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 Children’s 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 > 99% pure • Famous for “The Great American Duck Race” The Winners King and Queen of the Duck Ball

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 < 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

10. 59%

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 Bachelor’s 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

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 < 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