Texas is a big state with a big population. To be singled out as one of the most powerful and influential people in the Lone Star state is quite an achievement, and it’s one that Norma Martinez Rogers, Ph.D., R.N., F.A.A.N., can now celebrate.
Rogers, a clinical nursing faculty member at the University of Texas Health Science Center in San Antonio, was named one of the “Most Powerful and Influential Women in Texas” by the National Diversity Council in April 2011. She was one of 20 women given the title at the seventh annual Texas Diversity and Leadership Conference.
The National Diversity Council had ample accomplishments to review when considering Rogers as one of their honorees, particularly with regard to her mentoring initiatives. She founded the Juntos Podemos (Together We Can) mentoring program in 2000, with just 20 students. Since then the program has served about 2,400 students, around 200 each semester.
In 2010, both the Health Resources and Services Administration and Congressional Hispanic Caucus gave Rogers $900,000 and $500,000 grants, respectively, to support her mentoring programs. In her current role in the Department of Family and Community Health Systems, Rogers has developed even more mentoring programs specifically for diverse nursing students.
In addition to a slew of organizational roles, including a member of the U.S. Department of Health and Human Services’ Office of Minority Health’s Movilizandonos per Nuestro Futuro (as a part of the steering committee), the commissioner of the Medicaid and CHIP Payment and Access Commission, and a member of the Congressional Hispanic Caucus, Rogers also led the National Association of Hispanic Nurses from 2008–2010.
Find out more about the award and next year’s 2012 Texas Diversity and Leadership Conference at www.texasdiversityconference.com.
National Alliance for Hispanic Health 1501 Sixteenth Street, NW Washington, D.C. 20036 (202) 387-5000 Email: [email protected] www.hispanichealth.org
The National Alliance for Hispanic Health was founded in 1973 by a group of mental health professionals to improve the treatment of Hispanics by the mental health system. Within a few short years, the group had expanded its mission to addressing the health care needs of Hispanic families. Thirty-one years later its mission is multifaceted and includes helping consumers and providers, as well as promoting the appropriate use of technology, improving the science base for accurate decision making, and promoting philanthropy.
Since the Alliance was founded, the percentage of Hispanics in the United States has grown, and the needs of the community have changed. But the Alliance has maintained the same principles since the beginning: seeking out community-based solutions, representing all Hispanic groups, and refusing funding from alcohol and tobacco companies.
The U.S. Census Bureau predicts that by the year 2020, Hispanics will account for 18% of our total population (according to the Alliance, by 2050, that number is expected to reach 25%.) Although Hispanics have longer life expectancies than Americans of other ethnic and racial backgrounds, they are more likely to suffer from chronic illnesses. The exact causes for these discrepancies are unknown, but the Alliance hopes to keep such issues a major area of concern and research for the medical and scientific communities.
What does this mean for allied health care providers? According to Jane L. Delgado, president and CEO of the Alliance, those who provide health care to Hispanic people must understand and appreciate the culture. She adds that merely understanding the language or being tolerant of non-English speakers is not enough. In an interview with DAHC, Delgado talks about the AllianceÕs missions and challenges and what health care workers can do to help.
One of the Alliance’s missions is to raise ‘cultural proficiency’ among providers. What does the term mean and why is it significant in the medical treatment of Hispanics?
In the 1990s, cultural competency was the term used to encompass the ability to value another language or culture. The lessons learned were that the least competent providers believed themselves to be competent and that competency was inadequate for the often-intimate interaction that underlies the therapeutic encounter. What was needed was at the more advanced level of cultural proficiency in which a different language and culture is held in high esteem. This concept is an essential part of the clinical interaction. The interaction between provider and patient requires that the provider recognize and incorporate the values of the patient into their clinical work.
What can providers do to improve their treatment of Hispanic patients? What are common problems that could be avoided?
To improve treatment of Hispanics, providers must rely on what Pete Duarte, former CEO of Thomason Hospital in El Paso, Texas, defined as the ‘R&D’of good clinical care, (i.e., Respect and Dignity.) As a first step, providers should understand that the mentality of compliance is not helpful. Instead, all clinical encounters need to occur in a positive environment where the major theme is ‘working together.’ While this is true for all patients, it is more so the case with Hispanic patients because of the decades of disconnect with the health provider community.
