june 15, 2000 minority health project, university of north carolina, chapel hill issues and...

June 15, 2000 Minority Health Project, University of North Carolina, Chapel Hill

Issues and Challenges in Reducing Health Disparities Among

Hispanics/Latinos in the U.S.

Aida L. Giachello, Ph.D.Associate Professor and Director

Midwest Latino Health Research, training and Policy Center

University of Illinois at Chicago

1640 W. Roosevelt Rd, Suite 636

Chicago, Illinois 60608Tel. 312 413-1953

[email protected]

Copyright © 2000, Aida Giachello

UIC-Midwest Latino Health Reseach Center 2


Objectives of Presentation

• To share and discuss some of the social, economic and health disparities of Hispanics/Latinos in the U.S.

• To share some of the current issues and challenges in reducing health disparities

• To issues regarding cultural competency in serving this and other populations

• To provide some program, policy and research recommendations for health leaders, health care providers and institutions to reduce health disparities for the year 2000 and beyond



WHAT ARE THE FACTS?



Population Estimates, March, 1999

31.7 Million or 11.7% of Total U.S. Population

This population estimate does not take into account:

• 3 to 6 million undocumented workers• 3.8 million persons in the island of Puerto Rico• 7% to 12% estimated undercount-1990



Spanish Speaking Countries



Composition of the Hispanic/Latino Population, 1999

• Mexican/Mexican American 66.2%

• Puerto Rican 9.6%

• Cubans 4.3%

• Central and South American 14.4%

• Other Hispanics 6.6%

Source: U.S. Census, “The Hispanic Population in the U.S. March,1999- February, 2000.”



Diversity among Hispanics/Latinos (2)

For example,

• Some are U.S. citizens, others are not

• Some are recent arrivals to the U.S. while others have been in this country for many years and for many generations

• Many speak only Spanish, some are bilingual in English and Spanish, and others are monolingual in English.



Diversity among Hispanics/Latinos

There is diversity by:• National origin• Levels of acculturation and assimilation• Socioeconomic status• “Push” and “pull” factors for immigration• Health, knowledge, beliefs, and behaviors• Health status, and• Patterns of health services utilization.



Dramatic Population Growth1990-1998 Increases

1980-90 % Change

22.3 million 35%

1990-98

• Hispanics 7.7 million 34%• Blacks 3.8 million 12%• Asians 2.9 million 39%• Native Americans 0.3 million 1%• Non-Hispanics 6.9 million 4%• Puerto Rico 3.8 million



U.S. Hispanic Population 1990-2100

22m31m

41m51m

63m

95m

190m

0

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

120,000,000

140,000,000

160,000,000

180,000,000

200,000,000

1990 2000 2010 2020 2030 2040 2100

Series 1

Source: National Association of Hispanic Publications, United States Bureau of the Census, 1999.



U.S. Hispanic Population 1990-2100

0%

5%

10%

15%

20%

25%

30%

35%

1990 2000 2010 2020 2030 2035 2070 2100

Source: U.S. Census Bureau Projections of the U.S. Resident Population, 1999.



Population Projections

Of the total U.S. Population Hispanics/Latinos will be

• 12.6% by 2005

• 18.9% by 2030

• 21.7% by 2035

• 33.0% by 2100



POPULATION GROWTH

• Hispanics grew at six times the rate of non-Hispanic whites

• Arkansas: from 20,000 to 50, 000• Number almost doubled in North Carolina, Georgia

and Nevada• Other geographical areas with dramatic growth: Salt Lake City, Minneapolis, Oklahoma City and

Colorado Spring• In suburbs of big cities



States with the Largest Number of Latinos,1998

• California 10.1 million

• Texas 5.8 million

• New York 2.6 million

• Florida 2.2 million

• Illinois 1.2 million

• Arizona 1.0 million

• New Jersey 1.0 million



States With The Highest Concentration Of Latinos,1998

• New Mexico 40.3 %

• California 31.0 %

• Texas 29.7 %

• Arizona 22.1 %

• Nevada 15.9 %

• Florida 15.0 %

• Colorado 14.5 %



Social & Economic Disparities, 1999

Total ME P.R. Cuban C&S Total

Latinos Non-LMedian Age 26.5 24.3 27.0 40.8 28.7 38.1

% with HS+ 54.7 48.6 61.1 65.2 63.3 87.7

Median Family

Income $26,178 25,347 23,646 35,616 29,960 44,321

(1997)



Social & Economic Disparities, 1999 (2)

