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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 Children’s Hospital Medical Center. Texas. Total Population 21,325,018

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recognizing and overcoming the barriers to health care in the hispanic latino community

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 Children’s Hospital Medical Center

texas
Texas

Total Population

21,325,018

Hispanic Population

6,824,006

(32%)

2nd Largest Hispanic Population

new mexico the land of enchantment
New Mexico – “The Land of Enchantment”

Total Population 1,829,146

Hispanic Population

770,070

(42%)

deming nm home of pure water and fast ducks
Deming, NM – “Home of Pure Water and Fast Ducks”
  • Total Population 14,000
  • Hispanic Population 9,100 (65%)
  • Water is > 99% pure
  • Famous for “The Great American Duck Race”

The Winners

King and Queen of the Duck Ball

population growth in usa
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 < 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
population growth in greater cincinnati northern kentucky
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
the barriers to hispanic health care
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
slide17

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

slide18

Percent of Population with a Bachelor’s Degree or Higher by Hispanic Origin: 1999

(Population 25 years and over)

Percent

Source: Current Population Survey, March 1999, PGP-2

slide19

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

slide20

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
the health insurance crisis
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
disparity in health insurance coverage
Disparity in Health Insurance Coverage

White Non- Hispanic

10%

10%

22%

Hispanic FB - Naturalized

25%

55%

barriers to health insurance
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
the language barrier
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
the double burden
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
cultural differences
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
breaking down the barriers
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
breaking down the barriers30
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
breaking down the barriers31
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
breaking down the barriers32
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
motor vehicle safety the stats
Motor Vehicle Safety - The Stats
  • Motor vehicle crashes are #1 cause of death in Hispanics 1-24 years
  • Hispanic children < 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
slide34

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
motor vehicle safety hispanics vs whites
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
slide36

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
slide37

The Problem

Skyrocketing Hispanic Population + Barriers to Injury Prevention 

Marked Increase in Injuries and Deaths 

Emerging Public Health Crisis

slide38

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
slide39

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
slide40

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”
slide41

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
slide44

Abriendo Puertas

Abriendo Brazos

Abriendo Corazones