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 Childrens Hospital Medical Center

Texas Total Population 21,325,018 Hispanic Population 6,824,006 (32%) 2 nd Largest Hispanic Population

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 n Total Population 14,000 n Hispanic Population 9,100 (65%) n Water is > 99% pure n Famous for The Great American Duck Race The Winners King and Queen of the Duck Ball

The Latino Explosion

Population Growth in USA n Over 35 million Hispanics in USA today n Unprecedented growth –Increasing 7x faster than rest of US population –Almost 60% since 1990 n Have surpassed African-Americans as largest minority (13%) n 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 n By 2050, 1 of every 4 Americans will be of Hispanic/Latino heritage

59%

Population Growth in Greater Cincinnati/Northern Kentucky n 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) n Largest Hispanic populations in Cincinnati are in Springdale, Hamilton, Sharonville, Norwood, and Fairfield n Largest Hispanic populations in NKY are in Covington, Florence

The Barriers to Hispanic Health Care n Cultural differences n Language n Lack of health insurance n Education n Poor understanding of US health care system n Poverty n Transportation n Immigration status n Cultural insensitivity/racism

Percent of Population with Less Than 9th Grade Completed by Hispanic Origin: 1999 Percent (Population 25 years and over) Source: Current Population Survey, March 1999, PGP-2

Percent of Population with a Bachelors Degree or Higher by Hispanic Origin: 1999 Percent (Population 25 years and over) Source: Current Population Survey, March 1999, PGP-2

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

Migration Profiles n Mexicans: agricultural, restaurants and construction employment n Puerto Ricans: US Citizens at Birth n Cubans: 1 st migration well-educated, middle class or higher citizens n South Americans: Tend to bring higher labor skills n Central Americans: Limited work skills, Campesinos (farmers-domestic workers, child care providers, office cleaners, or other low-skill positions) n Information provided by Culturally Competent Communications

The Health Insurance Crisis n About 44 million Americans are uninsured (1 out of every 7) n # of uninsured increased by 2.4 million from n 12% of all children are uninsured n Hispanics are the least insured of all – nearly 40% of adults and 31% of children are uninsured

Disparity in Health Insurance Coverage 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 n Work for small, low wage businesses that do not offer insurance n Individual insurance is prohibitively expensive n Not poor enough to qualify for Medicaid, but too poor to buy private health insurance n Uninformed about existing assistance programs (ie. CHIP) n Cultural, educational, and language barriers limit interactions with physicians and ability to complete paperwork required for assistance n Concerned about being labeled a public charge n Immigrant, non-citizens

The Language Barrier n 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 n Lack of insurance poor access to health care n Limited English poor communication with health care providers disparity in quality of health care

Cultural Differences n Rely more on home remedies and over-the- counter meds n Rely on advice from family members n Seek professional advice only if problems persist n Less compliant with routine check-ups and preventive/screening measures n More apt to trust health care providers who speak their language or share similar cultural background

Breaking Down The Barriers n Master the language n Train bilingual staff (receptionists, nurses, technicians, physicians) n 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 n Provide signage and written instructions in Spanish n Aim for perfect communication/understanding

Breaking Down The Barriers n Develop child care programs in Latino communities so parents can take time to go to physician n Provide child care at health care facility n Provide information on importance of preventive care, especially for children n Develop local/regional/national telephone hotline in Spanish to respond to medical questions n Be familiar with community resources

Breaking Down The Barriers n Utilize focus groups to zero in on issues important to the Hispanic/Latino community n Establish bilingual liaisons with the Latino community to build relationships and earn trust n Establish health care facilities in Latino communities or send mobile units n Approach transportation authority to have buses routed to Latino communities n Print bus schedules in Spanish

Breaking Down The Barriers n Expand outreach for public assistance programs n Government incentives to encourage small businesses to offer coverage n Oppose federal health mandates that increase costs of providing health care n Change tax law to allow individuals to deduct entire cost of purchasing health insurance (Fair Care Act) n Lobby for health insurance for all

Motor Vehicle Safety - The Stats n Motor vehicle crashes are #1 cause of death in Hispanics 1-24 years n Hispanic children < 4 years have 2nd highest death rate from motor vehicle crashes (2nd only to African-American children) n Hispanic children 5-12 years have 72% higher death rate from motor vehicle crashes than Caucasians

Motor Vehicle Safety - The Stats n Per vehicle mile traveled, Hispanic children are 3x more likely to die n 3x less likely to use child safety restraints and 3x less likely to ride in the backseat n Much less likely to wear seatbelts n Despite fewer miles traveled, teenage Hispanics are twice as likely to die

Motor Vehicle Safety Hispanics vs Whites n seat belt use (22% vs 38%) n EtOH use (31% vs 24%) n EtOH levels n insurance (24% vs 50%) n 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 n Similar to African-Americans, Hispanics also have strong ties to family and the church n 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 n The model is in place, but must be culturally adapted for the Hispanic population and their specific injury prevention needs and concerns

Purpose n To partner with the faith community to identify and implement injury prevention strategies among Hispanics n To develop culturally-relevant materials to deliver the injury prevention message n To develop an injury prevention model for Hispanic communities around the country

The Plan n Develop an initiative to address injury prevention among high-risk Hispanic children in the Greater Cincinnati and Northern Kentucky area. n 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 n Conduct focus groups to identify unique areas of concern among Hispanics about injury and injury prevention n Develop culturally relevant injury prevention curriculum based on outcomes of focus groups n Implement curriculum into faith-based or school- based Hispanic community n Perpetuation of program by Hispanic leaders within the community

Growth, Opportunity, and Change

Abriendo Puertas Abriendo Brazos Abriendo Corazones