 6 parks and the Holy Cross cemetery (NYC Planning, 2018). The 465 facilities and institutions in the 11203 area serve a diverse range of purposes including administration of government; core infrastructure and transportation; education, child welfare, and youth; health and human services; libraries and cultural programs; parks, gardens, and historical sites; and public safety, emergency services, and administration of justice (NYC Planning, 2018; NYC Capital Planning Platform, 2018). Of the total number of facilities in the Community District 17, 293 are dedicated to education, child welfare, and youth – facilities that provide child and youth services, schools, and higher education facilities (NYC Capital Planning Platform, 2018). The second largest number of facilities and program sites in the area are for health and human services (NYC Capital Planning Platform, 2018). There are 57 facilities that provide health and human services which includes hospital, legal services, and homeless shelters (NYC Capital Planning Platform, 2018). Third is for parks, garden, and historical sites which have 35 facilities in Community District 17 (NYC Capital Planning Platform, 2018). This includes historic sites, recreational areas, parks, and nature preserves.
One such notable historical site and park in my neighborhood is the Fidler-Wyckoff House Park. Built around 1652, the Wycoff House is thought to be the oldest home in New York City, according to the New York City Department of Parks & Recreation (2019). The house was built by Pieter Claesen Wyckoff, a Dutch indentured servant who rose to become the wealthiest citizen of the neighborhood now known as, Flatlands (NYC Parks, 2019). Today, the Wycoff House operates as a park and museum with its surrounding 1.5 acres that are used for gardening, farming, and historical educational programming for K-12 school groups (Wycoff Museum, 2013).
Population
Community District 17 spans 3.4 square miles with a density of 45,662 persons per square mile (NYC Planning, 2018). The population density of East Flatbush is very high at 72.5 per acre as compared to the New York City average of 42.2 persons per acre (NYC Population FactFinder, 2016). According to the 2010 Census, the total population of East Flatbush is 156, 151 persons (NYC Planning, 2018). Stratified by age, the population of Community District 17 is 56.7% female and 43.3% male, with 25 to 29 years as the largest age group (NYC Planning, 2018), NYC Population FactFinder, 2016).
There is a total of 51,180 housing units in East Flatbush. 93.9% of these housing units are occupied and 6.1% of these housing units are vacant (NYC Population FactFinder, 2016). East Flatbush is comprised of family households with an average household size of 2.79 and an average family size of 3.34 (NYC Population FactFinder, 2016). Seventy percent of the households in East Flatbush are households with families and thirty percent are nonfamily households, which mostly include a householder living alone (NYC Population FactFinder, 2016). The median age in East Flatbush is 38 years old as compared to the New York City median age of 36 years old (NYC Population FactFinder, 2016).
At the time of the 2000 Census, the population of Community District 17 was 165,800 persons (NYC Planning, 2018). The total population count of the 2010 Census at 155,300 persons, has shown a 6% decrease in the population from 2000 to 2010 (NYC Planning, 2018). The estimated population for the years 2012 to 2016 is 138, 600 persons (NYC Planning, 2018). If this annual population decrease continues, the 2020 Census may have a population smaller than the 2012-2016 estimate for the area.
With 53.1% of the population of East Flatbush being foreign-born, the neighborhood is very culturally diverse (NYC Planning, 2018). The majority of the total population in East Flatbush is Black or African American alone at 87.3% (NYC Population FactFinder, 2016). The next largest race/ethnicity group is Hispanic/Latino which comprise 7.4% of the total population of East Flatbush (NYC Population FactFinder, 2016). White non-Hispanic is 2.2% of the population followed by Asian at 1.4% of the total population and person of two or more races at 1.3% of the total population of East Flatbush (NYC Population FactFinder, 2016).
Within each race/ethnicity group, a look at the places of birth, gives an even clearer picture of the cultural diversity represented in East Flatbush. Of the total population in my neighborhood, 46.9% were born in the United States and 53.1% are foreign-born (NYC Population FactFinder, 2016). Of those who are foreign-born, 92.9% were born in Latin America which includes 74.7% of the population born in the Caribbean, 13.9% born in South America, and 4.4% born in Central America (NYC Population FactFinder, 2016). Of the large Caribbean-born population, most persons are from Jamaica, Haiti, and Trinidad and Tobago (NYC Population FactFinder, 2016). Of the South American-born population, most persons are from Guyana (NYC Population FactFinder, 2016). Following Latin America and the Caribbean, the next largest foreign-born population in East Flatbush are from West Africa and Nigeria at 2.9% and 1.8% respectively (NYC Population FactFinder, 2016). Next, the foreign-born Asian population is 2.4% with the largest number of Asians from Yemen, Bangladesh, the Philippines, and China (NYC Population FactFinder, 2016). Lastly, foreign-born Europeans comprise 1.2% of the total population in East Flatbush with most persons from the United Kingdom, Czechoslovakia, France, and Greece (NYC Population FactFinder, 2016).
