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Addressing Social Determinants through Community

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Addressing Social Determinants through Community & System Change By Aida L. Giachello, Ph.D. Associate Professor & Director Midwest Latino Health Research, Training ... – PowerPoint PPT presentation

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Title: Addressing Social Determinants through Community


1
Addressing Social Determinants through Community
System Change
  • By
  • Aida L. Giachello, Ph.D.
  • Associate Professor Director
  • Midwest Latino Health Research, Training and
    Policy Center
  • University of Illinois at Chicago
  • aida_at_uic.edu
  • Presentation at the State Workshop on Latino
    Health, Columbia, MD

2
Objectives
  • Briefly list selected health disparities of
    Hispanics/Latinos (H/L) and the sources of the
    disparities
  • Share some strategies on how to address the
    health and social needs of the growing
    Hispanic/Latino population through community and
    system change

3
Public Interest in Hispanic/Latino Health
Disparities in Montgomery County in Maryland
  • Dramatic population growth
  • In 2006, 128,365 H/L lives in Montgomery Country
    representing the 2nd largest minority in the
    County
  • MC has the largest concentration of H/L in MD
  • Most H/L are from Central America (44), followed
    by South America (22.4)
  • 65 of H/L are foreign born

4
Interest in H/L Health Disparities issues.
  • 2. Mobilization of H/L groups and forming
    partnership with the Montgomery Dept of HHS and
    other sectors
  • Hispanic Health Initiatives
  • BluePrints for Latino Health in Montgomery County

5
Public Interest in H/L health Disparities 3.
Increased Research DataNational Mortality Data
  1. Heart Disease (65)
  2. Cancer (particularly breast, cervical (45) and
    lung (25-44) cancer)
  3. Injuries-- leading cause of death 24-44 yrs
  4. Cerebrovascular diseases
  5. Diabetes- 3rd cause of death for persons 45
  6. Homicide-- leading cause of death 15-24 yrs
  1. Pneumonia and influenza (65)
  2. Liver diseases (cirrhosis)
  3. Pulmonary diseases
  4. HIV/AIDS (25-64)
  5. Kidney failure (65)
  6. Maternal deaths

6
Interest in H/L Health Disparities issuesRes
Data
  • Montgomery County
  • HIV/AIDS
  • In 2005, H/L accounted for 1.6 times as many new
    HIV diagnoses as non H/L whites (MD Dept of PH,
    2007).
  • Tuberculosis
  • TB for H/L in Maryland is 3.5 times
  • Foreign-born Latinos in Maryland is 12.5 higher
    than for the US

7
Interest in H/L Health Disparities issuesRes
data...
  • Type 2 Diabetes
  • Leading cause of death
  • Latinos are diagnosed after the age of 38
  • New cases are emerging among children and
    adolescents and young adults
  • Diabetes complications serious problems
  • Diabetic end-stage renal disease among 55 is
    10-20 higher than whites
  • Hypertensive end-stage renal disease rates is 1.5
    to 5 times higher than whites

8
Interest in H/L Health Disparities issuesRes
Data
  • Over-weight and obesity
  • In 2005, 3 out of 4 H/L 40 years of age were
    overweight (46) or obese (30)
  • Community Safety issues discourage physical
    activity
  • Limited income lead to limited access to healthy
    food options
  • Communities designated food dessert
  • Occupation injuries fatalities
  • Social stress, violence, suicide/homicide,
    social discrimination anti-immigrant sentiment

9
Hispanic/Latino Health Vary By
  • Age
  • Socio-economic status
  • Place of birth
  • National origin
  • Acculturation and assimilation
  • Push and pull factors related to immigration
  • Neighborhood, place of employment, etc

10
High acculturation impact negatively Latino Health
  • Infant mortality
  • Low birth weight
  • babies
  • blood pressure
  • Obesity
  • Teen pregnancy
  • Smoking
  • Alcohol use
  • Other drug use
  • -breast-feeding

11
TRUE SOURCES OF DISPARITIES
  • Poverty Low SES
  • Neighborhoods and school segregation and
    neighborhood quality
  • Poor neighborhood becomes market for tobacco,
    alcohol and fast food
  • Large families, average size of 3.96
  • 44 have more than 4 members
  • H/L has the lowest per capita income in
    Montgomery Country (20,165), representing 37.4
    of whites (53,926).
  • 52 work in the Service or Construction
    industries

12
Factors affecting poverty rates
  • High teen pregnancy
  • parenthood
  • High no. of families headed by women
  • Low education
  • Low earnings
  • High unemployment
  • High poverty among married couple families

