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HealthLink: Queens Borough Public Library
The Queens Borough Public Library, one of New York City's three public library systems, serves a population of 2.2 million in one of the most ethnically and culturally diverse counties in the U.S. Queens Library consists of a Central Library and 62 branches spread over 112 square miles of heavily populated urban landscape.
Queens Library is heavily used by its customers. In 2006, circulation topped a record-breaking 20 million. FY 2006 budget was $104.5 million, more than 84% from the City of New York.
More than 47% of Queens' residents are born outside the U. S. and speak a language other than English at home. An unknown, significant number are undocumented. Queens Library has a long history of outreach to new Americans and a long tradition of trust that has been passed through word of mouth. Even those immigrants who are usually distrustful of what they perceive to be "government" agencies feel comfortable using the library.
Queens Library is partnering with the Queens Cancer Center, the American Cancer Society of Queens and Memorial Sloan-Kettering Cancer Center to bring cancer information, screenings, and treatment referrals to medically underserved communities in Queens. This is being accomplished using literature being distributed in the libraries, in English and several languages + low literacy formats; cancer information and prevention workshops in English and Spanish being held at various libraries; a mobile screening van that is making regular rounds in front of the library; and community organizing using the library as a locus, that will tailor and plan future projects to suit the community. Community Cancer Councils have been formed to create and administer local outreach programming.
According to the American Cancer Society, Queens has a lower rate of early stage cancer detection compared with the rest of New York State. In all major cancer sites, the Queens Health Network sees an increased likelihood of late-stage diagnosis and increased rates of mortality. The rate of late-stage detection found at Queens Health Network for breast cancer is almost three times the national average, and for prostate and colorectal cancers, it is nearly twice the national average. Communities with marked incidences of late diagnoses closely follow communities with low income. In Queens, low income often overlaps with recent immigration since language, immigration status, lack of health insurance and lack of wherewithal to navigate the complex system are all barriers to diagnostic and preventative health care.
Queens Library has had a long partnership with the Queens Health Network to bring health and wellness information and health literacy to the community. When Memorial Sloan-Kettering Cancer Center sought partners for a grant from the National Cancer Institute of the National Institutes of Health, Queens Library's physical presence in every community and unique position of trust, as well as our demonstrated multi-lingual and multi-cultural facility made Queens Library the obvious choice.
In January 2007, Queens Library HealthLink was launched.
Twenty out of 62 community libraries were identified as being geographically located within medically underserved communities in the context of cancer statistics. They are the primary focus of the project, although it is expected that information will spread throughout Queens. The following activities are being phased in:
- Workshops in English and Spanish are being held in the libraries on topics such as colorectal cancer, prostate cancer, cervical cancer, breast cancer, nutrition and healthy living. The speakers are physicians and health educators provided by the project partners.
- Cancer detection and prevention literature is being made available through the libraries. Of particular interest is the American Cancer Society's low reading level series, which will serve the library's large population of ESOL and low-literate adults.
- A Queens Library HealthLink van will visit each participating library at least three times a year to screen for colorectal, cervical, and prostate cancers. Referrals and follow-up visits will be made by the health care professionals on the van. There will also be a HealthLink mobile mammography van.
Those wishing to be screened will sign up at the library, a place they are accustomed to visiting with confidence, regardless of their immigration status or other confidentiality issues. Evidence of customer comfort: the Consul General of Mexico visited the Queens Library at Jackson Heights in December 2006, along with a sports caster from Telemundo, to publicize the ease of getting a library card using Mexican Consular identification cards. The appearance was well-publicized. Even though the visit was in the middle of the weekday, when the Consul General arrived, he was greeted by more than thirty Mexican nationals -presumably undocumented --who came to inquire about permanent resident status in the U.S. If they had fear of reprisal, they certainly wouldn't have come so openly.
They are also well-accustomed to Queens Library services being free and multi-lingual. Both increase comfort.
- Two Community Outreach Coordinators are being hired. They will be under the supervision of the library's Special Services Department. Every four months, the Community Outreach Coordinator will organize a Cancer Action Council out of one of the targeted libraries. The Council will meet regularly at the library to plan cancer information, prevention and awareness activities tailored to their own community. They may consider a need in their neighborhood for information and awareness materials in a particular language, or on a particular health issue that is of more concern in their community due to genetics or lifestyle. The Coordinator will work intensely with the Cancer Action Council, monitor and encourage them for a year. After that, the sustainability will be evaluated. The Coordinator will continue to monitor the councils.
The Coordinators will also gather data about the community to help in planning future activities and evaluating current ones.
Challenges in implementing this project include the presence of multiple partners. All activities and communications require redundant input and sign-offs.
Another challenge is clearly delineating the role of library staff to the public. It is obviously imperative that they never be viewed by the public as giving medical advice.
Every week, 182 people in Queens are diagnosed with cancer and 68 people die from it. A disproportionate share of people in Queens are diagnosed too late for successful treatment. While many factors play into that, reluctance to access available free healthcare is suspected as being significant.
Although the impact of the Queens Library HealthLink will not be known for many years, Queens Library and our partners the American Cancer Society, Queens Cancer Center and Memorial Sloan-Kettering hope to improve those statistics through education and early interventions. Because Queens Library is the trusted presence in the community, we hope to play a significant role in saving lives by providing information and referrals, and being an active conduit to medical care.
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