$$ OOOO OO OO O M Workshop Recommendations

Chapter 4: National Workshop

Recommendations

During the National Workshop, the participants
met in seven Work Groups to address the five key
areas of concern for Hispanic/Latino health—-two
groups each for access to health care and for
representation in the health professions and one
group each for data collection, research, and health
promotion and disease prevention. The Work
Groups were charged with (1) identifying priority
problems/issues for each area and (2) developing
aims and implementation strategies for addressing
each problem/ issue. This chapter lists the strategies
developed by the Work Groups.

Access to Health Care

 

Lack of universal health coverage.

Desired Aim

To establish a universal health plan that provides
comprehensive coverage to every resident of the
United States. Such a plan should include the
following provisions:

s Be affordable.

= Offer a basic package of services (to include
prevention) across the United States.

s Give choice of providers.

# Allow for a regular source of care and
facilitate continuity of care.

= Integrate systems of care; combine public
health, community health, and private
providers.

= Strive for innovative health care financing that

spreads the burden across all sectors of

society. To achieve this equity, tax mecha-
nisms—such as income tax (for persons
earning more than 250% of poverty level),
asset tax, value-added tax, and other mecha-

nisms—should be considered..

= Ensure coverage eligibility regardless of U.S

residency and employment status.

a Offer easy enrollment and service procedures
that facilitate participation.

= Provide measures of cost containment, quality
assurance, improved efficiency, and account-
ability to service recipients.

a Allow service recipients to participate in the
governance of plans.

= Offer rewards for providing services to
underserved and unserved populations.

s Provide incentives for coverage of preventive
services.

s Enforce uniform procedures for reimburse-
ment while recognizing regional differences.

w Provide outreach activities to increase
awareness and use of available programs.

= Be culturally competent.

= Address other needs unique to the Hispanic/
Latino population (i.e., language, transporta-

tion, child care, other support services).

Implementation Strategies

Establish health advocacy coalitions involving
public and private providers in each State with

significant Hispanic/Latino populations.

* Establish a methodology for accurately estimating

the cost of universal coverage.

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Workshop Recommendations © 060606660046 e¢¢ 4

 

Inadequate coverage by Medicaid for Hispanics/

Latinos.

Desired Aim

To provide full coverage by Medicaid for compre-

hensive services for Hispanics/ Latinos.

Implementation Strategies

¢ Reduce (or eliminate) categorical and other
eligibility restrictions for Medicaid coverage,
eliminate asset tests, enforce presumptive eligibility

for pregnant women and children.

¢ Require Medicaid and Medicare reform to
address the unique needs of the Hispanic/Latino
population; programs should support primary care
and shift from an emergency hospital care approach
to a comprehensive community-based care approach

(that includes preventive services).

 

Government and institutional policies are unrespon-

sive to the health needs of Hispanics/ Latinos.

Desired Aims
« To establish an integrated and coordinated
service-delivery system that links public
health, private providers, and community /
migrant health centers; foster collaboration.

a To establish policies that provide for linguisti-
cally and culturally competent programs.

= To support health professions education for
Hispanics/ Latinos in order to increase the
number of culturally competent health care

providers.

# To accurately define the health needs of
Hispanic/Latino communities and provide
resource allocations necessary to meet those

needs.

Implementation Strategies
Convene all stakeholders to explore ways to
collaborate and interface. (Federal, State, local—

public and private)

* Recognize that categorically funded programs do not
always meet the needs of the intended populations;
review criteria for categorically funded programs that
support health centers; influence the decision-making
process for placement of health centers and their

modes of operations so that they better serve the
unique needs of the Hispanic/Latino community.
(Federal, State, local—public and private)

Ensure that more Hispanics/ Latinos are in key
policy decision-making positions. (Federal, State,

local—public and private)

¢ Define the “minority” label. Programs and
policies should include all minority groups, includ-
ing Hispanics/Latinos. (Federal, State, local—
public and private)

* Develop standards for cultural competency.

 

Lack of health care facilities in Hispanic/Latino

communities.
Desired Aim

To develop an infrastructure in Hispanic/Latino
communities that ensures accessibility to health care

providers.

Implementation Strategies
° Enhance the health care infrastructure and
provide funds for construction of health facilities in

Hispanic/Latino communities (legislation).

# Reformulate the criteria for appointing physicians
and other health providers to medically under-

served areas.

* Offer economic incentives to practitioners for

locating practices in Hispanic/Latino communities.
oe OOO O © O M Workshop Recommendations

* Create community-based health training centers
that provide training and job opportunities in the

health professions (legislation).

     

eels) inate] Gamer

Exclusion of important subsegments of the
Hispanic/ Latino population from health programs.

Desired Aim

To establish a health care system that meets the
needs of all Hispanics/ Latinos, including undocu-
mented residents, migrant and seasonal workers,
rural residents and other subsegments of the
Hispanic/Latino population.

Implementation Strategies

Include intervention activities in the public health
arena to meet the needs of special subsegments of
the Hispanic/Latino population (i.e., migrant and
seasonal farmworkers, children, homeless people,
people in rural areas, immigrants, and undocu-

mented residents).

* Require that health-care institutions, programs,
and initiatives ensure health-care delivery that meets
the needs of special populations (i.e., migrant and
seasonal farmworkers, children, homeless people,
people in rural areas, immigrants, and undocu-

mented residents).

 
    
 
 
 

 

kaa) ease ara to tane te en

Lack of health objectives for the Hispanic/Latino

population.

Desired Aim

To include a Hispanic/Latino agenda in Healthy
People 2000; to develop detailed health objectives
that are specific to the Hispanic/Latino population.

Implementation Strategies

* Review the Healthy People 2000 plan to identify

gaps and develop objectives and implementation

strategies to address the health needs of the
Hispanic/Latino community. (Federal)

Problem/iooue #7:

 

A public health system and an infrastructure that are
inadequate and unresponsive to Hispanic/Latino
health needs.

Desired Aim

To create a strong Federal, State, and local public
health system that has the ability to monitor and
influence the planning and policy development of

health initiatives and interventions.

Implementation Strategies
* Allocate 6 percent of health expenditures to fund
public health programs and infrastructure.

* Make the public health system accountable for
meeting the health needs of the Hispanic/Latino
population; establish health goals (indicators) for all

public health interventions.

* Promote Hispanic/Latino participation at all
levels of public health decisionmaking.

Problem/looue

 

Omission of health care as an integral part of
economic and regional development planning.
Desired Aim

To include Hispanic/Latino health issues in regional
development strategies.

Implementation Strategies

Include Hispanic/Latino health issues in all social

and economic development programs.

age) a taaaraterel Caer

 

Lack of Hispanic/Latino participation in the
development and review of publicly funded
proposals to ensure that programs meet the health

needs of the Hispanic/Latino population.

Access to
Health

Care

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Workshop Recommendations $+ 066666 HOO OO

Desired Aim
To achieve equitable representation of Hispanics/
Latinos in the development and review of Requests

for Proposals throughout PHS.
Implementation Strategy

* Use legislative mechanisms and the regulation
process to increase Hispanic/Latino representation

in the proposal process.

Problem /soue “10:

 

Lack of proven models for alternative primary care
financing responsive to Hispanic/Latino community

needs,

Desired Aim

To explore innovative primary care financing and

delivery systems.

Implementation Strategies

* Fund pilot projects that explore alternative
primary health care financing and delivery systems
(analogous to Health Care Financing
Administration’s SHMO demonstrations).

* Include Hispanic/Latino-specific initiatives in the
Request for Proposal process to foster models of
primary /managed care that meet the health needs
of the Hispanic/Latino population.

 

Problem lesue #11:

Lack of well-planned, coordinated lobbying efforts

on Hispanic/Latino health issues.