13
Public Response to Health Disparities Blaming
the Victim
  • Dont be poor
  • Dont be unemployed
  • Change jobs
  • Change neighborhood
  • etc

14
True Sources of Disparities 2. Access to Care
Barriers
  • No regular source of carein MC Over 50 have no
    medical home)
  • Lack of health insurance (50-58) 2005 and 2007
    cancer study
  • System barriers
  • Limited bilingual and bicultural staff
  • Long traveling time to go to healthcare facility
  • Lack/limited transportation

15
True Source of Health DisparitiesAccess to care
Systems- barriers
  • Lack of capacity of health care facilities
  • Long waiting time between calling for an
    appointment and the actual visit
  • Long waiting time once you get to doctors office
  • Lack of hours of services during evening or
    weekends

16
Other Healthcare Systems-level barriers
  • In managed care organizations, financial
    incentives to providers tend to limit services
  • Fragmentation of services and poor
    coordination

17
True Source of Health DisparitiesAccess to
careSystem Barriers.
  • Lack of interpreters
  • For example 1 out 5 have Gone Without Care When
    Needed Due to Language Obstacles
  • Poor pt-doctor communication
  • NO interpreter services available
  • Only 1 out of 4 requests received interpreter in
    MC
  • 1 of 6 failed to make an appt due to language
    barrier in MC
  • 1 in 5 could not complete their phone calls in MC

18
True Source of Health DisparitiesAccess to Care
  • Low use of health and medical care
  • Delays seeking care and using preventive services
  • Limited familiarity with the health care system
    and low health literacy
  • Uses home remedies and OTC
  • Uses medication from their country of origin
  • Seek non professionals (e.g., faith healers)

19
True Source of DisparitiesAccess to care
  • Eligibility issues
  • 1996 Immigration reform made eligibility for
    public funder programs more restrictive for more
    immigrants
  • Concerns about deportation

20
July 29 August 6
21
Source Kaiser Health Tracking Poll, Election
2008 August 2008
22
The Obama Plan
  • Mandated coverage for kids
  • Pay-or-play for employers
  • New public plan offered
  • No tax credits/changes
  • Expansion of Medicaid/SCHIP
  • Invest 10 B in HIT
  • Cost estimates range from 50-110 B a year

23
3. Sources of Health Disparities Poor Quality
of Medical Care
  • Most of the improvements in health in the last
    100 years have been the results of improvement in
    public health, sanitation, nutrition and living
    conditions
  • Physicians and other health professionals are not
    familiarized with clinical guidelines for the
    management and control of chronic diseases

24
  • Racial and ethnic minorities and women receive
    poor care due to physicians biases and
    stereotypes

25
3. Source of Health DisparitiesPoor medical
care
  • Due to long history of race/ethnic and gender
    bias in the medical care system
  • Mexican Americans received 38 fewer medications
    (antiarrhythmics) than whites
  • Hispanics in a Los Angeles hospital ER, were
    least likely to receive no analgesia for their
    injuries
  • Source Goldberg et al. 1992 Herholz et al.
    1996 Blustein et al, 1995 Todd et al, 1993

26
3. Source of Disparities Poor Medical
CareConclusions of IOM Report
  • Across virtually every therapeutic intervention,
    ranging from high technology procedures to the
    most elementary forms of diagnostic and treatment
    interventions, minorities receive fewer
    procedures and poorer quality medical care than
    whites
  • Differences persist after controlling for health
    insurance, SES, stage and severity of disease,
    comobidity, and the type of medical facility

27
Disparities in the Clinical Encounter The Core
Paradox (Williams, 2004)
  • How could well-meaning and highly educated health
    professionals, working in their usual
    circumstances with diverse patient populations,
    create a pattern of care that appears to be
    discriminatory?
  • Williams argues that it has to due with
    stereotyping

28
Unconscious Discrimination
  • When one holds a negative stereotype about a
    group and meets someone who fits the stereotype
    s/he will discriminate against that individual
  • It is automatic and unconscious process
  • It occurs even among persons who are not
    prejudiced
  • I am not racist I know I dont stereotype

29
Factors that Increase Stereotype Usage in Medical
Care
  • Time Pressure
  • Need for Quick Judgments
  • High Cognitive demands
  • Task Complexity
  • Resource constraints
  • Anger or Anxiety
  • Source Williams, 2004 Van Ryan 2002

