promoting language access, health literacy and cultural competency to improve health equity sarah de...
TRANSCRIPT
Promoting Language Access, Health Literacy and Cultural Competency to Improve Health Equity
Sarah de Guia, Executive DirectorInstitute Of Medicine, Roundtable on Health Policy
Integrating Health Literacy, Cultural Competency, &Language Access ServicesOctober 2015
Together we’re stronger!
CPEHN’s Key Policy Areas
Presentation Overview• California’s diversity shows why language access,
cultural competency, and health literacy are key.
• Promoting change by:– Codifying language access standards– Engaging community to provide culturally
appropriate notifications– Creating consumer-friendly prescription labels
• Concluding thoughts
Race/Ethnicity of Medi-Cal Enrollees
47%
9%
12%
21%
11%
LatinoAfrican AmericanAsian/Pacific Is-landerWhiteOther/Unknown
Source: Medi-Cal Managed Care Performance Dashboard, September 2015 - http://www.dhcs.ca.gov/services/Documents/MMCD/September172015Release.pdf
Limited English Proficient Population Enrolled in Medi-Cal
English Proficiency Covered by Medi-Cal
Speaks English Very Well 19.6%
Speaks English Well 26.8%
Speaks English Not Well/Not at All 34.7%
Source: 2014 California Health Interview Survey
Race/Ethnicity of Covered California Enrollees
Race/Ethnicity # of Enrollees % of Respondents to Race/Ethnicity Questions
African American 23,520 2.4
American Indian Alaska Native
3,080 0.3
Asian 217,800 22.3
Latino 276,800 28.4
Native Hawaiian/Pacific Islander
2,320 0.2
White 385,130 39.5
Total Enrollment 1,307,750 -
Source: Covered California Data Book, June 2015 - http://hbex.coveredca.com/data-research/
Top Non-English Languages by Covered California Enrollees
• Spanish: 12.8%• Chinese: 3.6%• Korean: 2.0%• Vietnamese: 1.3%
Ability to Access Primary and Specialty Care by English Proficiency
English Proficiency Difficulty Finding Primary Care
Difficulty Finding Specialty Care
Does Not Have Usual Source of
CareSpeaks English Very Well
5.4% 13.7% 18.7%
Speaks English Well
6.6% 8.7% 20.4%
Speaks English Not Well/Not at All
3.8% 16.7% 27.2%
Source: 2014 California Health Interview Survey
Health Status by English Proficiency
English Proficiency Fair or Poor Overall Health
Speaks English Very Well 15.9%
Speaks English Well 20.3%
Speaks English Not Well/Not at All 43.9%
Source: 2014 California Health Interview Survey
Importance of Health Literacy, Language Assistance, and Cultural Competency
• Majority enrollees in Medi-Cal and Covered California are communities of color.
• Over one-third of enrollees are LEP.
• Communities of color and LEP patients face barriers to care and more health disparities.
Creating Language Access Standards: Overview of California Law
Medi-Cal Program
•Translation Thresholds:•3,000 per county•1000 per zip code•1500 per contiguous zip code
•Interpretation Services:•Anytime in any language
Commercial health plans and insurers
•Translation Thresholds:•based upon enrollment•Interpretation Services:•Any language during business hours
•Requires collection of demographic data
Creating Language Access Standards
Engaging Community as Experts in Culturally Appropriate Messages
Advised the State on translations of Medi-Cal application
Advised Covered Cal on marketing materials to communities of color
Ongoing review of materials from state agencies
Furthering Community Engagement
Key opportunities:
•Rapid response by organizations
•Involved in founding of Covered California
•Partnerships with legal organizations
Legislative and Administrative
wins
•Diversity provisions in Covered California Board•Consumer workgroup (AB 1296)•Notices are regularly reviewed by advocates
Limitations: •No funding, mostly volunteer work•Notices are still very complex
Creating Consumer-friendly Prescription Labels
Key opportuniti
es• Background data pointed to a crisis
• Committed leaders
• LEP concerns raised early on
Legislative and
Administrative wins
•Passage of SB 492 (Corbett) •Inclusion of LEP focus and support to study the issue•Passage of AB 1073 and new regs to review translations
Limitations
•Reluctance to adopt standard instructions in English
•Strong industry, different culture
Next Steps
Enforce current laws: Ensure plans and insurers are meeting current language access and data collection requirements.
Engage consumers of color and LEP consumers: Create alternative methods for surveying LEP consumers about their needs and experiences.
Develop a culturally appropriate workforce: Better address cultural competency through workforce opportunities and needs.
Utilize community partners: Work directly with communities to develop materials with culturally appropriate messages.
Thank you! For more information:
Contact us at: (510) 832-1160www.cpehn.org