Desired Aim

To create a strategically planned and coordinated
lobbying structure that advocates the advancement
of a Hispanic/Latino health agenda.

Implementation Strategies

¢ Enlist the interest and support of health organizations
around the country to participate in a unified effort.

* Create a national coalition that lobbies on behalf of
Hispanic/Latino health issues (e.g., National Hispanic/
Latino Coalition for a Healthy USA).

mn) An aVAlsiol bout Pe

 

Lack of Hispanic/Latino access to DHHS policy

decision makers.

Desired Aim
To develop rapport and fluid channels of communi-

cation with DHHS policy decision makers.

Implementation Strategies

* Meet regularly with the Secretary (or a representa-
tive) regarding Hispanic/Latino health issues.

® Establish an Advisory Committee to the Secretary of
Health and Human Services to advise the Department
on policies affecting Hispanic/Latino populations.

* Provide advocacy for Hispanic/Latino participa-
tion in the decision-making process. The number of

Latinos in decision-making positions should be .
proportional to the size of the population they

represent <

* Foster policies that encourage Hispanic/Latino
representation on boards, commissions, and

advisory committees.

Problem/Issue #13:

 

Underrepresentation of Hispanics/ Latinos in the
Office of Minority Health and other top-level
positions of DHHS.

Desired Aim

To achieve an equitable representation of Hispanic/
Latino representation in top-level positions of
DHHS.

Implementation Strategy

* Increase representation of Hispanics/ Latinos in
the Office of Minority Health and all departments of
DHHS, to include top-level representation. To the
extent possible, Hispanic/Latino issues should be
addressed by Hispanic/Latino representatives.

     

age) ed (et ATAte eet

Lack of participation by Hispanics/ Latinos in

leadership appointments in DHHS.

Desired Aim

To involve Hispanics/ Latinos in the leadership
scarch process within in DHHS.

Implementation Strategy

* Involve Hispanics /Latinos in the expert talent
search process and selection for leadership positions
in DHHS.

Data Collection

There are 22.4 million Hispanics/Latinos living in the
50 States and the District of Columbia and 3.5 million
persons who reside in Puerto Rico—a total of

25.9 million people. More than two-thirds of all
Hispanic/Latino Americans were born in the United
States, yet it was not until 1989 that the model birth and
death certificates included a Hispanic/Latino identifier.

Too often, organizational priorities and funding
decisions are established without taking into account
Hispanic/Latino data. Adequate planning is not
available without the appropriate availability, utilization,
and interpretation of Hispanic/Latino data. Therefore,
resources from government (Federal, State, and local)
foundations, nonprofit and for-profit corporations, and
education institutions are not allocated consistently with
the needs of the Hispanic/Latino community. As we
approach the year 2000 and beyond, the need for
Hispanic/Latino data will only increase. Given the
imperative to effectively target resources to maximize
benefit and efficiency, the six areas described below are
the minimal set of issues that must be addressed to serve

the health needs of the Nation.

aa)

Problen/locue 1:

 

Inclusion: the need for inclusion of Hispanics/
Latinos in data systems.
Desired Aim

To include data on Hispanics/ Latinos in all data

systems .

So O&O OO O O @ Workshop Recommendations

Implementation Strategies

* Include Hispanic/Latino and Hispanic/Latino

subgroup identifiers in all surveys and forms.

* Determine sample sizes for Hispanics/Latinos

that are adequate for analysis.

© Enforce OMB Directive 15 and Public Law
94-311. Educate agencies about the use of OMB
directives for inclusion of Hispanics/ Latinos (and
Hispanic/Latino subgroups) in data systems and in
federally funded intramural and extramural research

progr: ‘ams.

¢ Develop and maintain an advisory board to the
Office of the Surgeon General to oversee Federal,
State, and local Hispanic/Latino data issues.

     

Problem/lesue #2:

Local and regional data: lack of data on specific
Hispanic/Latino health issues at the local and

regional levels.

Desired Aim
To reduce gaps in Hispanic health data and improve
the overall availability of data at the local and

regional levels.

Implementation Strategies

* Develop guidelines and standard procedures within
all agencies and provide technical assistance on data
collection for Hispanic/Latino population groups at the
local, State, and regional levels.

* Focus on Hispanic/ Latino-specific issues. For
example, data that just enumerate the number of
gunshot wounds is not useful unless information is

also available on the community support programs.

* Use a series of local pilot studies that identify

patterns and trends to justify future activities.

Establish Healthy People 2000 and baseline data for

those objectives at the State and local levels.

Data

Collection

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Workshop Recommendations $¢0¢ 0 > ¢ ¢$¢¢ 0600 9

 

Quality: lack of quality, accurate, timely, and

culturally sensitive data system design, data collec-

tion, and analysis.

Desired Aim

To develop a foundation of high-quality, valid, and
timely information on Hispanic/Latino data,

equivalent to that of other ethnic/racial groups.

Implementation Strategies

* Include Hispanics/Latinos in the design, implemen-
tation, analysis, and dissemination of health assessment
and health monitoring data systems and in funding
decisions affecting these systems.

* Assess data collection and research designs to
include considerations of the heterogeneity of the
Hispanic/Latino population. Oversampling has

been identified as a feasible method for highly
concentrated Hispanic/Latino subgroups; other
methods need to be developed to sample geographi-
cally dispersed Hispanic/Latino subgroups.

* Test and validate data collection and research
instruments for cultural competence and linguistic

appropriateness.

® Foster collaboration between the Census Bureau
and the National Center for Health Statistics
(NCHS) to identify existing and emerging research
issues; address problems such as procedures for
assigning race, use of surname as a proxy,
adequateness of “Other Race” and “Other Hispanic”
categories, etc. Involve Hispanic/Latino research-

ers in seeking resolution to these issues.

* Study the problems associated with changes in

ethnic self-identification.

* Establish guidelines for the coding and keying of
data on birthplace, work history, generation status,
socioeconomic status, language use, family relation-
ship, etc., all of which may be powerful indicators

of the health status of Hispanics/ Latinos.

* Develop data release plans that meet priorities

and the needs of users for timeliness.

a,

mel AMT Ache lel emicae

 

Analysis: the need to identify (inventory) and
analyze existing data. Available data can be instru-
mental in understanding Hispanic/Latino health

concerns.

Desired Aim

To increase the analyses of Hispanic/Latino health
data at the Federal and State levels and by academia
and to increase the number of Hispanic/Latino

researchers involved in this process.

Implementation Strategies

* Include Hispanics/Latinos and researchers with
specific knowledge of the health status, living
conditions, and culture of Hispanic/Latino popula-
tions in the development of health theses and

conceptual frameworks.

* Identify existing data sets and determine their

accessibility to researchers.

*Develop a network of Federal/State, university,
and community-based analysts with a primary focus

in health data analysis.

* Provide funding for technical assistance to
researchers who are involved in Hispanic/Latino

health issues.

* Increase the technological capacity of researchers
to conduct more advanced analysis (i.e., Geographic

Information Systems).

* Encourage collaborative, interdisciplinary
research that bridges quantitative and qualitative

methods.

* Identify a person in each agency/organization to
serve as the principal point of contact for Hispanic/

Latino data analysis.
696 OOOO OO OO MM Workshop Recommendations

 

Dissemination: lack of availability or inaccessibility

of existing data, which are in critical demand.

Desired Aim

To maximize the availability of Hispanic/Latino data
to Hispanic/Latino and non-Hispanic/Latino policy
decisionmakers, funding sources, practitioners,

community-based organizations, and researchers.