30
Conclusions
  • Many sources are responsible for health
    disparities
  • Socioeconomic and environmental conditions
  • Financial, linguistic, cultural and system
    barriers to access to care
  • Poor medical care as a result of Medical
    Professional behaviors in clinical settings

31
STRATEGIES RECOMMENDATIONSFOR ACTION
32
To address the social determinants of health we
must work at different levels
  • Individual Empowerment of H/L
  • Family
  • Neighborhood
  • Macro
  • Health and other systems
  • Other systems

33
Long term institutional/structural changes
  • This calls for an improvement in the levels of
    education and income, and better distribution of
    resources and services for all Hispanics/Latinos
  • H/L health must be viewed within a broader
    societal context

34
Stronger Government Private Sector Commitment
at all Levels
  • For Example
  • To eliminate health disparities, in addition to
    the DHHS, you need to involve the Depts. of
    Education, housing, Commerce, Environmental
    Protection Agencies, etc.
  • You need Strong commitment from businesses,
    foundations, and many other key players
  • For example, MC DHHS should establish a
    multi-sectorial council across departments

35
For Example Structural Conditions Impacting
Health
  • Type and location of employment within the
    economic structure (i.e., services industry)
  • Environmental and occupational hazards.
  • By not addressing the origins of the problems we
    are treating the most costly symptoms

36
We need to Recognize Health Inequities
  • Systematic and unjust distribution of social,
    economic, and environmental conditions needed for
    health
  • Access to healthcare
  • Employment
  • Education
  • Access to resources (e.g. grocery stores, car
    seats)
  • Housing
  • Transportation
  • Freedom from discrimination

Source Whitehead M. et al
37
Social Determinants of Health Socio-ecological
Model
Source Institute of Medicine, 2003
38
Social Determinants of Health
39
Social Determinants of HealthRefers to
  • Life-enhancing resources, such as food supply,
    housing, economic and social relationships,
    transportation, education, and health care, whose
    distribution across populations effectively
    determines length and quality of life.

Source James S., 2002
40
Adopt Population based approach including
multiple determinants of Health For example
  • Public Health Working with the Business Community
  • Why should business care about diabetes
    prevention and control?
  • Loss productivity
  • Increased health care expenditures
  • Poorer quality of life for employees
  • Consequences related to permanent disability
  • What can the food industry do?
  • Educate its members, make available fruits and
    vegetables

41
5. Adopt a Population-level Approach,
including Multiple Determinants of Health
  • Work with the school system to change the School
    Environment
  • Changing School Environment Curbs Weight Gain In
    Children, Study Shows (Apr. 7, 2008)
  • Public Health Law Reform (federal, state, local)
  • Arkansas Act 1220, An Act to Combat Childhood
    Obesity Act 1220 is now codified, in part, at
    Ark. Code Ann. 20-7-135 (2005)

42
Population approach to address multiple
determinants of health
  • New York - The Board of Health voted to make New
    York the nations first city to ban
    artery-clogging artificial trans fats at
    restaurants-- MSNBC News Services, Dec. 5, 2006
  • U. S. District Court for the Southern District of
    New York upheld the constitutionality of New York
    Citys calorie-posting requirement for
    restaurants of a certain size and type. Apr. 16,
    2007)

43
Develop Sustain different partners
  • Role of the Workplace
  • What can employers do
  • Employee risk assessments
  • Employee education
  • Health plan benefit design/disease management
    vendors
  • Environmental change (supportive environment)

44
Sustaining partnerships
  • Partnerships will require
  • Forging a common language and understanding
  • Exchange of information and data
  • Learning together about effective strategies for
    the workplace
  • Recognizing efforts

45
Increase accountability
  • Review the regulatory authorities of DHHS
    agencies to maximize effectiveness and
    collaboration across departments, and with other
    state and local health agencies
  • How can WIC be used to impact on the childhood
    obesity epidemic?
  • How can the DOT integrate health and physical
    activity goals into transportation planning?
  • What is the role of DOE in supporting
    implementation of K-12 Health Education
    Standards?
  • Is there a body that coordinates activities
    across agencies to address the obesity epidemic?
    Do we need one?
  • Can we eliminate tobacco use in public housing

46
Advocate Support Health Care reform and
Single-payer System
  • Health care is a right and not a privilege
  • Sooner or later we must have a national solution
  • Without health we cannot work, we cannot take
    care of our families, and we cannot be productive
    citizens

47
Need for close monitoring of Managed-care Networks
  • Concerns exist with
  • Access to specialists and/or hospitalization
  • Marketing strategies
  • Limited support services and follow-up
  • Possible violations of patients rights
  • Assure that Health insurance plans/managed care
    cover preventive services according to guidances

