CULTURE AND RESILIENCE IN LATINO HEALTH
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This document summarizes a presentation given by Dr. Efrain Talamantes on culture and resilience in Latino health, past, present, and future. The presentation discusses how cultural strengths can be leveraged to improve health equity for Latinos. It outlines five strategies for making health equity a priority in healthcare organizations: making it a leader-driven priority, developing supportive structures and processes, taking actions to address social determinants of health, confronting institutional racism, and partnering with community organizations. The presentation then explores how personal experiences with language barriers, low income, and lack of resources can build qualities needed in healthcare providers today, like being bilingual and culturally competent.
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CULTURE AND RESILIENCE IN LATINO HEALTH
- 1. CULTURE AND RESILIENCE IN LATINO HEALTH: PAST, PRESENT AND FUTURE Efrain Talamantes, MD, MBA, MSc, Medical Director AltaMed Institute for Health Equity Elevating Equity
- 2. 2words and ideas can change the world No matter what people tell you
- 3. Internal Medicine Primary and Preventative Care Physician Hospital Medicine Health Services Researcher Teacher and Mentor Leader in Equity, Diversity & Inclusion in Health and Healthcare
- 4. Health Equity as a Core Strategy 1. Make health equity a leader-driven priority 2. Develop structures and processes that support equity 3. Take specific actions that address the social determinants of health 4. Confront institutional racism and other isms within the organization 5. Partner with community organizations 4 Kedar S. Mate, MD &Ronald Wyatt, MD, MHA
- 5. 2014 2019 Today 2014 2015 2016 2017 2018 2019 Hablamos juntos (together we speak): a brief patient-reported measure of the quality of interpretation. Patient Related Outcome Measures. Community College Pathways: Improving the U.S. Physician Workforce Pipeline. Academic medicine : journal of the Association of American Medical Colleges. 2014 Improving Health Care for the Future Uninsured in Los Angeles County: A Community-Partnered Dialogue. Ethnicity & Disease. 2015 Predictors of Primary Care Physician Practice Location in Underserved Urban and Rural Areas in the United States: A Systematic Literature Review. Academic medicine : Journal of the Association of American Medical Colleges. 2016 Strengthening the Community College Pathway to Medical School: a study of Latino students in California. Fam Med. 2016 Linguistic Isolation and Access to the Active Kidney Transplant Waiting List in the United States. Clinical Journal of the American Society of Nephrology : CJASN. 2017 Interest in Family Medicine Among U.S. Medical Students and its Association to a Community College Academic Pathway. Fam Med. 2017 Intensive procedure preferences at the end of life (EOL) in older Latino adults with end stage renal disease (ESRD) on dialysis. BMC Nephrology. 2017 Medical School Performance of Socioeconomically Disadvantaged and Underrepresented Minority Students Admitted after a Multiple Mini-Interviews. J Health Care Poor Underserved. 2018 U.S. Medical Students who Attended Community College during High School are More Likely to Train in Family Medicine. Ann Fam Med. 2018 The Termination of Deferred Action for Childhood Arrival (DACA) Protections and Medical Education in the U.S. 2019 Closing the Gap — Making Medical School Admissions More Equitable. New England Journal of Medicine, vol. 380, no. 9 2019 Publications
- 7. Health Equity as a Core Strategy 1. Make health equity a leader-driven priority 2. Develop structures and processes that support equity 3. Take specific actions that address the social determinants of health 4. Confront institutional racism and other isms within the organization 5. Partner with community organizations Kedar S. Mate, MD &Ronald Wyatt, MD, MHA Mercedes Jara 1929 - 2009
- 8. 8 1984
- 9. 9
- 10. “Just another wetback. You know the kind.” ― Sandra Cisneros
- 11. 11 Weakness or Strength? Personal Experiences growing up • English as a Second Language • Immigrant • Low educational background • Low income • Lack of resources Qualities we need in healthcare today • Bilingual physicians • Culturally competent • Understand how to navigate complex systems • Resource conscious decision making
- 12. “A reliable way to make people believe in falsehoods is frequent repetition, because familiarity is not easily distinguished from truth. Authoritarian institutions and marketers have always known this fact.” ― Daniel Kahneman
- 21. Equity as a moral compass
- 24. 24
- 25. 25 “We build a road out for people in need, people in poverty, people who because of poverty and racism and other barriers may have constrained and limited aspirations that we help to unlock by addressing their health needs,” - Dr. Jack Gieger