Total ME P.R. Cuban C&S Total Latinos Non-H/W

% Unemployment 6.7 7.0 7.3 4.9 5.9 3.6

% Male in LF 78.4 80.0 66.0 73.0 81.0 74.3

% Female in LF 55.8 55.2 52.6 49.2 61.8 60.3

% of Families

Headed by

women 23.7 21.3 37.2 17.0 23.7 13.0



Social and Economic Disparities (3)

Total ME P.R. Cuban C&S Total Latinos Non-H/W

% of families below

poverty levels

headed by a women

(1998 data) 43.7 46.9 48.0 25.3 31.6 20.7



% of persons below poverty, 1998 Social and Health Disparities (4)

Hispanics

Total 25.6%

< 18 34.4%

18-64 20.8%

65+ 21.0%

Non-Hispanic White

8.2%

10.6%

7.3%

8.2%



Social and Health Disparities (5)

• 3/4 were living in or near poverty

• Hispanic household report over 2 times the rate of food insufficiency and hunger



Factors affecting poverty rates

• Low education

• Low median earnings

• High poverty among married couple families

• Low participation in the labor force

• High unemployment

• Large family size

• High teen pregnancy

and parenthood

• high no. of families headed by women



Other key facts• % who speak Spanish: 64%-86%

• % who are Immigrants:36%-52%



Growth of the Latino Elderly Population

Latino elderly population has grown 61% since 1970

Latino Elderly Total Minority Elderly

1995 4% 14%

2025 18% 35%

Source: U.S. Census, CPS, 1995. Abstracted from the Henry S. Kaiser Foundation.



Facts about Latino immigrants

• Diversity• Low education• Older• Limited English • Levels of education

and income vary by country of origin

• Have higher fertility• Tend to live in larger

households • Work harder and earn

less income• Least likely to have

health insurance• Low prevalence of

certain illnesses but poor outcomes



HEALTH DISPARITIES



HISPANIC/LATINO’S HEALTH VARY BY

• National origin

• Age

• Socio-economic status

• Gender

• Acculturation

• Place of birth



Latinos are most Likely to die of:

• Heart diseases• Cancer• Injuries• Homicide• Cerebral Vascular

Diseases• Diabetes• Liver diseases

• HIV/AIDS• Pulmonary diseases• Suicide• Viral hepatitis• Tuberculosis• Drug-related

deaths• Infant mortality



Leading Causes of DeathU.S. Latinos: 1997 Rates

05

10152025303540

MALES

FEMALES



Diabetes Mellitus

• Overall, 6% (1.2 million) of U.S. Hispanics have Diabetes

• Prevalence & Mortality is twice the rate for non-Latino whites

• Mexican Americans and Puerto Ricans experience 110% to 120% higher rates

• Rates for Cubans are 50% to 60% higher• 40% to 60% do not know that they have diabetes

until complications develop



Age–adjusted prevalence of diabetes among persons aged 18 by ethnicity and location, United States

1994–1997

0 2 4 6 8 10 12

non-Hisp whites

Puerto Rico

S/SEast

NEast/MWest

West/SWest

PercentSource: CDC:United States, Behavioral Risk Factor Surveillance System, 1998



Prevalence of diabetes among persons aged 18 by age and ethnicity,

United States 1994–1997

0

5

10

15

20

25

18-44 45-64 65+ 18+ adjusted

Perc

ent

Hispanics non-Hisp whites

Source: CDC:United States, Behavioral Risk Factor Surveillance System, 1998



AIDSN=688,200 Accumulated Cases, 1998

• Women 19.1%

• Blacks/African Americans 39.2%

• Hispanics/Latinos 18.1%

• Persons currently living with AIDS: 270,841



Pediatric AIDS Cases, 1998N=1,875

• Whites 23.3%

• Blacks 63%

• Hispanics 11.5%



HIV Infection

Men Women

White 43.6% 24.0%

Black 46.9% 67.4%

Hispanics 0.7% 6.6%

Source: CDC:HIV/AIDS Surveillance Report, 1999



Other STDs• Primary & secondary syphilis: 5 times as

likely to contract it as whites

• Gonorrhea: 3 times most likely to contract it

• Chlamydia and trichomoniasis: most prevalent among Latino youth



Environmental Risk Factors

• Children have elevated lead blood levels

• Families live in neighborhoods near toxic waste dumps

• Workers are more likely to be exposed to hazardous chemicals and conditions in their workplace

• Violence in the street



Latino Women’s Health

• Live longer with a life expectancy of 77.1, compared to Latino men (69.6), but less compared to white women (79.2)

• Despite living longer, Latino women experience more symptoms of illnesses, chronic conditions, disabilities, depression and their quality of life and medical care is poorer.

