How Can We Work with Grassroots Organizations?

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How Can We Work with Grassroots Organizations? from Patient Empowerment Network on Vimeo.

Dr. Judith Flores of the National Hispanic Medical Association (NHMA) defines grassroots organizations and shares examples on how to work with them to provide trusted resources.

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Transcript

Sasha Tanori:

Can you briefly describe what a grassroots organization is? 

Judith Flores:

That is an interesting definition to come up with by someone like me, I think what I refer to are people that are working on the ground, people that are working, that have developed their organization, their structure from the community itself. They have within that community, the resources to organize to communicate and to provide other resources to their neighbors and larger community. 

Sasha Tanori: Can you give us an example on how to work with grassroots organizations to better provide everyday trusted resources?   

Judith Flores: Yes, of course. I’ve been doing a lot of work this year related to vaccine engagement and understanding of the COVID vaccine in communities, and I would have been able… I would not have been able to do any of this work without the community-based partners that you call grassroots organizations. I work with community-based partners that are faith-based, that are community-based within regions, and they are always the people that provide the bridge to that community and the entree to be able to be accepted and trusted when I’m giving my messages mostly around COVID vaccination.

What Are Community Healthcare Workers?

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What Are Community Healthcare Workers? from Patient Empowerment Network on Vimeo.

Dr. Judith Flores of the National Hispanic Medical Association (NHMA) explains the role of community healthcare workers and how you can identify them.

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Transcript

Sasha Tanori:

What is the purpose of Community Healthcare Workers?  

Judith Flores: A community healthcare worker provides a bridge. They come in different flavors and names, depending on where you are in the country. We call them community health care workers, we call them from promotoras, we call them navigators, they have different varieties of training and experience, but they are the bridge back to the community and back to the patient. They have more time to spend with the patient. They’re able, in many cases, to speak their language and understand their culture, and they’re able to direct them to the resources that will help them get the care that they need. 

Sasha Tanori:

And how can we identify community healthcare workers? 

Judith Flores:

A community healthcare worker comes in various varieties and with various names and titles, and they do have different types of training. The most important thing is community health workers provide that extra time with the patient. It’s been shown in… Actually, in the Journal of Internal Medicine, recently, as recent as 2017, that having a community health care worker integrated into the health care team of a hospital setting does reduce the number of emergency room visits and improves the quality of care, something that we are all judged on. Producing good quality care at lower cost.

Moving from Equality to Equity

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Health equality means giving everyone the same opportunities, care, and services.  This has been the focus for laws, polices, procedures, and medical training. This focuses on elimination of differences in health diagnoses and treatments. Health equity focuses on fundamental justice. The goal is to ensure equal access to quality healthcare and good health, even if this requires giving some people more support and resources. Health equity considers different cultures, access to resources, and socioeconomic status. 

Under an equality focused approach, a doctor might offer the same test to everyone at the same interval or provide the same information to everyone. The doctor might also believe that, if they treat everyone the same, they are not behaving in biased ways.  Policies and laws that focus on this can resolve some health disparities, especially when the disparity stems from lower quality treatment, deliberate discrimination, or lack of adequate screening.   

Disease and health disparities cause different but preventable outcomes among groups. These can include race, such as Black men dying more often from prostate cancer due to lack of access to quality care and social inequality. Sexism can lead to the level of pain not being believed. Disparities can also create barriers due to lack of transportation, age, financial status, and literacy levels, to name a few. While current cancer screening guidelines focus on it equality, data indicates that these need to be adjusted to disparities within specific communities. The incidences of preventable cancer and higher mortality are impacted by the type of cancer, geographic location, race and ethnicity, country of origin, and gender. Studies and guidelines also need to expand to add more underrepresented groups.  While studies show that at least half of the patients offered to participate in a trial do, physicians are less likely to discuss a clinical trial with a patient of color. 