Implementation Strategies

* Encourage public agencies to provide information
on existing data (i.e., perform more data analysis)
so that data can be used by broader audiences,
including Hispanic/Latino community-based
organizations. Dissemination efforts should include
informational packets, audio-visual materials,

videos, etc.

* Train community-based organizations in access

and use of data.

* Provide training and technical assistance on data
analysis so communities can draw their own

conclusions.

* Fund regional clearinghouses on Hispanic/Latino
health in areas of high Hispanic/Latino concentration.

# Make data available to Hispanic/Latino constitu-
encies as well as non-Hispanic health groups that
may play a role in the health status of the Hispanic/

Latino community.

 

Coordination: lack of coordination between

Federal and State agencies on Hispanic/ Latino
health data collection and analysis.
Desired Aim

To enhance and expand the development of

Hispanic/Latino data by public agencies.

Implementation Strategies Research

Agenda

* Use existing data systems (e.g., Census Bureau
and NCHS data) to establish cooperative agree-
ments with States to develop standard State and
local health status profiles for Hispanic/Latino

communities.

¢ Establish an inventory of existing Federal, State,
and local data resources; identify gaps and areas for

improvement.

* Provide government support for a network of
community-based health data collection efforts to
serve as an “early warning” system for setting health
policy priorities.

* Maintain an advisory board with the Office of the

Surgeon General to oversee the implementation of

recommendations.

* Establish a Federal interagency task force on
Hispanic/Latino health-related data with input from
appropriate nongovernmental Hispanic/Latino

advisors.

Research Agenda

 

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Lack of appropriate infrastructure and capacity to One

conduct research.

Desired Aim A

To increase the number of behavioral and biomedi-

Voice

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cal Hispanic/Latino scientists.

Implementation Strategies

* Develop specific support programs in PHS for pre-
and post-doctoral training of Hispanics/ Latinos in
behavioral and biomedical research to eliminate their

underrepresentation in health-related research.

Vision

* Develop programs directed at Hispanic/Latino
researchers to allow them to become better
equipped and to improve methodological expertise

in health-related research.
Research

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Workshop Recommendations &6¢¢06¢ 60666 HH HHO

* Target and intensify efforts to recruit Hispanics/
Latinos into PHS’s existing research and training

programs .

* Develop and fund distinguished research career
programs within PHS to allow Hispanic/Latino
researchers to concentrate on research, writing, and
mentoring and to free them from the multiple
requirements and responsibilities commonly faced
by minority academicians.

¢ Conduct grantsmanship workshops such as those
developed by the Hispanic Cancer Control Program
at the National Cancer Institute (NCI), where
Hispanic/Latino researchers have the opportunity
to improve proposal-writing skills and have their
pre-proposals reviewed by agency program review
staff. These programs must be made available at the
National Institutes of Health (NIH), the Centers for
Disease Control and Prevention (CDC), and other

Federal agencies concerned with health issues.

* Expand and evaluate specific initiatives within the
Department of Education and the National Science
Foundation to ensure that Hispanic/Latino middle
and high school students take courses essential for

pursuing science careers.

Assess the results of programs such as the
Minority Behavioral Research Supplement, Minority
Access to Research Careers, Health Careers
Opportunity Programs, and the Minority High
School Apprenticeship Program with respect to
Hispanic/Latino students.

* Encourage professional associations to stimulate
the involvement of Hispanic/Latino students in

research careers.

* Develop special initiatives to fund research
proposals submitted by new and established

Hispanic/Latino investigators.

Increase and enhance the capacity for institution-
alized Hispanic/Latino health research through the
establishment of Hispanic/Latino health research

centers and through support of individual Hispanic/

Latino investigators.

* Orient PHS program staff to Hispanic/Latino
health and related methodological issues.

Desired Aim B

To improve cultural competence and sensitivity of
Hispanic/Latino and non-Hispanic/ Latino scientists.

Implementation Strategies

* Develop requirements by regional and professional
accreditation agencies that Hispanic/Latino health
research issues be incorporated into curricula.

* Develop and institute courses,,seminars, and
conferences by educational, institutional, profes-
sional associations, and PHS on methods for
conducting research on Hispanic/Latino

populations,

* Orient members of IRGs on the procedures
required for culturally competent research that
targets Hispanics/ Latinos and on the evaluation of
proposals with respect to appropriate sampling,
instrumentation, methodology, and cultural

sensitivity in the development of research protocols.

* Provide appropriate training and guidelines to
reviewers of proposals so that IRGs will be compe-
tent in the evaluation of Hispanic/Latino research,
This initiative is consistent with and enhances the
recent NIH guidelines for including women and

minorities in study populations.

Desired Aim C

To improve communication and interaction among
Hispanic/Latino scientists.

Implementation Strategies

* Centralize and expand the existing PHS databank

on Hispanic/Latino researchers and on
non-Hispanics/ Latinos conducting research on
Hispanic/Latino populations.

* Encourage professional associations to facilitate

networking among Hispanic/Latino researchers.
>¢

&¢e¢e¢¢0% &@ @ @ @ Workshop Recommendations

caeledteiaavateicit omer

Dearth of research relevant to the health of

Hispanics/ Latinos.

Desired Aim A

To develop a health research agenda that is relevant

to and focused on Hispanics/ Latinos.

Implementation Strategies

¢ Commission a number of research efforts within
the Office of Minority Health that critically analyze
the literature on Hispanic/Latino health in each of
the areas identified by previous reports as deserving
attention (e.g., child and adolescent health,
women’s health, diabetes, HIV, cancer, substance
abuse, depression, violence, accidents, and uninten-
tional injury). These reports will present a review
of the current knowledge base on each of the areas
covered by Healthy People 2000, clarify objectives,

and identify research needs.

* Appoint a high-level committee within the Office of
Minority Health with appropriate Hispanic/Latino
health expert involvement to review the outcome of
the activities of the first year of the Hispanic/Latino
Health Initiative and the information obtained from the
state-of-the-art reviews cited above. This pancl must
be charged with developing an outline of priorities for

research with Hispanics/ Latinos.

* Develop special funding programs or initiatives at
the Federal level to fund research on the role of
factors such as acculturation, national origin or
background, socioeconomic status, and migrational

history on the health status of Hispanics/ Latinos.

* Require large-scale, cross-sectional, and longitu-
dinal research with Hispanics/Latinos funded by
Federal and State initiatives to include the effects of
acculturation, national origin or background,
socioeconomic status, and migrational history on
the health status of Hispanics / Latinos as possible

moderators of the findings.

    

* Develop special program initiatives at the Federal
level to analyze the health status of Hispanics/
Latinos working in high-risk environments such as
migrant agriculture, assembly plants (including
border maquiladoras), service professions, and other

industrial environments.

* Conduct health services research to identify the
characteristics of health care delivery, including the
characteristics of personnel and structure of services
that facilitate access, utilization, and effectiveness of
health services among Hispanics/ Latinos. At least 25
percent of the funds allocated for evaluation at the
Substance Abuse and Mental Health Services Adminis-
tration (SAMASA) and Health Resources and Services
Administration (HRSA) should be targeted for services
research to investigate questions pertaining to Hispan-
ics/ Latinos. The Office of Health Planning and
Evaluation should also direct funds for research on
health services utilization by Hispanics/Latinos.

@ Create an Office of Hispanic/Latino Health
within the Office of Minority Health, Office of the
Assistant Secretary for Health, to coordinate
Hispanic/Latino health-related initiatives and to
oversce their implementation within the Federal
Government. The Office must be properly funded
and must include an advisory board on Hispanic/
Latino health research to review its activities on a
quarterly basis. In addition, the Office of Minority
Health should issue a biannual report to Congress
detailing progress on the Hispanic/Latino health
agenda and the progress within PHS in meeting the
mandates in the Disadvantaged Minority Health Act

as they relate to Hispanics/ Latinos.

