State Health Lawmakers' Digest: Racial and Ethnic Disparities (Vol. 2, No. 4), What Works

WHAT WORKS

Many states have minority health programs, but few have adopted cross-cutting, statewide approaches to eliminating health disparities. In addition to taking aim at chronic illnesses in minority populations, states and communities are addressing racial disparities in access through improving data collection, linguistic and geographic access, cultural competence, and diversified health professions.

Data Collection

Without baseline and follow-up data on racial and ethnic health conditions, states cannot pinpoint interventions, justify expenditures on a specific population, and prove program success. Many states are enhancing their ability to collect and distribute data using federal Office of Minority Health State Partnership Initiative infrastructure development grants.

Officials with the Ohio Commission on Minority Health partnered with the National Council of La Raza, state agencies and community organizations to develop the first demographic overview of Ohio's Latino population-everything from history and heritage to educational attainment and health status.

South Carolina's Budget and Control Board linked data from state agencies and the private sector to create a fuller picture of various populations served in the state. The board's Office of Research and Statistics linked Medicaid claims, child care vouchers, education, welfare, vocational rehabilitation, mental health services, motor vehicle crashes, juvenile justice, private inpatient hospitalizations, emergency room visits and admissions, home health visits, and other services. The data system uses unique person numbers rather than personal identifiers to ensure confidentiality.

Linguistic Access

According to the 2000 census, more than 20 million people living in the United States are less than fluent in English. Many rely on family and friends to act as medical interpreters-a situation that compromises patient confidentiality, hinders the physician-patient bond, and may result in incomplete or inaccurate patient care instructions. Brandeis University researchers who surveyed more than 4,000 uninsured people with limited English language proficiency found that 27 percent of those who needed but did not get an interpreter did not know how to take their prescribed medication. Despite the need, only five states (Hawaii, Maine, Minnesota, Utah and Washington) use available federal Medicaid and SCHIP matching funds to assist health care institutions with the cost of providing interpreter services, according to the Brandeis report.

States are increasingly cognizant that bilingual laypeople are ill-equipped to translate medical terms and instructions. In 1999, Alabama trained 29 bilingual people in English-to-Spanish medical interpreter skills-including skills in medical terminology, ethics, interviewing, and Hispanic culture-using funding from its State Partnership Initiative. The New York University Center for Immigrant Health offers a variety of medical interpreter programs to serve New York's diverse linguistic population. Training is offered for all levels, from bilingual people who are new to medical interpretation to experienced veterans who need to sharpen skills and learn new terminology. The center also offers a "Train the Trainer" model and a pilot program in remote-simultaneous medical interpretation, where practitioners and patients wear headsets-like those used at the United Nations-to communicate in Spanish, Mandarin, Cantonese and Fukinese.

Geographic Access

North Dakota's Women's Way (Breast and Cervical Cancer Early Detection Program) travels to the Standing Rock Indian Reservation two to four times per year to provide health screenings to women who otherwise would go without. Before the Women's Way events, women had to travel more than 75 miles off reservation to reach the nearest mammography facility. With transportation barriers removed, women report feeling more comfortable having services available in a familiar location and are more likely to receive annual screenings. Indian Health Services workers, the Custer Health District, nursing colleges and other local groups contribute to the events, which provide transportation, child care, food and other incentives to bolster attendance.

Cultural Competence

Cultural competence involves recognizing ethnic differences and developing methods and strategies of providing health information in the most culturally sensitive way. South Carolina, which had one of the highest rates of prostate cancer mortality in the nation, noticed that organizations were having difficulty reaching African American males for education and screening on the disease. The South Carolina Office of Minority Health (OMH) gathered focus groups of African American men and women and uncovered barriers to screening. These barriers included ideas about masculinity, misconceptions about how cancer develops, fear of death, and lack of knowledge about the location and function of the prostate. Armed with this information, the OMH developed an information campaign called "Real Men Get It Checked," which has been used by hospitals and churches throughout the state.

California has used its purchasing power to ensure cultural competence and to enforce linguistic requirements with managed care organizations that contract with the state. MediCal issued five "policy letters" in April 1999 to clarify the contractors' responsibilities. Some issues addressed include establishing community advisory councils, assessing cultural and linguistic needs in the community and providing those services, and translating all written materials.

Diversifying Health Professions

Minority physicians play an important role in increasing health care access for minority populations. People are more likely to be trusting, honest and satisfied with physicians of their own race, and minority physicians are more likely to serve minority patients. One innovative program in Washington, the American Indian/Alaska Native (AI/AN) Family Practice Residency Program, was developed by the Seattle Indian Health Board and the University of Washington Medical School; it is the only AI/AN residency program in the United States. The three-year residency program at the Seattle Indian Health Board trains two new students per year in a community health center. Applicants are required to be AI/AN or have extensive experience in AI/AN communities and have a desire to pursue a career in a non profit health care setting.

In addition to sources cited in "Digging Deeper" and "In the Abstract," see Closing the Gap, the newsletter of the Office of Minority Health, http://www.omhrc.gov/omh/sidebar/archivedctg.htm

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