Katz

Immigrant Health Challenges in San Francisco, California: 

Immigrant Health Challenges in San Francisco, California Mitchell Katz, MD Director of Health & County Health Officer San Francisco Department of Public Health

Overview: 

Overview Background Communicable Disease Control—Tuberculosis Health Education/Empowerment— Immigrant Day Laborers Access to medical care

San Francisco & California Ethnic populations, Jan 1, 2006: 

San Francisco & California Ethnic populations, Jan 1, 2006 Source: California Department of Finance Demographic Research Unit

San Francisco & California Foreign born, Jan 1, 2006: 

San Francisco & California Foreign born, Jan 1, 2006 Source: California Department of Finance Demographic Research Unit, Recent immigration in the past ten years was estimated using Census 2000 estimates.

Tuberculosis among immigrants: 

Tuberculosis among immigrants

Reported cases of tuberculosis,San Francisco, 2005: 

Reported cases of tuberculosis, San Francisco, 2005 132 new cases reported Incidence rate = 16.6 per 100,000 per year Lowest in San Francisco history! However, highest TB rate of any metro area in the United States Cases concentrated in immigrant neighborhoods such as Chinatown

Tuberculosis among immigrants: 

Tuberculosis among immigrants Foreign born 75% of TB cases in 2005 Most foreign born TB cases immigrated from TB endemic areas and surges of refugees Late 70s/early80s, cases increased by ~67% following arrival of SE Asian refugees after the collapse of South Vietnam and rise of the Khmer Rouge Approximately ~5000 Chinese migrate to San Francisco every year. Ethnic Chinese make up 1/3 of TB cases

Tuberculosis cases by birth, San Francisco, 1990–2005 : 

Tuberculosis cases by birth, San Francisco, 1990–2005

Foreign born TB cases, by place of birth, San Francisco, 2005: 

Foreign born TB cases, by place of birth, San Francisco, 2005

Tuberculosis in immigrants:Special challenges: 

Tuberculosis in immigrants: Special challenges TB rates match their country of origin Cultural and language barriers Higher rates of drug resistance and multidrug-resistant (MDR) TB Frequent delays in diagnosis because of poverty, lack of health insurance and fear of medical bills Undocumented individuals risks deportation during TB treatment

Tuberculosis in immigrants:Special approaches: 

Tuberculosis in immigrants: Special approaches Hiring of health workers from same culture and language groups (16 different languages spoken at SF TB Clinic!) High clinical suspicion and rapid drug susceptibility testing (24 hour turnaround) TB screening program in Chinatown. Ongoing outreach to community via training, media and press conferences

Targeted testing & preventive treatment for foreign born : 

Targeted testing & preventive treatment for foreign born Highest priority: individuals with old scarring on chest radiographs N~70 annually placed on treatment B-notification treatment completion rate: ~90% (2003-2004) Latent TB infection (normal chest xrays) N~>1000 annually, LTBI treatment completion rate (2002-2003): 74% to 75%

Immigrant day laborers: Challenges and opportunities: 

Immigrant day laborers: Challenges and opportunities

Immigrant day laborers: Social context and local experiences: 

Immigrant day laborers: Social context and local experiences Walter N, Bourgois P, Loinaz HM. Social Context of Work Injury among Undocumented Day Laborers in San Francisco. Journal of General Internal Medicine. 2002;17(6):221-229.

SFDPH Program on Health, Equity, and Sustainability : 

SFDPH Program on Health, Equity, and Sustainability PHES supports San Franciscans working together to advance urban health by integrating local government and community efforts through... Public Access & Accountability Healthful Environments Equity Sustainability

Jornaleros Unidos con el Pueblo*: 

Jornaleros Unidos con el Pueblo* Partnerships between SFDPH Program on Health, Equity, and Sustainability, immigrant day laborers, and community service organizations. Goal is to improve working conditions for the immigrant day laborer community, including male day laborers and female domestic workers in the construction, house-cleaning, and landscape industries. *Day laborers united with the community.

Jornaleros Unidos con el Pueblo: Programs: 

Jornaleros Unidos con el Pueblo: Programs Vocational Skills for Safety on the Job The Worker's United Course: Cultivating Day Laborer Leaders Cleaning with Safety and Dignity Economic Hazard Feasibility Study Unidos Community Council *Day laborers united with the community.

Health access for all: 

Health access for all San Francisco is a refugee sanctuary San Francisco does not collect immigration status for services