¢ Fund research within PHS that is specifically
targeted at providing baseline data to enable
formulation of Hispanic/ Latino-specific objectives

for Healthy People 2000.

* Develop mechanisms to obtain and incorporate
community input into the formulation of a research

agenda.

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Workshop Recommendations 97H HHH HOO OOO

 

Lack of culturally appropriate research theories
and methods.

Desired Aim A

To increase the number and improve the availability

and validity of research instruments and measure-
ment tools used in investigations on Hispanic/
Latino health.

Implementation Strategies

* Develop Federal programs to fund research that
tests the usefulness of current instruments and to
develop new, culturally appropriate instruments
that meet applicable standards of validity and
reliability.

* Fund a repository of Hispanic/Latino
health-related instruments within PHS. This
repository must be managed by Hispanic/Latino
organizations or researchers who can properly serve
as the caretakers of these files and report on the

issues dealing with Hispanics/ Latinos.

Desired Aim B

To study the applicability of existing constructs and
theories to Hispanic/Latino populations.
Implementation Strategy

* Fund research within PHS to develop new
behavioral models and theories and to test the

validity of existing ones.

fear Tee A
me Olesli teen taloreti

 

Underrepresentation of Hispanics/Latinos in PHS.

Desired Aim A

To ensure proportional representation of Hispanic/
Latino researchers on scientific advisory boards,
national advisory councils, and IRGs and technical

evaluation groups.

Implementation Strategies

* Survey national agencies concerned with
Hispanic/Latino health issues, as well as researchers,
universities, or research institutes, on a yearly basis
to identify qualified individuals who may be willing
to serve in this capacity. Results of those surveys
should be published in a yearly updated directory
and made available to Federal and State agencies

funding health-related research.

* Include Hispanic/Latino representation on IRGs
within technical evaluation groups, national

advisory councils, and scientific advisory boards.

Desired Aim B

To ensure proportional representation of
Hispanics/ Latinos on the staff of PHS.

Implementation Strategies

* Expand short-term service initiatives that allow
Hispanic/Latino researchers and academicians to

serve within PHS without severing ties with their

home institutions,

* Implement special efforts to recruit, retain, and
promote Hispanics/ Latinos at all levels of PHS

scientific and administrative staff.

Health Professions

Problem/Iooue #1:

 

Insufficient numbers and inadequate preparation of
Hispanic/Latino students by the educational system
(kindergarten to undergraduate) for pursuit of

health professions education.

Desired Aim

To increase the number of Hispanics/ Latinos in the
education pathway toward health professions
education so that, by the year 2000, the number of
Hispanics/ Latinos admitted to health professional
schools reflects the size of the Hispanic/Latino

population by State.
(ooo @ Workshop Recommendations

Implementation Strategies

¢ Increase parental involvement in their

children’s education through family counseling,
dissemination of information, and enhancement of
established programs sponsored by the school,
community-based organizations, the private sector,

and the media.

¢ Assist low-income families in planning their

children’s education.

¢ Ensure that Hispanic/Latino children gain
English-language competency at an early age; early

childhood programs can play an important role.

* Stimulate private-sector investment in inner city
schools, colleges, and universities with high

Hispanic/Latino student bodies.

* Stimulate private sector and government investment
in scholarships and awards to Hispanic/Latino students
in inner city schools, colleges, and universities with
large Hispanic/Latino student bodies.

¢ Expand the scope and funding of Health Careers
Opportunity Programs.

* Encourage Hispanic/Latino health professional
organizations to develop and participate in

mentoring programs at all levels.

 

Poor infrastructure and lack of funding to promote

greater participation of Hispanic/ Latino students in
the health professions.

Desired Aim A

To increase the number of Hispanic/Latino

full-time equivalent faculty and students in universities
and health professions schools to reflect the percentage
of Hispanics / Latinos in the population of the area.

Implementation Strategy

Provide additional Federal funds, student loans, and
assistance to schools that have significant full-time

equivalent Hispanic/Latino faculty and students.

Desired Aim B

To improve the coordination of organizations and to

Health
Professions
build a better infrastructure that will augment the
pool of Hispanic/Latino students eligible to pursue
the health professions.

Implementation Strategies
@ Expand health professional clinical training at

community-based sites.

¢ Bridge health professions training of two- and
four-year colleges, including training of administra-
tive managers because they make day-to-day

decisions on service delivery to populations.

Develop formal linkages between Federal, State, and
private organizations serving Hispanics/ Latinos.

 

Obstacles to entry, retention, and graduation from

professional health education programs faced by
Hispanic/Latino students.

Desired Aim A

To increase the number of Hispanics/ Latinos
entering health professions schools by a minimum of
10 annually for the next 10 years; the ultimate
minimum goal is a doubling of the number of

students currently enrolled. One

Implementation Strategies

Voice

o

4

Establish a consistent definition of Hispanics/Latinos
in the criteria for admission to the health professions.

Set standards at the Federal and State levels for
increased Hispanic/Latino student enrollments;

these standards must be tied to funding. One

Incorporate qualitative measures in school
to. oo. Vision
admissions criteria.

Increase Hispanic/ Latino participation in the

admissions process.

@ Train admissions personnel in cultural diversity and
the health needs of the Hispanic/Latino community.
Health

Professions

One

Voice

One

Vision

Workshop Recommendations OOOO OOO OO @ 4

* Credit students for diverse personal and educa-

tional experiences.

Desired Aim B
To increase the number of Hispanic/Latino students
who graduate from professional health programs.

Implementation Strategies

* Develop, expand, and fund retention programs
that would enable Hispanic/Latino students to
graduate from professional education programs
(i.e., health career opportunity programs, peer
support groups, financial assistance programs,
National Service Corps activities, and other

educational initiatives targeting retention).

* Foster mentorship activities at health professions

schools.

* Assess standardized testing procedures; address
any biases that may affect the performance of
Hispanic/Latino candidates.

Desired Aim C

To make health professions education financially

accessible for Hispanics/ Latinos.

Implementation Strategies
* Expand scholarships, low interest loans, and loan

repayment programs available to Hispanics/ Latinos.

* Increase the proportion of grant monies (versus
loans) in financial aid programs targeted at
Hispanics/ Latinos pursuing health professions

education.

* Expand financial assistance programs to incorpo-
rate the support of hospitals, communities, and

other private or public organizations.

* Ensure thorough dissemination of financial
assistance information to Hispanic/Latino students;
ensure that the format and delivery of this informa-

tion are appropriate to the target audience.

Desired Aim D

To expand the funding and scope of Hispanic/
Latino Centers of Excellence to include all health

professions.

Implementation Strategies
* Influence the legislative process.
* Ensure equitable distribution of funds to

Hispanic/Latino Centers of Excellence relative to

the total funding allocated to such initiatives.

* Evaluate the performance (outcomes) of

Hispanic/Latino Centers of Excellence.

Froblem/losue #4:

 

Need for greater coordination between the private,
local, State, and Federal sectors to improve the

support to Hispanic/Latino health professionals.

Desired Aim
To ensure provision of technical assistance and
financial resources to Hispanic/Latino health

professionals.

Implementation Strategies

* Enhance programs and improve coordination of
initiatives within DHHS.

* Review Department annual fiscal reporting
mechanisms; delineate funding for activities
targeting Hispanic/Latino health professionals;
specify DHHS funding going to Hispanic/Latino
researchers; increase the number of Hispanic/

Latino researchers.

* Increase postgraduate training opportunities in
the health professions through private- and

public-sector funding.

