Quality health care

Quality health care has come to depend upon employment and wealth accumulation. The marginalization of healthcare among Latino families manifests itself in job availability. With the high Latino unemployment rate, families are seriously impacted and are not receiving healthcare. Latinas and families may have jobs, but many rarely offer health care benefits. Additionally, these jobs do not excuse medically related absences and can result in job losses if time is taken off for healthcare. Latina women are caught in this web. Their employment status discourages them from receiving adequate medical care and they are faced with financial family hardships, language issues, cultural barriers and access to quality health care for them and their families.


East Valley Tribune

January 18, 2012
Posted: Tuesday, January 17, 2012 11:27 am | Updated: 2:13 pm, Tue Jan 17, 2012.

By Howard Fischer, Capitol Media Services | 15 comments

A Senate panel led by an East Valley lawmaker agreed Tuesday to let schools opt out of the federal program to offer free and reduced-price lunches for needy students.

Sen. Rich Crandall, R-Mesa, said the state should not be imposing these mandates on public schools. He said the decision whether to participate in the National School Lunch Program – and deal with the various restrictions – is best left to local school officials.

Crandall said some districts, particularly those with only a small percentage of eligible children, may decide to continue to offer the free or discounted meals, but on their own terms, and with local taxpayers picking up the tab. But he said that, in some cases, schools may scrap the program entirely, meaning that children who want the service will have to transfer to other schools that still offer it.

The move drew fire from Jennifer Loredo, lobbyist for the Arizona Education Association.

“For a lot of students that we have out here in the state, the school lunch program that they are provided is the only quality meal that they get,” she told members of the Senate Education Committee.

But the panel voted to approve SB 1060 on a 6-1 vote, with only Sen. David Schapira, D-Tempe, opposed. The measure now goes to the full Senate.

Crandall said his concern is that the U.S. Department of Agriculture, which administers the program, is crafting new regulations that “could be burdensome.”

For example, he said that the USDA has been scrutinizing some school districts where what they are charging regular students for lunch is less than the government is providing in subsidies. Crandall said that has led to questions of whether the USDA is effectively subsidizing lunches for students who can afford to buy their own food.

“So who gets hurt the worst under this mandate is the middle income; people who don’t qualify for free and reduced-price lunch are just above it,” he said.

Crandall also said there are new requirements for fresh fruit at breakfasts that are offered under the program.

Ginny Hildebrand, chief executive of the Arizona Association of Food Banks, said Crandall’s assurances that most school districts will remain in the program provides little comfort.

“We know hungry kids have trouble learning,” she told lawmakers. “We know teachers that have hungry kids in their class have trouble meeting their teaching objectives.”

Loredo suggested that if lawmakers want to let schools opt out of the USDA program they should at least replace it with some requirement for schools to offer similar programs without the federal rules. Crandall, who chairs the committee, said he will not do that.

“I’m not going to take away one mandate and replace it with another,” he said.

Crandall said that was the lesson lawmakers learned in allowing the creation of charter schools. These schools, most privately operated, are public schools and get state aid. But they are exempt from most of the regulations the state imposes on traditional public schools.

In this case, he noted, the charter schools which educate about 135,000 youngsters in Arizona are exempt from the law on school lunches, though some do participate.

“We’re trying to take the same flexibility they have with regards to the National School Lunch Program and apply it to districts,” Crandall said.

And he said he’s not worried about what will happen to the affected children.

“That’s where I have complete confidence the local school board’s going to take care of that,” Crandall said. He said many will decide they are willing to provide free lunches, “but on our own terms.”

Crandall did agree to amend his legislation when it reaches the Senate floor to require any district proposing to opt out to first notify the parents.

Marketing Has Heavy Influence on Latino Childhood Obesity

Editor’s Note: This is Part 1 of a series on new Salud America! research briefs examining Latino youth nutrition, physical activity and marketing. Today’s focus is marketing.

