La Promesa: Delivering on the Promise of Health for Hispanic Communities 2005 Join Conference of the

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La PromesaDelivering on the Promise of Health
for Hispanic Communities2005 Join Conference of
the ASA and NCOA March 9-12, 2005
Philadelphia, PAMagdalena Castro-Lewis
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Who we are

• The National Alliance for Hispanic Health is
  the oldest and largest network of health and
  human service providers serving Hispanics.
  Members provide services to over 12 million
  Hispanic health consumers throughout the U.S.

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DEMOGRAPHICS
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Census estimates of Hispanic population in the
U.S

• U.S. Hispanic Population
• Estimate 38.8 million
• Commonwealth of Puerto Rico
• Population Estimate 3.8 million
• Total 42.6 million

Source US Census Bureau. Resident Population
Estimates of the United States by Sex, Race, and
Hispanic or Latino Origin, Table NA-EST2002-ASRO,
2003 and Census 2000 Redistricting Summary File
for Puerto Rico, Population by Race and Hispanic
or Latino Origin 2003.
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Some comparisons

• The 42.6 million Hispanics in the U.S. are
• Larger than the population of Canada
• (31.9 million)
• More than twice the population of Australia (19.5
  million)

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U.S. Population Composition
Source U.S. Bureau of the Census. (2000 data
for 50 states and D.C.) National Population
Estimates Characteristics, Jan. 21, 2003.
(2010-2050 data for 50 states and D.C.)
Projections of the Resident Population by Race,
Hispanic Origin, and Nativity Middle Series,
Feb. 14, 2000 (revised). (2000-2050 data for
Puerto Rico) Census International Data Base,
Puerto Rico Total Mid-year Population 2000-2050
Dec. 31, 2001 (revised). Note Figures include
the Commonwealth of Puerto Rico. American Indian
proportion is less than 1 percent.
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Hispanic Elderly

• The proportion of Hispanics who are elderly 65
  years will increase THREE FOLD from 4.0 today
  to 14.1 in the year 2020.
• U.S. Administration on Aging
• Serving Our Hispanic Elders, 2004

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Percentage of adults (65 years) living below
135 of poverty
Source U.S. Census Bureau. Income-to-Poverty
Ratio and Race 2002 Below 135 of Poverty,
Current Population Survey Annual Demographic
March Supplement, Revised September 26,
2003. Note Data does not include the
Commonwealth of Puerto Rico.
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Proportion of older adults without prescription
drug coverage
69
61
48
Source Center on an Aging Society. Analyses of
data from the 1999 Medical Expenditure Panel
Survey.
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LA PROMESAKeeping the Promisefor
HispanicMedicare Beneficiaries
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La Promesa

• Programs funded at 25 Hispanic CBOs
• Community developed action plans
• Monthly national conference calls and training
• Support materials and technical assistance
• Media and message support

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La Promesa Community Efforts

• Laptop to each program with wireless connect for
  outreach services.
• Medicare benefits session added to ongoing
  programs for older adults.
• Training older adults as Medicare peer
  counselors.
• Benefits sign-up at flu shot waiting lines and
  clinic waiting rooms.
• Local media outreach and profiles.

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Medicare Web Support
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Medicare Benefits Workbook Series
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Medicare Media Outreach
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Challenges

• Lack of trust about government programs
• Concerns about confidentiality
• Language and literacy
• Difficulty gathering application information
• Time needed to complete application
• Complexity of the program
• Cost of registration fee
• Difficulties reaching 1-800 Medicare lines
• Lack of data by race and ethnicity

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La Promesa What Hasnt Worked

• Mass mailings.
• Group presentations, unless individual follow-up
  appointments made.
• General appeals.

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La Promesa What Has Worked

• Using trusted source of information.
• (local agency, trusted spokesperson, Hispanic
  media).
• One-on-one assistance.
• Building on other activities for older adults.
• System navigation
• (benefits counseling sessions, Su Familia).
• Identified community person focused on outreach
  and counseling.
• Utilizing peer counselors.
• Including family and friends.
• Follow-up, Follow-up, and then Follow-up.

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Impact (Results July 2004 - December 2004)

• PSA audience 22.6 million
• One-to-one counseling 247,176 beneficiaries
• Direct benefit sign-up 3,075 beneficiaries
• Total prescription benefit 3.7 million

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FLEXIBILITY

• No one model
• Resources to respond to changing environment and
  opportunities

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PREVENTION
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Average life expectancy in years
Source US Census Bureau. Projected Life
Expectancy at Birth by Race and Hispanic
Origin1999-2100. Population Projections January
2000. Note Data does not include the
Commonwealth of Puerto Rico.
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Diabetes is a major health problem

• population 45-74 years of age with diabetes
• Non-Hispanic Blacks 19.3
• Non-Hispanic Whites 12.0
• Cuban Americans 15.8
• Mexican Americans 23.9
• Puerto Ricans 26.1

Source National Institute of Diabetes and
Kidney Diseases. Diabetes in Hispanic
Americans. NIH Publication No. 02-3265. May
2002 Note Data for persons 45-74 years of
age.
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About one-third of total diabetes among Hispanic
Americans is undiagnosed.
Source National Institute of Diabetes and
Kidney Diseases. Diabetes in Hispanic
Americans. NIH Publication No. 02-3265. May
2002, citing Harris MI, et. al. Prevalence of
diabetes in Mexican Americans, Cubans, and Puerto
Ricans from the Hispanic Health and Nutrition
Examination Survey (HHANES), 1982-84. Diabetes
Care. 199114(Suppl. 3) 628-638.
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Hispanics tend to have less heart disease than
non-Hispanic whites, even though heart disease
is the number one cause of death for all groups

• Rates of heart disease per 100,000 persons
• Hispanics 81.2
• Non-Hispanic Blacks 236.2
• Non-Hispanic Whites 315.3

Source National Center for Health Statistics.
National Vital Statistics Report, Vol. 47, No.
19, June 30, 1999 Note Rates per 100,000
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Depression is particularly pronounced

• Percentage of adult population with moderate to
  severe depressive symptoms
• Men Women
• Total 26 40
• Hispanics 36 53
• Non-Hispanic Blacks 32 47
• Non-Hispanic Whites 23 37

Source The Commonwealth Fund. U.S. Minority
Health A Chartbook. May 1999 Note Data are
percentage of population age 18 and older with
moderate to severe depressive symptoms in past
week by race and ethnicity, 1993.
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DISEASE MANAGEMENT
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Hispanics generally receive lower quality and
less intensive Rx treatment

• Fewer adolescent and adult vaccinations
• Fewer drugs for heart conditions
• Fewer antiretroviral drugs for HIV/AIDS
• Fewer antidepressants
• Less drug therapy for pain
• Less likely to be prescribed newer, more
  effective drugs

Sources Bach et al. N Engl J Med
19993411198-1205. Bernabei et al. JAMA
19982791877-1882. Moore et al. N Engl J Med
1994330763-768. Shapiro et al. JAMA
19992812305-2375. Schneider et al. Ann Intern
Med 2001135(5)328-337. Freeman and Payne. N
Engl J Med 2000342(14)1045-1047.
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Why MMA coverage is important

• Movement from hospital based to home based
  treatment models.
• Advances in pharmaceutical treatment resulted in
  management of disease, improved quality of life,
  and reduced health costs.
• Chronic illness and disease defines Hispanic
  health experience. Prevention is key to improved
  life quality.

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RESOURCES
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1-866-SU-FAMILIA
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Named a Best Consumer Health Book of the Year
by the Library Journal
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Patient Education Series with American College of
Physicians
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Hispanic Health Action Forum
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