Addressing Health Disparities though Community Partnership: Latino Health for All

1
Addressing Health Disparities though Community
Partnership Latino Health for All

• KDHE Center for Health Disparities Conference
• April 7, 2009
• Paula Cupertino1, Jerry Schultz2, Zora Pace2, Dan
  Schober2, Susan Garrett1, Blanca Mendoza2, and
  Stephen Fawcett2
• __________________________________________________
  __________________________________________________
  _______________
• 1. University of Kansas Medical Center
• 2. University of Kansas, Work Group for Community
  Health and Development

2
Theoretical Pathways of Health Disparities1
3
Potential Actions to Address Health Disparities1
4
Todays Objectives Share the Latino Health for
All Coalition

1. Identify the importance of a multi-sectoral
   approach in addressing the impact of social
   determinants of health and the elimination of
   health and healthcare disparities.
2. Facilitate community based and public/private
   partnerships to improve the health and well being
   of our community.

5
The Hispanic/Latino Population

• 45.5 million people in the U.S. identify
  themselves as Hispanic, non-whites2
• The Latino population is growing
• Growth in almost 3,000 of 3,141 U.S. counties3
• 34,640 Latinos live in Wyandotte County, Kansas2
• Statewide there are an estimated 244,278 Latinos
  (8.8)2

6
Distribution of Latinos in Kansas
__________________________________________________
______________ Source (Secondary) Cupertino, P.
Our Day A Celebration of Latinos in Kansas
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Latinos Face Health Disparities

• Disparities exist in CVD, stroke, cancer, and
  immunizations4
• Latinos are 1.5 times more likely to die from
  diabetes than Anglos5
• Life expectancies for Latinos are about 11 years
  shorter than for Anglos5

8
Contributors to Health Disparities

• Nutrition
• 16.5 of Latinos report eating 5
  fruits/vegetables per day6
• Physical Activity
• 30 of Latinos fail to meet recommended
  requirement for daily physical activity6
• Access to health services
• 31.7 of Latinos (under the age of 65) are
  uninsured vs. 11.9 of whites in Wyandotte and
  Leavenworth Counties7

9
Research Partnership

• Three unique organizations have partnered to
  address Latino health disparities
• University of Kansas Work Group for Community
  Health and Development
• University of Kansas Medical Center
• El Centro, Inc.

10
The Latino Health for All Coalition

• Funded by a 5-year grant from the National Center
  on Minority Health and Health Disparities (NCMHD)
  at the National Institutes of Health
• Studying Community/System Change new or
  modified
• Programs
• Policies
• Practices

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Community-Based Participatory Research Approach

• The Latino Health for All Coalition
• Recognizes the community as a unit of analysis
• Builds on strengths and resources within the
  community
• Facilitates a collaborative, equitable
  partnership with the community
• Promotes co-learning and capacity building among
  all partners
• Involves systems development though a cyclical
  and iterative process

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Best Processes for Change and Improvement

1. Analyzing Information about the Problem or Goal
2. Establishing a Vision and Mission
3. Developing an Organizational Structure and
   Operating Mechanism
4. Developing a Framework or Model of Change
5. Developing and Using Strategic and Action Plans
6. Arranging for Community Mobilization
7. Developing Leadership
8. Implementing Effective Interventions
9. Assuring Technical Assistance
10. Documenting Progress and Using Feedback
11. Making Outcomes Matter
12. Sustaining the Work

13
The Latino Health for All Coalitions Mission

• To reduce diabetes and cardiovascular disease
  among Latinos in Kansas City/Wyandotte County
  through a collaborative partnership to promote
  healthy nutrition, physical activity, and access
  to health services.

14
Best Processes for Change and Improvement

1. Analyzing Information about the Problem or Goal
2. Establishing a Vision and Mission
3. Developing an Organizational Structure and
   Operating Mechanism
4. Developing a Framework or Model of Change
5. Developing and Using Strategic and Action Plans
6. Arranging for Community Mobilization
7. Developing Leadership
8. Implementing Effective Interventions
9. Assuring Technical Assistance
10. Documenting Progress and Using Feedback
11. Making Outcomes Matter
12. Sustaining the Work

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Action Planning Meeting Held on November 1, 2008
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Action Planning Meeting Participants

• Approximately 50 key stakeholder of Latino health
  in Wyandotte County/Kansas City, including
• Latino health service providers
• Mattie Rhodes
• Alianzas
• Safety Net Clinics
• Argentine Family Health
• Cabot Westside Health Clinic
• Media representatives
• Univision 48 Kansas City