- 27. FQHC’s are well- positioned to fully address the root causes of poor health. Nearly 85 million Americans live in designated Health Care Professional Areas (HPSAs) Primary care physicians have to address an average of 3.8 problems every 15-minute appointments Today, we understand that the health of our patients is driven in large part by the conditions in which they are born, grow, live, work, and age — what we call the social determinants of health
- 28. FQHC-PCSAs were more likely to be high poverty areas (27.9% vs. 11.8%) and with higher proportions of disadvantaged populations 28 Geographic Expansion of Federally Qualified Health Centers 2007-2014 Chiang-Hua Chang, PhD,1 Julie PW Bynum, MD, MPH,2 and Jon D. Lurie, MD MS1,3 J Rural Health. 2019 Jun; 35(3): 385–394
- 29. “The beginning of all wisdom is to understand that you don't know. To know is the enemy of all learning. To be sure is the enemy of wisdom.” ― Victor Villasenor, Burro Genius: A Memoir
- 30. How do we measure quality in healthcare? Donabedian model
- 31. Six Dimensions of Health Care Quality Fundamentals of Health Care Improvement: Q101 Safe: Avoiding injuries to patients from the care that is intended to help them Timely: Reducing waits and sometimes harmful delays for patients and providers Effective: Providing the appropriate level of services based on scientific knowledge Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy Equitable: Providing care that does not vary in quality because of personal characteristics Patient-Centered: Providing care that is respectful of and responsive to individual patients
- 32. Disparity, Difference, Inequality, Inequity and/or Injustice? • African Americans, American Indians, and other racial and ethnic groups live shorter lives with a greater burden of ill health than white Americans. But why is this a disparity? Is disparity merely a difference between two groups, or is it a difference with negative and even malignant connotations? Inequality, Inequity, or Injustice?
- 33. Race • Race is a social classification based on phenotype and a marker for exposure to social factors that can influence health, including socioeconomic position, lifestyle habits, and use of health care
- 34. Ethnicity • Ethnicity is also a social construct referring to the sharing of a culture, including ancestry, language, religion, and traditions
- 35. Health Disparities • Agency for Healthcare Research and Quality (AHRQ) defines disparities as any differences among populations that are statistically significant and differ from the reference group by at least 10 percent. • Institute of Medicine (IOM) defines disparities as “racial or ethnic differences in the quality of health-care that are not due to access- related factors or clinical needs, preferences, and appropriateness of intervention. • World Health Organization (WHO) defines disparities as “differences in health which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust.
- 36. 2002 Institute of Medicine: Unequal Treatment • Racial & ethnic variation in quality of health care that are not due to • Access-related factors • Patient preferences • Clinical needs • Appropriateness of intervention
- 37. Differences, Disparities, and Discrimination: Populations with Equal Access to Healthcare
- 38. Disparities in Health Process & Treatment • Hispanics and African Americans less likely to receive rehabilitative care after traumatic brain injury.6 • Hispanic and African-Americans receive less curative surgery than whites for non-small cell lung cancer.7,8 • Hispanics less likely to receive smoking cessation messages.9 • African-Americans and Latinos receive less pain medication than whites for long bone fractures and cancer.11-13
- 39. Disparities in Health Outcomes • Infant mortality rates are 2X as high among African-American infants as whites.1,2 • Minority groups suffer and die disproportionately from conditions such as cardiovascular disease, diabetes, asthma, cancer, and HIV/AIDS.3 • American Indians and Alaska Natives die at higher rates than other Americans from tuberculosis (750% higher), alcoholism (550% higher), diabetes (190% higher.4 • Asian American and Pacific Islanders had the highest number of (TB) case rates (33 per 100,000) of any racial and ethnic population in 2001.5
- 40. Health Equity • Everyone has a fair and just opportunity to be healthier. • This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care
- 41. Health Equity Measurement • Measures that reduce and ultimately eliminate disparities in health and its determinants that adversely affect excluded or marginalized groups
- 42. Social Determinants of Health (WHO) • The conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.