* Increase the participation of Hispanic/Latino
health professionals in program and policy evalua-

tion committees, task forces, and oversight entities.
&$¢0e OOOO OO OO M Workshop Recommendations

 

Need for an increased number of Hispanic/Latino

health professionals in faculty, advanced career
positions, and decision-making bodies.

Desired Aim A

To increase the number of Hispanic/Latino health

professionals in management, policy, and research
positions in DHHS/PHS and other Federal and State

agencies .

Implementation Strategies
* Develop a substantive plan to develop and
promote Hispanics/ Latinos in management, policy,

and research positions.

* Hold government institutions and programs
accountable for promoting Hispanic/Latino health

professionals’ development.

* Enact legislation that requires all directors to be
evaluated on an annual basis on the following

criteria, among others:

a. Recruitment and retention of Hispanic/
Latino staff.

b. Representation of Hispanics/ Latinos on

review committees.

c. Grants awarded and programs established
with a Hispanic/Latino health focus.

d. Grants awarded to Hispanic/Latino principal
investigators.
e. Grants awarded to universities with

significant Hispanic/Latino graduation rates.

* Implement a reporting and review system of the

implementation and outcomes of the above plan.

Desired Aim B

To increase the number of Hispanic/Latino faculty

in health professions schools.

Health

Professions

Implementation Strategies

* Develop effective methods for addressing
deficiencies in hiring and promotion policies
affecting Hispanic/Latino faculty in health profes-

sions schools.

* Develop legislation that would add funding to the
Disadvantaged Minority Health Improvement Act
for Hispanic/Latino faculty positions in health

professions schools.

* Reconsider the balance between research,
training, and community and clinical service needs;

implement promotion mechanisms accordingly.

* Earmark funding of New Investigator Awards to

Hispanic/Latino researchers.

* Track the number of grants/contracts by
Hispanic/Latino researchers that have been submitted,
approved, and funded by DHHS.

* Provide technical assistance to support Hispanic/

Latino researchers as needed.”

Desired Aim C

To encourage mentoring of junior Hispanic/Latino
faculty.

Implementation Strategy

* Provide opportunities to establish mentoring Oo
ne

relationships with senior faculty.

Voice

>

Implementation Strategy One

Desired Aim D

To increase Hispanic/Latino representation on
local, State, and Federal grant review groups,

panels, task forces, and advisory committees.

* Develop and maintain a centralized information
bank of talented Hispanic/Latino health professionals.

Vision
Health
Promotion
and Disease

Prevention

One

Voice

One

Vision

Workshop Recommendations © OOOO OOOO @:

 

Lack of culturally relevant (Hispanic/Latino) input

in the licensing /certification process and the

accreditation of health professions schools.

Desired Aim A

To encourage accrediting bodies to use cultural

diversity standards relevant to Hispanics/ Latinos.

Implementation Strategies
* Communicate the need for use of cultural
diversity standards in the accreditation criteria of

health professional education programs.

* Provide awareness training on cultural diversity
issues to students and faculty at colleges/
universities and other educational programs.

Desired Aim B

To increase the number of Hispanics/ Latinos
participating in the development of licensing and

certification tests and procedures.

Implementation Strategies
* Promote Hispanic/Latino health professionals
within accrediting agencies to ensure Hispanic/

Latino representation.

* Work with the individual health professions
examination boards to determine the appropriate-

ness of tests, and to address cultural biases.

Desired Aim C
To enhance the entry of foreign-trained Hispanic/
Latino health professionals into the health service

delivery system.

Implementation Strategy

# Develop innovative programs and funding mecha-
nisms to assist /(re)train foreign-trained Hispanic /
Latino health professionals so that they can practice
in the United States.

LOT

Problem/sloaue 7:

 

Lack of data on practice characteristics of Hispanic/
Latino health professionals for planning purposes.
Desired Aim

To obtain data on practice characteristics of all
Hispanic/Latino health professionals.
Implementation Strategy

* Request that health professionals organizations
gather and analyze data on the practice characteris-

tics of Hispanic/Latino professionals.

Health Promotion and
Disease Prevention

Underlying all of the issues listed below are policy,
communication, cultural behaviors, resource develop-

ment, and community intervention factors.

imaelelcisavAlcet eae

 

Insufficient data and research on Hispanic/Latino
health issues: _
a Lack of research on health promotion and
disease prevention (HPDP) efforts that target
subgroups of the Hispanic/Latino population.

# Lack of data on awareness, attitudes, behav-
iors, and use of screening services by
Hispanic/Latino subgroups

# Lack of baseline data on morbidity and
mortality; lack of Hispanic/Latino-specific
HPDP year 2000 health objectives.

Desired Aims

« To gather and maintain adequate data on

Hispanic/Latino health issues.

« To initiate, enhance, and/or expand research
programs for the various Hispanic/Latino
subgroups. This research should be initiated,
used, and disseminated at the community level.
66 OOOOH HO OM M Workshop Recommendations

« To facilitate the development of appropriate
Hispanic/ Latino-specific year 2000 objectives.

Implementation Strategies

® Establish and maintain a comprehensive and
uniform database on HPDP efforts (comparable to
non-Hispanic/ Latino databases) that accommodates
different Hispanic/Latino subpopulations. (Federal,

State, local)

* Establish a body that will monitor the implementa-
tion of Hispanic/Latino HPDP initiatives and advocate
on behalf of community-based organizations and
funding for HPDP programs. (Federal, State, local)

* Monitor public agencies responsible for data

collection and hold them accountable.

Include Hispanics/Latinos on review panels,
study sections, PHS advisory councils and working

groups. (Federal, State, local)

¢ Establish culturally appropriate methods and

standards for data collection.

® Foster initiatives that will target and fund
Hispanic/Latino-specific HPDP activities (new
funding and reallocation of existing funds).
(Federal, State, local)

* Establish, implement, and monitor Hispanic/
Latino-specific objectives in all Healthy People 2000
prevention priority areas with a specific focus on those

affecting Hispanic/Latino youth. (Federal, State)

¢ Establish culturally sensitive and appropriate
methods for Hispanic/Latino data collection

methods and processes. (Federal, State, local)

¢ Establish, expand, and share data networks that
assist all research activities and community-based

organizations. (Federal, State, local)

lata] elicaga¥Aickcas emer

 

Lack of Hispanic/Latino health professionals in
HPDP decisionmaking and leadership positions and

in the field.

 

Health

Promotion

Desired Aim

To increase the recruitment, training, and retention
of Hispanic/Latino health and other related

professionals in the administration and management

and Disease

Prevention

of HPDP programs in the private and public sectors.

Implementation Strategies

Establish a comprehensive Hispanic/
Latino-specific HPDP mentorship program for
research, teaching, and community interventions.
(Federal, State, local)

* Secure scholarships for training Hispanic/Latino
leaders in HPDP. (Federal, State, local) -. -

* Increase funding for Centers of Excellence for
Hispanic/Latino health professions with emphasis in
HPDP and increase the number of Centers.
(Federal)

* Enforce existing Federal and State mandates to
ensure Hispanic/Latino opportunities in higher
education (faculty and boards), decision-making
positions (boards), and the workplace (manage-
ment). (Federal, State, local)

* Encourage PHS to develop incentives for primary
care providers serving hardship and underserved

areas. (Federal)

One

Voice

o

a

Weak organizational development of prevention

providers and lack of organizational development,
education, and training programs:

= Lack of HPDP curriculum in schools.

s Lack of multidisciplinary approaches to HPDP

. Oo
curriculum development. ne

= Lack of formal HPDP training for Hispanic/ Vision
Latino leaders.

s Institutionalized and individual racism as a
barrier to service delivery and professional

development.
Health
Promotion
and Disease

Prevention

One

Voice

One

Vision

Workshop Recommendations 997 OOOOH HOO OO

Desired Aims

= To develop a Hispanic/Latino-specific
cross-cultural and multidisciplinary curricu-
lum to address the HPDP needs of the
Hispanic/Latino population.

