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This piece by Alvaro Garza appeared in today's SF Chronicle. Right on Alvaro!
Latino health care is being left behind

Did you feel the quality of your health care improve last year? You may have missed it. The recent National Healthcare Quality Report from the U.S. Department of Health and Human Services found that, for 44 core measures, overall quality of care for Americans improved at a rate of 2.8 percent. It sounds small, but that's actually quite impressive for a nationwide improvement.

If you're Latino, however, your quality of care worsened. The companion National Healthcare Disparities Report found that inequities in quality of care and access to care are easing for all race and ethnic groups --except Latinos. Latinos received poorer quality of care than whites in more than half of 38 measures, and worse access to care for seven of eight measures. Nearly 60 percent of the disparities for 34 quality-of-care measures got worse for Latinos, and more than 80 percent of the disparities for access-to-care measures worsened for them.

The image this brings to mind is that, on the road to better health, most vehicles are moving forward, while the Latino car is going backward. An example of widening disparities is in the quality of diabetes care, which declined from 44 percent in 2000 to 38 percent in 2002 for Latino adults, while it improved from 50 percent to 55 percent among whites. This is all the more disappointing considering that Latinos have a higher prevalence of diabetes than other groups.

Another example is the quality of communication between patients and their health-care providers (as reported by patients), which declined from 87 percent to 84 percent among Latino adults, while it improved from 93 percent to 94 percent among whites.

Not all the federal government's findings were negative. An improved trend is access to a usual source of care, which increased from 77 percent to 78 percent for Latinos from 1999 to 2003, compared with an increase from 88 percent to 90 percent for whites. The report noted that more rapid improvement has occurred where there have been focused efforts to improve
performance, and that public reporting is a powerful tool for improvement.

This worsening of disparities for Latinos is bad news halfway through the decade for reaching Healthy People 2010, a federal initiative to achieve a number of health objectives by the end of the decade. One of its two goals is to reduce such disparities in our country. Often, reasons cited for the disparities relate to Latinos' language and cultural differences, lower education, greater poverty and underinsurance. Not often do we see any
focus on the health-care system being customer-unfriendly for many Latinos.

A major deficit of our health-care system is the lack of diversity in the health-care workforce. In "Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare", the Institute of Medicine recommended increasing the proportion of underrepresented racial/ethnic minorities among health professionals. They noted that the race/ethnic concordance between patient and health-care provider is associated with greater
patient participation in care processes, higher patient satisfaction and greater adherence to treatment. Also, minority health professionals are more likely than non-minorities to practice in underserved communities.

One objective of Healthy People 2010 is to increase the national representation of Latinos in the medical professional workforce to 12 percent. Nationally, and in California, this has been less than 5 percent for many decades. That goal is appropriate, because Latinos comprise 12 percent of the U.S. population. For California to contribute its fair
share, our medical-care workforce should be about 35 percent Latino.

Adding to the backward trend for Latinos, recent federal budget cuts have stopped in their tracks programs that were succeeding in improving the numbers of Latino health professionals.

It is time for California's universities and policy-makers to put more focused efforts in improving the health-care education and delivery for Latinos and to require regular public reporting on this performance.

Public and private funding to improve the diversity of the health-care workforce in our state should make up for the federal failing. One promising change for improving care for all is that, as of this July, continuing medical education geared toward patient care will be required to include training in cultural and linguistic competence.

It is urgent that the Latino health vehicle get up to speed in the proper direction. Only all of us pushing together can reverse the backward trend.

Alvaro Garza, MD, MPH, is an assistant adjunct professor in the Department of Family and Community Medicine and director of Health and Policy Research at the Latino Center for Medical Education and Research at UCSF Fresno.

by Alvaro Garza

The original article can be found on SFGate.com here

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