Community-Based Health Research to Eliminate Health Disparities 2004

1
Community-Based Health Research to Eliminate
Health Disparities 2004

• Elena Rios, MD, MSPH
• President CEO
• National Hispanic Medical Association

2
Insurance Coverage

• Hispanics have the highest rates of uninsured of
  racial/ethnic groups, for all or part of 2000
• 50 Hispanics under age 65
• 37 Hispanic children
• In 2002, comprised 14 of U.S. population, but
  29 of the uninsured.
• In the last decade the number of uninsured
  Hispanics increased from 7.4 to 12.8 million.
• Less likely to have insurance, even when offered
  through employer.
• By 2050, 25 of Americans ? 50 uninsured.
• Source The Commonwealth Fund, Nov. 2003

3
(No Transcript)
4
(No Transcript)
5
Research Needed to Address Uninsured Hispanics

• 75 of uninsured Hispanics are classified as
  low-income (200 poverty level).
• Foreign-Born Hispanics have the highest uninsured
  rate, declines with length of time/generations in
  U.S.
• Legal immigrants have a 5 yr wait for public
  insurance
• For non-elderly Hispanics, 61 of those who
  primarily speak Spanish are uninsured, compared
  to 36 of those who primarily speak English.
• US-Mexico Binational Insurance products

6
IOM Unequal Treatment Report

• Despite insurance, minority patients suffer from
  unequal treatment quality care.
• Recommendation Promote research that is
  population-based and patient centered.
• Health Disparity Legislation focus on major
  recommendations increase minority health
  providers, cultural competence, language
  services, and research on Hispanic health,
  resources, use of care, generation, family,
  community.

7
Research Needed on Quality Care

• Spanish- speaking report greatest problems
  communicating with doctors and staff.
• Access to interpreters limited, only 1 of those
  used are medically trained.
• Lack of cultural competence training for
  physicians or in medical education.
• Less likely to report confidence in their doctor.
• Difficulty in understanding prescription
  instructions.
• Low representation of Hispanics as physicians
  (only 5 of U.S. physicians).

8
(No Transcript)
9
NHMA and CHC 2002 National Hispanic Health
Leadership Summit, San Antonio, TX

• Purpose to build consensus recommendations to
  improve Hispanic health programs and policies at
  the Federal, State, private, and community levels
  for the next 5 years.
• Partners Congress, DHHS, RWJF, Ca Endowment,
  Amgen, Aventis, GSK, PhRMA, EPA, NHTSA, HSHPS,
  natl groups 170 participants

10
Health Access

• Ensure that outreach, education, and enrollment
  efforts are community-based and target LEP.
• Develop automatic re-enrollment in highly
  uninsured populations.
• Develop uniform financial screening tools for
  public programs and migrant insurance program.
• Establish a web-based clearinghouse to promote
  research on underutilization and disenrollment of
  underinsured populations.
• Expand Medicaid/SCHIP eligibility, including
  parents and pregnant women, waivers, tax breaks
  for employers.
• Adopt universal healthcare policy.

11
Health Professions Training

• Encourage Hispanic students to pursue health
  careers
• Expand the HRSA Health Career Opportunity and
  Centers of Excellence programs, NIH career
  programs.
• Establish partnerships with the Department of
  Education
• Short Term New Counseling for students on MCAT
  list.
• Short Term Workforce Development Research, eg.
  examine impact of reciprocity between U.S. and
  other Hispanic countries.
• Long Term Pipeline Development,
• School District should establish a Health
  Professions Academy for Latino Students
• Mentoring programs with Hispanic health
  professionals

12
Building Hispanic Community- Based Research

• Increase Hispanic leadership and participation
  with DHHS, state/private organizations.
• Build community-based research infrastructure
  (Empowerment Zone, Community Access Program,
  Reach, Exceed).
• Develop and facilitate pipeline to produce more
  Hispanic researchers.
• Develop culturally appropriate research methods
  eg. the Hispanic epidemiological parodox.
• Make partnerships with community organizations
  mandatory for funding of research on Hispanic
  populations.

13
National Hispanic Medical Association and Future
Research

• Established in 1994 in D.C. to improve the health
  of Hispanics underserved
• Journal with Amer Acad Family Physicians
• 9th Annual Hispanic Health Conference, LA
  4/1-2/05
• National Hispanic health research network
• National Hispanic Health Foundation - affiliated
  with Wagner Grad School of Public Service, NYU
• Research Training on use of Hispanic health data
• White Papers think tank
• Hispanic Health Professional Student Scholarship
• www.nhmamd.org