As with other children and adolescents, marketing may also have a powerful influence on the health behaviors of Latino youth.

A new Salud America! research brief shows that:

  • The amount of time young people spend with entertainment media has risen dramatically, particularly among Latinos.
  • Latinos are avid users of digital media, including the Internet and mobile phones, among other new media platforms (e.g., Facebook, MySpace).
  • Latino youth, have been identified as an important target market segment among fast-food and soda companies.
  • Children viewing Spanish-language TV in the U.S. are heavily exposed to food and drink commercials.
  • Low-income Latino communities are disproportionately exposed to outdoor ads for high-calorie, low-nutrient foods and beverages.
  • Latinos perceive greater exposure to fast-food promotions and see fast-food restaurants as more conveniently located relative to whites.

To address the paucity of research on the influence of marketing practices specifically targeted to Latino youth, a full range of studies is necessary related to these findings.

But what should policymakers do?

Policymakers should, as the brief suggests, consider banning all junk-food advertising to young children and banning junk-food advertising techniques that are deceptive and misleading to adolescents to reduce the potential influence of marketing for high-calorie, low nutrient-dense foods. Fast-food, soda, snack, and cereal companies should be encouraged to adopt meaningful standards for child-targeted marketing.

Also, public and private funds should be used for culturally competent, Spanish-language
counter-marketing and health promotion efforts.


WASHINGTON, D.C. – A major report to be released at 1 p.m. EDT/10 a.m. PDT Tuesday (September 20, 2011) will show that one out of two Hispanic Americans faces serious health risks due to living in counties that frequently violate air quality standards.

In response, leading Latino organizations are urging Latinos everywhere to sign on to a major campaign urging elected officials to pledge to take action to protect and strengthen the federal Clean Air Act, which is currently under fire in some quarters in Congress.

The new report is co-authored by the Natural Resources Defense Council, the National Latino Coalition on Climate Change, the Center for American Progress and the National Wildlife Federation. Problem areas highlighted in the report are major markets that are home to large numbers of Latinos in Arizona, California, Colorado, Florida, Illinois, Massachusetts, Nevada, New Jersey, New York, Pennsylvania, and Texas, among other states.

More than 23 million Latino children, grandparents, siblings, and friends consistently face a higher risk of asthma, bronchitis, and even death from air pollution. As of 2008, 4.7 million Hispanics had been diagnosed with asthma in their lifetime. Latinos are three times more likely to die from asthma than other racial or ethnic groups.

The growing U.S. Latino population, including millions who are uninsured, faces special pollution-related burdens arising from the additional unforeseen costs that come from asthma attacks, medication, hospitalizations and lost work days.

MEDIA CONTACT: Leslie Anderson, (703) 276-3256 or landerson@hastingsgroup.com

New Research on Hispanic Women and Breast Cancer

Yale University researchers will examine biological factors in Hispanic women in hopes of one day developing a test to detect breast cancer very early, with research funding announced today by Susan G. Komen for the Cure.
Yale University researchers will examine biological factors in Hispanic women in hopes of one day developing a test to detect breast cancer very early, with research funding announced today by Susan G. Komen for the Cure.

The $270,000 training grant is part of Komen for the Cure’s $66 million investment in new research, patient support and scientific conferences in 2011. Komen has spent more than $685 million for breast cancer research in its 29 years, making it the largest non-profit funder of breast cancer research outside of the federal government.

“Our research investments are geared to bringing results to the table – and soon – for the most difficult questions in breast cancer,” said Ambassador Nancy G. Brinker, founder and CEO of Susan G. Komen for the Cure.

The Yale research is led by Nita Maihle, Ph.D., who will look for biomarkers that could detect cancer in Hispanic women months before conventional imaging can today.

“This grant may lead to a better understanding of issues unique to Hispanic women as we attempt to better understand and address breast cancer’s impacts across diverse groups,” said Komen President Elizabeth Thompson.