- 44. Social Determinants of Health
- 47. What kind of social determinist are you? Downstreamist • Factors that are temporally and spatially close to the health effects (and hence relatively apparent), but are influenced by upstream factors) Upstreamist • Fundamental causes that set in motion causal pathways leading to (often temporally and spatially distant) health effects through downstream factors) • These factors are the most important opportunities for improving health and reducing health disparities
- 49. In the first image, it is assumed that everyone will benefit from the same supports. They are being treated equally. In the second image, individuals are given different supports to make it possible for them to have equal access to the game. They are being treated equitably. In the third image, all three can see the game without any supports or accommodations because the cause of the inequity was addressed. The systemic barrier has been removed.
- 50. 50
- 52. U.S. Community College Students 52 13% 23% 40% 56% 0% 10% 20% 30% 40% 50% 60% Black Latino Low Income Women American Association of Community Colleges 2017
- 53. Medical School Applicants who attended Community College 53
- 54. College pathways to medical school High School University Medical School Community College 54
- 55. Elite Slides Keynote Presentation Number of Latino healthcare professionals isn't keeping pace with population, study says Background Quality Health Care for all. Culture & Language Pathways to career in medicin Mentors Why Medicine? Our Story
- 56. Community of and current health professionals Mentoring Tools to enhance pathways to health professions Up-to-date information & resources to rapidly support our students, trainees, and communities MiMentor’s Mission To develop and support innovative mentoring opportunities to inspire the next generation of healthcare leaders for underserved communities
- 57. 43
- 58. 44
- 59. Identity - Gender - Religion - Socioeconomic status - Multiple identities Friends, Mentors Role Models, Relationships First Generation Life Experiences Immigrant Experience Family & Community Values - Resilience - Competing Priorities MiMentor.org a mentoring community for aspiring and current health care profession Fears, hopes and dreams
- 61. National Impact Community - Student - Trainee - Practice in the Community cc:GustavoG-https://www.flickr.com/photos/80122196@N00 45
- 62. As a first generation aspiring Latina physician, MiMentor has provided me with mentors who have helped me successfully gain acceptance to various medical schools where I will serve our growing Latino population. 50
- 63. 63 AltaMed Legacy Elementary, Junior, High School & College Graduate, Nursing, Medical School Graduate Medical Education & Fellowships Practice § Escalera & Lideres § Youth Champions § HCOP Ambassadors & Academy § AmeriCorps § Health Career Connections (HCC) § AltaMed Fellows § NMF Primary Care Leadership Program § UCI PACE Clerkship § Partnerships such as CDU & UCLA PRIME § LMSA & NHMA Sponsorships § Scholarships § Primary Care, HIV, Geriatrics § Urgent Care § Hospitalist § Leadership § Informatics § Quality & Safety § Medical Management § Health Education & Wellness § Teaching § Research § NHMA Advancement & Retirement Building a Culture of Learning and Teaching § AltaMed Clinical Experience (ACE) Elective Rotation § Lecture Series § CHLA Pediatric RP § Future FMRP § Medical Education § Physician Leadership Development Program § Primary Care Champion Fellowship § Long-Term Incentive Plan (457f) § Succession Planning
- 64. 64 National Medical Fellowships Primary Care Leadership Program 2018
- 66. Nearly 20 million or one in four children have at least one immigrant parent
- 67. PUBLIC CHARGE
- 68. Barriers to Civic Participation Patients I don’t know how to vote?- Patient- M.L. Why should I vote…does it matter? Patient- J.S. There are generations of American born Latinos who have never voted. No one has ever taught them how to. Advocate- J.C. Healthcare Professionals The communities we serve are severely underserved, they don’t get better because of the conditions where they live, work, grow. Medical Leader- R.M. Do healthcare professionals care if their patients vote? Physician- A.L. 68
- 69. 69
- 70. Key Issues Social Determinants of Health: Housing, Education, Food, Healthcare, Criminal Justice System Reform, Immigrants, Climate Change Medicare reform, regulations, electronic health records, student debt relief, telemedicine, prescription drug abuse and addiction, and prescription drug pricing. 70
- 72. Social Determinants of Health 72 Current State Future State
- 73. GOTV Campaign at AltaMed
- 74. 74 Voter Engagement & Mobilization Current State Future State
- 77. Recommended Reading Unequal Treatment- IOM Burro Genius- V. Villaseñor Outliers- M. Gladwell Good to Great- J. Collins Thinking Fast and Slow- D. Kahneman The Power of Positive Deviance- R. Pascale 77
Editor's Notes
- This painting was originally produced on 1931. Rivera looked to represent the individuals of Mexico through painting, and in doing so, he captured the country's essence. In the painting Peasants, the workers reflect Mexico's culture, people, struggle, and even its social/political structure. In this way, the simple image of a peasant can be both specific and universal. Any daughter of industry or son of agriculture could look at that painting and see Mexico. By covering a deep yet simplistic meaning in his paintings, Rivera often unified his people through his art.