48
Improve H/L Access and use of
Health and mental health services Advocate
for better quality of health/medical care, mental
health Human services
49
Develop and implement Creative Public Health
Solutions and Models
  • Example
  • Racial and Ethnic Approaches to Community Health
    (REACH) 2010, a CDC Initiative
  • Center of Excellence for the Elimination of
    Disparities

50
REACH 2010 Building partnerships
  • Calls for community mobilization and system
    change
  • Encourage coalition building and establishing
    partners with non-traditional sectors
  • Chamber of Commerce, food industry
  • Faith communities
  • etc

51
Increase data and Research on Hispanics/Latinos
  • Issues
  • Health data systems are poorly equipped to
    provide information on the health status of
    Hispanic groups (GAO Report, 1992)
  • Insufficient Identifiers for subgroups
  • Incompleteness
  • Ethics (informed consent is often violated)
  • Managed-care systems do not collect data on
    demographic and socioeconomic characteristics of
    participants enrolled in the plans

52
Community Participatory Action Research Model
Action Planning
53
UIC CSDCAC Phase I Participatory Action
Research Coalition Building Model
1
2
3
4
Giachello, 2003)
6
Community Dialogue
Coalition Formation
Capacity- Building (Training)
Assessment, Data Collection Analysis
Dissemination of findings Community Consultation
Finalize ACTION PLAN (logic Model)
Process
Values Goals Objectives
Problem Definition
Orientation
Community Organizing Coalition-building
Telephone Survey
Community Forums/Town Meetings
Activities
Strategies
Topic area 101 201
Focus Groups
Community Involvement
Strengthening
Formations of Committees
Strengths limitations
Resources Needed
Analyses of Epidemiological Data
APPLIED Research Methods
Establishing Com. Action coalition
Evaluation
Resource Survey Community. mapping
Community Organizing
On-Going
54
CEED_at_Chicago Model Systemic Links Across
Socio-ecological Levels
SEM level Activity/ Target Effects Intermediate Outcomes Long-term Outcomes
Political/ Economic System
Health-Social Service System
Organiza-tional
Community/ Interpersonal
Involve non-health sectors
Policy Change
Influence Power-brokers
ltSocio-economic Barriers to Health Equity
Cross-organiza-tional policy change
Develop Policy Agenda
Strengthen Coalition
Capacity-Building Workshops
Practice Change
gtAccess minority clients
Obesi-ty Reduc tion
gtResources at Local Level
Trainers Trained
Change in Local Norms
Training delivered in Comm.
ECP 2-20-09
55
CEED REACH-US HEALTHY EATING PHYSICAL
ACTIVITY PROGRAM
TRAINING TECHNICAL ASSISTANCE
MULTI-SECTORAL PARTNERSHIPS
PUBLIC POLICY INITIATIVES
EMPLOYERS
NEIGHBORHOOD BLOCK CLUBS
PARK DISTRICT
APPOINTED ELECTED OFFICIALS
GROCERY STORES
SCHOOLS
PROFESSIONAL ORGANIZATIONS e.g. ADA
CHAMBER OF COMMERCE
FAITH COMMUNITY
CBOs
RESTAURANTS
MEDIA
CDOH WIC FOOD INSPECTION
56
Create Capacity and Engage in Workforce
Development by Training Community Residents as
Health Promoters
Effectiveness of Health Promoter as diabetes
educators
57
Integration of Health in Human Services delivery
  • Establishing Health Promotion Wellness Center
    in the community managed by Health Promoters
  • These centers have walking clubs, and engages in
    policy and advocacy activities in addition to
    health education and support
  • Integrating health promoters in primary care
    settings
  • Integrate health promotion programs in social
    services organizations

58
Examination of the impact of recent social
health Policies
  • Welfare Reform on health status and on access to
    health care
  • Immigration Reform
  • Childrens Health Insurance Program (CHIP)
  • Affirmative Action
  • Child Care Legislation
  • Medicaid and Medicare Managed-Care
  • Medicare Prescription Drug Plan

59
Increase Latino representation in health and
human services Professions
  • Between 60 to 75 of Latinos never go to college
  • Those that do go, less than 10 will graduate
  • 90 of our students are in urban public schools
    which suffer from a limited tax base
  • School segregation has increased for
    Hispanics/Latinos
  • Only 3 of all teachers in US are Hispanics

