Im Improvin ing Public lic Housin ing Healt lth Center Servic ice Deliv livery ry Through Cult ltural Competence and Healt lth Lit iteracy Learning Collaborative: Session 1 Wednesday, March 18, 2020
NATIONAL CENTER FOR HEALTH IN PUBLIC HOUSING DISCLAIMER: The National Center for Health in Public Housing (NCHPH), a project of North American Management, is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U30CS09734, a National Training and Technical Assistance Cooperative Agreement (NCA) for $608,000, and is 100% financed by this grant. This information or content and conclusions are those of the author and should not be Training and Outreach Research and construed as the official position or policy of, nor should any Technical and endorsements be inferred by HRSA, HHS or the U.S. Evaluation Government. Assistance Collaboration The mission of the National Center for Health in Public Housing (NCHPH) is to strengthen the capacity of federally funded Public Housing Primary Care (PHPC) health centers and other Increase access, quality of health care, and improve health health center grantees by providing training and a range of outcomes technical assistance. 2
MUTE CHAT RAISE HAND Q&A
Health Centers clo lose to Public Housing • 1,400 Federally Qualified Health Centers (FQHC) = 28.4 million • 385 FQHCs In or Immediately Accessible to Public Housing = 4.4 million patients • 107 Public Housing Primary Care (PHPC) = 817,123patients Source: UDS 4
5 Public Housing Demographics 2.2 million 2.2 persons/ 38% children residents household 55% less than 83.2% below 59% female high school federal diploma poverty
A Health Picture of HUD-Assisted Adults, 2006-2012 Adults in HUD-assisted housing have higher rates of chronic health conditions and are greater utilizers of health care than the general population. HUD- Low- All Adults Adult Smokers with Housing Assistance Assisted income renters 50 35.3% 33.6% Fair/Poor 35.8% 24% 13.8% 45 30.9% 40 Health 35 30 Overweight/ 71% 60% 64% 25 Obese 20 22% 15 Disability 61% 42.8% 35.4% 10 5 Diabetes 17.6% 8.8% 9.5% 0 Public Housing Housing Choice Multi Family Voucher COPD 13.6% 8.4% 6.3% Source: Helms VE, 2017 Asthma 16.3% 13.5% 8.7%
Child Health Outcomes • 76% lived at or below poverty level • 75% in single female-headed households (compared to 27% of the gen pop) • 4.3% in a household with a college degree or higher • 27% lived in a household without a high school diploma or GED. • 14.2% had two or more ER visits in the last year (compared to 8.5% in the gen pop) • More likely to miss school due to illness or injury. • 1 in 4 have a learning disability compared to 1 in 5 children in the general population. • 16% have ADHD or ADD (compared to 12.7% of children in the gen pop) Source: A Health Picture of HUD-Assisted Children 2006-2012 7
Impacts of Housing on Health 8
Percentage of Latino Population in PHPC Program and Health Center Program Settings PHPC Health Centers Percentage of Hispanic/Latino in PHPC Settings Percentage of Hispanic/Latino Population in HC Settings 41% 36% 59% 64% % of Hispanic/Latino in PHPC Settings % of Hispanic/Latino in HC Settings % of Non-Hispanic/Latino in PHPC Settings % of Non-Hispanic/Latino in HC Settings 9
Patients by Linguistic Barrier to Care PHPCs Health Centers Patients by Linguistic Barriers to Care Patients Best Served in a Language Other than English 24% 31% 69% 76% Patients Best Served in a Language Other than English Patients Best-Served in a Language Other Than English Patients Served in English Patients Served in English 10
Abdín Noboa-Ríos, Ph.D .D. 11
Making the Case: Increasing knowledge about the need for health literacy and culturally-competent care Abdín Noboa-Ríos , Ph.D. LC Session 1: March 18, 2020
Cult ltural Shif ifts in in America
True/false Quiz on Demography 1. Current demographic shifts across the country are uniquely different from previous shifts in U.S. history. ○ true ○ false 2. Demographic shifts always imply cultural change. ○ true ○ false 3. Current demographic shifts convey changes in the healthcare system. ○ true ○ false
Cult ltural Shif ifts in in America 1. 1. Demog Demograph phic tr ic tren ends ds wi will ll cha hang nge e the the f fac ace e of of America co America conside nsiderabl bly. 2. 2. As As a r a resu esult, c lt, cha hang nges es in de in demog mograph phy y wil will l alw always ays co convey cu ey cultur ltural sh al shifts. ifts. 3. 3. The hese se cu cultur ltural shifts wil al shifts will l ine inevita vitabl bly y lead lead to a to a dif differ eren ent t he health althca care e syste system. m. 4. 4. Suc Such h cha hang nges es in h in hea ealthca lthcare e wi will ll de deman mand d grea eater cultur ter cultural comp al compete etenc nce. e.
