BY TONY BEST

MICHAEL, A BAJAN, came to New York as an immigrant at the turn of the 21st century in relatively good health.

He still has his X-rays and other documents to prove it.

Five years later, Michael, not his real name, is far from being in stellar condition.

"Some health challenges set me back," was all he said.

The Bajan is not alone. Indeed, that's the story of many Caribbean immigrants and others from around the world, especially those who are low-income workers.

Yes, when they land in the City, they tend to be healthier than native New Yorkers. But as time passes their condition falls below the level of people born and raised in the five boroughs of the City.

"Generally speaking, people from Barbados and the Caribbean, indeed most immigrants coming to New York as green card holders are in good health," said Yvonne Graham, and one of the City leading health care advocates for immigrants and the working poor.

"As in the case of the Barbadian, it's what happens after you have been here for about five years that counts," Graham added. "You will find that on average Barbadians and other West Indians who work for low wages and are employed in jobs that don't offer health coverage, their health status declines."

That surprising fact was detailed in a new report: The Health Of Immigrants In New York City and confirmed by Graham.

"This may shock many people in Barbados, but we have known this for a while," she pointed out. "Yes, the infant mortality rates in the Caribbean may be higher than in New York City. Maternal deaths are also higher. But those selected to come must have good health profiles to be allowed in. The problem is, though, their health worsens the longer they live in the City."

As evidence of this surprising situation, the Health Department's report cited lower death rates for the foreign born than native New Yorkers. For example, the overall death rate for immigrants between 2001 and 2003 was 768 for every 100 000 people, while for natives it was 1 073.

Specifically, while immigrant deaths from heart disease were 350 per 100 000 people, for those born in the United States, the rate was 438. For cancer the figures were 175 for immigrants but 246 for native New Yorkers; and influenza/ pneumonia 36 and 47 respectively.

Among Caribbean immigrant groups, Guyanese, Jamaicans and Dominicans (from the Dominican Republic) had the highest death rates from heart disease in that order while Jamaicans, Guyanese and Dominicans suffered the most from cancer.

"As persons from the Caribbean continue to live in the City, a lack of access
to quality health care and the fact that many of them are uninsured result in a sharp deterioration of their health," Graham explained. "Then, they are living in conditions where stress, poor dietary habits and other factors play a part."

According to the report, immigrants tend to be in better health because they often:

* Smoke much less than native New Yorkers, 13 per cent as compared with 23 per cent for those born in the United States.

* Have smaller numbers of obese people, 16 per cent compared with 21 per cent for those born in the United States.

* Avoid binge drinking, meaning they down less than five or more drinks on any single occasion, 12 per cent compared with 16 per cent.

But on the other side of the fence, foreign-born adults below the age of 65 years are less likely to have a regular primary care physician than their American-born counterparts.

Interestingly, foreign-born New Yorkers are more likely to be uninsured in every racial and ethnic group. Those who have lived in the country for less than four years are nearly 50 per cent more likely to be uninsured.

Graham explained that Caribbean immigrants often settle in "high health risk" neighbourhoods in Manhattan, Brooklyn, Queens and the Bronx, communities that suffer from high rates of poverty and unemployment, a lack of medical care, poor health indicators, overcrowded housing, low levels of education and high rates of violence and substance abuse.

Other indicators were:

* Among a selected group of countries, Jamaicans had the highest rate of infant mortality.

* The rate of low birth weight babies was highest among Guyanese.

* The incidence of HIV/AIDS among Caribbean-born adults fell in 2002 but rose in 2003.

"The picture that emerges from the figures point to the need for a holistic approach to health care regardless of where you were born," said Graham.

The Caribbean remains a key source of immigrants in the City. While in 1990 West Indians accounted for 205 184 New York residents by 2000 the total had skyrocketed to 283 749, an increase of 38 per cent while the Italian community suffered a 30 per cent decline.