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Immigrant Health Challenges in San Francisco, California

Mitchell Katz, MD Director of Health & County Health Officer San Francisco Department of Public Health. Immigrant Health Challenges in San Francisco, California. Overview. Background Communicable Disease Control—Tuberculosis Health Education/Empowerment— Immigrant Day Laborers

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Immigrant Health Challenges in San Francisco, California

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

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

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

  4. 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.

  5. Tuberculosis among immigrants

  6. 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

  7. 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

  8. Tuberculosis cases by birth, San Francisco, 1990–2005

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

  10. 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

  11. 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

  12. 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%

  13. Immigrant day laborers: Challenges and opportunities

  14. 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.

  15. 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

  16. 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.

  17. 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.

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

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