Community-Based Health Community-Based Health Research toResearch to

Eliminate Health Disparities Eliminate Health Disparities 20042004

Elena Rios, MD, MSPHElena Rios, MD, MSPHPresident & CEOPresident & CEO

National Hispanic Medical AssociationNational Hispanic Medical Association

Insurance Coverage Insurance Coverage

Hispanics have the highest rates of uninsured of Hispanics have the highest rates of uninsured of racial/ethnic groups, for all or part of 2000: racial/ethnic groups, for all or part of 2000: – 50% Hispanics under age 65 50% Hispanics under age 65 – 37% Hispanic children37% Hispanic children

In 2002, comprised 14% of U.S. population, but 29% of In 2002, comprised 14% of U.S. population, but 29% of the uninsured.the uninsured.

In the last decade the number of uninsured Hispanics In the last decade the number of uninsured Hispanics increased from 7.4 to 12.8 million.increased from 7.4 to 12.8 million.

Less likely to have insurance, even when offered through Less likely to have insurance, even when offered through employeremployer..

By 2050, 25% of Americans By 2050, 25% of Americans 50% uninsured. 50% uninsured.

Source: The Commonwealth Fund, Nov. 2003Source: The Commonwealth Fund, Nov. 2003

Research Needed to Address Research Needed to Address Uninsured HispanicsUninsured Hispanics

75% of uninsured Hispanics are classified as low-75% of uninsured Hispanics are classified as low-income (200% poverty level).income (200% poverty level).

Foreign-Born Hispanics have the highest Foreign-Born Hispanics have the highest uninsured rate, declines with length of uninsured rate, declines with length of time/generations in U.S.time/generations in U.S.

Legal immigrants have a 5 yr wait for public Legal immigrants have a 5 yr wait for public insuranceinsurance

For non-elderly Hispanics, 61% of those who For non-elderly Hispanics, 61% of those who primarily speak Spanish are uninsured, compared primarily speak Spanish are uninsured, compared to 36% of those who primarily speak English.to 36% of those who primarily speak English.

US-Mexico Binational Insurance productsUS-Mexico Binational Insurance products

IOM Unequal Treatment ReportIOM Unequal Treatment Report

Despite insurance, minority patients suffer from Despite insurance, minority patients suffer from unequal treatment – quality care.unequal treatment – quality care.

Recommendation: Promote research that is Recommendation: Promote research that is population-based and patient centered.population-based and patient centered.

Health Disparity Legislation focus on major Health Disparity Legislation focus on major recommendations: increase minority health recommendations: increase minority health providers, cultural competence, language services, providers, cultural competence, language services, and research on Hispanic health, resources, use of and research on Hispanic health, resources, use of care, generation, family, community.care, generation, family, community.

Research Needed on Quality CareResearch Needed on Quality Care

Spanish- speaking report greatest problems Spanish- speaking report greatest problems communicating with doctors and staff.communicating with doctors and staff.

Access to interpreters limited, only 1% of those Access to interpreters limited, only 1% of those used are medically trained.used are medically trained.

Lack of cultural competence training for physicians Lack of cultural competence training for physicians or in medical education.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 Low representation of Hispanics as physicians (only

5% of U.S. physicians).5% of U.S. physicians).

NHMA and CHC 2002 NHMA and CHC 2002 National Hispanic Health Leadership National Hispanic Health Leadership

Summit, San Antonio, TXSummit, San Antonio, TX Purpose: to build consensus Purpose: to build consensus

recommendations to improve Hispanic recommendations to improve Hispanic health programs and policies at the Federal, health programs and policies at the Federal, State, private, and community levels for the State, private, and community levels for the next 5 years.next 5 years.

Partners: Congress, DHHS, RWJF, Ca Partners: Congress, DHHS, RWJF, Ca Endowment, Amgen, Aventis, GSK, Endowment, Amgen, Aventis, GSK, PhRMA, EPA, NHTSA, HSHPS, natl PhRMA, EPA, NHTSA, HSHPS, natl groups; 170 participantsgroups; 170 participants

Health AccessHealth Access

Ensure that outreach, education, and enrollment efforts are Ensure that outreach, education, and enrollment efforts are community-based and target LEP.community-based and target LEP.

Develop automatic re-enrollment in highly uninsured Develop automatic re-enrollment in highly uninsured populations.populations.

Develop uniform financial screening tools for public Develop uniform financial screening tools for public programs and migrant insurance program.programs and migrant insurance program.

Establish a web-based clearinghouse to promote research Establish a web-based clearinghouse to promote research on underutilization and disenrollment of underinsured on underutilization and disenrollment of underinsured populations.populations.

Expand Medicaid/SCHIP eligibility, including parents and Expand Medicaid/SCHIP eligibility, including parents and pregnant women, waivers, tax breaks for employers.pregnant women, waivers, tax breaks for employers.

Adopt universal healthcare policy.Adopt universal healthcare policy.

Health Professions TrainingHealth 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 Expand the HRSA Health Career Opportunity and Centers of Excellence programs, NIH career programs. Excellence programs, NIH career programs.

– Establish partnerships with the Department of EducationEstablish 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. Short Term: Workforce Development Research, eg.

examine impact of reciprocity between U.S. and other examine impact of reciprocity between U.S. and other Hispanic countries.Hispanic countries.

Long Term: Pipeline Development, Long Term: Pipeline Development, – School District should establish a Health Professions Academy for School District should establish a Health Professions Academy for

Latino StudentsLatino Students– Mentoring programs with Hispanic health professionalsMentoring programs with Hispanic health professionals

Building Hispanic Community- Building Hispanic Community- Based ResearchBased Research

Increase Hispanic leadership and participation with DHHS, Increase Hispanic leadership and participation with DHHS, state/private organizations.state/private organizations.

Build community-based research infrastructure Build community-based research infrastructure (Empowerment Zone, Community Access Program, (Empowerment Zone, Community Access Program, Reach, Exceed).Reach, Exceed).

Develop and facilitate pipeline to produce more Hispanic Develop and facilitate pipeline to produce more Hispanic researchers.researchers.

Develop culturally appropriate research methods – eg. the Develop culturally appropriate research methods – eg. the Hispanic epidemiological parodox.Hispanic epidemiological parodox.

Make partnerships with community organizations Make partnerships with community organizations mandatory for funding of research on Hispanic mandatory for funding of research on Hispanic populations.populations.

National Hispanic Medical National Hispanic Medical Association and Future ResearchAssociation and Future Research

Established in 1994 in D.C. to improve the health of Established in 1994 in D.C. to improve the health of Hispanics & underservedHispanics & underserved

Journal with Amer Acad Family PhysiciansJournal with Amer Acad Family Physicians 9th Annual Hispanic Health Conference, LA – 4/1-2/059th Annual Hispanic Health Conference, LA – 4/1-2/05 National Hispanic health research networkNational Hispanic health research network National Hispanic Health Foundation - affiliated with National Hispanic Health Foundation - affiliated with

Wagner Grad School of Public Service, NYU Wagner Grad School of Public Service, NYU – Research Training on use of Hispanic health dataResearch Training on use of Hispanic health data– White Papers – “think tank”White Papers – “think tank”– Hispanic Health Professional Student ScholarshipHispanic Health Professional Student Scholarship

www.nhmamd.orgwww.nhmamd.org