Recognizing and Overcoming the Barriers to Health Care in the Hispanic/Latino Community Rebeccah L...
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Transcript of Recognizing and Overcoming the Barriers to Health Care in the Hispanic/Latino Community Rebeccah L...
Recognizing and Overcoming the Barriers to Health Care in the Hispanic/Latino Community
Rebeccah L Brown, MD
Associate Professor of Clinical Surgery and Pediatrics
Associate Director of Trauma Services
Cincinnati Children’s Hospital Medical Center
Texas
Total Population21,325,018Hispanic
Population6,824,006
(32%)2nd Largest Hispanic
Population
New Mexico – “The Land of Enchantment”
Total Population 1,829,146
Hispanic Population770,070 (42%)
Deming, NM – “Home of Pure Water and Fast Ducks”
Total Population 14,000
Hispanic Population 9,100 (65%)
Water is > 99% pure Famous for “The
Great American Duck Race”
The Winners
King and Queen of the Duck Ball
The Latino Explosion
The Latino Explosion
Population Growth in USA Over 35 million Hispanics in USA today Unprecedented growth
– Increasing 7x faster than rest of US population
– Almost 60% since 1990 Have surpassed African-Americans as largest minority (13%) Hispanic children are the largest minority group of children
(11.6 million; 16% of population < 18 yrs)
– In CA, Hispanics outnumber whites; by 2010, Hispanic children will outnumber whites by 2 million
By 2050, 1 of every 4 Americans will be of Hispanic/Latino heritage
59%
Population Growth in Greater Cincinnati/Northern Kentucky Hispanic population is escalating in the Greater
Cincinnati/NKY area as well– 435% Boone County (KY)– 140% Campbell County (KY)– 137% Kenton County (KY)– 83% Hamilton County (OH)
– 113% Dearborn County (IN) Largest Hispanic populations in Cincinnati are in
Springdale, Hamilton, Sharonville, Norwood, and Fairfield Largest Hispanic populations in NKY are in Covington,
Florence
The Barriers to Hispanic Health Care
Cultural differences Language Lack of health insurance Education Poor understanding of US health care system Poverty Transportation Immigration status Cultural insensitivity/racism
Percent of Population with Less Than Percent of Population with Less Than 9th Grade Completed by Hispanic Origin: 19999th Grade Completed by Hispanic Origin: 1999
Perc
ent
(Population 25 years and over)(Population 25 years and over)
28
33
17
20
24
5
0
5
10
15
20
25
30
35
Hispanic Mexican Puerto Rico Cuban Central andSouth American
Non-HispanicWhite
Source: Current Population Survey, March 1999, PGP-2
Percent of Population with a Bachelor’s Degree or Percent of Population with a Bachelor’s Degree or Higher by Hispanic Origin: 1999Higher by Hispanic Origin: 1999
Perc
ent
(Population 25 years and over)(Population 25 years and over)
11
7
11
25
18
28
0
5
10
15
20
25
30
Hispanic Mexican Puerto Rican Cuban Central andSouth
American
Non-HispanicWhite
Source: Current Population Survey, March 1999, PGP-2
Percent of Hispanics with Income $50,000 or More Percent of Hispanics with Income $50,000 or More in 1998 by Type of Hispanic Origin in 1998 by Type of Hispanic Origin
(Population 15 years and over with income)(Population 15 years and over with income)
Perc
ent
5.2
7.0
10.6
7.3
0
2
4
6
8
10
12
Mexican Puerto Rican Cuban Central and SouthAmerican
Source: Current Population Survey, March 1999, PGP-2
Migration Profiles Mexicans: agricultural, restaurants and
construction employment
Puerto Ricans: US Citizens at Birth
Cubans: 1st migration well-educated, middle class or higher citizens
South Americans: Tend to bring higher labor skills
Central Americans: Limited work skills, “Campesinos” (farmers-domestic workers, child care providers, office cleaners, or other low-skill positions)
Information provided by Culturally Competent Communications
The Health Insurance Crisis
About 44 million Americans are uninsured (1 out of every 7)
# of uninsured increased by 2.4 million from 2001-2002
12% of all children are uninsured Hispanics are the least insured of all –
nearly 40% of adults and 31% of children are uninsured
Disparity in Health Insurance Coverage
0 20 40 60
HispanicFB-Not aCitizen
HispanicNative Born
% Uninsured
55%
25%
22%
10%
Hispanic FB - Naturalized
White Non- Hispanic
10%
Uninsured Hispanics Benefit US Economy But Do Not Reap Health Benefits
Barriers to Health Insurance Work for small, low wage businesses that do not offer
insurance Individual insurance is prohibitively expensive Not poor enough to qualify for Medicaid, but too poor to buy
private health insurance Uninformed about existing assistance programs (ie. CHIP) Cultural, educational, and language barriers limit interactions
with physicians and ability to complete paperwork required for assistance
Concerned about being labeled a “public charge” Immigrant, non-citizens
The Language Barrier
Hispanics who speak primarily Spanish
– 61% are uninsured
– Most do not have a regular doctor
– 1/3 rely on public or community clinics (compared to 12%
English-speaking Hispanics, 10% Blacks, and 7% Whites)
– Of 600 uninsured Spanish-speaking Hispanics surveyed,
almost 60% responded that interpretive language
assistance was not available from their health care
provider
The Double Burden
Lack of insurance poor access to health care
Limited English poor communication with health care providers disparity in quality of health care
Cultural Differences Rely more on home remedies and over-the-
counter meds Rely on advice from family members Seek professional advice only if problems persist Less compliant with routine check-ups and
preventive/screening measures More apt to trust health care providers who
speak their language or share similar cultural background
Breaking Down The Barriers Master the language Train bilingual staff (receptionists, nurses,
technicians, physicians) Provide skilled medical interpreters
– “Medical interpreters should be recognized as allied health professionals, who bill for their services, which should be just as reimbursable as lab services.”