At a fundamental level, the issue of language spoken must be addressed. While it is unlikely that every provider can communicate in the same language as every patient, there is a need to have mechanisms in place to make possible communication when the language of the patient is not English. At a minimal level, well meaning providers need to understand that interpreting is a skill that must be learned; merely being able to speak a language does not make a person skilled. There are some simple cautions to keep in mind, e.g., use of pantomime is open to misinterpretation and that speaking slowly and loudly will not make English understood by a non-English speaker.
Hispanics live longer than other ethnic groups in the United States, yet suffer a higher incidence rate of diabetes, depression and arthritis. What is the Alliance doing to improve the quality of life for Hispanic people with chronic illnesses?
We work through our four centers to improve the quality of life for Hispanics: 1. Center for Consumers operates national information help lines (for general information (866) SUFAMILIA and for prenatal care (800) 504-7081); develops materials on a variety of health topics; works with youth to involve them in health; reaches out to consumers to make sure they have the latest information to make healthier decisions about their lives; and, through the action forum on our Web site, directs communication by individuals with their elected officials.
2. Center for Providers improves the cultural proficiency of providers through training and technical assistance, works with community-based organizations, and forms local and national coalitions to address health issues.
3. Center for Technology works to ensure that Hispanics benefit from the appropriate use of technology. As founding board members of the Patient Safety Institute, we strive to make sure that the most accurate data are available at the point of care.
4. Center for Science and Policy works with the National Institutes of Health and the greater research community to understand how basic science, risk factors, treatment and outcome apply to Hispanics; to increase the number of Hispanics in the sciences; and to fill the gap between the bench and the bedside. All of our knowledge from consumers, providers, technology and science drive what we do in the policy area.
What is the most significant project the Alliance is involved in now?
All of our projects are significant to the 25 dedicated national staff who have made their life work improving the health of Hispanics. We understand that each project helps us to fulfill our mission regardless of whether it is releasing our report on genes and Hispanics, answering the concerns of a consumer who does not know where there is a clinic close to their home, or launching a national campaign to make sure that older Hispanics obtain the new prescription drug discount card.
What type of research is the Alliance advocating to be conducted in the upcoming years?
We want good research that is inclusive of Hispanics in a way that insures a healthy lifespan for all. We need research that creates models of health, risk factors, diagnosis, treatment, and follow-up that include and explain the Hispanic experience.
How can allied health professionals and students help the organization’s missions?
You can do several things:
Keep us informed of emerging issues and opportunities to improve health.
Become a member of the Alliance.
Be an active member of your respective professional organization.
Make your voice heard by communicating with elected officials. Our Web page (hispanichealth.org) has a new feature ÒAction ForumÓ that makes it easy for you to track legislation of interest to you and send an email to your elected representatives.
In less than 50 years Hispanics are expected to make up one fourth of the population in this country. How far has the medical community come in treating this growing patient population at the same level as the population at large, and how far does it have to go to meet the resulting challenges?
All of our projects are significant to the 25 dedicated national staff who have made their life work improving the health of Hispanics. We understand that each project helps us to fulfill our mission regardless of whether it is releasing our report on genes and Hispanics, answering the concerns of a consumer who does not know where there is a clinic close to their home, or launching a national campaign to make sure that older Hispanics obtain the new prescription drug discount card.
The answers are simple: 1. Not far enough, 2. How far we have to go varies by where we are. The important point is that by working together we will all get there and enjoy healthier lives.
According to the most recent U.S. Census, Hispanics are the nation’s largest and fastest-growing minority group, accounting for 13% of the total population. Moreover, that figure is expected to rise to more than 25% by 2050. Yet in many parts of the country, Hispanics continue to face substantial health disparities, including underinsurance, a lack of linguistically and culturally competent health care providers, and disproportionately high rates of serious chronic diseases such as asthma, diabetes, cancer and HIV/AIDS.
[ads:education]
In a nationwide effort to reduce these gaps, the Department of Health and Human Services (HHS) has launched the “Su Familia” National Hispanic Family Health Helpline (866-783-2645/866-SU-FAMILIA), a toll-free bilingual information center for Hispanic health consumers. Open to callers from 9 am to 6 pm Eastern Time, Monday through Friday, the helpline provides free, confidential health information in English and Spanish, as well as referrals to local health care providers and to federal assistance programs like the State Children’s Health Insurance Program (SCHIP).
