Federal Policies to Eliminate Health Disparities

1. Federal Policies to Eliminate Health Disparities Elena Rios, MD, MSPH President & CEO National Hispanic Medical Association March 1, 2005 CDC Chronic Disease Prevention Conference

2. NHDR & Policy • Lifespan approach & State profiles • Databases – link to new bill • 109th: NIH, CDC Futures, Disparities/AHRQ/OMH and Health Professions, Pt Navigator – need advocacy • Develop Interventions and tracking • Leadership development program • market prevention & target services with efficiency • Advocacy training for Health Disparities

3. Insurance Coverage • 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 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. • Puerto Rico public insurance lower coverage. • By 2050, Hispanics will be 25% of all Americans. • Source: The Commonwealth Fund, Nov. 2003

6. Profile of Uninsured Hispanics:Risk Factors • 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. • 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.

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

8. 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. • Partners: Congress, DHHS, CDC, AHRQ, HRSA, NIH, RWJF, Ca Endowment, Amgen, Aventis, GSK, PhRMA, EPA, NHTSA, natl groups; 170 participants

9. Summit Workgroups and Recommendations • Health Access • Cultural Competence and Language • Health Professions Development • Community-Based Research • Chronic Disease Prevention & Management • Public Health Emerging Issues – asthma, injury, immunizations, behavioral health • Women’s and Children’s Health • Bio-terrorism, US-Mexico Border Health, and Puerto Rico, environmental health

10. Health Access • Ensure that outreach, education, and enrollment efforts are community-based and target LEP. • Develop automatic re-enrollment in highly uninsured populations. • 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. • Expand Medicaid/SCHIP -eligibility, parents and pregnant women, waivers, tax breaks for employers. • Adopt universal healthcare policy.

11. Cultural Competence and Limited English Proficiency • Increase funding for the enforcement of Title VI of the Civil Rights Act. • Adopt CLAS standards devised by DHHS Office of Minority Health. • Mandate and reimburse CC & LEP services in Medicare, Medicaid, SCHIP, med ed, clinics, etc. • Make CC & LEP core value of physicians, delivery systems – for quality care, patient centeredness. • Develop measures for CC & LEP performance, outcomes, interpreter training, and link to surveys.

12. Health Professions Training • 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: National Database and Tracking. • Short Term: Workforce Development Research and reform of federal programs. • Long Term: Pipeline Development, eg. School District should establish a Health Professions Academy for Latino Students. • Sullivan Commission Report – Sept. 2004.

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

14. DHHS – Office of Minority Health • Cultural Competence and LEP - CLAS Standards • Disparities in Health Initiative • Resource Center, Agencies & Regions • Language Access Initiative - IT • Community-based Coalitions – Obesity • Coordination of DHHS efforts – Medicare outreach to providers, community • Links to agencies thru Offices of Minority Health

15. Health Disparities BillsFrist and Kennedy/Min.Caucuses • Access to health care • Data Collection • Research • Cultural Competence • Language Services • Health Professions Diversity • Office of Minority Health

16. Health DisparitiesKennedy/Min Caucuses • Indian Health • Environmental Justice/Chronic Disease • Empowerment Zones • New Scholarships for Health Students • CLAS Standards & Ctr for CLHCS • COE – public hospitals • Capacity – clinics • OMH – FDA, CMS

17. Cultural Competence Trends • IOM Quality Chasm – CC=Quality with Patient Centeredness • Standards adopted by LCME and RRCs • Evaluation and Tools being developed by NCQA, JACHO, AAMC, ACGME, LCME, NQF, and OMH • NHMA and OMH Forum – Sept. 9, 2004

18. NHMA The National Hispanic Medical Association and its Foundation (the National Hispanic Health Foundation) were established in 1994 in Washington D.C. to respond to the compelling need for a leading voice to educate the public and private sectors on strategies for improving health care to the U.S. Hispanic population. NHMA, a non-profit association, represents licensed Hispanic physicians in the United States and is the parent organization for the National Network of Latin American Medical Students.

19. NHMA Programs • Support for Physicians • Nominations for Boards and Committees • Resume Bank/Job Search/Membership • Media Breakfasts with the CHC, NHTSA • Leadership Development • NHMA Leadership Fellowship • Promote Access to Quality Care • Policy Development & Testimony • NHMA Press, Journal • NHMA Annual Conference • Hispanic Health Policy Forums • Hispanic Health Congressional Briefing Series

20. NHMA Strategic Assets National Hispanic Health Leadership Network • State and Local Medical Societies • NHMA National Advisory Committee • NHMA Physician Fellows Leadership Network • NHMA Resident Leadership Network • National Association of Hispanic Nurses (NAHN) • Hispanic Dental Association (HAD) • OMH Regional Offices & Contacts • Government Agencies • Foundations • Health Care Industry • NHHF Corporate Advisory Council • Hispanic-Serving Health Professions Schools

21. 8 Annual NHMA Conferences The NHMA Leadership Fellowship Program The NHMA Resident Leadership Program The NHMA Medical Student Mentorship Program Cultural Competence GME Curriculum Projects Uninsured & Quality Health Care Series Capital Hill Briefing Series Congressional Earmark Health Policy Consultant to the Congressional Hispanic Caucus Health Policy Consultant to the Congressional Black Caucus Health Policy Consultant to the Senate Majority Leader Frist NHMA Accomplishments

22. Developed the Hispanic-Serving Health Professions Schools, Inc. Foundation Partnerships California Endowment RWJ Foundation Commonwealth Fund Cooperative Agreements USDHHS US DOT, NHTSA Coalitions National Hispanic Health Coalition REDEC, Out of Many One Media Breakfasts CHC/DHHS Hispanic Health Leadership Summit The National Hispanic Leadership Agenda Board Membership Partnership for Prevention Women’s Policy Inc. (Women’s Congressional Caucus) AMA – MAC, Commission on Health Disparities Pharma Adhoc Advisory Boards D. Satcher Task Force L. Sullivan Commission AMA Disparities Commission Senate Task Force U.S.-Mexico Binational Health Insurance Summit NHMA Accomplishments

23. NHMA Advocacy Projects • Media Breakfasts with Congressmen and TV, Newspaper (English/Spanish) Management in major Cities • Campaign with Congress, State Govt, Health Leaders in LA, Atlanta, DC on Hispanic Uninsured • Congressional Hispanic Health Briefing Series • Sacramento and Albany Leadership Forums and Receptions • Leadership Fellowship DC Institute Week • Media Interviews, Press Conferences • National Partnerships and Campaigns – HHS, AMA, ACP, AAFP, ADA, ACS, Redes, Partnerships in Prevention Board, Pharma, etc. • Legislative Alerts - website

24. NHHF Programs • Education Programs • NHMA Leadership Fellowship • NHMA Resident Leadership Program • Hispanic Health Portal www.hispanichealth.info • Research and Research Training on Hispanic Health • Health Services Research Institutes • Diversity in the Health Professions • Hispanic Health Professional Student Scholarship • 1st GALA DINNER – Marriott Marquis, NYC, Dec. 2nd

25. NHMA ---leading the way to a healthier America For more information WWW.NHMAMD.ORG