“This ties squarely to our mission to fund cutting-edge breast cancer research along the entire cancer continuum – from prevention to early diagnostics, disparities in outcomes, more effective treatments, and answers for aggressive and metastatic disease,” she added.

The national research grants announced last week augment community health program funding totaling $93 million last year to deliver screening, education and treatment support through more than 1,900 community partnerships nationwide.

Komen’s Connecticut Affiliate provided more than $1 million in community grant funding in Connecticut last year, with a focus on serving low-income and uninsured women.

“The projects we’re investing in today are critical to the momentum we’ve built during the last 30 years in our quest to understand, and ultimately solve, the many questions surrounding breast cancer,” said Eric Winer, M.D., Komen’s chief scientific advisor, chief of the Division of Women’s Cancers at Dana-Farber Cancer Institute and Professor of Medicine at Harvard University.

The Americano / Agencies

Diabetes deadlier among Hispanics

Tuesday, August 23, 2011

Study: Death rate 50% higher than for Anglo patients.
By Don Finley
Updated 01:24 a.m., Friday, August 19, 2011

According to the latest grim findings from a landmark San Antonio-led study, diabetes seems to be deadlier for Mexican Americans than for Anglos, and much deadlier for diabetics living in Mexico.
The San Antonio Heart Study, which followed the health of thousands of residents over three decades, was among the first large studies to show that Mexican Americans were at higher risk of developing diabetes.

With the latest paper, published online in the Annals of Epidemiology this week, researchers looked at people who died over the course of the study, as well as those who died in the Mexico City Diabetes Study — an offshoot that included both Mexican and San Antonio researchers.

They found that while Anglo diabetics had double the risk of nondiabetics of dying, Mexican Americans had three times the risk. And diabetics living in Mexico City were four times more likely to die.

“I think it’s interesting and alarming,” said Kelly Hunt, associate professor of biostatistics and epidemiology at the Medical University of South Carolina in Charleston. “Although the prevalence of diabetes is so much higher in Mexican Americans than in non-Hispanic whites, it wouldn’t be all that surprising to me that if the severity of the disease was somehow worse. But it’s hard to measure that.”

Hunt, formerly of the University of Texas Health Science Center, said the study has a few limitations. Because of the way data were collected, it included U.S. deaths only through the year 2000, while deaths in Mexico occurred through 2007.

A number of treatment advances — including better drugs and a greater awareness of the disease, leading to earlier diagnosis — have taken place in the past decade. Hunt said those advances made the greater risk of death among the Mexican residents even more notable.

Also, the risk of death was almost identical in those who didn’t have diabetes, whether they were Anglo American, Mexican American or residents of Mexico. That would also suggest differences in the quality or availability of medical care aren’t so great, Hunt said.

Hunt said there might be genetic differences that might make for a more aggressive disease in Hispanics than in Anglos. But that also wouldn’t explain the higher risk of death in Mexican residents compared to San Antonio Hispanics.

Dr. Roberto Treviño, a diabetes researcher and director of the Social and Health Research Center in San Antonio, who wasn’t involved with the study, was skeptical of the findings. He pointed to a 1999 paper from the San Antonio Heart Study that showed that living in a poor neighborhood also is a major predictor of diabetes.

“Because living in socially deprived neighborhoods is a powerful predictor, it did not surprise me that the mortality from diabetes would be highest among Mexico City residents, Mexican Americans and non-Hispanic whites, in that order,” Treviño said. “I would argue that the cause of this health disparity is not genetic but environmental.”

Dr. Michael Stern, who designed and launched the San Antonio Heart Study, and later collaborated with Dr. Clicerio Gonzalez-Villalpando of Mexico City to compare U.S. and Mexican diabetics, found in the 1990s that Mexican nationals actually had less diabetes than San Antonio Hispanics. He found differences in diet and physical activity that seemed to favor Mexicans.