= To expand the pool of qualified Hispanic/
Latino HPDP providers; to conduct aggres-
sive recruitment and retention programs of

Hispanic/Latino HPDP professionals.

= To enhance the capabilities of non-Hispanic/
Latino HPDP professionals to better serve
Hispanic/Latino communities.

= To increase the capacity of Hispanic/Latino
community-based organizations to provide

prevention/ service programs.

Implementation Strategies

° Develop partnerships among training institutions,
community-based organizations, and national
Hispanic/Latino agencies to better provide HPDP

services.

* Mandate all public organizations and institutions
receiving Federal, State, and local HPDP funding to
(1) develop a cross-cultural, multidisciplinary

HPDP curriculum and (2) recruit, train, and retain
Hispanic/Latino HPDP professionals to practice in

underserved communities.

* Provide incentives (tuition, loan forgiveness
programs, financial benefits) to providers for serving
Hispanic/Latino and underserved communities.

* Develop training and other sensitivity initiatives
to address issues of cultural diversity and racism.
* Develop attractive HPDP continuing education

programs for health professionals in the delivery of

preventive health services to Hispanics/ Latinos.

ea Glo ciseratcl 1b merase

 

Lack of culturally sensitive and population-specific

primary prevention programs.

Desired Aims
= To develop and evaluate Hispanic/Latino-
specific models and approaches (e.g., clinics
on wheels, bilingual outreach programs) to

prevention programs.

s To develop grass-roots community-based
programs,

a To develop a short- and long-term prevention
strategy for communities at risk of environ-
mental hazards, communicable and chronic

diseases, etc.

Implementation Strategies

* Build on nontraditional methods of access to care
(i.e., nurse practitioners, dental hygienists, etc.).
(Federal, State, local)

* Establish linkages among community-based
organizations, universities, the private sector, and

lay people in the community. (Federal, State, local)

* Leverage public health initiatives with support of
community-based organizations and community

coalitions. (State, local)

* Emphasize the importance of awareness, educa-
tion, early identification, and intervention through

HPDP programs via community coalitions.

* Ensure that organizations serving Hispanics /
Latinos have at least 12 months of experience in
working with the Hispanic/Latino community, and
that at least 50 percent of their board is Hispanic/
Latino with Hispanics/Latinos in key administrative
and program staff positions. (Federal, State, local)

 

Lack of comprehensive and systematic approaches

to clinical and preventive services; lack of appropri-
ate screening and diagnostic procedures for

Hispanics/ Latinos.
-o$ oO OOOO OO O OM M Workshop Recommendations

Desired Aim
To develop, implement, and, where appropriate,
reinstitute culturally relevant and comprehensive

preventive services.

Implementation Strategies

Increase the use of community settings for the
delivery of primary care/preventive services (i.e.,
churches, community centers, schools, community

clinics). (Federal, State, local)

* Train staff in cross-cultural issues (i.e., involve-
ment of family members, use of culturally relevant
screening, and diagnostic procedures, etc.) in the

delivery of services. (Federal, State, local)

* Recruit and use community leaders and
“Promotores de Salud” effectively to conduct

outreach and deliver services. (State, local)

* Require that evaluation be built into service
delivery programs to ensure adequacy of services.
(Federal, State, local)

av

2 Loss al 7 ror
Problem/osir: fe:

 

Lack of public-private partnerships in support of
HPDP goals for Hispanics/ Latinos.

Desired Aim

To increase collaboration between private and public

organizations in the development of HPDP initiatives.

Implementation Strategies
* Create a solid Hispanic/Latino HPDP information
network and clearinghouse via a public-private

partnership. (Federal, State)

* Develop regulations that require private and
nonprofit institutions (including universities)
serving Hispanics/ Latinos to include adequate
Hispanic/Latino representation at decision-making

and program levels. (Federal, State, local)

* Encourage the creation of a national Hispanic/Latino
philanthropic federation that includes representation of

grass-roots organizations. (Fedcral)

* Establish guidelines for Hispanic/Latino
community-based organizations and national
organizations for accepting corporate contributions;
corporations’ products and services must be

compatible with HPDP goals.

* Obtain corporate sponsorship and funding of
HPDP programs for Hispanics/Latinos from

industries that do not promote disease.

 

Problem/lesue 77:

Lack of cooperation among nations in addressing

health issues.

Desired Aim

To develop, expand, and maintain cooperative
efforts in environmental and HPDP areas among
countries in the Americas (the United States,
Mexico, Central/South America, Caribbean).

Implementation Strategies

* Foster close collaboration between Latin Ameri-
can countries and the United States regarding HPDP
issues. (Federal, State, local)

* Make health and prevention (including environ-
mental issues) critical elements in the regulations
and implementation of the free-trade agreement.
(Federal, State)

aed i {i orn
I roblem/iooue rey

 

Lack of a constituency for Hispanic/Latino political
advocacy.
Desired Aim

To build a political constituency for HPDP.

Implementation Strategies
* Build rapport and working relationships with
Hispanic/Latino, other appointed/elected officials,

and national organizations. (Federal, State, local)

° Develop a Hispanic/ Latino constituency to
counter disease-promoting industries. (Federal,

State, local)

Health
Promotion
and Disease

Prevention

One

Voice

One

Vision
Health
Promotion
and Disease

Prevention

One

Voice

One

Vision

Workshop Recommendations ©9006 OOOO OOO O@

* Develop a consensus within the Hispanic/Latino
community for acceptable universal standards of

primary care.

 

Lack of diffusion of culturally appropriate HPDP

models:

a Lack of consistency in defining

community-based HPDP interventions.

= Lack of community resources for the replica-
tion of successful Hispanic/Latino HPDP

models.

Desired Aims
= To identify, showcase, and disseminate
successful Hispanic/Latino HPDP models.

= To develop strategies to fund successful
HPDP models.

Implementation Strategies

* Establish mechanisms and procedures by which all
prevention RFPs have Hispanic/Latino community
input. (Federal, State)

* Appoint Hispanics/ Latinos to the proposal review

process for research, training, and services.

 

Lack of media involvement and sensitivity to
Hispanic/Latino health and HPDP issues.

Desired Aim

To increase media’s awareness of Hispanic/Latino

health issues and the media’s role in disseminating
information on HPDP.

Implementation Strategies

¢ Develop an agenda/ workshops/ training for
media representatives to participate in HPDP
programs. (Federal, State, local)

* Develop community-based training programs in

media advocacy.

¢ Use paid media to complement other HPDP efforts.
ooo Oo © 0 OOO = Work Group Presentations

Chapter 5: Presentation of National
Workshop Recommendations

A representative from each Work Group at the
National Workshop was chosen to present the
recommendations developed by the Work Group.
This chapter contains the presentation of the
recommendations, which are listed in Chapter 5.

Access to Health Care
Castulo de la Rocha, J.D.

President and Chief Executive Officer
AltaMed Health Services Corporation

 

Access to health care is probably the most important
issue facing Latino communities today, and I am
certain it will be the most important issue facing this
community for the remainder of this decade.

Nearly one-third of all Latinos are uninsured or
underinsured. We're the poorest, the youngest,

and the least educated of major ethnic groups. We
depend less on the welfare system, and we have a
strong work ethic and strong family values. Our
population is increasing rapidly. We have high
visibility. But at the same time, the needs of our
community also continue to expand very rapidly.
The current focus of public debate regarding health
care reform has focused on issues such as cost
containment, the impact of business, governance,
financing, and the role of the private sector in health
care reform.