• Latino women experience higher levels of physical sexual and emotional abuse.



Selected Maternal Characteristics, 1998

Total ME P.R. Cuban C&S Total Latinos White

% Birth rate 24.3 26.4 19.0 10.0 23.2 12.1

% Fertility rate 101.1 112.1 75.5 50.1 90.2 56.7

% Mothers born in U.S. 39.9 39.7 63.8 39.7 10.1 94.9

Source: National Vital Statistics March, 2000



Hispanic Birth Rates, 1998

12.1%

24.3%

26.4%

19.0%

10.0%

23.2%

0%

5%

10%

15%

20%

25%

30%

Non-Hispanic

White

TotalLatino

Mexican PuertoRican

Cuban Central &South

American

Birth Rates by Ethnicity



Births to Unmarried Latino Mothers by Place of Birth, 1998

22.5%

40.7%48.0%

37.2%

46.3%

35.1%

61.8%55.2%

45.8%

24.4%

47.5%

41.6%

Non-Hispanic

White

TotalLatino

Mexican PuertoRican

Cuban Central &South

American

Births to Unmarried Mothers

US Born

Foreign



Latino Teen Births by Place of Birth & Nationality, 1998

9.7

3.5

25.4

11.2

26.4

11.6

23.7

18.7

12.1

3.5

21.8

9.0

24.0

9.8

0

5

10

15

20

25

30

Non-Hisp.White

TotalLatinos

Mexican PuertoRican

Cuban C & SAmerican

Other andUnknown

Hisp.

Mothers Under 20 Years of Age (by Percent)

Mothers Born In US

Mothers Born Outside US



Latino Mothers’ Levels of Education by Place of Birth, 1998

87.0%

90.2%64.5%

41.4%

62.7%32.7%

64.3%63.6%

86.1%87.6%

78.4%59.5%

Non-Hispanic White

Total Latino

Mexican

Puerto Rican

Cuban

Central & South American

Mothers' Level of Education12 years of School or More

Mothers Born Outside US

Mothers Born In US



1st Trimester Prenatal Care

0.0%

50.0%

100.0%

1998 1989

1998 82.8% 87.9% 74.3% 72.8% 76.9% 91.8% 78.0% 73.3%

1989 75.5% 82.7% 59.5% 56.7% 62.7% 83.2% 60.8% 59.9%

All Races

Non-hispanic

Total Latino

MexicanPuerto Rican

CubanC&S

Amer.Non-

Hispanic



Selected Maternal Characteristics, 1998

Total ME P.R. Cuban C&S Total Latinos White

% Teen birth (U.S. born) 25.4 26.4 23.7 12.1 21.8 9.7% Teen birth (Non US born) 11.2 11.6 18.7 3.5 9.0 3.5

% With 4+ birth (U.S. born) 11.2 11.8 11.1 4.9 5.0 8.4% With 4+ birth (Non US born) 15.2 16.6 14.5 6.2 11.8 9.7

% Birth to unmarried mothers (US) 48.0 46.3 61.8 25.5 45.8 22.5% Birth to unmarried mothers (N.US)37.2 35.1 55.2 24.4 41.6 10.7

% Mothers with HS+ (US) 64.5 62.7 64.3 86.1 78.4 87.0% Mothers with HS+ (Non US) 41.4 32.7 63.6 87.6 59.5 90.2

Source: NCHS: Ventura et al, National Vital Statistics March, 2000



High Acculturation danger to Latino Health

• Infant mortality• Low birth weight

babies• Cancer rates• High blood

pressure• Obesity

• Teen pregnancy

• Smoking

• Alcohol use

• Illicit drug use

• Less breast- feeding



STRATEGIES & RECOMMENDATIONS



1. Need for long term institutional/structural changes

This calls for an improvement in the levels of education and income, and better distribution of resources and services

Hispanic health must be viewed within a broader societal context



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.



2. Stronger Government & Private Sector Commitment at all Levels

For Example: To eliminate health disparities, in addition

to the U.S. DHHS, you need to involve the Depts. of Education, housing, Commerce, Environmental Protection Agencies, etc.