60
increase/encourage H/L leadership development
  • This calls for
  • vision
  • passion
  • Commitment
  • team work
  • Knowledge and skills
  • Willing to lead and seeking opportunities to lead
  • Risk taking
  • Perseverance

61
Achieve Cultural Competency in the health care
system
  • At the individual level
  • Organizational level

62
Cultural Competency at the Institutional Level
  • Refers to practices, norms, value and policies
    (written or not) in the health care delivery
    system that either respond or do not respond to
    the needs of racial and ethnic minority (or no-
    minority) groups, or other diverse populations
    (e.g., the poor, women, gay and lesbians, people
    with special needs, etc)

63
(No Transcript)
64
Cultural Competency strategies at the
Institutional/Organizational level of the health
care Delivery System
  • Steps
  • Commitment from the top organization leadership
    (e.g., board of directors/Bd of Trustees,
    President/CEO, Medical Director, etc)
  • Commitment must be reflected in budget allocation
  • Recruitment of H/L in policy decision-making
    positions

65
Steps to achieve CC in the health care system (2)
  • Establishment of a Community Advisory Committee
    to the Agency
  • They can also contribute to identifying problems
    and the solutions
  • Conduct an assessment of needs and assets
  • Within the institution/organization
  • Target communities/catchments' areas

66
Steps to achieve CC in the health care system
(3)
  • From the community assessment of needs and assets
    data develop policies programs
  • Suggested Policies and practices
  • Board of Directors/bd of Trustees
  • Recruitment of minorities in board
  • Given minorities leadership roles
  • Establishment of a policy on cultural diversity
  • etc

67
Steps to achieve CC in the health care
system (4)Suggested Policies..
  • Personnel
  • When positions are open, qualified H/L should be
    recruited with appropriate salary compensation
  • Hire Executive Recruiters to assist, if needed
  • Establish community personnel committee
  • Promote jobs in ethnic media
  • Use informal minorities network

68
Steps to achieve CC in the health care system
(5)
  • Suggested Policies..
  • Research Data
  • inclusion of ethnic identifiers
  • partnership with Universities
  • On-going analyses of agencys data
  • On-going collection of data (e.g., pt.
    Satisfaction surveys)
  • Development and dissemination of reports

69
Steps to achieve CC in the health care system
(6)Suggested Policies..
  • Marketing of programs services
  • Assess channel of health information used by H/L
  • Provide contracts to H/L media
  • Develop bilingual educational materials (e.g.,
    program brochures, newsletters) for population
    with low levels of health literacy

70
Steps to achieve CC in the health care system
(7)Suggested Policies..
  • Plan and implement cultural, gender and
    educational-appropriate Diversity Training
  • Form a planning committee with members of staff
    at different levels
  • Assure to conduct training with administrative
    staff (particularly middle management staff and
    supervisors)

71
Steps to achieve CC in the health care system
(8)
  • Suggested Policies..
  • Cultural Diversity Training.
  • Focus on one racial/ethnic group at a time
  • Assure that training has group/individual
    self-assessment exercises and activities
  • Provide a forum for honest discussion and
    ventilation of problems, concerns and
    identification of solutions

72
Steps to achieve CC in the health care system
(9)
  • Suggested Policies..
  • Cultural Diversity Training.
  • Provide multiple training sessions so everyone
    can attend, including administrators
  • Recognize that CC is an on-going process
  • Identify minority vendors as trainers

73
Steps to achieve CC in the health care system
(10)
  • Suggested Policies..
  • Cultural Diversity Training.
  • You need to have realistic expectations. Things
    at times have to get worse before they get
    better. Be careful with firms that assures that
    they can sensitize everyone in one-two training
    session

74
Steps to achieve CC in the health care system
(11)
  • Suggested Policies..
  • Establish translation services
  • Establish a telephone hotline for non-English
    speaking persons calling in
  • Develop an interpreter/translation system with
    trained individuals who knows the medical
    terminologies
  • Hire minority vendor for translation of materials
  • Establish patient navigator programs
  • Integrate trained health promoters as educators
    and to conduct outreach, home visits and follow
    up with professional backup

75
Steps to achieve CC in the health care system
(11)
  • Suggested Policies..
  • Establish translation services.
  • Use ATT interpreter telephone line, only if
    bilingual interpreters are not available
  • Do not use bilingual staff with other assignments
  • Do not use bilingual children, other relatives,
    neighbors or friend, due to ethical issues (e.g.,
    violation of confidentiality)