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Breakout Groups by Action Committee of Interest
18
Inventory of Community/System Changes
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Action Committees formed lists of Community
System Changes

• Healthy Nutrition
• Change school district menu to provide healthier
  food through advocacy.
• Physical Activity
• Increase access to facilities that will enable
  community residents to be more physically active
• Access to Health Services
• Improve access to screening and follow up for
  diabetes through an open access, community-based
  laboratory available at convenient hours

20
Action Planning Participants were Satisfied

• Overall, how satisfied are you with the action
  planning workshop?
• (Ratings, n 33)
• 87.9 were Very Satisfied
• 12.1 were Satisfied
• 0 were Neutral, Dissatisfied, or Very
  Dissatisfied

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Best Processes for Change and Improvement

1. Analyzing Information about the Problem or Goal
2. Establishing a Vision and Mission
3. Developing an Organizational Structure and
   Operating Mechanism
4. Developing a Framework or Model of Change
5. Developing and Using Strategic and Action Plans
6. Arranging for Community Mobilization
7. Developing Leadership
8. Implementing Effective Interventions
9. Assuring Technical Assistance
10. Documenting Progress and Using Feedback
11. Making Outcomes Matter
12. Sustaining the Work

22
Structure of the LHFA Coalition
The Community Action Board (CAB) (N 11)
Access to Health Services (N 32)
Physical Activity (N 12)
Healthy Nutrition (N 14)
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Action Committees Facilitate Change

• Each Action Committee Elected a Chair and
  Co-chair
• Healthy Nutrition (total 14)
• Academic/research (K-State Research Extension)
• Community-based organization (KC Healthy Kids)
• Physical Activity (total 12)
• Academic/research (University of Kansas Medical
  Center)
• International organization (Heart to Heart
  International)
• Access to Health Services (total 32)
• Community-based organization (El Centro, Inc.)
• Health Organization (Argentine Family Health)

24
Structure of the LHFA Coalition
The Community Action Board (CAB) (N 11)
Access to Health Services (N 32)
Physical Activity (N 12)
Healthy Nutrition (N 14)
25
Community Action Board (CAB)(total 11)

• Lead the Coalition
• Elected by the members of the LHFA Coalition
• Each Action Committee chair co-chair are on the
  CAB (total 7)
• At-Large members (total 4)
• Faith organization (Sisters of Charity of
  Leavenworth)
• Community-based organization (Bethel Neighborhood
  Center )
• Media (Univision 48 Kansas City)
• Community member (Union de Comerciantes y
  Recidentes Latinos)

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Structure of the LHFA Coalition
The Community Action Board (CAB) (N 11)
Mini-grant Recipients (N 10)
Access to Health Services (N 32)
Physical Activity (N 12)
Healthy Nutrition (N 14)
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Mini-grant Process

• An open request for proposals by the community to
  address healthy nutrition, physical activity,
  and access to health services
• 100,000 in mini-grants available to the
  community
• 10,000 maximum per grant

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22 Mini-grant Applications Received
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Mini-grant Review Process

• The 11 members of the CAB reviewed the grants
• Each member rated 2-3 applications (1 Disagree,
  5 Agree)
• Overall Project Goals
• Specific Project Objectives
• Project Action Steps
• Proposed Budget and Justification
• Overall Significance

30
Mini-Grant Group Review

• A grant review discussion was held
• Grants were reviewed as a group
• Group ratings on each application were made
• Adjustment to previous ratings

31
Funded Grants(95,233)

• Healthy Nutrition - 2 grants (15,633)
• Physical Activity 1 grant (10,000)
• Access to Health Services - 1 grant (10,000)
• Multiple Goal Areas - 6 grants (59,600)

32
Healthy Nutrition Grants

• Educacion para una major salud
• Kansas State Research and Extension, Wyandotte
  County
• Cocinando Saludable / Cooking Healthy
• Grandview Park Presbyterian Church

33
Physical Activity and Access to Health Services
Grants

• Physical Activity
• Salon de Baile
• El Centro, Inc.
• Access to Health Services
• Medical Translation Services
• Duchesne Clinic

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Multiple Goal Areas

• Healthy Nutrition and Access to Health Services
• Celebrating Healthy Families-Health Focus Event
• Truman Medical Centers
• All Three Goal Areas
• Health for All Educational Videos
• Cultural Horizons Inc.
• Operation Healthy Life
• KUKC-TV 48 (Univision)
• Health Section (SALUD)
• Enye Publishing LLCC (N Magazine)
• Viva! Salud Para Todos
• Bethel Neighborhood Center
• Historias de Casa
• El Centro, Inc.

