A recent report released by the Pew Foundation and the Robert Wood Johnson Foundation HispanicTips » » Hispanics Need “Health Reform Plus,” with ...indicates that access to health care is only part of the problem facing Hispanics in their search for health care. While a significant number of Hispanics lack health insurance and this is a critical issue related to access, an even greater concern is how many Hispanics access care and what happens in that encounter. Once care is accessed the health care is often not provided in a linguist and culturally appropriate manner, thus the individual may leave the encounter with incomplete understanding of the treatment plan prescribed by the provider.
Given the high percentage of Hispanics with lower paying positions (many of which have insurance) a high percentage are unable to take time off from work to seek health care. For lower income employees who work hourly or are paid based on their production (i.e. how many sack of onions picked) they are simply unable to afford the time for health care. Taking time off from work means loss of income and choices between having enough income to care for their families and seeking treatment for a health problem have to be made. Thus when the health problem is significant enough (in the judgment of the individual) healthcare for most of these individuals must be sought during regular business hours and frequently travel to some distant clinic/hospitals is required.
For immigrants another challenge in seeking health care is a lack of understanding how the USA health care system works. For example, unlike programs in Mexico where the care is free or requires a small co-payment those who seek care at hospital emergency rooms can find themselves saddled with unwieldy medical bills. Even with insurance the co-payment when seeking care at emergency rooms for non emergency treatment can create a substantial co-payment requirement. Unlike Mexico where individuals can purchase many medications at the local pharmacy such options in the USA are not available. Our system requires a prescription for most medication and this means the individual who need medications must first be examined by a healthcare provider. A lack of understanding in how the USA and Mexico healthcare systems differ may lead immigrants to spend more money on healthcare and eventually lead to less access. Hispanics in compared to other minority groups already are reported to spend a higher percentage of their personal income on healthcare than others.
Another challenge for Hispanics particularly those with limited health literacy and who lack English language skills, they are unable to communicate effectively with their healthcare provider. Even those of us who have the ability to read, write, and speak English fluently our encounter with a physician may leave us with a lack of understanding regarding what transpired in the office visit including the treatment plan prescribed. This lack of health literacy is even more critical when the patient is unable to speak English and when the health encounter is conducted in English. This lack of understanding can lead to errors in taking prescribed medications, uncertainty about follow-up treatment recommendations, and lack of knowledge regarding the diagnosis.
Insuring that healthcare is provided both in an appropriate linguist and culturally relevant manner is critical if we are going to make inroads to eliminating the gaps in health disparities in Hispanics compared to Anglos.
At UTEP, School of Nursing we are committed to insuring our graduates are able to provide such care to this growing segment of our population. We offer courses in Spanish for healthcare providers and are actively integrating the Health and Human Resources Administration recommendations regarding cultural competency and work force diversity into both our undergraduate and graduate curriculum. The need to address these access and quality of care issues impacting Hispanic is urgent.
Sunday, August 31, 2008
Salmonella Outbreak is now Over – But for How Long?
According to the Center for Disease Control (CDC) the most current salmonella outbreak is now over. The bacteria were found primarily in Jalapeño peppers, secondarily in Serrano peppers, and possibility early in the outbreak in tomatoes. Over a 1000 cases of individuals with confirmed cases of salmonella infections were reported.
University of Texas at El Paso students enrolled in an international health research course while conducting a health survey of farm worker harvesting Jalapeño peppers in the Mexico state of Chihuahua during the summer of 2008 reported a variety of environmental issues. While the students were not specifically researching salmonella, however in the process of interviewing the farm workers they noted the unsanitary working conditions. The workers had no fresh water supply, there were no toilets, and no way for them to wash their hands. Shortly after this field visit officials of the Department of Health in the State of Chihuahua notified the public that Jalapeño peppers from their area were found to be contaminated with salmonella.
The crops may have contaminated by unclean water, from unsanitary harvesting procedures, and possible contamination during the transportation and processing of the peppers at the variety of way points as the pepper found their way into the USA.
The CDC and the US Department of Agriculture (USDA) really lack the resources to provide the necessary timely testing of imports to insure fruits and vegetables are safe. The use of irradiation has been approved by the USDA but costs associated with using this technology and consumer acceptance create a significant barrier to its widespread adoption. Do not look for this technology at least in the next few years to be available to help protect our food supply.
Standards for the production of agricultural products do exist and with enforcement in both USA and other international settings particularly in Mexico and Chile the safety of our fresh fruits and vegetables have a greater chance of being safe for consumers. Food preparation is still the first line of defense. Suppliers should be held accountable to insure that the food products being sold are safe. A simply field visits to the peppers fields such as that conducted by our UTEP students are needed.
Growers and middle men should be required to adhere to standards that will insure our fruits and vegetable are safe. The costs of having hand washing facilities, providing clean drinking water to the farm workers, providing proper toileting facilities, insuring a clean processing plant and transportation that is free from contamination, and using non polluted water to irrigate the crops are costs effective and should be enforced.
Illnesses that can result from eating unsafe food products should not be underestimated. Children, the elderly, and those with impaired immunities are at particular risk. Some of us in the USA may have taken for granted the safety of our food products. The most recent outbreak reminds us that we must also take responsibility for food safety. All fresh produce and fruits should be washed thoroughly with running tap water prior to being used. Additional safeguards are cooking, using only canned items or peeling the product.
University of Texas at El Paso students enrolled in an international health research course while conducting a health survey of farm worker harvesting Jalapeño peppers in the Mexico state of Chihuahua during the summer of 2008 reported a variety of environmental issues. While the students were not specifically researching salmonella, however in the process of interviewing the farm workers they noted the unsanitary working conditions. The workers had no fresh water supply, there were no toilets, and no way for them to wash their hands. Shortly after this field visit officials of the Department of Health in the State of Chihuahua notified the public that Jalapeño peppers from their area were found to be contaminated with salmonella.
The crops may have contaminated by unclean water, from unsanitary harvesting procedures, and possible contamination during the transportation and processing of the peppers at the variety of way points as the pepper found their way into the USA.
The CDC and the US Department of Agriculture (USDA) really lack the resources to provide the necessary timely testing of imports to insure fruits and vegetables are safe. The use of irradiation has been approved by the USDA but costs associated with using this technology and consumer acceptance create a significant barrier to its widespread adoption. Do not look for this technology at least in the next few years to be available to help protect our food supply.
Standards for the production of agricultural products do exist and with enforcement in both USA and other international settings particularly in Mexico and Chile the safety of our fresh fruits and vegetables have a greater chance of being safe for consumers. Food preparation is still the first line of defense. Suppliers should be held accountable to insure that the food products being sold are safe. A simply field visits to the peppers fields such as that conducted by our UTEP students are needed.
Growers and middle men should be required to adhere to standards that will insure our fruits and vegetable are safe. The costs of having hand washing facilities, providing clean drinking water to the farm workers, providing proper toileting facilities, insuring a clean processing plant and transportation that is free from contamination, and using non polluted water to irrigate the crops are costs effective and should be enforced.
Illnesses that can result from eating unsafe food products should not be underestimated. Children, the elderly, and those with impaired immunities are at particular risk. Some of us in the USA may have taken for granted the safety of our food products. The most recent outbreak reminds us that we must also take responsibility for food safety. All fresh produce and fruits should be washed thoroughly with running tap water prior to being used. Additional safeguards are cooking, using only canned items or peeling the product.
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