America’s Demographic Shift • By nature, this implies cultural changes. • This implies major adjustments. • It also implies changes in health care. • Current trends will continue long-term . Conclusion : As the Face of America is altered, conditions will change
Cultural Shifts Convey Changes in: Na Nation tional al cu cultur lture • Heigh Heighte tene ned d multicu multicultur lturalism alism • Div Diver erse se att ttitud itudes es an and d be beha havior viors • Music Mus ic • Foo ood • Dr Dres ess • Alte Altering ring wor orld views ld views • Grea Gr eate ter r div diver ersity sity • More li Mor e ling nguist uistic ic to toler leran ance ce •
The Challenge: Major growth among racial minorities will create challenging conditions nationwide • Latinos and Asian/Pacific Islanders are growing considerably faster than all other groups in America. • This will affect the delivery of health care significantly.
Significance The future of America is fully linked to the progress and prosperity of these rapidly growing populations. For America to succeed, Brown people must succeed.
1. 1. White te popul pulation tion is d dec ecreas easing ing at t 5% 5% yea early y 2. 2. Blac ack popul pulation tion has as plate teau aued ed at t 13 13% yea early What do 3. 3. Asi sian an Ameri erican can popula pulation tion is s growing wing significa cant ntly ly, but t ¾ due e these trends to immigration to tion indicate ? 4. 4. Ther eref efore, , rac acial al minori orities ties ar are e incr creas easing ing much h fas aste ter th than an wh white tes 5. 5. The e res esult? t? Minori rities ties, , an and spec ecifical cally ly Latino tinos, , will bec ecome me th the e futur ture e of th this s co country untry
1. 1. End of last t centu ntury: ry: Latinos tinos had becom come e the largest est racial cial minori ority ty nationwide tionwide. 2. 2. 2011: 11: Mor ore e minor ority ity babies ies were e Among born rn than an White te babies ies, , with th Latino inos as the e large e majori ority ty. Latinos, 3. 3. AY2014 014-2015 2015 marked ed the e first st time e public lic-sc schoo hools ls (K-12) 12) becam came e a growth is nonw nwhite hite majority jority. phenomenal 4. Last 4. st year, among ng the e 15 largest est school ool distric tricts, , Latinos tinos repr presente esented d the e highest hest percen cent in 13 of these ese distric tricts ts. 5. 5. By end of this is gener neration, tion, the U.S. . will l be a major ority ity- minority nation (≈2043), with th Latinos inos near arly ly 1-in in-3 residents idents. .
His ispanic Population Growth, 1970- 2016 2016
Different from Asian/Pacific Islanders, the Hispanic Growth is not due to immigration: U.S. Births v. Immigration (1970s to 2000s)
Percentage of Hispanic or Latino (of any race), demographic map from US 2010 census using quantile classification bands (equal number of records in each class) US Census / US Census
Projected White Population Change, 2010-2030
Projected Black Population Change, 2010-2030
Projected Hispanic Population Change, 2010-2030
Media ian Per Capit ita In Income, by Race: 2016
Shifts in the general makeup of the country will be causing significant changes in the overall national culture as this change will create major challenges to the healthcare industry.
What’s going on? • Dramatic demographic shifts are occurring, where Latinos are front and center. • Major ‘browning’ and ‘Latinization’ of America is taking place. • Nearly half the country (largely minority) has been ignored and grossly underserved, especially for health care, housing, and education.
No country can sustain a prosperous future if Implication? half its population is in poor health, poorly paid, and grossly undereducated.
Questions re. cultural competence 1. Have you ever participated in a cultural competence training ○ yes ○ no 2. If “yes,” how helpful was it? ○ very helpful ○ somewhat helpful ○ barely helpful ○ not helpful
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