What has been missing in this debate are the
financial, structural, and institutional barriers and
obstacles that we have to face as Latinos. What we
are attempting to do is to outline these barriers.

We will focus on the lack of health care financing;

Government policies that have been unresponsive to

needs; the structure of the health care system,
which inhibits opportunities and the appropriate use
of health services; and institutions and their inability
to care for our population.

The specific recommendations are the following:
First, health care reform must eliminate disincentives
that work to cause the linkages of lack of public health
coverage and unemployment, specifically focusing on
the Medicaid system. Second, require Medicaid and
Medicare reform to specifically address the needs of the
Latino community by supporting primary health care
services and shifting from the emergency hospital care
to comprehensive community-based care, including
preventive services. Third, develop demonstration
models within HCFA [Health Care Financing Adminis-
tration] that look toward alternative health care
systems that are responsive to Latino community
needs. This includes managed care systems. Fourth,
even if we had adequate health care financing, there is
no assurance that our population, based on historical

practices, would be able to access those institutions.

 

Access to

Health

Care

One

Voice
Access to
Health
Care

One

Voice

o

One

Vision

Work Group Presentations

Thus, we strongly recommend the improvement of the
infrastructure and access to working capital for the
construction of health care facilities in Latino
communities and the development of economic
incentives to provide and to place medical practices
within Latino populations.

We should also reformulate the administrative
rules for designating physicians and other health
manpower in shortage areas and medically
underserved areas. The present indicators and
determinants for medically underserved areas are,
in fact, discriminatory and prejudicial to the Latino
population. I strongly urge that we move aggres-
sively in the direction of redefining those indicators.

We strongly support the funding of public
health programs and infrastructure by the provision
of at least 6 percent of health expenditures that
must be accountable to the needs of the Latino
community. What has happened over the years is
that the attention has been moved away from public
health services. We view this as an integral part of
having an effective system of health care in the
delivery of services to Latino populations.

We should require Latino participation in
proportion to the total population in the
decisionmaking process and in positions that affect
policies in DHHS [Department of Health and
Human Services], specifically in boards, commis-
sions, and advisory committees, and in the RFP
[request for proposal] process, development, and
review. It is equally important that Latinos be
involved in the search and selection of leadership
within DHHS. An advisory committee to the
Secretary of Health and Human Services should be
established to advise the Department on policies
affecting Latino populations. It’s critically impor-
tant that we have some way of monitoring and
holding people accountable for the recommenda-
tions that we have developed.

Finally, we strongly recommend the forma-
tion and the development of a national effort aimed

at lobbying for legislative issues that are important

i a

to the Latino community. This is particularly
important in light of the recommendations that we
will receive today. We also recommend the
development of a national Latino coalition for a
healthy U.S.A.

 

Aida L. Giachello, Ph.D.

Assistant Professor
Jane Addams College of Social Work
University of Ilinois—Chicago
The main problems/issues identified by our group
have to do with the fact that we feel that there is no
universal health coverage that would facilitate entry
into the health care system. And there were all
kinds of discussion in terms of what the ideal system
is. Portability and affordability are essential. The
people, regardless of where they are in the United
States, should be able to have entry into the system.
There should be a basic package of services where
prevention would be emphasized. The consumer
should have a choice of providers and comprehen-
sive coverage allowing for continuing of care. It
should be an integrated system of care where you
would have a public sector, community health
services, and the private provider that, in most
instances, will usually be included in any kind of
meaningful discussion. The system should provide
progressive health care financing that spreads the
burden across all sectors of society based on level of
personal wealth. Eligibility would not be based on
residency status, or employment status for that
matter, or on any preexisting condition. It should
be easy in terms of enrollment and participation; it
should have measures of cost containment, quality
assurance, improved efficiency, and accountability
to recipient; and it should allow the recipient and
the consumer to be active agents in the process of
planning any implementation of services.

Another element that was discussed is that
the system should reward providers who develop

services for the underserved and unserved
¢e oe @ 00 OO @ = Work Group Presentations

 

populations. It should provide incentives for

coverage for prevention services and have a uniform
procedure for reimbursement that recognized
regional differences.

In terms of the strategy, we felt very strongly
that there should be some kind of advocacy
coalition, involving the public and the private
sectors, in every State with a significant Latino
population. There should be some kind of method-
ology of assessing the cost of universal coverage that
factors in preventive measurements. We felt that
Government and institutional policy right now have
been unresponsive to Hispanic/Latino health needs.
Therefore, there should be policy that would
integrate service delivery systems and coordinate
referral mechanisms linking the different sectors —
the public, the private provider, the community,
the migrant health centers, and the mental health
centers. There should also be policy that would
consider linguistic and cultural issues. The system
should foster collaboration among all parties and
target health profession education funding to
increase a number of primary care providers. It

should determine the unique health needs of

Hispanic/ Latino communities and provide resource -

allocation necessary to meet those needs.

In terms of implementing strategy for this
particular issue, we need to bring together all
parties to explore areas of collaboration and

partnership. We also need to recognize that the

categorically funded programs as they stand now

do not meet the needs of the different populations
that they’re supposed to serve; all kinds of examples
were given of how the many assistance programs

do not address the basic needs in our community.
We also need to establish guidelines to review those
categorically funded programs such as HIV
programs and maternal and child health programs,
to figure out a way of supporting Centers of
Excellence, which would best meet the needs of the
Hispanic/Latino community at all levels. And then
we need to ensure that greater numbers of the
Hispanics/Latinos are in key policymaking ._.
positions. Allocation of resources and the relevance
of services to our community are better handled
when you have people in key positions who would
be able to advocate and bring the concerns to the
discussion table.

The third area has to do with the fact that
right now, the Latino community does not have
access to the full array of health services. Examples
were given in services such as primary care and
preventive services, acute hospitalization, emer-
gency services, dental services, drug and alcohol
abuse prevention and rehabilitation, occupational
health and rehabilitation, mental health services,
social service, nutrition and health education,
prescription drug, and visual and hearing services.
These are some of the many areas of priorities that
any comprehensive package should include and
make available to our community.

We also acknowledged the fact that Latinos
are not linked to’a regular source of care. Accord-
ing to a recent report by the Robert Wood Johnson
Foundation, one-third of our Latino population do
not have a point of entry. One of the biggest
barriers is that if you do not have that point of
entry, you end up going to the hospital emergency
room because you just do not know where to go
when you become ill. Therefore, we feel that we

need to address this issue.

Access to
Health

Care

One

Voice

>

One

Vision
Access to
Health

Care

One

Voice

o

One

Vision

Work Group Presentations

We also feel that, in terms of an ideal system,
we want to eliminate language and cultural barriers.
We want a system that can provide service to
mobile populations like seasonal migrant farm
workers, the homeless, refugees, and border and
other transient populations. We want to reduce
fragmentation and poor communication and
coordination among services providers—linking the
private provider with other local public and private
sectors and community and mental health facilities.

We want reimbursement for services, for
public information and public education and
transportation, as well as provision for child care
and social services. We believe that to be able to
begin linking consumers to the available sources of
care, we need to engage, particularly at a local
level, in a series of outreach and marketing
strategies that would increase consumer knowledge
about what is available and how to enter a system.
We also discussed the whole issue of interpreters,
and we were concerned about the fact that the role
of the interpreter may affect the quality of care.

We were concerned also about the issue of confi-
dentiality. There are ethical issues involved when
you use interpreters and so the lack of guidance, the
lack of training, the lack of really establishing
protocols to serve providers was a clear concern of
the group.