• You need Strong commitment from industries, foundations, and many other key players



3. More Funding to Public Health Activities

It calls for greater commitment to prevention

Example:• 70% of premature mortalities are due

primarily to environmental and behavioral factors

• However over 90% of our resources go to medical care



No Leisure Physical Activity% Adults 1988-94 NHANES III

0

5

10

15

20

25

30

35

40

45

NHWhite Hispanic NHBlack

MenWomen



Fruit\Vegetable ConsumptionBRFSS 1997

0

2

4

6

8

10

12

Nwhite NHBlack Hispanic

US < 1/dayIL <1/day



Overweight Persons, 20-74NHANES III, 1988-94

0

10

20

30

40

50

60

NHWhite NHBlack Mex-Amer

MaleFemale



PREVALENCE OF SMOKING % Persons 18, NHIS 1997

05

1015202530354045

MENWOMEN



Overweight Persons, 20-74NHANES III, 1988-94

0

10

20

30

40

50

60

NHWhite NHBlack Mex-Amer

MaleFemale



4. Reduce Institutional Racism &Sexism

“The established, customary, and respected ways in which society operates to keep the minority in a subordinate position” (Bacca Zinn, 1989).



Racism

“Any policy, practice, belief or attitude that attributes characteristics of status to individuals based on their race, and sexism when it is done so according to sex.” (Rosenberg, 1995)

It can be:

• Conscious or unconscious

• Intentional or unintentional



Institutionalization of Racism and Sexism:

When all institutions in society act to maintain the subordination of people of color by white people, or the subordination of women by men, and they call upon the force of history to reinforce the system of subordination and inequality (Rosenberg, 1995)



Latino Experience with Being Treated Unfairly when Seeking care due to Race or Ethnicity

• Have you? 13%

• A Family Member? 21%

• A Friend or Someone

You know? 25%

Source: Kaiser Family Foundation Survey of Race, Ethnicity & Medical

Care: Public Perceptions & Experiences, Oct.1999



5. Increase Access to Health Care

Hispanics/Latinos are:• Least likely to be linked to a regular source

of health care • Least Likely to have health insurance• Experience a host of inconveniences in

accessing the health care system• Have poor health status• Under utilize the health care system



People Without Health Insurance, 1998

All People Poor PeopleWhite 15.0 % 33.8 %

Non-Hispanic White 11.9 % 28.5 %

Black 22.2 % 28.8 %

Asian And Pacific 21.1 % 32.3 %

Hispanic Origin 35.3 % 44.0 %



People Without Health Insurance, 1998(cont.)

All People Poor People

Native 14.4 % 29.0 %

Foreign Born 34.1 % 53.3 %

Naturalized Citizen 19.2 % 35.2 %

Not a citizen 49.9 % 58.6 %

Source: U.S. Bureau of the Census, 1999 (online)



Universal Health Care

• 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



6. Reduce the Inconveniences in Obtaining Care

• Long waiting time when calling for a doctor’s appointment and the actual visit

• Low time in getting to the source of care

• many private physician and clinics do not have hours of services during evening or weekends

• Cultural and linguistic barriers



7. Close monitoring & regulations on Managed-care Networks

Concerns exist with

• Access to specialists and/or hospitalization

• Marketing strategies

• Limited support services and follow-up

• Possible violations to patients’ rights



8. Need for Quality of Care Improvement

Some health care providers serving minorities are not familiarized with clinical guidelines on the management and control of chronic conditions

Example: • Treatment of Asthma & Diabetes



Total Latinos

African

Americans P Value

Education

Percent

% Observed inhaler use 77.4 77.8 77.1 NS

% Peak flow meter use 23.9 9.1 33.7 0.001

% Literature given 56.5 41.8 66.3 0.005

% Home control 63.4 46.2 74.1 0.002

% Crisis written plan 36.2 21.8 45.8 0.004

Medications

% Oral steroids 64.7 46.3 77.1 <0.0001

% Inhaled steroids 64.7 49.1 74.7 0.002

% Steroids bursts 41.0 18.0 56.0 0.002

Asthma Treatment Variations, 1996

Source: McDermott, Silva, Giachello, Al. Journal of Medical Systems. Plenum Press, New York, 1996



9. Need for Creative Solutions and models

Example:• REACH 2010 Initiative• Use of trained community lay

persons or health promoters• Community Participatory

Research Models



The Department of Health and Human Services identified six priority areas

• Infant Mortality

• Deficits in Breast and Cervical Cancer Screening and Management

• Cardiovascular Diseases

• Diabetes

• HIV Infections/AIDS

• Child and/or Adult ImmunizationsSource: CDC:Racial and Ethnic Approaches to Community Health (REACH 2010) Demonstration Projects



