Citizens Health Care Working Group

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Citizens Health Care Working Group

• Adela S. Valdez M.D.
• Past Presiding Officer
• Health Disparities Task Force
• Asst. Dean for Education, UTHSCSA-RAHC

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Citizens Health Care Working Group

• Objectives
• Review how HDTF and DSHS approached Health
  Disparities with overview of Hispanic Health
  Disparities
• Review organizational processes utilized to
  address Health Disparities
• Highlight best practices
• Lessons learned

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Review HDTF and DSHS approach to Health
Disparities
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Priority Health Areas - USDHHS

• Infant mortality
• Cancer
• Cardiovascular disease
• Diabetes
• HIV/AIDS
• Immunizations

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OMH AND HDTF Initiatives

• Immunizations
• Obesity and Diabetes Prevention( CA, CV disease)
• Physical Activity and Fitness (CV disease)
• Tobacco Use (Cancer prevention)
• Responsible Sexual Behavior (HIV/AIDS)
• Prenatal Care (Infant mortality)

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Burden of Chronic Diseases andRacial/Ethnic
Disparities
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Causes of Death in United States-2000
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Obesity
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Obesity Trends Among U.S. AdultsBRFSS, 2002
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Americas Fattest Cities - 2004
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The Perfect Storm
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Lifestyle Changes that Promote Sedentary Behavior
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Tobacco Prevention and Control

• Tobacco remains the single most preventable cause
  of death and disease in Texas and the US
• Over 24,000 Texans Die each year
• Cost of over 10 Billion dollars
• In 1998, about 15 of all Texas Medicaid
  expenditures

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Success of Tobacco Intervention
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Trends in Cigarette Smoking Prevalence
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Plan to resolve the problem

• Appropriate Funds allocated into six main
  components
• Community and School based
• Public Awareness
• Cessation efforts with Quitline
• Efforts targeting specific populations
• Youths in alternate settings
• Enforcement of tobacco control policies
• Pilot initiatives in four East Texas Counties
• Jefferson, Harris, Fort Bend, and Montgomery

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Results

• After first two years of implementation
• 36 reduction in 6th-12th grade tobacco users in
  East Texas
• 55,000 fewer 6th 12th graders using tobacco
  products as result of the comprehensive program
• 18.6 reduction in adult smoking rates which
  translates to 90,000 fewer adult smokers in the
  area

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Overview of Hispanic Health Disparities
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CHANGING POPULATION DEMOGRAPHICSEDUCATION

• Hispanics and Blacks, in general, are
  disproportionately undereducated.
• School drop-out rates are excessively high.
• SAT scores for Hispanic and Black students are
  relatively low.
• Enrollment in early childhood education programs
  (Head Start, kindergarten) disproportionately low.

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HEALTH PROFESSIONALSGENERAL

• Hispanics and Blacks are disproportionately
  underrepresented in virtually ALL the health
  professions.
• The underrepresentation involves those in
  practice, academia, research fields,
  post-baccalaureate degrees.

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HISPANICS IN DECISION-MAKING POSITIONS

• Major disparity in the number/proportion of
  Hispanics and Blacks in decision-making positions
  in the health professions, state/national bodies,
  business sector, educational sector, governmental
  sector, etc.

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HEALTH INSURANCE

• Hispanics and Blacks in U.S. and Texas are
  disproportionately underinsured and uninsured.
• This problem is greater among Hispanics in the
  Southwest and even greater still in communities
  closer to the U.S.-Mexico border.

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Texas Has the Highest Uninsured Rate in the
Nation
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Majority of Uninsureds Are Employed
Percent Texas Uninsured by Labor Status
Not in Labor Force
80 of Uninsured Hispanics Are Employed
Unemployed
Employed
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HEALTH INSURANCE

• Texas ranks 2nd among states in the percentage of
  children 0-17 years old who do not have public or
  private health insurance.
• 44 of the uninsured children in Texas are
  Hispanic.

