The presentations at the 2008 annual minority health policy meeting each provided a window on pockets of inequality in the national health care system, from the barriers to care faced by Portuguese speakers in Boston to the continuing mental health needs of Hurricane Katrina survivors. Taken together, the talks depicted a troubling landscape of health care disparities across the nation, affecting multiple groups and regions.
The talks were given by current fellows and alumni from the Commonwealth Fund/Harvard University Fellowship, the California Endowment Scholars Program, and the Joseph L. Henry Oral Health Fellowship. The meeting was capped by a keynote address from Thomas Perez, the secretary of labor, licensing, and regulation in Maryland and a professor in the Department of Health Policy at George Washington University.
Two fellows discussed linguistic barriers to health care. Monica Hau Hien Le, a California Endowment Scholar, in an effort to understand the “chasm between the first roadblock of access and actually reaching quality care,” studied the provision of cultural and linguistic services in California. Specifically, she analyzed data from a survey submitted by plan providers in the California Healthy Families Program, which is the state’s version of SCHIP. Out of the 866,000 Healthy Family enrollees in 2007, 57 percent designated a language other than English for their preferred language. Le did find that improvements were being made, but she also discovered some worrisome trends. For instance, most plans relied only on self-reporting to evaluate provider linguistic proficiency to fulfill contract requirements with state agencies.
Despite funding challenges, Le said it was important to keep cultural competence in the spotlight. “We are paving a road not only for California, but the nation.”
Keila Lopez, a Commonwealth Fund/Harvard University fellow, studied gaps in health coverage and care for Portuguese speakers in the Boston area, particularly under the new Massachusetts health care reform law. Lopez and her colleagues from the Blue Cross Blue Shield Foundation recruited Portuguese speakers into five insured and non-insured focus groups. Most participants were ineligible for Commonwealth Care.
Though she found that overall, study participants are satisfied with the quality of care and cultural competence in Massachusetts, they were also “tremendously confused” by how to access care under the Health Safety Net, the state’s free care program for individuals who are not eligible for insurance or cannot afford it. The confusion was so great that many opted to return to their country of origin for surgery or complex procedures, highlighting a need for the state to provide more information about public insurance programs to Portuguese-speaking communities in their own language.
In his keynote address, Perez said that he wanted to focus on only one question in his talk: “What does it mean to be a change agent?” He elaborated on what he thought were the “core competencies” of a change agent, which included not shying away from creating tension. He cited Martin Luther King’s “Letter from a Birmingham Jail.” In the letter, King suggests that tension is a critical component of productive change.
“If you are going to cause change, you have to be willing to create tension in your communities,” said Perez. “That is such a critical component of being a change agent—that willingness to confront authority when necessary in productive and nonviolent ways, as we learn so vividly from Dr. King.”
The program also included poster presentations by Dana–Farber/Harvard Cancer Center junior investigators. The event was sponsored by the HMS Office for Diversity and Community Partnership, directed by Joan Reede, dean for diversity and community partnership.
