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Recognizing and Overcoming the Barriers to Health Care in the Hispanic/Latino 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 – PowerPoint PPT presentation

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Title: Recognizing and Overcoming the Barriers to Health Care in the Hispanic/Latino Community


1
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

2
Texas
Total Population 21,325,018 Hispanic
Population 6,824,006 (32) 2nd Largest Hispanic
Population
3
New Mexico The Land of Enchantment
Total Population 1,829,146 Hispanic
Population 770,070 (42)
4
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
5
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6
The Latino Explosion
7
The Latino Explosion
8
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

9
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10
59
11
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12
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13
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14
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15
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

16
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

17
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
18
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
19
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
20
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

21
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

22
Disparity in Health Insurance Coverage
White Non- Hispanic
10
10
22
Hispanic FB - Naturalized
25
55
23
Uninsured Hispanics Benefit US Economy But Do Not
Reap Health Benefits
24
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25
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

26
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

27
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

28
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

29
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

30
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

31
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

32
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

33
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

34
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

35
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

36
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

37
The Problem
Skyrocketing Hispanic Population Barriers to
Injury Prevention ? Marked Increase in Injuries
and Deaths ? Emerging Public Health Crisis
38
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

39
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

40
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

41
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

42
Growth, Opportunity, and Change
43
Growth, Opportunity, and Change
44
Abriendo Puertas Abriendo Brazos Abriendo
Corazones
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