REACH 2010 Demonstration Projects are

• Two-phase projects

• Communities to mobilize and organize their resources

• Effective and sustainable programs

• To eliminate the health disparities of racial and ethnic minorities

Source: CDC:Racial and Ethnic Approaches to Community Health (REACH 2010) Demonstration Projects



10. Participatory Research Model

DIABETES REACH 2010 MODEL



CHICAGO SOUTHEAST DIABETES ACTION PLANNING GROUPPARTICIPATORY RESEARCH & COMMUNITY ORGANIZING MODEL

(REACH 2010)

Process

Activities

1. Coalition

Formation

2.CapacityBuilding

(Training)

3. Data

Collection

4.Community Organizing

5. Action Plan

6. Implemen-tation

Action Plan

Orientation

Expansion

Strengthening

DiabetesToday

Research Methods

Secondary data analysess , ex.- vital Statostocs- hospital data-

Focus Groups

Telephone Survey

Hlth providers FGs & Survey

Community Assets/Inv

Community

Forums

Working Groups

Policy Training

Comm. Educ. Prov. Training

Values

Goals/Objectives

Strategies

Strengths & Limitationes

Resources Needed

Workplan

Evaluation

Resourcedevelopment

Community Leaders

Ex. FocusGroups

Others



11. Use of Train Community Lay Workers

Role of the Health Promoter • Diabetes Educator• Person that takes time to listen to participant’s concerns• Provides individualized attention• Provides the human care that many of the participants

seem to need• Creates social-capital (social connectedness, rapport,

trust) among participants



Role of Health Promoter (cont.)

• Delivers an educational program that takes into consideration the sociocultural, linguistic, religious, and other environmental realities of minorities



Changes Hb A1c Wave I

16.5

14.7

12.4

11.8

10

11

12

13

14

15

16

17

Class #1 Class #12 6 Months after class #12 12 Months after class #12

Time of Intervention

HbA

1c3

Ran

ge

Hb A1c

Effectiveness of Health Promoter



Relatives Perceived Change of Participant’s Behavior

Examples:Participant’s General Health Status,

compared with three months ago.

Percent

Better 71.1

Much Better 17.8



% of Changes in Selected BehaviorsReported by Relatives

Diabetes-Related Health Services Utilization In the past three months ...% Who had Emergency Room Visit 4.4

% Who had Hospitalization 4.4

% Who had Unscheduled Doctor's Visit 17.8

% Who had a Nutritionist/Dietician Appt 24.4



% of Changes Reported by Relatives (2)

% Who had a Podiatrist Appt. 24.4

% Who had a Ophthalmologist Appt. 42.2

% Who had Changed Doctors/Clinics 6.7

% Who had Blood Test (at Clinic) 55.6



Relatives Perceived Change of Participant’s Behavior (2)

In the Last Three Months, How often (the Patient) engaged in the following behavior? Was it more, the same, less or quit?

% More % The same

Took Medication regularly 24.4 62.2

Injected prescribed Insulin 6.7 20.0

Checked and Cleans his/her

Feet Daily 57.8 15.6




In the Last Three Months, How often Patient engaged in the following behavior? Was it more, the same, less or quit?

% More % The same % QuitSmoke Cigarettes 2.2 4.4 22.2Obtained inf.bout

Diabetes 42.2 33.3Engaged in regular Alcohol drinking 0 80.0 20.0Used Home

Remedies 31.1 28.9Kept Appts/MD 44.4 48.9




3 Months Post-data

In the Last Three Months, How often patient… More The same

Checked his/her Blood sugar 60.0 17.8

Discussed Diabetes Concerns 64.4 17.8Is Involved in Grocery shopping 77.8 15.6 Reads Food Labels 77.8 8.9 Cooked with Less Oil 86.7 8.9 Used Less Salt 84.4 8.9 Eats more Vegetables and Fruits 88.9 6.7

Eats smaller Portions 82.2 8.9 Drinks Diet refreshments 71.1 15.6 Exercises 53.3 33.3



11. Improvement of Data

Issues

• Health data systems are poorly equipped to provide information on the health status of Hispanics groups (GAO Report, 1992)

• Insufficient Identifiers for subgroups

• Incompleteness

• Puerto Rico is excluded from data systems.

