1. Impact of the ACA on Public Health Efforts to Address Latino Health Disparities: Paula A. Espinoza, Ph.D. Department of Ethnic Studies University of Colorado Denver

2. Q1: Can we anticipate and get ahead of ACA impact to maximize our efforts to address Latino health disparities? YES!

3. Anticipation to foresee a wish and perform in advance (Webster’s New World Dictionary)

4. Foresight Familiarize ourselves with the Patient Protection and Affordable Care Act (ACA) Read Title IV: Prevention of Chronic Disease & Improving Public Health, p. 1114 Section 4302-Understanding health disparities data collection and analyses Familiarize ourselves with 2011 National Prevention Strategy document and other guides identified in the ACA

5. Resources for EBI’s and Guidance identified in ACA Center’s for Disease Control www.cdc.gov/ www.cdc.gov/ U.S. Preventive Task Force Clinical and Community Preventive Services Guides www.uspreventiveservicestaskforce.org/ www.uspreventiveservicestaskforce.org/ Agency for Healthcare Research & Quality www.ahrq.gov/ www.ahrq.gov/ National Institutes of Health www.nih.govwww.nih.gov Institute of Medicine www.iom.edu/www.iom.edu/

6. Foresight Reacquaint ourselves with evidence-based and promising practices for health promotion and illness prevention, if needed Expectation of funding to better support the work we have been doing Key points identified in presentations today Increased access to healthcare Increased funding for health promotion and illness prevention programs Increased need for a diverse workforce

7. Foresight “ The history of the relationship between the U.S. government and racial/ethnic minorities plays an important role in understanding why health disparities exist and how they might be eliminated* ” Recognize that undocumented residents will remain marginalized under ACA * LaViest (2005). Minority Populations & Health, pg. 1

8. Perform now Let’s not get ahead by going back We don’t have to reinvent the wheel ACA presents an opportunity to reconvene and organize, refocus, prioritize, strategize, and implement known EBI and best practices

9. Q2: What does the ACA mean in relation to how we plan and practice public health to reduce Latino health disparities? For Healthcare Systems For Individuals and Communities

10. Planning Take advantage of current known data to identify level of participation in the ACA by Colorado Latinos Collect additional data as needed Strategic planning or revive previous strategic plans

11. Public Health Practice under ACA for Healthcare System Disparities: Equality ≠ Equity Increased access does not guarantee participation or outcomes Increased need for HCP and support staff cultural competency training Increased need for medical interpreter training Great need for increased Px health literacy Increased need for interventions improving Px- HCP communication and other interaction

12. Public Health Practice under ACA for Healthcare System Disparities: Equality ≠ Equity Example: Annual Wellness Visits and a Personalized Prevention Plan is included under ACA Opportunity to market to Latinos Latino patients may benefit from patient navigation services or education regarding this feature

13. Public Health Practice under ACA for Socio- environmental and Behavioral Disparities: Communities and Individuals ACA identifies priorities for interventions addressing Tobacco Cessation Increasing physical activity Better nutrition Top 5 killers (heart disease, cancer, respiratory disease, stroke, unintentional injury) NEW AREAS: Mental & Behavioral health, oral health

14. Public Health Practice under ACA for Socio- environmental and Behavioral Disparities: Effective interventions (evidence-based) Achievable goals, objectives, and timelines Community-based (partnerships, collaborations, and with continual feedback) Tied to current surveillance mechanisms (i.e. BRFSS)

15. Modest Suggestion for Moving Forward— Adapt the Public Health Preparedness Model for Terrorism Regional and local Responders Operations Command—CDPHE/OHD? Engaged partnership Tiered response at different levels United effort Readiness to act (continuing coalition building and capacity building/training)

16. Dedicated to Former Comadre Mary Helen Duran Presente!1938-2013RIP Educated 1000s Navigated 1200 Latinas to receive ScreeningMammograms She made a positive Difference for Our Gente