Source Office of Public Insurance Counsel
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HEALTH INSURANCE

• For migrant children who are actually enrolled in
  the Texas Medicaid program, the coverage becomes
  moot as soon as they leave the state.
• Lack of health insurance affects access to health
  services, contributes to poorer health, higher
  hospitalization rates and more advanced disease
  state by time health services finally received.

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Hispanics Typically Low Utilizers of Healthcare
Services

• Lower Utilization of Healthcare
• Culture - Home remedies commonly first line of
  defense.
• Reactive vs Proactive Healthcare
• Women set the health agenda in the household.

• Fewer Hispanic Physicians
• Only 13 of the states 13,000 primary care
  physicians are Hispanic.

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DIABETES (ADULT-ONSET TYPE)

• Higher rate of diabetes for Hispanics and Blacks
• Higher rate of diabetic complications
• Higher death rates for Hispanics and Blacks, 2 to
  2.5 times higher than Anglos in 1990 and 2000 in
  Texas

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DISEASE/HEALTH DISPARITIESHOMICIDES

• Homicide rate for Hispanic and Black males was 2
  to 4 times higher than that for Anglo males in
  Texas in 1990 and 2000. (Rates among females are
  similar between Hispanics and Anglos.)

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Age-Adjusted Death Rates for Cervical Cancer by
Race/Ethnicity, Texas 1995-1998(Rate per
100,000 population)
Source Texas Department of Health, Vitalnet
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SCREENING FOR BREAST CANCER

• Rates for breast examination by a clinician are
  lower in Hispanic and Black females.
• 78.8 White, non-Hispanic
• 57.5 Hispanic
• 75.7 Black, non-Hispanic
• Data for 1998-2000

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SCREENING FOR BREAST CANCER

• Rates for mammography are lowest for Hispanic
  females
• 61.0 Hispanic
• 72.1 Black, non-Hispanic
• 71.5 White, non-Hispanic
• Data for 1998-2000

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DISEASE/HEALTH DISPARITIESTEENAGE PREGNANCY

• Hispanic and Black teenage pregnancy rate 2 to 3
  times higher than that for White non-Hispanics.
• Percent unmarried (2/3 of teenage pregnancies) is
  similar between Hispanics and White
  non-Hispanics.
• Percent unmarried (about 94 percent of teenage
  pregnancies) much higher for Blacks.
• Rates over the last decade relatively stable.

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DISEASE/HEALTH DISPARITIESOBESITY

• Being overweight and obesity are
  disproportionately increased in Hispanics and
  Blacks, particularly females.

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DISEASE/HEALTH DISPARITIESMENTAL HEALTH

• Need more frequency information, risk factors,
  mental health care access, outcomes in Hispanics
  and Blacks in Texas and in the U.S.

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SUMMARY

• Rapidly growing numbers
• Increased under-education, low income, language
  barriers
• Greater lack of access, underutilization,
  mis-utilization of health care system
• Greater uninsured, underinsured

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REPRESENTATIVE HEALTH POLICY IMPLICATIONS

• Expansion of health insurance
• Increased inclusion of Latinos and Blacks in
  medical/health research as consumers, researchers
• Increased numbers of Latinos and Blacks in
  Academic Health institutions (administration,
  tenured faculty, researchers)

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REPRESENTATIVE HEALTH POLICY IMPLICATIONS

• Enhancement of early educational opportunities.
• Dramatic focus needed in eliminating disparities
  in access to care, utilization of care, and
  preventive services.

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CHALLENGES

• Increasing health care costs
• Lack of societal mandate for all to have
  sufficient access to the health system
• Increased expectations of health with increasing
  technology
• Improving health requires improving education,
  employment, decision-making capacity in a variety
  of community and organizational sector.