• Ethics (informed consent, community participation, etc)

• Ex: Improve section to data state holders



11. Increase amount and quality of Research on Latinos and other minorities

• The research on minority health traditionally has had limited or no utility in understanding or solving important health and social issues.

• Most research on Latinos and on other people of color has not been culture, gender, age or education-appropriate



Research (1)

• Most research on Latino health have been done by researchers who belong to either the middle class and/or have a middle class mentality

• Stress a cultural deficit model that reinforces, as a result of the findings, the victim blaming ideology



Research (2)

• The research process has included methods of observation, criteria for validating facts and theories that intentionally or unintentionally have been designed to justify pre-conceived ideas and stereotypes of people of color



Research (3)

It consequently, …has reinforced in our society the traditional patterns of power, status and privilege (Hixson, 1993)



Research (4)

Because research is done within a socio-political and historical context,

The research agenda is one of confronting issues of power, politics, sexism and racism



12. Examine the impact of recent social and health Policies

• Welfare Reform on health status and on access to health care

• Immigration Reform• Children’s Health Insurance Program

(CHIP)• Affirmative Action• Child Care Legislation• Medicaid and Medicare Managed-Care



13. To increase Latino representation in health 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



Health Professions (2)

• To increase Latino health professionals in proportion to their representation in the US we will need an additional 200,000 Latino workers



14.

Achieve Cultural Diversity & Competency in the health care

system



Additional thoughts about Cultural Competency



cultural competence

• The capacity to work effectively with people, using the elements of their culture such as values and beliefs in a constructive manner.

• Involves working with 3 aspects: cognitive (vocabulary, symbols, knowledge), affective (values, attitudes), and process (relationships, skills, learning styles)

• Policy/Organizational changes



Cultural Competence Skills

• Distinguish between cultural and environmental/contextual and social (class) issues

• Sensitivity to diversity within and across cultural groups (race vs. ethnicity)

• Use cultural values and beliefs in communication and behavioral change (affective appeals, collaboration)



Cultural Diagnosis

• Immigration motives & experience

• Acculturation is multidimensional

• Language skills• Literacy/education• Urban/rural/suburban• Religion/spirituality

• Family networks• Family leadership• Community

participation• Experience with health

providers and systems• Use of indigenous &

alternative healers



A Cultural Approach 1

• Maintain respect for cultural differences.• Obtain information on sociocultural factors in

a nonjudgmental way.• Reach a negotiated understanding of the

illness and mutual agreement regarding management

• Work with cultural systems as much as possible. Recommendation should be consistent with values and norms.




• Be sensitive to culturally-based interaction styles, rules, and preferences.

• Involve relevant family members in discussions on illness management.

• Use appropriate language and culturally relevant materials.

• Use an interdisciplinary team approach to diabetes care and education.



Cultural Learning

• Listen and observe! Take the time.

• Learn to ask questions (open-ended).

• Visit homes and workplaces. Participate in their lives.

• Spanish media: Watch\listen\know it.

• Immerse yourself. Visit their homelands.

• Have a mentor/consultant.



Cultural Diversity at the Organizational level

Steps

• Commitment from the top administrators (board of directors, President/CEO)

• Recruitment of Latinos in decision-making positions



Steps to achieve Competency in the health care system (cont)

• Establish a Community Advisory Committee to the Director/CEO

• Conduct a community assets and needs assessment



Develop & implement Comprehensive Institutional Policies Impacting areas such as

• Board of Directors• Personnel• Research and Data• Marketing• Community outreach, Education & Partnership• Cultural, gender and educational-appropriate

Diversity Training• Contract with Minority businesses



Steps: Policies (cont)

• Services delivery (example, examining appointment vs. walk-ins system, cost, accessibility of care, interpreter Services)

• Policy on investment in Latinos and other minority communities by providing – Jobs, training opportunities

– scholarships to youth

– Supporting community-based organizations

– providing uncompensated emergency care to those in needs



Conclusion

• To eliminate health disparities among Latinos will require a comprehensive and coordinated approach working with health and human services organizations, commitment from different levels of government, and the private sector

• Hispanic ethnicity may be a marker for access to health care, and for social/cultural factors that may explain differences in risk and prevalence of illnesses.

• There is a sense of urgency to intervene now in developing and implementing strategies that works



Multiculturalism

• The 1990s started with an increased interest in reducing health disparities and and addressing issues of Multiculturalism s in health care, These issues are about ones

of addressing issues of social justice!

june 15, 2000 minority health project, university of north carolina, chapel hill issues and...

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