Hispanic Health Leadership to Eliminate Health Disparities

1. Hispanic Health Leadership to Eliminate Health Disparities Elena Rios, MD, MSPH President & CEO National Hispanic Medical Association November 19, 2005

2. 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 2050, 1 out 4 Americans will be Hispanic • 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. • Source: The Commonwealth Fund, Nov. 2003

3. 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.

4. Quality of Care • 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).

5. Health Priorities • Medicare – drug benefit enrollment • Medicaid – maintain federal focus • Increase primary care/prevention programs • Cultural Competence – support CLAS standards and curriculum development • Language Services reimbursement • Health Professions – expand recruitment, new regional tracking system (HRSA workforce centers), mentoring, financial aid, faculty development

6. Health Priorities • Data Collection – Hispanic subgroups • Research – expand community-based research and research training on Hispanics • Chronic Diseases – increase prevention, treatment for Heart Dz, Cancer, Diabetes, HIV/AIDS, asthma, mental health, obesity • Border & Immigrant and Puerto Rico – expand capacity for services • US-Mexico Binational Insurance

7. 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, RWJF, Ca Endowment, Amgen, Aventis, GSK, PhRMA, EPA, NHTSA, HSHPS, natl groups; 170 participants

8. 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

9. 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, including parents and pregnant women, waivers, tax breaks for employers. • Adopt universal healthcare policy.

10. 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.

11. 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.

12. 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.

13. DHHS – Office of Minority Health • Cultural Competence – doctor and nurses training videos available • Disparities in Health Initiative • CLAS Standards • OMH Resource Center • CDC, HRSA & Regions & States • Language Access Initiative – link to Health Information Technology • Cancer PRG Recommendations – community focus and support for integration of programs

14. Health Disparities BillsFrist and Kennedy/Min.Caucuses What they have in common • Access to health care • Data Collection • Research • Cultural Competence • Language Services • Health Professions Diversity • Office of Minority Health & agency offices

15. Health Education and Equality ActHR 3561/S1580 • Introduced by the Tri-Caucuses, Congressman Honda, Christiansen, Solis • See NHMA website for Action Alert and letters to be sent to your Congressman • Bipartisan Senate Bill to be introduced by Senator Frist and Kennedy and Reid in the Spring, 2006

16. NHMA Recommendations • Center for Cultural and Linguistic Competence with new grants – OMH • Leadership Development grants for clinics, hospitals, health system diversity of Boards, CEOs • Health Professions grantees– link to data collection organizations now funded by HRSA • Faculty development with loan repayment and minority supplements

17. Cancer Legislation 2005 • Patient Navigator and Chronic Disease Act of 2005 (Congressman Menendez, Congresswoman Pryce and Sen. Hutchison) • HRSA Grant Program with NCI • National Cancer Act of 2003 to be reintroduced (Sen. Feinstein) • Association Health Plans opposition – One Voice Against Cancer (ACS) • NIH Reauthorization

18. U.S. Mexico Binational Health Insurance • NHMA requested to conduct a Briefing for the Senate Republican Task Force for High Costs and the Uninsured – done Feb. 2005 • Speakers included US DHHS, Mexico Ministry of Health, Dept of Labor, Texas Health Insurance Commissioner, Blue Cross, Health Net, California Endowment • Stakeholder List of Reactors • Result: Request for Demonstration Project

19. CDC Public Health Protection Research Agenda • Process started in January – I have served as CoChair, Core Team • Agenda in Federal Register this month for public comment • Basis for future CDC Research grants • Cross Cutting Research: Genomics, Disparities, Law, Ethics, Public Health System, Mental Health, Marketing and Communications

20. NHMA Obesity Campaign • NHMA Networks to provide information • Portal with diet, nutritionists, community resources • Private Physician Counseling research • School Clinics & doctors • Media • Sponsor: DHHS OMH, RWJF

21. 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

22. National Hispanic Health Professional Leadership Network and Portal (www.HispanicHealth.info) • NHMA Council of Medical Societies • NHMA Board & National Advisory Committee & Members • NHMA Physician Fellows Leadership Network • NHMA Resident Leadership Network • National Association of Hispanic Nurses (NAHN) • Hispanic Dental Association (HAD) • National Hispanic Mental Health Assoc • National Hispanic Health Executives • OMH Regional Offices & Contacts • Hispanic-Serving Health Professions Schools • Hablamos Juntos

23. 9 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

24. 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 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 Advisory Boards AMGEN Astra Zeneca Aventis Pfizer D. Satcher Task Force L. Sullivan Commission Senate Task Force U.S.-Mexico Binational Health Insurance Summit NHMA Accomplishments

25. 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 • 2nd GALA DINNER – Marriott Marquis, NYC, Dec. 1st

26. NHMA ---leading the way to a healthier America 10th Annual Hispanic Health Conference Washington, DC Mar. 23-26, 2006 WWW.NHMAMD.ORG