© 2011

U.S. Health Department lays out flexible timetable for state insurance exchanges

By Jeremy Duda – jeremy.duda@azcapitoltimes.com
Published: July 11, 2011 at 6:47 pm

Arizona lawmakers who are hesitant about creating a state-run health insurance exchange, a key provision of President Barack Obama’s health care overhaul, will have some extra time to debate the issue.

Officials from the U.S. Department of Health and Human Services today released a set of regulations that will govern the health insurance exchanges, including a flexible timeline for states that aren’t quite ready for the federal deadlines. Under the Affordable Care Act, every state must have either a state-run or federally run health insurance exchange.

In order to meet the January 2014 deadline for implementing the health insurance marketplaces, states that wish to run their own exchange must have them ready for federal certification by January 2013. But HHS officials said states that haven’t completely finished their work can get conditional certification for their exchanges if they can show that they’re “making progress,” and that states that have a federally run exchange can shift back to a state-run model after the 2014 deadline.

“The fact that a state, maybe as we sit here today, maybe hadn’t made strong progress compared to some of the other states certainly doesn’t rule out them being positioned in either 2013, 2014 or even later. And I think that’s one of the strong points of this reg is providing that flexibility for states,” Steve Larsen, the director of HHS’s Center for Consumer Information and Insurance Oversight, told reporters on a conference call today.

The regulations outline states’ abilities to run their exchanges in partnerships with the federal government, nonprofit groups or other states. Another area of flexibility the states have under the regulations is the ability to decide what role insurance agents and brokers will have under the new system.

HHS Secretary Kathleen Sebelius said the system is designed to give states a great deal of leeway while ensuring that they all meet certain minimum standards. She said all state exchanges will have three mandatory features that they must include – implementing a “one-stop shop” where all individuals and small businesses can buy coverage; be transparent in terms of cost and coverage; and provide a basic level of coverage, similar to the health plans offered by employers.

“This isn’t a one-size-fits-all solution. Each state will have the flexibility to design its exchange. And they will also have the option to partner with each other and with our department in order to meet the goals they have for their exchange. But all exchanges will have certain features in common,” Sebelius said.

Rep. Nancy McLain, who sponsored a failed bill to create a state-run health insurance exchange during the 2011 legislative session, said the flexible timetable has always been an implied part of the Affordable Care Act. But the Bullhead City Republican said it’s good for Arizona’s insurers to have the guidelines officially codified so they know how to proceed.

“As I understand it, there was a lot of ambiguity. Until they actually set the policies and procedures there were some things that the insurance folks weren’t absolutely sure on. They were trying to make educated guesses on the way it would go,” said McLain, whose HB2666 never received a vote of the full House. “The timelines were set in stone, but as far as just being able to show progress by 2013 was the assumption that they were working under.”

HHS still has not released the highly anticipated “essential health benefits” guidelines, which will detail the minimum coverage standards for insurers in the exchanges. Agency officials said the agency would release those regulations later this year.

Health Disparities in the Latino community

The following is a featured article by Lea Mollon, a pharmaceutical student at the University of Arizona.

One organization’s approach to addressing health disparity and inequity

By: Lea Mollon mollon@pharmacy.arizona.edu

Statistics show that 46 million people in America are without health insurance, many of which lack adequate access to pharmaceuticals, preventive and mental health care, oral care, and complementary or alternative medicine. This number translates into one in five people in America with limited access to health care, which contributes to increased health risks and decreased positive health outcomes. For the Latino community, this number is one in three. This means that approximately 33% of Latinos are more vulnerable to health risks that could otherwise be prevented. In addition, language and cultural barriers contribute to poor health outcomes, health disparities, and health inequities. Health disparity statistics show that:

Latina women are 2.3 times more likely to have late or no prenatal care
Latina women are 1.6 times more likely to get cervical cancer than non-Hispanic white women; Latina women are also 1.4 times more likely to die due to cervical cancer
Latinos are twice as likely to develop diabetes compared to non-Hispanic whites; Latinos are also 1.5 times more likely than non-Hispanic whites to die from complications associated with diabetes
Latina women are 3.8 times more likely to contract HIV than white females
Latinos have the highest percentage of tuberculosis cases (29%) than any other ethnic group in the United States
Although research repeatedly confirms the prevalence of these health disparities, addressing them requires adequate resources and appropriate, culturally sensitive methods and patient education materials. Additionally, clinicians must be educated and trained to address health issues from a culturally sensitive perspective.

