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Health Issues for Latino Immigrants. Net Population Change in North Carolina by Race and Hispanic or Latino Origin, 1990-2004* Census Data. * Source: US Census Bureau. Mecklenburg County, 1990 – 2004* Census Data. * Source: US Census Bureau.
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Health Issues for Latino Immigrants
Net Population Change in North Carolina by Race and Hispanic or Latino Origin, 1990-2004* Census Data * Source: US Census Bureau
Mecklenburg County, 1990 – 2004* Census Data * Source: US Census Bureau
Hispanic Breakdown by EthnicityMecklenburg County 2000 Census Data
“The Browning of America” • 20 years ago, demographers predicted that the US population would flatten • Demographic projection revised due to • Age of immigrants • Fertility indicators • Foreign born Hispanic = 112.3 live births per 1,000 women • US born non-Hispanic = 59.9 live births per 1,000 women
America’s Color Adjustment Source: James H. Johnson, Jr., UNC Chapel Hill, 2003
Insurance Status of Latinos in the United States • 37% of Latinos are uninsured in the U.S. • 54% of all Latino adults in North Carolina are uninsured, compared to 11% Non-Latino Whites, and 22% African Americans. • Latinos are more likely to work for employers who do not provide health care coverage, and Latinos are less likely to qualify for federally and state-funded insurance. Source: NC Latino Health, 2003
Unique Hispanic / Latino Patients 2005 • Mecklenburg County Health Department – 17,500 Latino patients • 16,620 Latino patients have a medical home • CMC Clinics – 15,000 Latino patients • CW Williams Community Health Center – 820 Latino patients • Physicians Reach Out – 350 Latino patients • Charlotte Community Health Clinic – 450 Latino patients
Patients by Race / EthnicityMecklenburg County Health Department 2005
Public Health DepartmentHispanics as a % of Total Patients * Source: Mecklenburg County Health Dept.
CMC Ambulatory Care Clinics Hispanic/Latino Primary Care Growth CMC North Park, CMC Myers Park, CMC Biddle Point & CMC Eastland * Source: Carolinas HealthCare System
CMC Ambulatory Care DivisionVolume of Spanish Speaking Patients 61,000 visits provided to Spanish speaking patients in the CMC Ambulatory Care Division in 2005 • 34,000 visits at CMC NorthPark • 11,000 visits at CMC Myers Park Pediatrics • 11,500 visits at CMC Myers Park OB Gyn • 2,000 visits at CMC Myers Park Orthopaedics & Surgery • 1,000 visits at CMC Myers Park Internal Medicine • 1,000 visits at CMC Biddle Point • 500 visits at CMC Eastland
CMC Ambulatory Care Clinics Hispanic/Latino Primary Care Growth * Source: Carolinas HealthCare System
Patients by Race / Ethnicity on CMC Sliding Scale vs Total Clinic Population - 2005 Sliding Scale Ambulatory Clinics 30% of patients seen in the CMC clinics are Hispanic. 11% of the patients on sliding scale are Hispanic. Many Hispanic/Latinos do not qualify for Governmental (Federal, State or County) programs.
Importance of Bilingual Staff • For non-bilingual staff, caring for a Spanish speaking patient takes 17.65% longer than caring for an English speaking patient. • Compensating a bilingual staff member is 9 times more cost effective than paying an internal interpreter and 30 times more cost effective than paying an outside agency interpreter. • 33% of the employees at CMC NorthPark and 25% of the employees at CMC Myers Park are bilingual.
CMC Clinics The CMC Clinics employ 11 interpreters at an annual cost of $440,000 Bilingual staff provided an additional 15,500 hours of interpretation at a cost of $23,000 above base pay Mecklenburg County HD MCHD employs 6 full-time interpreters at an annual cost of $300,000 Bilingual staff are paid an additional $25,000 above base pay for their bilingual skills Non-English Speaking Patients
CMC Initiatives to recruit Bilingual Staff • Bilingual Incentive Pay Program: per hour compensation incentive for time staff spend using their language skill • Bilingual Referral Bonus: referral bonus for CHS employees who refer a bilingual new hire to high need areas • Advertising Campaign: culturally appropriate advertisement to recruit bilingual staff placed in Charlotte Observer and La Noticia
CMC Initiatives to Meet the Needs of Spanish Speaking Patients • All interpreters & bilingual staff must pass competency test • Bilingual staff and interpreters on site in areas where > 5% or population speaks Spanish; on-call in other areas • Bilingual English / Spanish signage & telephone prompts • Patient information brochures and education materials widely available in Spanish • Prescription bottles printed in Spanish. CMC Outpatient Pharmacies filled 75,000 prescriptions in Spanish in 2005. • Spanish and bilingual books given to children at their well child checks (Reach Out and Read Program) • In 2003 and 2005, CMC participated in the Latino Health Coalition’s immersion experience to Mexico • Physician continuing education on Cultural Competency for care of Latinos • AHEC classes on “Spanish for the Healthcare Provider”
Some Latino Health Issues • Mexican Paradox: Generally healthy, but worsen as acculturate • In US, highest prevalence of childhood dental caries (43%)(Healthy people 2010) • In US, higher rates of diabetes than average (66/1000) (1999 NC OMHHD/SCHS) • In NC, highest prevalence of childhood obesity (17%) (2003 NC OMHHD/SCHS) • In NC, increasing rates of STDs • Chlamydia (+478% from 1991-1995) (1999 NC OMHHD/SCHS)
1st Trimester Prenatal Care & Outcomes • Hispanics are twice as likely as African Americans to receive no 1st trimester prenatal care. • Hispanics rates of prematurity and low birth weight, however, are significantly lower. • Early prenatal care does not have a strong, independent correlation with birth outcomes or infant mortality. *Mecklenburg County Residents, 2004
Hispanic Birth Indicators Selected Characteristic Hispanic % Total % < 12 yrs education 57.7 16.2 (lower education level) 1st trimester care 80.1 89.4 (less early prenatal care) No Care 1.9 1.1 (more w/ no care) Adequate Care 77.0 86.0 (more with inadequate care) Outcomes Hispanic % Total % Low birth weight 5.8 9.3 (fewer low birth weight) < 37 weeks gestation 6.8 11.5 (fewer premature babies)
Barriers to Health Care • Understanding of important Latino Cultural Beliefs • Use of Folk Medicine • Inability to pay for medical care • Lack of interpreter services • Lack of knowledge of available resources