We also felt that we need to introduce
legislation. There should be policy and guidance to
promote bilingual and culturally competent,
relevant services. We need to develop standards
for those services; we need to revise criteria of
eligibility for funding for community and other
health programs to ensure responsiveness to
Hispanic/Latino health needs; and we need to
assess service delivery. There were discussions
about the fact that the clinics available, public or
private, don’t have flexibility of hours or services.
The services are organized to the convenience of

the provider, not to the convenience of the

$$ HHH 04

consumer. And the only way that we would be
able to change this is by assessing the policy that
every clinic follows, by seeing how we can make it
more responsive to the specific needs of a given
community.

People expressed concern that if you are
under Medicaid and you move to another State,
what you have is not portable. You cannot really
access another system from another State. There
has to be a guideline or policy; we need to explore
how can we make programs more helpful, more
useful, in addition to decreasing the number of

Latinos who are left out because of the existing

criteria.

[also want to mention the need to address
and assess the needs of Hispanic women. Somehow
the discussion of meaningful policy planning in
general left out the health needs of Hispanic
women, and please keep that in mind.

The final issue I want to address concerns
the labeling of minority. There was concern among
members of the Work Group that sometimes when
the label “minority population” is used in allocation
of funding, the term is not identified specifically
with Asian American, Native American, or
Hispanic/Latino American. Perhaps we should be

more specific when we are stating policies in the

allocation of resources.

 
oe¢ee? &¢ OO OO OM = Work Group Presentations

Data Collection

 

Manuel R. Modiano, M.D.

Director, Arizona Cancer Center

Minority Cancer Control

We must not underemphasize the importance of
data; without them, access to care, health profes-
sions, health promotion, etc., will never happen.
There are 22.4 million Hispanics living in the 50
States and D.C., and 3.5 million people living in
Puerto Rico, for a total of 25.9 million Hispanics in
the United States. More than two-thirds of all
Hispanics were born in the United States, yet it was
not until 1989 that the model birth and death
certificates included a Hispanic identifier.

Too often, organizational priorities and
funding decisions are established without taking
into account Hispanic data. Adequate planning is
not available without the appropriate availability,
utilization, and interpretation of Hispanic data.
Therefore, resources from governments (Federal,
State, and local), foundations, nonprofit and for-
profit corporations, as well as educational institu-
tions, are not allocated consistently with the needs
of the Hispanic community.

As we approach the year 2000 and beyond,
the need for the Hispanic data will only increase.
Given the imperative to effectively target resources
to maximize benefit and efficiency, the six areas
that I am going to describe are the minimal set of
issues that must be addressed to serve the health
needs of the Nation.

The first issue is inclusion. There is a need
for inclusion of Hispanics in all data systems. Our
aim is to increase the mainstream inclusion of
Hispanics in all systems, and the strategies for
implementation are the following: First, all surveys
and forms must include Hispanic and Hispanic
population subgroups identifiers. Second, there
must be sufficient numbers of Hispanics and Latinos
included for analysis. Third, enforce OMB [Office
of Management and Budget] Directive 15 and

Public Law 94-311. Educate the agencies about the Data
use of the OMB Directive for inclusion of Hispanic Collection
and Hispanic/Latino subpopulation groups and data
systems. Similar policies should be set for State,
regional, and substate levels as well as for non-
Federal purposes. And fourth, all agencies must
report progress on inclusion of Hispanics and
Latinos and their subgroups in data systems as well
as in federally funded, intramural, and extramural
research programs.

The second issue is local and regional data.
There is a need for data relevant to the identified
Hispanic health issues at the local and regional levels
for specific subpopulations. We hope to be'able to
do this by improving the availability and reducing
the gaps in local and regional Hispanic health data
through the following implementation strategies.
First, all agencies need to develop guidelines and
technical assistance to be used by State or regional
groups to collect data for Hispanic population
groups at the local or local-regional level, including
emerging Hispanic populations. Second, focus on
Hispanic-specific generated issues. For example,
collected data that only enumerate a number of
gunshot wounds in a specific community would
be useful only if they are made available to the
community and if they are integrated with other
data that already exist in that community. Third, One

develop a new series of local pilot studies to identify Voi
o1ce

®

One #

patterns and strengths that will justify the use of
further activities in the same community and
outside. And fourth, establish new objectives for
the year 2000 and baseline data for those objectives
at the Federal, State, and local levels.

There is a need for quality, precise, timely,
and culturally sensitive data design, collection, and
analysis. We hope to do this through the develop-

Vision

ment of a foundation of high quality, valid, and
timely information on Hispanics equivalent to or
better than that existing in other ethnic or racial
groups. The strategies for implementation are the

following: First, include Hispanics in the design,
Data
Collection

One

Voice

®

One

Vision

Work Group Presentations

implementation, analysis, funding, decisions, and
dissemination of health assessment and health
monitoring data systems. Second, assess the data
collection research designs to include considerations
of the heterogeneity of the Hispanic population.
Third, oversampling has been identified as a feasible
method of inclusion, but other methods need to be
developed to efficiently locate less concentrated and
dispersed Hispanic subgroups. Fourth, validate data
collection and research instruments for cultural
competency and linguistic appropriateness for use
within Hispanic population and subpopulation
groups. Fifth, bring the Census Bureau and NCHS
together to identify the existing and emerging
research issues with denominator and numerator
problems, such as the rules for assigning race, using
surname as a proxy, and the usefulness of other
races and, quote, “other Hispanic categories.” It is
imperative that we involve Hispanic researchers in
seeking the resolution to these issues. Sixth, study
the problems associated with changes in ethnic self-
identification. Seventh, establish guidelines for the
coding and keying of data on birthplace, work
history, generation status, socioeconomic status,
language usage, family relationship, etc., which
have been shown to be predictive of Hispanic health
status. And finally, develop data release plans that
meet priorities and the timeliness needs of users.

On the issue of analysis, there is a need to
identify and inventory the large amount of available
data. These data need to be analyzed for use in
understanding the Hispanic health concerns. To do
this, we need to increase the analysis and produc-
tion of Hispanic health data at Federal, State, and
academic levels, and to increase the number of
Hispanic researchers involved in these processes.

The strategies for implementation include the
following: First, research on the health status,
living conditions, and culture of the Hispanic/
Latino populations should be included, in the
development of hypotheses and conceptual frame-

works. Second, identify existing data sets and

FF OHHHHHHHHHSM

determine their access to the researchers. Third,
support a network of Federal, State, university, and
community-based analysis and analysts with a
primary focus on health data analysis. Fourth,
provide support for technical assistance to research-
ers who are involved in the urgent health issues for
Hispanics. Fifth, increase the technological capacity
of researchers to conduct more advanced analysis—
for example, the geographic information system.
And finally, encourage collaborative interdiscipli-
nary research, which bridges quantitative and
qualitative investigation.

In the area of dissemination, there are data
that are unavailable or inaccessible, but are in
critical demand. Our goal is to maximize the
availability of Hispanic data to Hispanic and non-
Hispanic policymakers, funding sources, practitio-
ners, community-based organizations, and research-
ers. The data must be made accessible by training
community-based organizations to.access the data in
training others in data cultural competency. The
data produced by public agencies through public
funds need to be made available to the community
by providing information packets that include
audiovisuals, slides, and other materials for
community-based organizations.

We need to provide assistance on how to
analyze data so that people can draw their own
conclusions. The data should be balanced to include
not only the negatives but also the important
strengths of the Hispanic/Latino community and
other issues. Federal regional offices should fund
statewide clearinghouses on Hispanic health in high-
impact States. There is a need to provide informa-
tion to a broad range of groups, Hispanic civic
advocacy groups and non-Hispanic white groups,
and we need to identify in each agency and
organization a person or people to serve as principal
point of contact on Hispanic health data.

There is a need for coordination between
and among Federal and State agencies in Hispanic

health data collection and analysis. The aim is to