How can we best support initiatives that foster minority health?

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How can we best support initiatives that foster minority health?

As the ancient Roman poet Virgil wisely observed, “The greatest wealth is health.” However, health is an issue that usually is approached reactively—not proactively— by Hispanic older adults because they simply face too many competing basic needs. This presents a challenge when it comes to health promotion among Latino seniors. Telling them to “eat healthy” or “do more exercise” is meaningless when food insecurity, hunger, chronic disease and transportation are top of mind.

Hispanic older adults also tend to feel overwhelmed and confused by healthcare systems and programs either due to language proficiency and/or health literacy issues. This makes explaining how Medicare works or fraud prevention or showing Latino seniors how to sign up for SNAP benefits is challenging at best. Therefore, NHCOA’s approach to our health programming places emphasis on culturally and linguistically appropriate practices that promote health literacy and awareness, followed up with prevention and management.

In our decades of experience working with Hispanic older adults, we know that the first step in approaching this hard-to-reach population is bridging the cultural and linguistic gap. Latino seniors tend to be isolated and unaffected by mainstream practices, which is why a lot of up-front personalized outreach is imperative to create a relationship based on trust and respect. Outreach must be conducted in Spanish and largely based on the premise that health is a family affair, whether it be Medicare fraud prevention, HIV awareness, vaccine promotion, or diabetes prevention and management.

Once trust and interest are established, short, informal presentations and popular education techniques followed up with one-on-one or small group follow-ups constitute the most effective health literacy-building strategy for Latino seniors. Creating a welcoming setting with refreshments (coffee is a must!) is also key. Food is a unifying element within the Hispanic community, and even more so for Latino seniors for whom food security and hunger are major health barriers.

And, as we work to help Hispanic older adults take specific steps to improve their current health, we also encourage the involvement of their families and caregivers as they reinforce the information that is provided.  More importantly, seniors’ families and caregivers are also learning about different health issues before they enter the golden years. Our hope is that their involvement through their parents and grandparents will spur increased health prevention and awareness as they age because at the end of the day, the greatest wealth IS health. 

Yanira Cruz
NHCOA President and CEO, NHCOA

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Yanira Cruz
NHCOA President and CEO, NHCOA

Dr. Yanira Cruz is the President and CEO of the National Hispanic Council on Aging (NHCOA). She focuses on providing the Latino perspective on public health and older adult issues to increase policy-maker and public understanding of the needs impacting Latinos and disenfranchised sectors of our society, and to encourage the adoption of programs and policies that equitably serve everyone. To further these efforts, Dr. Cruz serves on the Boards of the Consumer Health Foundation, the National Senior Citizens Law Center, and the American Society on Aging. Dr. Cruz is also an appointee serving on the Advisory Panel on Medicare Education (APME), which advises the Secretary of the Department of Health and Human Services and the Administrator for the Centers for Medicare and Medicaid Services (CMS) on opportunities to enhance the federal government’s effectiveness in implementing a national Medicare education program.

She holds an adjunct faculty appointment at The George Washington University School of Public Health. Before joining NHCOA, she served as executive director and chief operating officer of the Hispanic-Serving Health Professions Schools (HSHPS) in Washington. She joined HSHPS after serving as director of the Institute for Hispanic Health at the National Council of La Raza (NCLR) where she led numerous public health programs to improve the health status of Latinos nationwide. Dr. Cruz received her Bachelor of Science in Biology and holds a Master’s degree in Public Health and a Doctorate in Public Health with a specialty in global health from The George Washington University School of Public Health and Health Services.

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How can we best support initiatives that foster minority health?

When we think about improving minority health, we rarely think of clinical trials and research. But we should. To move closer to health equity, we must increase the participation of diverse communities in clinical trials.

Clinical trials are essential in determining whether a drug is ready for mass consumption, as well as revealing important information for doctors and patients about prevention, diagnostic and treatment methods. They can also help shed light on whether there are unique bio-markers across the different groups the product is being provided to.

The challenge is that for far too long, racial and ethnic minorities have been underrepresented in clinical trials. Researchers at the University of California, Davis found that “less than 5 percent of trial participants are non-white, and less than 2 percent of clinical cancer research studies focus on non-white ethnic or racial groups.” Those low participation numbers are a serious cause for concern when the leading cause of death for Asian Americans is cancer. Lacking a diverse trial group means lacking a clear understanding on how a drug will affect a diverse population.

So, why are minority groups underrepresented? For Asian Americans, Native Hawaiians and Pacific Islanders (AAs and NHPIs), there are a number of factors at play. One factor is the sheer diversity of AAs and NHPIs who come from more than 50 countries and speak more than 100 languages. The dearth of translated materials, as well as a shortage of ethnic minority trial navigators to guide participants through the trials are major roadblocks. Another challenge is mistrust of the health care system, stigma about particular medical conditions and prior incidents of using diverse communities as test subjects, without their consent, such as the post-World War II nuclear testing in the Marshall Islands.

