Hispanic Health Issues in the Low Country

1
Hispanic Health Issues in the Low Country

• Dr. Charlene Pope, PhD
• Dr. Deborah Williamson, DHA
• Hispanic Health Initiative,
• MUSC College of Nursing

2
Acknowledgements

• Supported by funding from the Duke Endowment
  HRSA
• We would like to thank MUSC College of Nursing
  Staff Melanie Slan Maria Toler
• Jason Roberson, Language Specialist Medical
  Interpreter
• Student volunteers who conducted the health
  survey from the MUSC College of Nursing and MUSC
  Hispanic Health Alliance

3
New Growth Demographic Changes Implications

• Increase in Hispanic population
• Health systems must keep up with the change
• Patient identification (ethnicity language
  status)
• Language access
• Provide interpreter, signage, Spanish language
  materials
• CLAS Standards

4
MUSC Medical Center

• Spanish Language Code
• 1995 186 total patients (SPA)
• 2000 1983 total patients (SPA)
• 2005 19,604 total patients (SPA)

5
Second Language Status in South Carolina
2000
Spanish Speakers are 72 of Second Language
Speakers in South Carolina
6
Limited English Proficiency
44.9 LEP
Comparison California 20
7
Interview with Nursing Manager

• QUESTION
• How do you check to see if a patient has
  LEP..limited English proficiency?
• ANSWER You mean if they speak EnglishYou just
  ask them. If they stand there like a deer in head
  lights, then you know. Area that uses consent
  forms.

8
Hispanic Health Issues Nationally

• Diabetes
• Stomach liver cancer cervical cancer
• Prenatal Care (Late)
• Unintentional Injuries Accidents
• HIV/AIDS (15 of cases)
• Over 65 year flu immunization
• Obesity

9
The Hispanic Health Needs Assessment National
Alliance for Hispanic Health adaptation
http//www.hispanichealth.org/
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Limits of the LC Hispanic Survey

• Open-ended nature of questions
• Venues for the sample (More health
  motivated)
• 1/3 asked interviewers to read and write for them
  (Spanish)
• Missing data (Topic)
• Would benefit from fixed choice ranking, now that
  we know more of the choices

11
Average Education of Low Country Survey
Respondents
12
Comparison with Non-Hispanic Education for
Charleston County
13
Age Differences Program Planning
14
Hispanics Rank Top Health Problems
Interview with Hospital Administrator Some
servicesits very hard to get Hispanics to come
into care. Like mental health and drugs. you
hardly ever see them.

• Alcoholism
• Cancer
• Diabetes
• Cardiovascular disease
• Depression mental health
• Drug use addiction
• Occupational injuries accidents
• HIV/AIDS and STDs

15
Contrast of Self-Identified Concerns CDC data

• Top 3 out of 6 are psychosocial
• Addiction
• Alcoholism
• Depression
• Community-identified concerns consistent with CDC
  (cancer, diabetes, HIV, etc)
• Accidents injuries in Top 10, consistent with
  young age occupational groups

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Where do you go for help?
17
Access to Services by Gender
58 Reported Barriers on Open-Ended Questions
about Problems Getting Health Care
18
5 Most Important Health Needs of Hispanic
Children

• 25 Hearing vision problems
• 12 Obesity
• 12 Allergies ear infections
• 10 Nutrition
• 10 Vaccinations

19
What health topics do you want to learn more
about?

• Addiction
• Accidents
• Stress
• Sexually Transmitted Diseases
• Prenatal care
• Pollution (Caution Language)
• Physical health
• Preventive Focus

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Preventive Health Risks

• Smokers
• Alcohol use
• Diabetes
• Hypertension

12 Smoke
Non-drinkers 35
Self-Report 3
Self-Report 9 Dont know 64
21
Other Preventive Services

• Mammography
• Mean age of women 29
• Range 15 to 65 years
• Possible candidates
• 15 sample(35-65 years)
• 17 sample Yes

• Depression
• 24 screened positive on the Primary Care 2
  Question
• 19 did not answer

22
(No Transcript)
23
Primary Barriers to Care
24
Pattern of Service Acute or None

• Thank God I havent had a problem
• I dont need anything
• I just go to the ER if I need something
• Just take medicines at home
• Here there are no health centers

25
Complexity of Language Problems

• I dont speak English well
• They (the hospital) had no interpreters
• The Doctors/Clinics dont speak Spanish
• I dont know what to say about the health
  problem
• I couldnt explain what was bothering me

Culture
26
Complexity of Financial Barriers

• I have no health insurance
• The care is very expensive
• Not enough money
• Many companies dont give Hispanics benefits
• High price of consultations
• I found insurance complicated
• My insurance does not cover that

27
Refusals of Health Service The Doctor Refused
to See Me

• EXCUSES
• Need a social security number
• Would not attend me because I did not have a
  medical history
• Without an ID from this country, you cannot make
  an appointment
• Because it would be too expensive

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Unequal Treatment

• Racism
• To be Hispanic, you dont always get good
  service
• Discrimination
• Attention given to Latinos is very superficial
• One time they infected me and left me
  nothingand because of the language I didnt know
  who could help me

29
FEAR

• Deportation
• We need safe places to go when we are sick

30
Survey Outcomes

• Community partners identified
• Joint projects for Hispanic health
• Students Faculty immersions affect curriculum
• Changes in language access in participating
  hospital
• Identified questions for subsequent
  investigations