Socially, 48.9% of males over the age of 15 in East Flatbush., have never married (NYC Population FactFinder, 2016). 48.2% of females over the age of 15 in East Flatbush have never been married (NYC Population FactFinder, 2016). Of the population of those 25 years and older in East Flatbush, 36% have attained a high school diploma (or its equivalent), 22.3% have attained a bachelor’s degree or higher, 18.9% have reached some college but no degree, 14.8% have attained a bachelor’s degree and an equal percentage have attained less than high school level education, 7.9% have attained an associate’s degree, 7.6% have attained a 9th to 12th grade education level with no diploma, 7.5% have attained a graduate or professional degree, and 7.2% have completed less than a 9th grade education level (NYC Population FactFinder, 2016). 1.8% of the population in East Flatbush are veterans and 8.5% are of disability status (NYC Population FactFinder, 2016).
Economically, 62.2% of the population in East Flatbush who are 16 years and older are employed and 5.7% are unemployed (NYC Planning Community Profile, NYC Population FactFinder, 2016). The majority of those employed, work in the educational services, and health care, and social assistance industry at 42.2%, followed by 9.6% in the retail trade (NYC Population FactFinder, 2016). 75% of workers are employed by the private sector, 19.8% are employed by the government, and 4.7% are self-employed (NYC Population FactFinder, 2016). The majority of households have a household income of $50,000 to $74,999, with the average household income in East Flatbush being $61, 132 (NYC Population FactFinder, 2016). The majority of residents of East Flatbush have health insurance coverage, with 87.9% covered and 12.1% with no health insurance coverage (NYC Population FactFinder, 2016). Using the NYCgov Poverty Measure – which takes into account the high cost of living in NYC – 19.0% of residents in Community District 17 have incomes below the NYCgov poverty threshold and 14.5% below the federal poverty level (NYC Planning, 2018, NYC Population FactFinder, 2016).
Health status
In the 2015 Community Health Profile for East Flatbush, 80% of residents self-reported their health as “excellent”, “very good”, or “good” (New York City Department
of Health and Mental Hygiene (NYC Health, 2015). The 2015 Community Health profile also measured the neighborhood conditions; social and economic conditions; healthy living; health care; and health outcomes in Community District 17 (NYC Health).
The most disheartening find from the community health profile was the rate of preterm births in East Flatbush (NYC Health, 2015). The rate for preterm births in East Flatbush was 13.8%, the highest of all 59 community districts in New York City (NYC Health, 2015). Preterm births are a key driver of infant mortality and with such a high rate of preterm births in East Flatbush as compared to the Brooklyn average of 8.8% and the NYC average of 9%, this should be a cause for alarm and swift public health interventions to address this disparity in our community district (NYC Health, 2015). This should not be a health outcome that we are ranked number one in. A closer analysis of the data shows that from the start, there is a high rate in East Flatbush of late or no prenatal care at 14.9% (NYC Health, 2015). Compared to the Brooklyn rate of 6.4% and the New York City rate of 7.4%, the rate of late or no prenatal care in East Flatbush is also alarmingly high at double the NYC rate (NYC Health, 2015).
Community Health Project: Cultural Awareness in East Flatbush
As we know, lack of quality health care and the access to it are barriers to achieving positive health outcomes. Community District 17 is predominantly populated by people of color and foreign-born residents. As historically marginalized and vulnerable populations, we must take a multi-faceted approach to address the maternal health care inequities that persist in East Flatbush as compared to the greater New York City area. As a community health nurse, to address this negative health outcome, I would begin by understanding the unique needs of the population by looking at educational attainment, languages spoke, countries of origin, and economic conditions. The next step I would take would be raising awareness of this issue in the community through the publicizing of this community health profile in multiple languages and the presentation of this data to healthcare providers. One of the top 3 pressing issues identified by the Brooklyn Community Board 17, was the need for cultural facilities & programs (NYC Planning, 2018). In trying to address the issue of access to prenatal care and the high rate of preterm births, I would propose a plan to integrate information on where to access free/low-cost high-quality prenatal and postnatal care within the community, through cultural outreach programs that were specific to the predominantly Caribbean, Hispanic, and African populations. The goal should be to reach as many residents as possible. Finally, I believe a way to address this negative health outcome is to teach doctors and other healthcare providers in the community, cultural competency training so that they may better understand their patients which could lead to the development of strong, trusted patient-provider relationships and therefore, better health outcomes for all.
One very amazing strength from this community health profile, was that East Flatbush had the lowest percentage of current smokers in New York City at 10% as compared to the Brooklyn average of 16% of current smokers and the New York City average of 15% of current smokers (NYC Health, 2015). Of all the community districts, East Flatbush was named the best-performing in NYC for its low percentage of current smokers (NYC Health, 2015). As a long-time resident of this neighborhood, I believe the low incidence and prevalence of current smokers is due to minimal tobacco advertising in the neighborhood, slightly lower prevalence of tobacco retailers than the Brooklyn and NYC average, and high access to park and recreational areas in the community (NYC Health, 2015). As the world’s leading agent of death, reducing the use of tobacco has positive far-reaching health benefits for many communities, especially a population-dense community such as East Flatbush (NYC Health, 2015). In order to maintain and improve upon the current low smoking rate in East Flatbush, as a community health nurse, I would find the evidence for what works in reduce the prevalence of tobacco use and put these interventions to use in our communities, especially the most populated and those with the highest burden of tobacco use.
References
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