1. Community-Based Health Research to Eliminate Health Disparities 2004 Elena Rios, MD, MSPH President & CEO National Hispanic Medical Association

2. Insurance Coverage Hispanics have the highest rates of uninsured of racial/ethnic groups, for all or part of 2000: Hispanics have the highest rates of uninsured of racial/ethnic groups, for all or part of 2000: –50% Hispanics under age 65 –37% Hispanic children In 2002, comprised 14% of U.S. population, but 29% of the uninsured. In 2002, comprised 14% of U.S. population, but 29% of the uninsured. In the last decade the number of uninsured Hispanics increased from 7.4 to 12.8 million. In the last decade the number of uninsured Hispanics increased from 7.4 to 12.8 million. Less likely to have insurance, even when offered through employer. Less likely to have insurance, even when offered through employer. By 2050, 25% of Americans  50% uninsured. By 2050, 25% of Americans  50% uninsured. Source: The Commonwealth Fund, Nov. 2003 Source: The Commonwealth Fund, Nov. 2003

5. Research Needed to Address Uninsured Hispanics 75% of uninsured Hispanics are classified as low- income (200% poverty level). 75% of uninsured Hispanics are classified as low- income (200% poverty level). Foreign-Born Hispanics have the highest uninsured rate, declines with length of time/generations in U.S. Foreign-Born Hispanics have the highest uninsured rate, declines with length of time/generations in U.S. Legal immigrants have a 5 yr wait for public insurance Legal immigrants have a 5 yr wait for public insurance For non-elderly Hispanics, 61% of those who primarily speak Spanish are uninsured, compared to 36% of those who primarily speak English. For non-elderly Hispanics, 61% of those who primarily speak Spanish are uninsured, compared to 36% of those who primarily speak English. US-Mexico Binational Insurance products US-Mexico Binational Insurance products

6. IOM Unequal Treatment Report Despite insurance, minority patients suffer from unequal treatment – quality care. Despite insurance, minority patients suffer from unequal treatment – quality care. Recommendation: Promote research that is population-based and patient centered. Recommendation: Promote research that is population-based and patient centered. Health Disparity Legislation focus on major recommendations: increase minority health providers, cultural competence, language services, and research on Hispanic health, resources, use of care, generation, family, community. Health Disparity Legislation focus on major recommendations: increase minority health providers, cultural competence, language services, and research on Hispanic health, resources, use of care, generation, family, community.

7. Research Needed on Quality Care Spanish- speaking report greatest problems communicating with doctors and staff. Spanish- speaking report greatest problems communicating with doctors and staff. Access to interpreters limited, only 1% of those used are medically trained. Access to interpreters limited, only 1% of those used are medically trained. Lack of cultural competence training for physicians or in medical education. Lack of cultural competence training for physicians or in medical education. Less likely to report confidence in their doctor. Less likely to report confidence in their doctor. Difficulty in understanding prescription instructions. Difficulty in understanding prescription instructions. Low representation of Hispanics as physicians (only 5% of U.S. physicians). Low representation of Hispanics as physicians (only 5% of U.S. physicians).

9. NHMA and CHC 2002 National Hispanic Health Leadership Summit, San Antonio, TX Purpose: to build consensus recommendations to improve Hispanic health programs and policies at the Federal, State, private, and community levels for the next 5 years. Purpose: to build consensus recommendations to improve Hispanic health programs and policies at the Federal, State, private, and community levels for the next 5 years. Partners: Congress, DHHS, RWJF, Ca Endowment, Amgen, Aventis, GSK, PhRMA, EPA, NHTSA, HSHPS, natl groups; 170 participants Partners: Congress, DHHS, RWJF, Ca Endowment, Amgen, Aventis, GSK, PhRMA, EPA, NHTSA, HSHPS, natl groups; 170 participants

10. Health Access Ensure that outreach, education, and enrollment efforts are community-based and target LEP. Ensure that outreach, education, and enrollment efforts are community-based and target LEP. Develop automatic re-enrollment in highly uninsured populations. Develop automatic re-enrollment in highly uninsured populations. Develop uniform financial screening tools for public programs and migrant insurance program. Develop uniform financial screening tools for public programs and migrant insurance program. Establish a web-based clearinghouse to promote research on underutilization and disenrollment of underinsured populations. Establish a web-based clearinghouse to promote research on underutilization and disenrollment of underinsured populations. Expand Medicaid/SCHIP eligibility, including parents and pregnant women, waivers, tax breaks for employers. Expand Medicaid/SCHIP eligibility, including parents and pregnant women, waivers, tax breaks for employers. Adopt universal healthcare policy. Adopt universal healthcare policy.

11. Health Professions Training Encourage Hispanic students to pursue health careers Encourage Hispanic students to pursue health careers –Expand the HRSA Health Career Opportunity and Centers of Excellence programs, NIH career programs. –Establish partnerships with the Department of Education Short Term: New Counseling for students on MCAT list. Short Term: New Counseling for students on MCAT list. Short Term: Workforce Development Research, eg. examine impact of reciprocity between U.S. and other Hispanic countries. Short Term: Workforce Development Research, eg. examine impact of reciprocity between U.S. and other Hispanic countries. Long Term: Pipeline Development, Long Term: Pipeline Development, –School District should establish a Health Professions Academy for Latino Students –Mentoring programs with Hispanic health professionals

12. Building Hispanic Community- Based Research Increase Hispanic leadership and participation with DHHS, state/private organizations. Increase Hispanic leadership and participation with DHHS, state/private organizations. Build community-based research infrastructure (Empowerment Zone, Community Access Program, Reach, Exceed). Build community-based research infrastructure (Empowerment Zone, Community Access Program, Reach, Exceed). Develop and facilitate pipeline to produce more Hispanic researchers. Develop and facilitate pipeline to produce more Hispanic researchers. Develop culturally appropriate research methods – eg. the Hispanic epidemiological parodox. Develop culturally appropriate research methods – eg. the Hispanic epidemiological parodox. Make partnerships with community organizations mandatory for funding of research on Hispanic populations. Make partnerships with community organizations mandatory for funding of research on Hispanic populations.

13. National Hispanic Medical Association and Future Research Established in 1994 in D.C. to improve the health of Hispanics & underserved Established in 1994 in D.C. to improve the health of Hispanics & underserved Journal with Amer Acad Family Physicians Journal with Amer Acad Family Physicians 9th Annual Hispanic Health Conference, LA – 4/1-2/05 9th Annual Hispanic Health Conference, LA – 4/1-2/05 National Hispanic health research network National Hispanic health research network National Hispanic Health Foundation - affiliated with Wagner Grad School of Public Service, NYU National Hispanic Health Foundation - affiliated with Wagner Grad School of Public Service, NYU –Research Training on use of Hispanic health data –White Papers – “think tank” –Hispanic Health Professional Student Scholarship www.nhmamd.org www.nhmamd.org www.nhmamd.org