- Esperanza Cordero is relating the story of Geraldo, who was killed in a hit-and-run accident. She thinks this is how the (likely non-Hispanic) police officers and medical personnel feel when a Mexican kid with no identification shows up in the emergency room. They don't care about him because he's not like them.
- Our Lady of Guadalupe (Spanish: Nuestra Señora de Guadalupe), also known as the Virgin of Guadalupe(Spanish: Virgen de Guadalupe), is a Catholic title of the Blessed Virgin Mary associated with a venerated image enshrined within the Minor Basilica of Our Lady of Guadalupe in Mexico City. The basilica is the most visited Catholic pilgrimage site in the world, and the world's third most-visited sacred site.[1][2] Pope Leo XIIIgranted the venerated image a Canonical Coronation on 12 October 1895. Religious imagery of Our Lady of Guadalupe appears in Roman Catholic parishes, especially those with Latin American heritage.[70] In addition, due to the growth of Hispanic communities in the United States, religious imagery of Our Lady of Guadalupe has started appearing in some Anglican, Lutheran, and Methodist churches.[70] The iconography of the Virgin is fully Catholic:[71] Miguel Sanchez, the author of the 1648 tract Imagen de la Virgen María, described her as the Woman of the Apocalypse from the New Testament's Revelation 12:1, "clothed with the sun, and the moon under her feet, and upon her head a crown of twelve stars.” She is described as a representation of the Immaculate Conception.[53] Virgil Elizondo says the image also had layers of meaning for the indigenous people of Mexico who associated her image with their polytheistic deities, which further contributed to her popularity.[72] Her blue-green mantle was the color reserved for the divine couple Ometecuhtli and Omecihuatl;[73] her belt is interpreted as a sign of pregnancy; and a cross-shaped image, symbolizing the cosmos and called nahui-ollin, is inscribed beneath the image's sash.[74] She was called "mother of maguey,"[75] the source of the sacred beverage pulque.[76] Pulque was also known as "the milk of the Virgin."[77] The rays of light surrounding her are seen to also represent maguey spines.[75]
- Please limit to 3 objectives
- Moneta Sleet Jr. (American, 1926–1996). Rosa Parks, Dr. and Mrs. Abernathy, Dr. Ralph Bunche, and Dr. and Mrs. Martin Luther King, Jr. leading marchers into Montgomery, 1965, printed circa 1970. Gelatin silver print, 13 3/8 x 10 3/4 in. (34 x 27.3 cm). Saint Louis Art Museum, Gift of the Johnson Publishing Company, 426:1991. © Johnson Publishing Company, LLC Civil rights movement and President Johnson’s War on Poverty Dr. H. Jack Geiger, a young doctor and civil rights activist, witnessed how community-based care had brought about astonishing health improvements for the poorest citizens of South Africa. Dr. Geiger and others submitted proposals to establish health centers in medically underserved areas based on the South African model. Funding for the first two “Neighborhood Health Centers” – one in Boston, MA, and the other in Mound Bayou, MI – was approved in 1965.
