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Congressional Testimony: Hispanic Health

Statement of Cristina Beato, M.D. Deputy Assistant Secretary for Health Office of Public Health and Science U.S. Department of Health and Human Services

September 23, 2002
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Statement of Cristina Beato, M.D. Deputy Assistant Secretary for Health Office of Public Health and Science U.S. Department of Health and Human Services

Committee on Senate Health, Education, Labor and Pensions Subcommittee on Public Health

Good afternoon, I am Cristina V. Beato, M.D. Deputy Assistant Secretary for Health.

I want to thank Senator Jeff Bingaman and the other members of the Subcommittee on Public Health for the invitation to testify at this important hearing on the health care needs of the Hispanic population. In my testimony today, I will primarily focus on the efforts of President George Bush and Secretary Tommy Thompson to eliminate those health disparities that disproportionately affect Hispanic Americans.

Demographic Profile of Hispanics in the United States

The Hispanic population is the largest minority group in the United States, based on the latest U.S. Census Bureau data. According to the Census Bureau, the nation's Hispanic population grew 57.9 percent from 1990 to 2000-from 22.3 million to 35.3 million. Hispanics now constitute 13.0 percent of the total U.S. population and are projected to comprise 25% of the total population by the year 2050. The dramatic growth of the Hispanic population is attributed to two factors, high birth rates and immigration.

The states with the highest concentration of Hispanics are California, Texas, New York, Florida, Illinois, Arizona, and New Jersey. The Hispanic population is also relatively young, with a median age of 25.9 years (the median age for the U.S. population overall is 35 years).

The Hispanic population represents a diverse array of ancestry and cultures. According to the 2000 census, 58 percent of the nation's Hispanics are of Mexican origin, 10 percent are from Puerto Rico, 3.5 percent are of Cuban origin, and the remaining 28.5 percent are Central and South American, Dominican, and other Hispanic origins.

A large percentage of Hispanic Americans speak Spanish as their predominant language. The census reports that 26.7 million Hispanics in the U.S. over the age of five speak Spanish at home and estimates that 12.4 million Hispanics speak English less than "very well."

HHS Efforts to Eliminate Health Disparities Affecting Hispanic Americans

The Department recognizes that Hispanics are disproportionately affected by certain health conditions such as heart disease, breast cancer, unintentional injuries, diabetes, and HIV/AIDS. Additionally, HHS notes that Hispanics are also the largest group without any health insurance coverage.

Under the leadership of Secretary Thompson, the Department has made elimination of racial and ethnic disparities in health a priority. Departmental efforts focus on six major areas where minorities experience serious disparities in health access and outcomes-diabetes, heart disease, stroke, cancer, infant mortality, child and adult immunizations and HIV/AIDS.So with this effort, the Department strategically uses and applies its resources to effectively target those health disparities that also disproportionately affect Hispanics.

Specifically, the Department has aggressively undertaken the following activities to address Hispanic health disparities.

Preventing the Spread of HIV/AIDS

HHS continues to support a vigorous, broad-based public health response to HIV/AIDS that includes extensive research, prevention initiatives, and efforts to expand access to quality health care and services for those who need them. HHS is also working to address disproportionate impact of HIV/AIDS on racial and ethnic minorities. African-Americans and Hispanics account for more than half of the nation's AIDS cases, although they represent only about 25 percent of the population. Department funds will continue to be used for expanded treatment, services, and community-based prevention activities (HRSA's Ryan White Care and Treatment Programs, Minority HIV/AIDS activities, OMH-RC expanded technical assistance program for HIV/AIDS).

Prevention of Diabetes

HHS's National Diabetes Education Program, a joint program sponsored by CDC and the National Institutes of Health, has reached 3.6 million Hispanics to date with PSAs, media broadcasts and print media, including the Hispanic/Latino Campaign called "Mas que Comida es Vida" (It's More than Food, It's Life) that focuses on Hispanics who have diabetes or who are at high-risk to develop the disease. This effort is slated to continue in FY 2003.

