Community Diagnosis: Pearland, Texas Community Diagnosis

The community of Pearland is an ethnically-diverse, growing community located adjacent to the thriving metropolis of Houston, Texas (PEDC, n.d.). The population for the community was estimated to be 93,305 in 2011, up by 2.25% from the previous year (Census, 2013a). By comparison, the U.S. population grew by just 1.67%. There are slightly more females than males (51.4 vs. 48.6%) in Pearland and the median age is 34.1 years. This represents more women on average and a younger population by 3.1 years than the rest of the United States. An estimated 97.5% of residents considered themselves to be of one race and these are: 49.8% White, 20.0% Hispanic or Latino, 15.2% African-American, and 12.5% Asian. Pearland is therefore a minority community.

In terms of immigration patterns, Pearland is equivalent to the rest of the country (Census, 2013a). An estimated 15.3% and 12.8% of the Pearland and U.S. population, respectively, were born in another country. However, the success rate of achieving U.S. citizenship in Pearland is considerably higher than the national average, with 56.3% of Pearland's immigrant population obtaining U.S. citizenship versus 43.7% nationally. In terms of secondary educational achievement, Pearland beats the national averages by a wide margin, with 29.0% and 16.3% of the adult population over 25 having earned a bachelors or graduate degree, respectively. By comparison, only 28.2% of Americans have done the same.

Pearland adults are much more likely to be married, have kids, and remain in one location, but slightly less likely to have served in the military (Census, 2013a). Although most households use the English language at home, the percentage who feel competent it its use is lower than the national average. In addition, given the larger than average Asian population in Pearland, the frequency with which Asian languages are used at home is almost three times the national average.

Based on a 2011 5-year survey, the U.S. And Pearland unemployment rates were 8.7% and 4.2%, respectively (Census, 2013). The national per capita income was $27,915, but in Pearland it was $35,329. An estimated 35.7% of employed Americans worked in white collar jobs, but close to 53.5% of Pearland residents were white collar workers. More Hispanics (12.8% vs. 8.3%), African-Americans (13.4% vs. 7.1%), Asians (11.1% vs. 5.7%), and women (29.4% vs. 28.8%) own businesses in Pearland compared to national averages (Census, 2013b, 2013c). The relative economic health of the Pearland community is also evident when public assistance numbers are examined (Census, 2013a). When supplemental social security, cash assistance, and food stamp recipients are combined, only 6.7% of Pearland households received these benefits compared to 17.1% nationally.

Compared to national averages, the community of Pearland represents an ethnically diverse, highly educated, and economically strong community. Pearland residents, including the immigrants within the community, are also putting down roots and investing in their futures. Based on this analysis, most residents will likely have adequate health insurance or income to meet routine medical expenses. However, ethnic diversity will be a significant public health challenge due to cultural influences and the routine use of languages other than English.

Probably the most striking difference between Pearland residents and the rest of Eastern Texas is the size of the Asian community. An informal, but relevant sign of this difference is the number of acupuncturists listed on the services rating website AngiesList.com. In nearby Houston there are 118 acupuncturists listed for a city of over 2 million residents, but in Pearland there are 74. This suggests that there is 1 acupuncturist for every 1,260 and 17,000 residents in Pearland and Houston, respectively. This traditional form of Chinese medicine is gaining wider acceptance in Western countries and empirical studies support its use for specific medical conditions, including back pain, knee pain, insomnia, nausea, and vomiting (Barns, Bloom, and Nahin, 2008). From a public health perspective, acupuncturists and other non-Western medical practitioners should be considered key stakeholders in any public health initiative in Pearland.

Some of the concerns Asia-born women feel when...

These women as a group tend to avoid seeking medical care because many of them feel that providers do not understand traditional medicine, can be cold and impolite, unresponsive to questions, and are ignorant of Asian cultural beliefs (Zhao, Esposito, and Wang, 2010). The same researchers found that beliefs about disease causality do not align with evidence-based beliefs in Western medicine. For example, foreign-born Chinese women believe genes can cause cancer, but that cancer can also be contagious. Vietnamese women believe cancer does not exist in the absence of symptoms, while Korean women believe cancer is God's punishment. The percentage of foreign-born Asian women in Pearland may be small, but these same belief systems will probably persist in many Asian-American families. This is consistent with the relatively low percentage of Pearland residents who feel comfortable using the English language in public or at home.
The Pearland health genogram presented on the next page highlights both the strengths of the community and public health concerns. The strengths are economic, cultural diversity, educational achievement, a demonstrated commitment to a future in the community, stability, and youth. The primary public health concerns are related to the influence of culture on provider choice and perceptions of disease causality. For example, when different ethnic groups in the U.S. were surveyed regarding their attitudes towards mental illness, those with the greatest confidence in treatment efficacy and tolerance towards the mentally ill were Whites (69.4%), followed by African-Americans (61.4%) and Hispanics (53.8%) (Mandersheid et al., 2007). These findings reveal how different ethnic groups can perceive health and disease. Discrimination was not included in the genogram because the community is so diverse. Access to care was not included as well, because of the economic strength of the community and the fact that healthcare is the biggest industry in Pearland by a wide margin (Census, 2013a).

The predicted health risks associated with being a Pearland resident would therefore be divided along cultural lines to some extent. The communication of genetic and environmental disease risks, strategies to moderate these risks, and stress management techniques would be impaired by language and cultural barriers. Recommended screenings would be missed and treatment compliance low. For example, there are significant differences in breast cancer incidence and mortality rates between different racial groups (DeSantis, Siegel, Bandi, and Jemal, 2011). White women, followed by African-American women, suffer the highest risk for developing breast cancer, while African-American women have the greatest mortality risk. In contrast, Asian-American women have the lowest breast cancer risk, followed by Hispanic and Latino women.

The reverse is true when considering type 2 diabetes (Ho, Chesla, and Chun, 2012). Chinese-Americans, despite having a lower body mass index on average, have double the risk of type 2 diabetes than non-Hispanic Whites. Under Traditional Chinese Medicine, diabetes comes in three different forms with distinct symptoms and is classified as a "depletion-thirst disease." The recommended remedies include Chinese medicine, diet modification, and behavioral changes. In addition, diabetes is often viewed as a social stigma. These cultural traits tend to make communicating the risks of diabetes, getting regular screenings, and managing the disease difficult.

Of all the statistics available for Pearland, Texas, very few could be considered to be health indicators. Fertility was the one exception (Census, 2013a). Life expectancy, cause of death, self-reported health status, and the number of days feeling ill in the past month could not be found for Pearland specifically. Generating these statistics would be required before developing a community health plan. Despite this missing information, the primary challenges facing public health officials in Pearland appear to be adherence to cultural beliefs that inhibit health communication, screenings, and treatment compliance. Other important considerations include significant environmental pollution due primarily to the oil industry in the region and crime rate; however, the latter…