News Relase from the NC Center for Public Policy Research

GROWING HISPANIC POPULATION HAS UNIQUE HEALTH CARE NEEDS, SAYS CENTER

The Hispanic/Latino population is growing faster than any other part of North  Carolina's population, says the N.C. Center for Public Policy Research in a new  study released today. The Center says this rapid growth in population is having  a high impact on local health departments and that the health care needs of Hispanics are different in key ways from white or black populations in the state. The Center makes policy recommendations to address Hispanic health  issues.

"North Carolina is experiencing a wave of Hispanic/Latino immigration," says Mike McLaughlin, editor of the Center's magazine, North Carolina Insight.  "But the image of Hispanics only as migrant farmworkers no longer applies. Hispanics now hold a growing number of jobs in construction, food service,  landscaping, and slaughterhouses. They work in lower-wage and more dangerous  jobs with fewer benefits like health insurance, and they use local health  department services in greater numbers. State government needs to help these  departments meet the need."

Growth in Hispanic/Latino Population

The U.S. Census Bureau and state health officials estimate that the  Hispanic/Latino population has nearly doubled since the 1990 Census to more than 200,000, or some 2 percent of the state's population. Some estimates range as high as 350,000. Hispanics/Latinos are settling in urban communities along the  Interstate Highway 85 corridor; in western Piedmont counties such as Forsyth,  Rockingham, Surry, and Yadkin; near military bases in eastern North Carolina; and in eastern farming areas such as Johnston, Robeson, and Duplin counties.

Because Hispanics are mostly in low-wage occupations, they rely more heavily than the rest of the state's population on local health departments for health  care services. The Durham County Health Department, for example, reports serving  5,000 Hispanics in 1997-98, or 22.6 percent of its total caseload. The Wilson  County Health Department reported 30 percent of its clients were Hispanic, and in Randolph County, the estimate was 40 percent.

Center Survey of Health Providers Reveals Most Significant Hispanic  Health Issues

The Center's year-long study of Hispanic/Latino health issues began with a survey of all 87 local health departments, 22 community and migrant health centers, 34 rural health centers, and 75 rural hospitals. Ninety-four percent of the health departments responded, as well as a majority of all other groups of  health care providers. All health care providers ranked access to health care and lack of health insurance as two of the three most significant health issues  facing Hispanics.

The significance of the remaining health care issues varied by age and gender. For example, prenatal care ranked as the most significant issue for females. For males, health care providers indicated that the key issues beyond access and health insurance were (1) on-the-job injuries, (2)  sexually transmitted diseases, and (3) drug and alcohol abuse. For children, the key issues were (1) immunization rates, (2) dental care,  and (3) nutrition.

Only 68 percent of Hispanic/Latina females in North Carolina receive prenatal  care in the first trimester of pregnancy, compared to 87.7 percent for whites  and 72.6 percent for African Americans. And Hispanic/Latino males are disproportionately more likely to be injured or killed on the job than whites or African Americans. In 1997, Hispanics/Latinos represented only 2 percent of the  state's population but accounted for 9 percent of its workplace deaths. In 1998,  this number declined to 6 percent of state workplace deaths, but it is still  three times the proportion of Hispanics in the state's population.

Finally, both national studies and a previous Center study in North Carolina show that Hispanic/Latino children are less likely than the overall population to be immunized against childhood diseases. This can lead to greater concentration of vaccine-preventable illnesses among Hispanics/Latinos. For example, in the 1990 U.S. measles outbreak, Hispanic/Latino children were 7.3  times more likely than non-Hispanic white children to contract the illness. Hispanics in North Carolina also experience higher rates of hepatitis B and tuberculosis. And, in a 1996 North Carolina rubella outbreak, 79 of 83 cases occurred in Hispanic/Latino children, endangering them and the general population. This potentially serious illness causes rashes, swollen glands, and  arthritis and can lead to ear infection, pneumonia, diarrhea, seizures, and  sometimes death. When pregnant women contract the disease, their babies can suffer birth defects. These are good examples of how improving Hispanic health also protects the public health, says the Center's McLaughlin.

Barriers to Hispanics Receiving Health Care

The Center says the primary barrier to Hispanics receiving health care in  North Carolina is the language barrier. When asked to identify the three most  significant barriers to Hispanics/Latinos obtaining adequate health care in  their communities, health departments and other health care providers cited: (1)  language (85.8 percent) followed by (2) lack of insurance or other means to pay  for health services (55.9 percent) and (3) lack of transportation (55.2  percent). A distant fourth was lack of information and/or awareness about services available (35.0 percent).