HHS's "Take Time to Care about Diabetes" is another bilingual campaign to make women more aware of the dangers of diabetes. "Cuide Su Corazon" is one more campaign aimed at Hispanic Americans, to help them understand the need to control all aspects of their diabetes to help prevent heart disease.

Initiative to Reduce Racial and Ethnic Disparities in Adult Immunization

Through the Racial and Ethnic Adult Disparities in Immunization Initiative (READII), HHS will conduct two-year demonstration projects in five sites to improve influenza and pneumococcal vaccination rates in African-American and Hispanic communities. San Antonio, Texas, a predominately Mexican-American community, is one of the selected sites, and the efforts in Chicago, Illinois, also target a significant Hispanic population. Immunization rates for adult Hispanics are at least 43% lower than those of their nonHispanic white counterparts. Over two years, the READII project sites will collaborate with stakeholders to develop and implement a community-based plan utilizing existing and innovative approaches.

Bilingual Outreach Efforts

HHS developed a bilingual booklet to provide information to Spanish-speaking parents whose children may be eligible for health insurance benefits through the State Children's Health Insurance Program (SCHIP) and Medicaid. State agencies and others involved in SCHIP and Medicaid programs are encouraged to use the booklet to assist Spanish-speaking residents learn about the availability of free and low-cost health insurance for children in low-income families through their state's SCHIP program. Increasing the awareness and utilization of this program by the Hispanic community is the goal.

HHS uses the Internet technology to provide health information to consumers. Recently, Secretary Thompson launched Health finder Espanol, a Spanish-language Web site that helps consumers track down reliable health information quickly and easily By providing this essential resource in Spanish, HHS is creating a gateway for Spanish speaking people to learn about preventing and treating illness and developing a healthy lifestyle.

Furthermore, Health finder' Espariol brings together in one easy- to-use site Spanish language health information on over 300 topics from 70 government agencies and nonprofit organizations, including the health issues of greatest concern to those of Hispanic heritage. The site offers both a Spanish text search and a list of topics in Spanish that can be browsed.

HHS's MEDLINEplus, the National Library of Medicine's consumer- friendly health Web site, is also now in Spanish.The Department is using tools at its disposal to increase health education and awareness to Americans across the country.MEDLINEplus, en Espanol is one more step to ensuring that Hispanic Americans have real-time access to the important health information that they need.

HHS continues to support increased funding for Community Health Centers, which play a vital role in treating and serving the health care needs of Hispanics. Last month, Secretary Thompson announced $30 million in grants to create 70 new and expanded health centers, a vehicle to extend health care services for people without health insurance.For FY 2003, HHS proposes to increase its funding of Community Health Centers to a level of $1.5 billion - a $114 million increase above the current year's appropriation and $290 million above the funding level of the last two years. This funding will add 1,200 new and expanded health center sites over a five-year period and increase the number of patients treated annually from 11 million to 16 million. Again, Community Health Centers act as safety-net providers for the provision of primary health care and preventive health services to the medically uninsured and under-insured, including Hispanic Americans residing in rural and inner-city areas.

Bilingual/Bicultural Service Demonstration Program

HHS continues to support its principal demonstration grant programs such as the Office of Minority Health's Bilingual/Bicultural Service Demonstration and its Community Programs to Improve Minority Health Grant programs.Both of these grant programs support the development of strategies geared at eliminating health care access barriers, improving coordination of integrated community-based screening, outreach, and other enabling services of Spanish-speaking individuals.

The US-Mexico Border Health Commission

The US-Mexico Border Health Commission (BHC), created in July 2000 by joint action of the U.S. and Mexican Governments, exemplifies HHS's commitment to a binational framework. The goals for the Commission are to:

Create "Healthy Borders 2010" objectives and health indicators pertinent to the region;

Provide international leadership; and

Optimize health and quality of life along the U.S./Mexico border.