The good news is there are a number of promising practices to increase diversity in clinical trials and foster minority health. Clinical trial “navigators” can be used to help work directly with communities to build trust and overcome misconceptions. Navigators can answer questions about the process, adding credibility and assurance for communities and participants alike. Investing in the community can also help to overcome historical challenges related to involving minority populations in research (willingly and unwillingly) and foster trust in the system by providing information in ways that are culturally and linguistically sensitive. Increasing sensitivity can, in turn, improve enrollment and retention of patients in trials and studies. Lastly, when it comes to including Asian Americans and Pacific Islanders in clinical trials, we cannot discount the barrier that language plays. Thirty-two percent of Asian Americans and Pacific Islanders have difficulty speaking and understanding English. Translated materials, both print and online, are needed to advertise and promote trial participation.

Translation and health navigators are a step in the right direction, but the road to achieving health equity for all our communities is a long one. By focusing efforts and practices to ensure that clinical trials look like the diverse country we live in, we can create better health for all. 

Kathy Ko Chin
President & CEO, APIAHF

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Kathy Ko Chin
President & CEO, APIAHF

Kathy is president and CEO of the Asian & Pacific Islander American Health Forum (APIAHF), which influences policy, mobilizes communities and strengthens organizations to improve the health of Asian Americans, Native Hawaiians and Pacific Islanders (AA & NHPI).  At the helm of APIAHF, she leads efforts to promote robust health coverage, ensures AA and NHPI health needs are addressed in national priorities and works to build the capacity of community based organizations to be strong service providers and advocates.

Kathy is recognized as an authority on national health policy and is a frequent contributor in the media on AA and NHPI perspectives and health issues, including in the Huffington Post and in ethnic media outlets. As a renowned leader in the AA & NHPI community, Kathy is a member of the President’s Advisory Commission on Asian Americans and Pacific Islanders and serves on the boards of many nonprofits. 

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How can we best support initiatives that foster minority health?

In looking at avenues to support minority health initiatives, particularly in the Hispanic community, it is essential to develop relationships with trusted leaders within the community. Organizations, religious institutions, local businesses, and community health centers are where advocates with real community touch points can be found. These leaders will be central to sharing safe, reliable information with their friends, neighbors and clients. They already have the trust and confidence of the community and utilizing those relationships will be vital to spreading health and wellness information that will benefit their friends and families.

Once those community connections have been identified and established, it will be crucial to have culturally and linguistically appropriate resources. For the Hispanic community, that means having literature translated in a culturally sensitive way.  The Spanish-speaking community is quite diverse linguistically and this needs to be accounted for in any translation. What might be a colloquialism for one segment of the population may be offensive to another. Something as simple as translating the word beans as habichuelas rather than frijoles could be enough to turn away a reader, depending on their country of origin.

Including your community leaders in the process, as health initiatives are being formed, rather than simply as a means to transmit health information, will help ensure that information is being tailored to the constituents they serve. As the professionals and concerned volunteers on the ground, they are as much a resource to the development of health initiatives as they are to the community. When you have that level of involvement from the beginning, health initiatives have the best chance of taking root in the community and being successful.

For over 40 years, MANA has taken pride in participating in both local and national health initiatives to educate the Hispanic community. Our local volunteers in Chapters and Affiliates nationwide are active members of their communities and are engaged daily in educational initiatives that inform Latinas from all walks of life. Our goal has always been to build strong foundations and the capacity to maintain vital, healthy communities nationwide.

Amy Hinojosa
Executive Director, MANA

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Amy Hinojosa
Executive Director, MANA

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Amy Hinojosa is the Executive Director of MANA, A National Latina Organization, the oldest and largest Latina membership organization in the United States. MANA focuses on leadership, advocacy and community service through educational programming for adults in the areas of financial literacy, child passenger safety and mentor training. The signature HERMANITAS® program is the only mentoring program specifically designed for Latina youth in the country. Amy is responsible for the operations and oversees the educational programming of the national organization, as well as national advocacy efforts. Prior to joining MANA, Amy served as the Executive Director of the National Association of Hispanic Publications, Inc. (NAHP) and the National Hispanic Press Foundation (NHPF), based in Washington, DC. NAHP is a non-partisan trade advocacy organization representing the leading Spanish language publications in the United States, and NHPF is the partner non-profit organization that promotes Hispanic publications through community outreach to academic and professional institutions, facilitation of research and recognition of excellence in the field. Amy has extensive experience working on local and national grassroots campaigns targeted at mobilizing voices and actions in Hispanic communities nationwide on topics ranging from financial literacy and retirement, mentoring, long term care planning, and census participation to advocacy efforts on student loans, immigration reform and health care reform. Community education and engagement have been central to Amy’s work, with a particular emphasis on youth. She has has experience working for and volunteering with community organizations such as the Girl Scout Councils of the Nation’s Capital and South Texas, the Women’s Institute for a Secure Retirement, The National Hispanic Institute, and Hugh O’Brian Youth Leadership. Currently, she serves as the Chair of the Board of Directors for Mosaica, a national nonprofit organization that focuses on capacity building and organizational development for nonprofit organizations that serve communities of color. Amy also represents MANA on national coalitions such as the National Hispanic Leadership Agenda (NHLA) and the Hispanic Association on Corporate Responsibility (HACR). Originally from Baytown, Texas, Amy is an alumna of the University of St. Thomas in Houston. She currently resides in Arlington, VA.

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