 To address the underlying issues and individual needs, public health needs to move toward an equity-based approach. Health equity considers different cultures, access to resources, and socioeconomic status. The goal is to ensure equal access to quality healthcare and good health, even if this requires giving some people more support and resources. Some initiatives are underway to address this.  The Woodlawn Center in Chicago, added a clinic to serve Black men. This has improved the experiences with the health care system, increasing a positive environment leading to increased usage. In Multnomah County Oregon a partnership between nonprofits, government organizations, local health care providers and several community- and faith-based groups was formed to address the specific needs of the local Black and Latino communities.   

We must strive to take equity further by applying justice, where we move to fix the issues. Equity-minded medical professionals must consider how social determinants of health such as access to a healthy diet, stress, and trauma affect outcomes. They must also consider how apparently equal systems lead to inequitable and unjust outcomes. An equity lens moves health systems closer to removing disparities. It also encourages policymakers to think about the myriad ways social environments affect health. 

Until medical schools and training of health care professionals expand to include environmental and social impacts, patients and care partners need to work with the health care professionals to include these factors.  Find out if the testing and screening is based on the “average” person or includes the segment of the population that includes the patient.  Do the “standard of care” recommendations consider the ability of the patient to comply?  For example, a doctor who knows a person has limited access to healthy food may work with the person to strategize ways to overcome this challenge and reduce the risk of health issues. The doctor might also lobby for policies to address this issue. There is no “average” person.  Everyone is unique and the best outcomes come from the medical personnel, patient, and care support working together as a team. 

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References

“What are the differences between health equity and health equality?”, Medical News Today 

“Racial Disparities in Cancer Outcomes, Screening, and Treatment”, KFF 

“Equity vs. Equality: What’s the Difference?”, Milken Institute School of Public Health at George Washington University 

How Can We Address Language Barriers?

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How Can We Address Language Barriers? from Patient Empowerment Network on Vimeo.

Dr. Judith Flores of the National Hispanic Medical Association discusses the importance of addressing language barriers so people with cancer can receive the best care.

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Transcript

Sasha Tanori:  

Over the past few years, how have you seen language barriers addressed and how can we continue addressing them? 

Judith Flores:  

I think we have to understand that addressing language barriers is extremely important. It can be fatal for someone if they don’t access care because they cannot get it in their own preferred language. Of course, we have some federal funds through the Accountable Care Act that allow us to have resources for limited English proficiency, but to be honest, the best thing to do is to try to develop a workforce that looks like the patients they serve, speaks their language and understands their culture.  

I’m going to quote from the cdc’s definition of health equity. Health equity implies that every person has the opportunity to attain their full health potential. No one is at a disadvantage because of social position. That’s a tall order, and that’s something that we all have to work towards, especially now, and we want to add the piece of health justice which implies that people, all people are valued and that health and reconciliation is a goal for all of us.

How Can We Make Resources Accessible to Everyone?

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How Can We Make Resources Accessible to Everyone? from Patient Empowerment Network on Vimeo.

Dr. Judith Flores of the National Hispanic Medical Association discusses barriers to care and ways to overcome them.

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Transcript

Sasha Tanori:

What specific barriers to care have you noticed that stand out to you?   

Judith Flores:

I’ve been doing quite a lot of work with communities and populations in New York City for over many years, and it’s always the very same thing we look at. We always think in terms of finances, can someone have coverage to access care? But to be honest, once you do have coverage, a lot of the other things have to do with what’s available to you, what is in your preferred language, what speaks to you and to your community.   

Sasha Tanori:

All right, thank you. Why aren’t all resources accessible to everyone, and how can we change that?   

Judith Flores:

I think that’s a very, very important question for us, and it’s a question for us to look at in this country as we evolve health care. We’ve always had a financial barrier in this country. The opportunities are very uneven across the states, and that produces a lot of unequity or disequity from person to person and group to group, even within states, people that may not have access because they don’t know that they are eligible for certain resources due to perhaps language barriers or culturally incompetent practices.