Secretary Thompson, who co-chairs the Commission with the Mexican Minister of Health, has made border health a priority for the Department.

A Healthy Border 2010 program was recently launched by the BCH to promote and improve the health of people living on the United States-Mexico border region. The two major objectives of the program are to increase and improve the quality and years of healthy life and to eliminate health disparities.

A border commission office now operates out of El Paso, Texas, and funding is provided to support the BCH objectives. Recently, Secretary Thompson and the Mexican Minister of Health signed a cooperative agreement to enhance the safety of food supplies in both countries, and reduce the incidence of food-borne illnesses on both sides of the border through

improved inspections. Other projects that address health issues along the U.S.-Mexico border include HRSA's HIV/AIDS Border Health Initiative, the HRSA and NIH Salud para su Corazon project to reduce heart disease, and HRSA's Workforce Diversity Border Initiative, "Building a Workforce for a Health Border."

Diversification of Health Workforce/Researchers

HHS's Centers for Medicare and Medicaid Services funds researchers, including Hispanic researchers, to conduct research on access, utilization, quality of services, and activities related to health screening, prevention, and education of Hispanic Medicare and Medicaid beneficiaries.

The National Center on Minority Health and Health Disparities (NCMHD), at HHS's National Institutes of Health, is authorized to promote minority health and to lead, coordinate, support and assess the NIH effort to reduce and eliminate health disparities.Addressing the health research needs of Hispanics is a key activity of the Center.

Promoting NIH minority health disparities research and health disparity career opportunities for minorities is also a major goal of the NCMDH.Since FY 2001, NCMHD has operated two loan repayment programs---the Loan Repayment Program for Health Disparities Research and the Extramural Clinical Research Loan Repayment Program for individuals from disadvantaged backgrounds.There is outreach to Hispanic health professionals and researchers for participation on these two pipeline programs.

Grants administered by Centers of Excellence (COE), in HHS's Health Resources and Services Administration, assist health professions schools to support programs of excellence in health professions education of minority individuals in allopathic and osteopathic medicine, dentistry and pharmacy, and graduate programs in behavioral or mental health (clinical and counseling psychology, clinical social work, marriage and family therapy). COE strengthen the national capacity to train students from minority groups that are under-represented in these health professions and build a more diverse health care workforce.HRSA currently supports eleven Hispanic Centers of Excellence.

Efforts to Expand Health Insurance Coverage

In August 2001, Secretary Thompson launched the Health Insurance Flexibility and Accountability (HIFA) waiver initiative to encourage states to expand access to health care coverage for low-income individuals through Medicaid and State Children's Health

Insurance Program (SCHIP) demonstrations. This initiative gives Governors more tools and flexibility to coordinate state Medicaid and SCHIP programs and offers a simpler application for states that commit to reducing the number of people without health insurance. Thousands of Hispanic Americans, living in California, New Mexico, and Arizona, among other states, now enjoy health insurance benefits as a result of waivers granted to their states under the HIFA initiative.

President Bush's Health Insurance Tax Credits

Finally, the absence of health insurance coverage for some 40 million Americans, including many Hispanic Americans, is a problem calling for an immediate solution. President Bush's FY 2003 budget sets forth a package of solutions, including, most importantly, a proposal for the use of tax credits to offset the cost of obtaining health insurance. This proposal has received broad bipartisan support. If enacted, it can lead to a significant reduction in the uninsured population and at the same time lead to improvements in the market for individually purchased health insurance, greater choice and flexibility for individuals in determining the coverage that best fits their needs, and improvements in quality and price of health care provided not just to Hispanic Americans, but to all Americans.


In closing, I have provided a snapshot of some of the President's and the Secretary's activities that focus on eliminating health disparities that disproportionately affect Hispanic Americans. The Department is making progress, but we know that more can be done. And we will continue to do more in order to lessen the social and economic burden of not improving the health status of Hispanic Americans.

Again, thank you for the opportunity to testify before you today. At this time, I would be happy to answer any questions.

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