76
Steps to achieve CC in the health care system
(12)
  • Suggested Policies..
  • Establish translation services.
  • Train or hire interpreters who knows the medical
    terminologies

77
Steps to achieve CC in the health care system
(13)
  • Suggested Policies..
  • Develop benefit package for target communities.
    E.g.
  • Support and attend cultural events
  • Support and attend community organizations
    benefits
  • Provide scholarships in health career development
    (e.g., nursing) for local residents

78
Steps to achieve CC in the health care system
(13)
  • Suggested Policies..
  • Have staff to sit in board of directors of CBOs
  • Provide job opportunities to local residents,
    including training and recruitment of community
    health workers or health promoters
  • Provide uncompensated care for poor families

79
Steps to achieve CC in the health care system
(14)
  • Suggested Policies..
  • Engage in Effective outreach and community
    education strategies
  • Use health promoters
  • Organize or participate in health fairs and other
    community educational events
  • Obtain bilingual education, low literacy
    materials and have them available for physicians
    and other health professionals in direct services
    delivery

80
Steps to achieve CC in the health care system
(16)
  • Suggested Policies..
  • Use minority vendors for diverse services within
    your institution, particularly in you are working
    or serving racial/ethnic minorities

81
Steps to achieve CC in the health care system
(17)
  • Suggested Policies..
  • Develop services delivery policies related to
  • appointment system
  • Walk-ins
  • Cost (e.g., sliding scale)
  • Translation services
  • providing uncompensated emergency care to those
    in needs

82
Steps to achieve CC in the health care system
(17)
  • Suggested Policies..
  • Develop services delivery policies.
  • Make the doctor office, clinic or hospital
    user-friendly places
  • Have decorations that reflects the patients
    preference
  • Have staff trained in customer services

83
Engaging in Cultural Competency practices at the
individual level
  • Greet people with smile, hand-shaking, look at
    persons eyes. If he/she looks puzzle, approach
    the person and see I they need assistance
  • You need to do your homework about the specific
    racial/ethnic population being served
  • It requires
  • knowledge on culture environmental conditions

84
Engaging in Cultural Competency practices at the
individual level
  • Developing awareness/sensitivity
  • A deep understanding not only at the intellectual
    level but at an emotional level empathy
  • Developing cultural competency- the skills to use
    the cultural knowledge and sensitivity in an
    effective manner in working with diverse
    populations

85
Engaging in Cultural Competency practices at the
individual level (2)..
  • Engaging in cultural assessment. Find out
  • Gender roles
  • Place of birth
  • Language proficiency (fluency)
  • Immigration history and experience
  • of years in US, as measure of acculturation
  • of years of schooling (literacy)
  • Family composition
  • Language
  • Lifestyle practices
  • Health practices (use of home remedies)

86
Engaging in Cultural Competency practices at the
individual level (3)..
  • Cultural assessment
  • Religion/spirituality
  • Socioeconomic status, poverty/resources
  • Gender role
  • Urban/rural origin
  • Social support systems/networks
  • Community participation/civil engagement
  • Previous experience with the health delivery
    system

87
Engaging in Cultural Competency practices at the
individual level (4)..
  • Physicians and other providers should greet the
    person (s)
  • Establish contact with a smile and looking at
    persons eyes.
  • Use a word in Spanish Buenos Dias/Tardes. It
    relaxes the patient.
  • Do not try to learn Spanish during the encounter
  • If you are looking at the medical recordsinform
    the person what you found (most pts do not know
    their diagnosis or results of lab test and other
    results
  • Explain what will happen doing the clinic visit

88
Engaging in Cultural Competency practices at the
individual level (5)..
  • Involve the family
  • Treat patients/clients with
  • Respeto (respect)a internal Latino value where
    the elderly, professionals, and persons in
    position of authority are treated with respect
    and dignity
  • Personalismoperson-to-person contact where the
    professional demonstrate interest for the
    patient (and his family) well-being while
    maintaining a professional image

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Engaging in Cultural Competency practices at the
individual level (6).
  • Listen attentively to the situational context
    surrounding pt. clinical condition
  • Explore the fear related to doctor visits and
    health conditions
  • Give patient specific referrals, when needed
  • Be aware of barriers to seeking using services
    (e.g., lack of health insurance, inconveniences
    in obtaining care, etc.)

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Conclusion
  • There is a sense of urgency to intervene now in
    developing and implementing strategies that will
    improve the health and well-being of H/L and to
    implement effective strategies
  • To eliminate social and health disparities we
    must commit to an agenda of social action
  • THANK YOU!

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