Su Familia (Spanish for “your family”) is designed to give Hispanic individuals and families basic health information to help them prevent, manage and receive treatment for chronic health conditions. The helpline is staffed by bilingual health information specialists who can answer callers’ questions, refer them to one of over 16,000 local health providers (including community and migrant health centers) and provide bilingual fact sheets on a variety of health topics, including asthma, cancer screening, diabetes, cardiovascular disease, immunizations, HIV/AIDS and domestic violence.
Supported by HHS’ Health Research and Services Administration (HRSA) and the Office of Minority Health, Su Familia was developed and is operated by the National Alliance for Hispanic Health. The Alliance also provides two other bilingual helpline services: the National Hispanic Prenatal Helpline (800-504-7081) and the National Hispanic Indoor Air Quality Helpline (800-SALUD-12).
The recent discovery of the major susceptibility gene for type 2 diabetes in Mexican Americans—10.6% of whom are inflicted with the disease—is being hailed as a major accomplishment. This finding, previously considered a genetic impossibility, will ultimately result in medical advancement for the treatment of type 2 diabetes.
As reported in the October issue of Nature Genetics, this breakthrough by researchers from the University of Texas-Houston Health Science Center, the University of Chicago and several supporting centers found a biochemical pathway leading to diabetes in Mexican Americans. The discovery offers a unique approach to prevention, diagnosis and treatment.
The identification of this gene is important to genetics researchers because it is the first time a genome-wide approach has successfully led to the discovery of a susceptibility gene responsible for a genetically complex disorder.
“[This] accomplishment is a tour de force,” says Dr. Allen Spiegel, director of the National Institute of Diabetes and Digestive and Kidney Diseases. “Actually identifying susceptibility genes for diseases such as diabetes has proved exceedingly difficult. [This discovery] is exciting for all individuals suffering from type 2 diabetes because it will lead to a greater understanding of the pathogenesis of type 2 diabetes and possibly to new forms of treatment.”
Researchers have found it particularly difficult to isolate the genes responsible for type 2 diabetes, because diabetes is not a single disease but a group of related disorders with similar symptoms. In addition, because type 2 diabetes is typically diagnosed after age 40 and results in a shortened life span, it has been hard to gather information from the large multi-generation families that are normally used for genetic studies.
However, this obstacle was overcome with the help of the Human Genetics Center of the University of Texas-Houston. The Human Genetics Team spent nearly 20 years studying and working with a community of Mexican Americans in Starr County, Texas—a group with very high rates of diabetes. The team provided extensive family histories, clinical data and DNA samples from 330 pairs of brothers and sisters affected by diabetes.
“People kept telling us it was impossible,” recalls research team leader Graeme Bell, a professor of biochemistry, molecular biology and medicine at the Howard Hughes Medical Institute at the University of Chicago.
[ads:other]
While this genetic variation on its own does not cause diabetes, the gene interacts with lifestyle factors such as diet and exercise to put people at greater risk of developing the disease.
The combination “is not the whole story of genetic liability,” Bell says. “But we think it accounts for about 14% of the risk in Mexican Americans and about 4% in Europeans.”
The ambitious goal of the U.S. Department of Health and Human Services (HHS)’s Healthy People 2010program is to ensure good health and long life for all Americans. By definition, the term “all Americans” would obviously include Hispanics. But according to some of the nation’s most influential Hispanic health leaders, Healthy People’s commitment to meeting the needs of America’s largest and fastest-growing ethnic minority group is questionable at best.
In a policy brief entitled Healthy People 2010: Hispanic Concerns Go Unanswered published earlier this year, the Washington-based National Alliance for Hispanic Health argues that:
Over one-third (40%) of Healthy People 2010’s population-based objectives do not include Hispanic baseline data, and therefore progress on these objectives cannot be measured for Hispanic communities.
More than two-thirds (86%) of recommendations submitted by Hispanic community leaders during the public comment period for Healthy People 2010 are not fully incorporated into the program’s final objectives.
The Alliance’s 46-page report not only contains extensive evidence in support of these charges but also presents recommendations for making Healthy People more responsive to the priorities of Hispanic communities. The organization is urging HHS to act on these recommendations when the program comes up for its mid-course review in 2005. For more information, or to receive a copy of the report, contact the National Alliance for Hispanic Health at (202) 387-5000 or visit www.hispanichealth.org.
