Emergency and Health Preparedness Strategies to Reach the Hispanic Population

Presentation to the Institute of Medicine
October 30, 2009
Elena Rios, MD, MSPH
President and CEO
National Hispanic Medical Association
Established in 1994 in Washington, DC, The National Hispanic Medical Association is a 501c6 nonprofit membership and advocacy association, representing the interests of Hispanic physicians in the U.S. The NHMA’s mission is to improve the health of Hispanics and other underserved.
I applaud the work done to develop our National Health Care Security Strategy, especially, in this era, with the global health community having a heightened awareness of the potential pandemic threats lurking in our midst.
According to the U.S. Census, Hispanics are now 50 million or 15 percent of the U.S. population and are projected by the year 2042 to be one out of four Americans. One of the greatest challenges to the health security planning of the nation is the changing demographics of the population and the need to develop health communications that are can reach Hispanics.
The U.S. public health system consider the importance of building its public health and medical preparedness and response coordination at the Federal, State and local levels should with the following principles:
  1. The targeted Hispanic community needs to be better understood by including community public health leaders as well as Hispanic physicians and health professionals in the design and implementation and evaluation of the tactics.
Hispanics tend to live in blue collar neighborhoods where most people, whether in a Hispanic dominant population or a mixed population area, are struggling with low literacy and low education attainment and insecurity about their employment. They are a religious and conservative group interested in a better tomorrow, living with hope of attaining the American dream –which really means, getting to a better place than your parents, who in many instances are immigrants from Latin America – Mexico, Central and South America and from the Caribbean countries and Puerto Rico.
Families have very strong support systems and should be the focus of public health preparedness tactics. Hispanic families are subject to more than the average American family stress ---with environment stressors (gangs, drugs, violence, unsafe areas), community stressors (lack of services, limited choices, public health nearly nonexistent), family stressors – discrimination, small business stressors, and more. Yet, they are very interested in doing what is going to be protective of their family members ---so preparedness becomes a priority in that context.
  1. Trust and “local” public health information need to be core elements of the message.
In order to increase trust in the community, the messenger should include Hispanic community leaders and health professionals, members of the clergy, and others not associated with the government per se. The government officials should be showcased as invited to help link the local public health program with the national campaign ----not as the national coming to rescue the community.
Community based programs need to be showcased at schools, churches, agencies, clinics, hospitals, pharmacies, medical offices, supermarkets -----where the community lives. In addition, the training drills for community mitigation needs to be practiced in schools, neighborhoods.
Private sector partners are key, especially, those businesses who have supported other community cultural and social events ----linking preparedness education with the celebrations, a key cultural tradition.
  1. Health Communications planning and implementation need to include the language and cultural competence needs of Hispanics.
Hispanics have cultural roots from the countries of origin, mainly in Mexico (65%) and the other large groups from Puerto Rico, Cuba, Central and South American countries and have language needs based on three groups ---English dominant, Bilingual and Spanish dominant. You must include members of the targeted community in your planning
National campaign should have tool kits targeted to the various Hispanic families, co-branded with the local community organizations, Hispanic medical and health professional groups, local public health department. Local Hispanic communications agencies and radio and tv/cable and newspapers should be contracted as part of the effort. Of note, to reach the younger generation, there should be more social networking communications.
  1. High risk individuals in our communities need to be a focus of the effort, foreign born legal immigrants and refugees and unauthorized immigrants who have higher rates of stress, lower rates of being immunized and participating in public health programs.[1]
Estimates are that in 2005, foreign born were 37.5 million persons, 30 percent being unauthorized immigrants and 7 percent being refugees. This group is critical to public health planning because they are at higher risk of not participating in preparedness programs during public health emergencies due to fear of deportation or fear of government.
  1. Emergency preparedness should include sustainable support of local public health education, medical and mental health services targeted to Hispanic patients.
Services developed for national health security must be coordinated at the Federal, State and local levels with the Hispanic community and should be announced throughout the year at certain key Hispanic celebrations or with national health months ---in the schools and in the community. As recommended in the IOM Report, the Future of the Public’s Health, the Department of Health and Human Services should provide a forum for the development of an incentive-based Federal-State-funded system to sustain a governmental public health infrastructure that can assure the availability of essential public health services to every American community and can monitor progress toward this goal.[2]
  1. A prepared public health workforce is needed to deal with the Hispanic community.
Hispanics make-up only 5 percent of the total physicians and 2 percent of the nurses and probably less of the public health leadership at the Federal, State and local levels. The National Health Security Strategy should support targeted recruitment and outreach to Hispanic college and graduate students for entry level and mid-management public health program positions to be mentored into the future decision-making positions. In addition, there should be a concerted attempt to diversify the leadership positions of key public health institutions at Federal, State, local level.
Cultural competence training should be mandatory for the managers and outreach workers in the programs with an expansion of the programs developed by the Office of Minority Health working with state offices of minority health and health professional organizations.
Medical and public health emergency preparedness should be incorporated into the curriculum of the health professions as well as into continuing education of physicians and nurses and in-service training for public health departments and hospitals and in the accreditation of hospitals.
As for future public health strategies, I will end with the summary quote from the Drexel University and HHS Office of Minority Health Summit on Public Health Emergencies of 2008 –Such a strategy must recognize and emphasize the importance of distinctive individual and community characteristics such as culture, language, literacy and trust, and promote the active involvement and engagement of diverse communities to influence understanding of, participation in and adherence to public health emergency preparedness actions”.[3]

[1] B Truman et al, “Pandemic Influenza Preparedness and Response Among Immigrants and Refugees,” American Journal of Public Health, 99, no S2 (2009).
[2] The Future of the Public’s Health in the 21st Century, Institute of Medicine, Washington, DC, 2003, p.169
[3] Drexel University Center for Health Equality HHS Office of Minority Health June 11, 2008
4D. Andrulis, N.J. Siddiqui, and J. Gantner, “Preparing Racially and Ethnically Diverse Communities for Public Health Emergencies,” Health Affairs 26, no.5 (2007).

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