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Importante: Facing Health Disparities in Ohio’s Hispanic Population Civil Rights Act of 1964 Gaps in adequate health care for different cultures and ethnicities, specifically the Hispanic population, are no longer an issue solely for southern and western states. Though the number of Hispanic residents in the Midwest remains lower than other areas of the country, Ohio experienced a 36 percent increase in the Hispanic population from 1990-2000, eclipsing the 4.5 percent increase in the state’s overall population. Nationally, the Hispanic population surpassed other minorities in 2000 to become the largest minority population in the country—12.5 percent of the U.S. population is Hispanic and 11 percent rely on Spanish as their primary language. Hospitals, like many other organizations, are confronted with new challenges in offering effective services to a Spanish-speaking population with different cultural norms, beliefs and frameworks. Though Ohio’s hospitals work to fulfill the promise of the Civil Rights Act of 1964 in their missions to provide the best care possible to their communities, many Hispanics residents of Ohio and throughout the U.S. still face the challenge of adequate health care. The U.S. Census Bureau reported three times as many U.S. Hispanic children than non-Hispanic white children had no type of health insurance in 2001. The Commonwealth Fund found Spanish-speaking Hispanics have poorer health status, are less likely to have a regular doctor and often do not have insurance, relying instead on public or community health care. Confronting language and cultural differences through improved patient-physician communication and access to affordable care will help hospitals continue to improve care to Ohio’s Hispanic population. Lack of insurance coverage, combined with cultural norms that may not encourage seeking care, contribute to the high volume of the Hispanic population not visiting a health care provider, or not choosing the appropriate provider. Even if Limited English Proficient patients visit a provider, they may be unable to comprehend diagnoses, treatment instructions or follow-up and medication instructions. Miscommunication compromises treatment and increases costs to hospitals due to inefficiency and unnecessary testing. The health care disparity dilemma has no single or simple answer. State and federal policy changes are one piece of the puzzle, programs and services instituted by individual hospitals and other organizations such as the Ohio Commission on Minority Health are a second. U.S. Congress this month introduced the Health Care Equality and Accountability Act of 2003, an effort to improve access for minority populations, increase cultural competence and diversity in the workforce and provide funding for research. The Health and Human Services’ Office of Civil Rights also developed several steps for battling health disparities. It encourages organizations to look at the language needs of the various populations they serve and seek out resources to meet those needs. It suggests developing and implementing Limited English Proficient policies and procedures, training staff in these policies, and annually monitoring the changing populations, their needs and current programs. Encouraging diversity among associates at all levels also helps alleviate language barriers and fosters awareness of cultural difference that may affect care. Promoting English proficiency among patients, translating written materials and seeking out third party interpreters—either in person, over the phone or through video conferencing—also help bridge the gap. The American Hospital Association (AHA) conducts a conference call series on related issues, with a Dec. 2 call on the interpreter services program at UMass Memorial Medical Center, Mass. AHA also launched a Web site, www.aha.org under “Racial and Ethnic Disparities,” with resources, best practices and more. Funding sources also exist, but are often unknown and unused. Though Ohio is not one of the nine states currently receiving direct reimbursement through Medicaid and SCHIP for language services, grants and matching funds are available through these programs, as well as grants from other organizations and foundations. Several facilities in Ohio are currently working to meet the needs of Hispanic patients. This month the Health Alliance of Greater Cincinnati, Cincinnati Children’s Hospital Medical Center and University of Cincinnati Medical Center brought together more than 900 community leaders, social workers, health experts and others for Closing the Gap, a conference dedicated to minority health care. Health Alliance also pledged $2 million over 10 years to form a center for health disparities. Mercy Health Partners, Springfield, in conjunction with various community organizations, offers two free clinics each summer to migrant workers and their families in Clark and Champaign Counties. Physicians, nurses, nurse practitioners and others volunteer time and services to see patients, distribute literacy information and give referrals. The Cleveland Clinic collaborates with El Barrio, a latino social services provider, on Creando Posibilidades, a $1.3 million bilingual health care nursing program. Increased awareness and the commitment to reach out to the growing minority populations are important steps in the journey of Ohio’s hospitals toward providing access to quality health care for all members of their communities.
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