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SUMMARY

• Major under representation in health
  professionals
• Major under presentation in decision-making
  bodies in health, government, business,
  education, entrepreneursarenas that intersect
  with health and health care
• Numerous health disparities (i.e.,
  disproportionately greater disease burden)
• Less health and research data available

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New Innovative Initiatives

• State Program Initiatives
• Regional Initiatives
• Texas State Heath Strategic Partnership

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Strategies
Eliminating health disparities in Texas requires
an ability to identify and address the underlying
causes of higher levels of disease
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Strategies
Research is needed to understand why vulnerable
populations have disparate health outcomes
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Strategies

• Improved Access / Outreach
• Enhanced public information
• Community partnerships
• Realignment of funding priorities

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Underlying Causes of Disparity

• Race
• Ethnicity
• Gender
• Age
• Geography
• Education

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Small Steps,BIG Impact
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Strategies

• Linking potential external partners to SHS
  programs
• Promoting SHS programs that improve the health of
  racial/ethnic minorities to the health care
  community, in addition to the public and private
  sectors
• Each Region is addressing problems in their own
  communities

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Texas Public Health Regions                     
                                                  
                                                  
                                                  
          
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Community Outreach

• Promotora Community Outreach

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3-Share Plan
2004
2005
Jan-May June July Aug Sep Oct
Nov Dec Jan Feb Mar
April May June July Aug
Sep Oct
Certify and Enroll Business Partners and Patient
Base (3000-4000 patient population)
Program Development
Secure State Approval
3-Share Clinic Start-up
3-Share Clinic Ongoing Service/Evaluation and
Policy Development

• Working Uninsured Project
• Access to Health
• Target low income workers (median in family
  income 30,000 per year)
• Premium sharing employee, employer and
  government (1/3 each estimated premium 50-75
  per month per individual)
• Focus on wellness, provide physicals and pharmacy
  benefits

In Texas, 28 of the population lacks health
insurance
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What TI is Doing
Texas Instruments is focusing on addressing
the issue of health care disparity by

• Designing disease management programs that have
  relevance for each employee
• Participating in a multi-company research project
  in conjunction with the Washington Business Group
  on Health to better understand employee
  perceptions about health care and employees
  experiences with health care providers. The study
  will help to provide information about
  correlations between health care delivery and the
  impact of health care disparity on health outcomes

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What TI is Doing (cont.)

• Working to use our influence in the local
  business community to increase awareness of
  health care disparity. Ultimately we want
  employers to begin to make specific requirements
  of health plans/carriers
• 1) Diversity of networks
• 2) Cultural proficiency in the delivery of health
  education programs
• 3) Data tracking of disease outcomes based on race

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What TI is Doing (cont.)

• Helping to increase the awareness of the need for
  cultural competency for health care providers
• Ensuring health plan physician panels have
  diversity representation
• Encouraging health plan carriers to begin
  addressing health care disparities

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Texas State Strategic Health Partnership Goals

• Promoting health nutrition and physical activity
• Promoting health choices with regard to risky
  behavior
• Recognizing mental health as a public health
  issue
• Increasing rates of high school graduation, adult
  literacy and college attendance to improve
  socioeconomic and health status
• Reducing health threats due to environmental and
  consumer hazards
• Reducing infectious disease

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Texas State Strategic Health Partnership Goals

• By 2010, Texas state statue and local policy will
  ensure that essential public health services (
  emphasizing disease/injury prevention and health
  promotion) are available for all communities in
  Texas.
• By 2010, a diverse set of governmental and
  non-governmental partners will actively
  participate and collaborate to provide the
  services necessary to meet the public health
  needs of Texas
• By 2010, Texas communities will be aware of the
  structure, function, and availability of the
  public heath system.

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Presidential Advisory Commission
onEducational Excellence for Hispanic
Americans
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Three Major Strategies

• Cooperation / Collaboration
• FOCUS High Yield Practice
• CommunicateCommunicate-Communicate
• Do Something About It....wpl

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The Health of Texas
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Is up to Us.