Betsy Richards of the Harvest Family Medical Clinic in Nash County recalls an  encounter at the office of a private obstetrician/gynecologist in which a  Hispanic/Latina woman who was having a miscarriage brought her 15-year-old son to interpret. Richards stepped in and offered to provide the service, but the fact that the woman was unable to communicate with the doctor in her own language only added to her struggle. Says Mary Anne Tierney of the Blue Ridge Community Health Center in Henderson County, "The language we want to communicate in when we're hurting is our own."

Inadequate health insurance or lack of means to pay for health services is another key issue, says the Center. National estimates place the number of uninsured Hispanics/Latinos at 33.6 percent, not including undocumented and  uncounted immigrants. In North Carolina, 15.5 percent of all citizens are not  covered by health insurance. North Carolina's Health Choice for Children insurance program is restricted by federal law to citizens or lawful permanent residents, which excludes Hispanic/Latino children who are legal residents if  they arrived after August 22, 1996. Furthermore, while U.S.-born children are  eligible for the program, their parents might not apply if they themselves aren't legal residents because they fear deportation or jeopardizing their own immigration status.

Center Recommendations for Addressing the Health Needs of  Hispanic/Latino Citizens

The Center offers seven recommendations to better provide health services to the state's growing Hispanic/Latino population. Among the key recommendations  are: (1) that the Governor include in his proposed budget to the 2000 legislative session $2.3 million for interpreter services at 85 local health  departments; (2) that the Governor include in the 2000 budget an additional $250,000 appropriation to allow more health departments, community and migrant health centers, and rural health centers to provide Maternal Care Coordination services to women ineligible for Medicaid; and (3) that the legislature make an annual appropriation to fund immunization outreach workers in the 20 counties with the largest Hispanic/Latino populations.

The Center says that not only is funding interpreter services essential to improving Hispanic health, but failure to provide this funding could have legal  consequences. The Office of Civil Rights in the U.S. Department of Health and  Human Services mandates that all recipients of federal funds provide free interpreter services. All health departments in North Carolina receive federal funds so there appears to be a legal mandate to provide interpreter services. McLaughlin says the state recently has lost several lawsuits costing the state  more than a billion dollars, and failure to provide interpreters could extend  this losing streak.

Among the other recommendations are: (4) that the N.C. Department of Labor devise and implement a plan for enhancing workplace safety among  Hispanics/Latinos, and (5) that the legislature form a study commission to  examine reimbursement issues for facilities treating Hispanic/Latino patients,  including whether to extend state-funded health care coverage to non-citizen  children who by income standards alone might otherwise be eligible to participate in the state's child health insurance program.

Not only has the Hispanic/Latino work force provided a ready supply of labor,  but the economic impact of the earnings of this population also is significant.  A study conducted by East Carolina University's Regional Development Institute found that the impact of dollars and jobs directly attributable to  Hispanic/Latino wages flowing back into the economy is as much as $391 million  and 20,000 jobs generated in the eastern region of the state alone. And, the  Selig Center for Economic Growth at the University of Georgia reports that Hispanic/Latino buying power in North Carolina increased from $8.3 million in 1990 to $2.3 billion in 1999.
 

McLaughlin says this study of health issues affecting the Hispanic/Latino  population is a follow-up to the Center's 1995 study of "The Health of Minority  Citizens in North Carolina," also published in Insight. Earlier, in a  1993 report entitled "North Carolina's Demographic Destiny, " the Center had  identified the state's rising Hispanic/Latino population as a major demographic  trend affecting North Carolina in the 21^st century.

The N.C. Center for Public Policy Research is an independent, nonpartisan, nonprofit corporation created to study public issues facing North Carolina and to evaluate state government programs. The Center's research on Hispanic/Latino  health was supported by a grant from the Kate B. Reynolds Charitable Trust in Winston-Salem, N.C. The Health Care Division of the Trust provides grants to meet the health and medical needs of the people of North Carolina, especially  the underserved. The Center receives general operating support from the Z. Smith  Reynolds Foundation in Winston-Salem, 14 other foundations, 190 corporate  contributors, and almost 1,000 individual and organizational members across the  state.

In addition to North Carolina Insight magazine, the Center also publishes book-length research reports, a citizens' guide to the legislature,  and a textbook for teachers of state and local government. The Center is  currently conducting studies of public university governance in North Carolina, wood chip mills and state forestry management, and state lotteries. Recent  studies also have examined programs for children with special needs, rural economic development policy, and state job training programs.

Copies of the issue of North Carolina Insight containing the Center's research on Hispanic/Latino health are available for $20, which includes tax,  postage, and handling. To order, write the Center at P.O. Box 430, Raleigh, N.C.  27602, call (919) 832-2839, fax (919) 832-2847, or order through the Center's  web site at www.ncinsider.com/nccppr.

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For more information on the Center's study of Hispanic/Latino health issues  in North Carolina, call Mike McLaughlin, editor of North Carolina Insight, at the N.C. Center for Public Policy Research at (919) 832-2839.

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