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 Population21,325,018Hispanic

Population6,824,006

(32%)2nd Largest Hispanic

Population

New Mexico – “The Land of Enchantment”

Total Population 1,829,146

Hispanic Population770,070 (42%)

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

The Latino Explosion

The Latino Explosion

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

59%

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

Cultural differences Language Lack of health insurance Education Poor understanding of US health care system Poverty Transportation Immigration status Cultural insensitivity/racism

Percent of Population with Less Than Percent of Population with Less Than 9th Grade Completed by Hispanic Origin: 19999th Grade Completed by Hispanic Origin: 1999

Perc

ent

(Population 25 years and over)(Population 25 years and over)

28

33

17

20

24

5

0

5

10

15

20

25

30

35

Hispanic Mexican Puerto Rico Cuban Central andSouth American

Non-HispanicWhite

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

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

Perc

ent

(Population 25 years and over)(Population 25 years and over)

11

7

11

25

18

28

0

5

10

15

20

25

30

Hispanic Mexican Puerto Rican Cuban Central andSouth

American

Non-HispanicWhite

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

Percent of Hispanics with Income $50,000 or More Percent of Hispanics with Income $50,000 or More in 1998 by Type of Hispanic Origin in 1998 by Type of Hispanic Origin

(Population 15 years and over with income)(Population 15 years and over with income)

Perc

ent

5.2

7.0

10.6

7.3

0

2

4

6

8

10

12

Mexican Puerto Rican Cuban Central and SouthAmerican

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

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

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

0 20 40 60

HispanicFB-Not aCitizen

HispanicNative Born

% Uninsured

55%

25%

22%

10%

Hispanic FB - Naturalized

White Non- Hispanic

10%

Uninsured Hispanics Benefit US Economy But Do Not Reap Health Benefits

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

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

Lack of insurance poor access to health care

Limited English poor communication with health care providers disparity in quality of health care

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 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 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 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 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 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

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 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

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

The Problem

Skyrocketing Hispanic Population +

Barriers to Injury Prevention

Marked Increase in Injuries and Deaths

Emerging Public Health Crisis

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

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

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”

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

Growth, Opportunity, and Change

Growth, Opportunity, and Change

Abriendo Puertas

Abriendo Brazos

Abriendo Corazones