Impact of the ACA on Public Health Efforts to Address Latino Health Disparities:

Paula A. Espinoza, Ph.D.

Department of Ethnic Studies

University of Colorado Denver

Q1: Can we anticipate and get ahead of ACA impact to maximize our efforts to address Latino health disparities?

YES!

Anticipation to foresee a wish and perform in advance

(Webster’s New World Dictionary)

Foresight Familiarize ourselves with the Patient Protection

and Affordable Care Act (ACA) Read Title IV: Prevention of Chronic Disease &

Improving Public Health, p. 1114 Section 4302-Understanding health disparities data

collection and analyses

Familiarize ourselves with 2011 National Prevention Strategy document and other guides identified in the ACA

Resources for EBI’s and Guidance identified in ACA Center’s for Disease Control www.cdc.gov/ U.S. Preventive Task Force Clinical and

Community Preventive Services Guides www.uspreventiveservicestaskforce.org/

Agency for Healthcare Research & Quality www.ahrq.gov/

National Institutes of Health www.nih.gov Institute of Medicine www.iom.edu/

Foresight Reacquaint ourselves with evidence-based and

promising practices for health promotion and illness prevention, if needed

Expectation of funding to better support the work we have been doing

Key points identified in presentations today Increased access to healthcare Increased funding for health promotion and illness

prevention programs Increased need for a diverse workforce

Foresight “The history of the relationship between

the U.S. government and racial/ethnic minorities plays an important role in understanding why health disparities exist and how they might be eliminated*”

Recognize that undocumented residents will remain marginalized under ACA

*LaViest (2005). Minority Populations & Health, pg. 1

Perform now Let’s not get ahead by going back We don’t have to reinvent the wheel ACA presents an opportunity to reconvene

and organize, refocus, prioritize, strategize, and implement known EBI and best practices

Q2: What does the ACA mean in relation to how we plan and practice public health to reduce Latino health disparities? For Healthcare Systems For Individuals and Communities

Planning Take advantage of current known data to

identify level of participation in the ACA by Colorado Latinos

Collect additional data as needed Strategic planning or revive previous

strategic plans

Public Health Practice under ACA for Healthcare System Disparities:

Equality ≠ Equity Increased access does not guarantee

participation or outcomes Increased need for HCP and support staff

cultural competency training Increased need for medical interpreter training Great need for increased Px health literacy Increased need for interventions improving Px-

HCP communication and other interaction

Public Health Practice under ACA for Healthcare System Disparities:

Equality ≠ Equity Example: Annual Wellness Visits and a

Personalized Prevention Plan is included under ACA

Opportunity to market to Latinos Latino patients may benefit from patient

navigation services or education regarding this feature

Public Health Practice under ACA for Socio-environmental and Behavioral Disparities:

Communities and Individuals ACA identifies priorities for interventions addressing

Tobacco Cessation Increasing physical activity Better nutrition Top 5 killers (heart disease, cancer, respiratory disease,

stroke, unintentional injury) NEW AREAS: Mental & Behavioral health, oral health

Public Health Practice under ACA for Socio-environmental and Behavioral Disparities:

Effective interventions (evidence-based) Achievable goals, objectives, and timelines Community-based (partnerships,

collaborations, and with continual feedback)

Tied to current surveillance mechanisms (i.e. BRFSS)

Modest Suggestion for Moving Forward—Adapt the Public Health Preparedness Model for Terrorism

Regional and local Responders Operations Command—CDPHE/OHD? Engaged partnership Tiered response at different levels United effort Readiness to act (continuing coalition

building and capacity building/training)

Dedicated to Former Comadre Mary Helen DuranDedicated to Former Comadre Mary Helen Duran

Presente!Presente!1938-20131938-2013RIPRIP

Educated 1000sEducated 1000s

Navigated 1200Navigated 1200Latinas to receiveLatinas to receiveScreening Screening MammogramsMammograms

She made a She made a positivepositiveDifference forDifference forOur GenteOur Gente