Opinion: Latinos win big in health care reform, but swelling numbers cloud victory

A year after the passage of national health reform, pundits and partisans continue to make a political football out of the landmark legislation. But one (potential) winner is clear: Latinos.

According to the Kaiser Family Foundation, Latinos make up 59 percent of the state’s uninsured population, and many will qualify for an expanded Medi-Cal and subsidized insurance exchanges that the reforms will create. Improving access and services to historically underserved communities is a critical first step, but what type of care will Latinos receive when they walk through a provider’s door?

Latinos often suffer from language and culture barriers that create difficulties between health care providers and recipients, which can be a cause of health disparities. Part of the problem is a lack of diversity within the health workforce.

The gap between the size of the Latino population and the number of health professionals able to communicate competently is widening. This is certainly true for doctors and nurses, but it’s also the case in the allied health professions – the 50-plus positions that make up 60 percent of all health workers.

While the 2010 Census reveals that California’s population is about 38-percent Latino, only 15 percent of physician assistants, 13 percent of respiratory therapists and five percent of physical therapists in California are Latino (2009 American Community Survey).

The information that allied health workers glean from explicit communications (medical histories) or subtle inferences (a veiled pain complaint) can profoundly affect how doctors treat with patients.

Miscommunications can be as simple – but quite serious – as a pharmacist assistant not realizing that a label instructing a patient to take a powerful medication “once” a day will be read as “eleven” in Spanish.

These miscommunications not only lead to disaster for some patients but also to unnecessary tests and treatments, driving up the cost of care for all. That’s why some health providers are taking action.

In the Central Valley, Kaiser Permanente’s launched programs that enable employees to learn the best Spanish translations for medical terminology, and sends Community Health Workers (“promotoras”) to promote health careers in the community. Hopefully, other providers will recognize the positive impact that these efforts have on the quality and efficacy of care.

We must also make sure that current laws are enforced. In 1973, the Dymally-Altorre Act became one of the first U.S. laws to require access to government services for limited-English speakers. An audit of state agencies conducted last year showed that compliance with this law falls far short.  Additionally, Senate Bill 853 mandated that, as of Jan. 2009, California health insurers can only work with care providers that have language services available to patients who don’t speak English. Less clear is how providers and insurers are monitored to actually follow that law. That should change.

But state agencies and providers should not have to shoulder the burden of closing the gap in cultural competency. In our 2010 report, Ethnic Health Assessment for Latinos in California, LCHC recommends cross-sector collaboration to further diversification. Beyond simply growing the number of trainings available, local government, educators and community-based organizations must work together to promote those opportunities among Latinos. Without proactive, targeted recruitment efforts, new positions may simply be filled by more students that don’t fully understand the population they serve.

We must confront our new demographic reality with a larger, more diverse health workforce that ushers in lower costs and higher-quality, equal care – for all. If our health professionals cannot communicate with and understand the cultural context of their patients, the promise of reform (including expanded access and reduced costs) will go unrealized.