- In this March 7, 1979, file photo, United Farm Workers President Cesar Chavez talks to striking Salinas Valley farmworkers during a large rally in Salinas, CalifSource: http://us.pressfrom.com/news/us/-36835-students-to-stay-home-farmworkers-to-march-for-cesar-chavez/
- The power of maps: exploring the frontiers of geospatial analysis to address health equity Andrew Bazemore MD MPH Community Oriented Primary Care- is an approach to health care delivery that is responsible for the health of a defined population- epidemiologic and social interventions.
- Dr. Geiger initiated the community health center model in the USA, founding and directing the nation’s first two community health centers, in the Mississipi Delta and in Columbia Point, Boston. These centers became models for what is now a national network of more than 1000 CHCs serving some 17 million low-income and minority patients.
- The Donabedian Model is a conceptual model that provides a framework for examining health services and evaluating quality of health care.[1]According to the model, information about quality of care can be drawn from three categories: “structure,” “process,” and “outcomes."[2] Structure describes the context in which care is delivered, including hospital buildings, staff, financing, and equipment. Process denotes the transactions between patients and providers throughout the delivery of healthcare. Finally, outcomes refer to the effects of healthcare on the health status of patients and populations.[2] Avedis Donabedian, a physician and health services researcher at the University of Michigan, developed the original model in 1966.[3] While there are other quality of care frameworks, including the World Health Organization (WHO)-Recommended Quality of Care Framework and the Bamako Initiative, the Donabedian Model continues to be the dominant paradigm for assessing the quality of health care.[4]
- So why study the community college? There are approximately 8 million community college students in the US. For example, there are 112 community colleges in California This figure shows the percentage of women, low income and minority students in the community college system. Community colleges are a gateway to higher education for these students. Prior to this study, there was no research exploring the community college as a pathway to medical school.
- One in four physicians didn’t vote in all of the last three presidential elections.
- Current State Chronic Disease Prevention Systems Change: Healthy Communities, Healthy Lives Coalition Environmental Advocacy: WECAN Initiative Healthy Communities, Healthy Lives initiative in Southeast Los Angeles Purpose: Increase access to healthy food options, opportunities for physical activity, and utilization of community-based chronic disease prevention and management programs. Future State Large Scale and Long Term Health Equity Programs through AltaMed’s Institute of Health Equity Development of a 5-year Healthy Southeast LA Plan Pilot programs in SELA Initiate and Activate Youth Leadership Development The long-term programmatic strategy is to develop and implement a 5-year Healthy Southeast LA Plan that is informed by the community to address the social determinants of health. This 5-year plan will complement the existing Southeast Collaborative Three-Year Plan by adding an intentional a health equity perspective to the existing plan, including a roadmap for each of the health priority focus areas outlined above, and outlining strategies for each type of stakeholder (residents, community-based organizations, health organizations, schools, government and the philanthropy sector). This will be among the first initiatives to comprehensively address the health needs of the Southeast LA communities.
- Current State Get Out The Vote Campaigns in LA & OC: Primary & General Elections To date, reached over 600,000, over 17,000 Yes Commitments to Vote Voter Registration: Registered 2,300 new voters this year Voter Education in community & local high schools (High School Democracy Project) Strategic Partnerships: City of Los Angeles, community colleges, high schools, community based organizations Development of Youth Advocates: AltaMed Health Fellows, Escalera & Lideres Future State Development of Get Out the Vote Statewide Model Get Out The Census Build Community Leadership Capacity through AltaMed Advocacy Leadership Program Partnerships City of Los Angeles Swearing In Ceremonies Community Colleges: East Los Angeles Community College, Santa Ana City College (Town hall or Candidate Forum), Norco Community College- Riverside County, Riverside Community College. High Schools: Roosevelt High School, Miguel Contreras Academic Leadership Community School- Los Angeles, Southeast High School- South Gate. Community-based organizations and government entities: Mi Familia Vota: LA & OC OCCORD: OC NALEO Unidos US (Formerly NCLR) Mexican American Opportunity Foundation (MAOF) Office of Mayor Eric Garcetti, City of Los Angeles Youth Council (2019 & 2020)