• Elena Rio, President, National Hispanic Medical Association
Provide signage and written instructions in Spanish Aim for perfect communication/understanding
Breaking Down The Barriers Develop child care programs in Latino
communities so parents can take time to go to physician
Provide child care at health care facility Provide information on importance of preventive
care, especially for children Develop local/regional/national telephone hotline
in Spanish to respond to medical questions Be familiar with community resources
Breaking Down The Barriers Utilize focus groups to “zero in” on issues
important to the Hispanic/Latino community Establish bilingual liaisons with the Latino
community to build relationships and earn trust Establish health care facilities in Latino
communities or send mobile units Approach transportation authority to have buses
routed to Latino communities Print bus schedules in Spanish
Breaking Down The Barriers Expand outreach for public assistance
programs Government incentives to encourage small
businesses to offer coverage Oppose federal health mandates that
increase costs of providing health care Change tax law to allow individuals to deduct
entire cost of purchasing health insurance (Fair Care Act)
Lobby for health insurance for all
Motor Vehicle Safety - The Stats
Motor vehicle crashes are #1 cause of death in Hispanics 1-24 years
Hispanic children < 4 years have 2nd highest death rate from motor vehicle crashes (2nd only to African-American children)
Hispanic children 5-12 years have 72% higher death rate from motor vehicle crashes than Caucasians
Motor Vehicle Safety - The Stats
Per vehicle mile traveled, Hispanic children are 3x more likely to die
3x less likely to use child safety restraints and 3x less likely to ride in the backseat
Much less likely to wear seatbelts Despite fewer miles traveled, teenage
Hispanics are twice as likely to die
Motor Vehicle Safety Hispanics vs Whites seat belt use (22% vs 38%) EtOH use (31% vs 24%) EtOH levels insurance (24% vs 50%) hospital costs
• Motor Vehicle Safety in Illinois Hispanic Communities - Findings from Focus Groups
Barriers to Hispanic Injury Prevention
Poverty– Unable to afford child safety restraints, helmets– Older cars without seatbelts, airbags– Overcrowding of cars– Riding in back of pickup trucks
Language barriers Cultural barriers Lack of insurance access to medical care Not familiar with US child restraint and safety belt laws
The Problem
Skyrocketing Hispanic Population +
Barriers to Injury Prevention
Marked Increase in Injuries and Deaths
Emerging Public Health Crisis
The Approach
Similar to African-Americans, Hispanics also have strong ties to family and the church
We hypothesize that a faith-based initiative similar to that developed for African-American youth will be successful in the rising Hispanic population as well
The model is in place, but must be culturally adapted for the Hispanic population and their specific injury prevention needs and concerns
Purpose
To partner with the faith community to identify and implement injury prevention strategies among Hispanics
To develop culturally-relevant materials to deliver the injury prevention message
To develop an injury prevention model for Hispanic communities around the country
The Plan Develop an initiative to address injury prevention among high-
risk Hispanic children in the Greater Cincinnati and Northern
Kentucky area.
Identify and build relationships with key contacts in the Greater
Cincinnati and Northern Kentucky area to build a committee for
the initiative– Hispanic Resource Center– Abriendo Puertas– Su Casa– AHORA (Alliance for Hispanics of the Ohio River Area)– Santa Maria “Bienstar”
The Plan
Conduct focus groups to identify unique areas of
concern among Hispanics about injury and injury
prevention
Develop culturally relevant injury prevention
curriculum based on outcomes of focus groups
Implement curriculum into faith-based or school-
based Hispanic community
Perpetuation of program by Hispanic leaders within
the community
Growth, Opportunity, and Change
Growth, Opportunity, and Change
Abriendo Puertas
Abriendo Brazos
Abriendo Corazones