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Best Processes for Change and Improvement

1. Analyzing Information about the Problem or Goal
2. Establishing a Vision and Mission
3. Developing an Organizational Structure and
   Operating Mechanism
4. Developing a Framework or Model of Change
5. Developing and Using Strategic and Action Plans
6. Arranging for Community Mobilization
7. Developing Leadership
8. Implementing Effective Interventions
9. Assuring Technical Assistance
10. Documenting Progress and Using Feedback
11. Making Outcomes Matter
12. Sustaining the Work

36
Structure of the LHFA Coalition
The Community Action Board (CAB) (N 11)
Mini-grant Recipients (N 10)
Community Mobilizer (N 1)
Access to Health Services (N 32)
Physical Activity (N 12)
Healthy Nutrition (N 14)
Media Policy (Forming)
Neighborhood (Forming)
37
Community Mobilizer

• Blanca Mendoza
• Relationships with stakeholders of Latino Health
  in Kansas City
• Bi-lingual
• Responsibilities
• Provide assistance to the CAB, mini-grantees, and
  action committees
• Facilitate Community System Change

38
WorkStation kclatinohealth.org
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Best Processes for Change and Improvement

1. Analyzing Information about the Problem or Goal
2. Establishing a Vision and Mission
3. Developing an Organizational Structure and
   Operating Mechanism
4. Developing a Framework or Model of Change
5. Developing and Using Strategic and Action Plans
6. Arranging for Community Mobilization
7. Developing Leadership
8. Implementing Effective Interventions
9. Assuring Technical Assistance
10. Documenting Progress and Using Feedback
11. Making Outcomes Matter
12. Sustaining the Work

40
Documentation of Activities and Accomplishments
41
Analysis of Contribution
42
Real-Time Participatory Research
43
Real-Time Participatory Research
44
The Community Tool Box
45
Individual Level Assessment

• Currently developing/testing an individual level
  assessment
• Behavioral Survey
• N 300 (100 in the target community, 200 in
  comparison communities)
• Objective assess characteristics of Latino
  residents
• Years residing in community
• Gender
• Age
• Knowledge of Coalition Activities
• Selected health behaviors

46
Next Steps

• Action Committee Work
• Community assessment of healthy foods
• Increase soccer fields
• Leveraging the media to promote health care
  access
• Mini-grants begin
• Your involvement is welcome!

47
Theoretical Pathways of Health Disparities1
48
Potential Actions to Address Health Disparities1
49
Conclusion

• Some Challenges
• Engaging members of the community
• Measurement of outcomes
• Diversity of culture and language
• Some Strengths
• Multi-sectoral approach
• Sustainable public/private partnerships
• Community-based participatory research

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Questions

• Daniel J. Schober
• Graduate Research Assistant
• Work Group for Community Health and Development
• 1000 Sunnyside Ave.
• Dole Center, Room 4082
• Lawrence, KS 66045
• E-mail dschober_at_ku.edu
• Office Phone [phone]

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References

• Fawcett, SB. Addressing the social determinants
  of health How to evaluate and support change in
  communities? Proceedings of the World Health
  Organization Lunchtime Seminar 2007 Mar 15
  Geneva, Switzerland.
• United States Census Bureau. State County
  QuickFacts. 2009 cited 2009 March 27. Available
  from http//quickfacts.census.gov/qfd/states/00000
  .html
• Pew Hispanic Center. Hispanics account for half
  of U.S. population growth since 2000, new report
  finds. 2008 Oct 23.
• United States Department of Health and Human
  Services. Healthy people 2010. Washington, DC
  2000.
• Farakhan C, Thompson F. Minority health
  indicators. Kansas City Health Department, Kansas
  City, Missouri. 2000.
• Centers for Disease Control and Prevention. REACH
  2010 risk factor survey Year 4 sampling and
  weighting report Missouri Coalition for Primary
  Health. Final report. Chicago (IL) NORC, Inc.
  2005 Oct.
• Kansas Insurance Department. Finding and filling
  the gaps Developing a strategic plan to cover
  all Kansans. 2001.