Recognizing and Overcoming the Barriers to Health Care in the HispanicLatino Community

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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 Childrens Hospital Medical Center

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Texas
Total Population 21,325,018 Hispanic
Population 6,824,006 (32) 2nd Largest Hispanic
Population
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New Mexico The Land of Enchantment
Total Population 1,829,146 Hispanic
Population 770,070 (42)
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Deming, NM Home of Pure Water and Fast Ducks

• Total Population 14,000
• Hispanic Population 9,100 (65)
• Water is gt 99 pure
• Famous for The Great American Duck Race

The Winners
King and Queen of the Duck Ball
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The Latino Explosion
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The Latino Explosion
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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 lt 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

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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

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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

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Percent of Population with Less Than 9th Grade
Completed by Hispanic Origin 1999
(Population 25 years and over)
Percent
Source Current Population Survey, March 1999,
PGP-2
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Percent of Population with a Bachelors Degree or
Higher by Hispanic Origin 1999
(Population 25 years and over)
Percent
Source Current Population Survey, March 1999,
PGP-2
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Percent of Hispanics with Income 50,000 or More
in 1998 by Type of Hispanic Origin
(Population 15 years and over with income)
Percent
Source Current Population Survey, March 1999,
PGP-2
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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

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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

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Disparity in Health Insurance Coverage
White Non- Hispanic
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10
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Hispanic FB - Naturalized
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55
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Uninsured Hispanics Benefit US Economy But Do Not
Reap Health Benefits
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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

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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

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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

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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

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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

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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

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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

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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

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Motor Vehicle Safety - The Stats

• Motor vehicle crashes are 1 cause of death in
  Hispanics 1-24 years
• Hispanic children lt 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

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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

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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

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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

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The Problem
Skyrocketing Hispanic Population Barriers to
Injury Prevention ? Marked Increase in Injuries
and Deaths ? Emerging Public Health Crisis
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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

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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

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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

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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

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Growth, Opportunity, and Change
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Growth, Opportunity, and Change
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Abriendo Puertas Abriendo Brazos Abriendo
Corazones