Although awareness of health disparities and inequities within the Latino community and other underserved populations has somewhat improved in recent years, there still exists a growing need for developing initiatives to improve care for conditions with marked disparities; producing new and revising existing patient education materials to meet the needs of patients with limited health literacy and proficiency in the English language; and training clinicians to integrate cultural sensitivity, health literacy, and language access in clinical care settings. Furthermore, continuing trends of health disparities, despite knowledge of their existence, necessitates the enhancement of support for health care teams to deliver comprehensive primary care and preventive services to these populations, increased access to information on health disparities relevant to clinical practice, and opportunities for training relevant to providing health care to underserved populations. In addition to promoting research to increase understanding of underserved practice, meeting these objectives can promote access to quality health care that meets the needs of patients and improve long-term health outcomes. Fortunately, there are some organizations that have begun to address these issues through ongoing health advocacy and education.

The Association of Clinicians for the Underserved (ACU), established in 1996 by participants and alumni of the National Health Service Corp, is a non-profit, transdisciplinary organization of more than 8,000 clinicians and 900 organizations committed to improving the health of America’s underserved populations while enhancing the development and support of the health care clinicians serving these populations. The ACU represents 18 professional disciplines and several community clinics, health care organizations and professional societies. It comprises a broad range of health professionals including clinicians in practice, students, advocates, and academicians in widely varying practice settings and geographic areas who are on the front lines of delivering health care to America’s underserved, vulnerable communities, like the Latino community. Programs focus on improving the quality of care, expanding access to care, and developing a well-trained, culturally sensitive and adequately resourced health care workforce.

The ACU believes in a transdisciplinary, holistic approach to health care with a highly collaborative team of health care professionals and community organizations. They focus on issues such as health care reform, health care access, elimination of health disparities, workforce development and diversity, cultural competency in the health care setting, health care quality improvement, access to medicines and pharmacy services, and integration of behavioral health into primary care practice, all of which are important components in the improvement of health care outcomes.

The ACU aims to “strengthen and support the health care workforce through workforce development activities, including training lay health advisors or promotoras as part of the health care team, promoting use of health information technology and Strength for Serving, a special initiative that recognizes the inherent stresses of working in environments with limited resources.” As part of its mission, the ACU is strongly committed to ensuring that providers have access to current, appropriate knowledge, innovations and strategies; and possess the skills and competencies to provide quality care and patient safety in the most efficient manner. It supports patient-centeredness and providing care to the increasing number of medically underserved and the most disadvantaged while respecting a patient’s dignity and cultural beliefs.

Organizations like the ACU should be supported and promoted as an important tool in improving the health and well-being of the vulnerable Latino community. Their education materials, resources, and programs are valuable assets for clinicians and members of the community to address health disparities and their associated health risks. By supporting this organization, we can begin to change the health statistics of the Latino community and help to improve the overall health outcomes.

Take one minute to show your support by visiting ACU’s Facebook page and clicking the “like” button: http://www.facebook.com/#!/CliniciansfortheUnderserved

Read more about the ACU and how to become a member at http://www.clinicians.org/index.cfm

Lea Mollon is a pharmacy student at the University of Arizona College of Pharmacy. Her experience includes working in the inpatient pharmacy at the Mayo Clinic and working with underserved populations as a part of the Rural Health Professions program. Her interests include working with and advocating on behalf of minority populations, mental health awareness and education, and LGBT issues.