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CHRONIC DISEASE & ELDER HISPANICS

Insufficient English skills and low economic status are common barriers in the health care system for elderly Hispanics in the United States, especially when it comes to getting early diagnosis and treatment of various chronic diseases. Further complicating the matter is the fact that one in three Hispanics lacks health insurance and still more have little or no access to health care services, which puts the Hispanic elderly at an even greater risk of not getting the required services for chronic diseases such as diabetes, asthma or high blood pressure.

There is a growing need for community-based interventions that improve the health behaviors and health status among the elderly Hispanic population, as well as for a meaningful health care policy and legislation that can be replicated throughout the country.

The leading causes of death in the U.S. Hispanic population are heart disease/stroke, cancer, accidents and diabetes. Although diseases such as diabetes and heart disease are chronic, they are manageable. The challenge is to take control and manage the disease, rather than being controlled and managed by it. And even when chronic diseases are likely, some people live in denial of their increased risk of developing these diseases. We may know that our grandmother (abuela), for example, had diabetes or that our aunt (tia) also had it. Yet we close our eyes to the genetic link that puts us in the pathway of the disease, whether by choice or lack of knowledge and information.

Arizona State Rep. Amanda Aguirre said chronic diseases in the Hispanic community—particularly diabetes—are at “epidemic proportions.” Aguirre is a registered dietician who has been involved for more than 20 years in public health education and administration with a strong emphasis in U.S.-Mexico border health issues.

Approaching cultural differences
Chronic disease conditions can be the result of poor lifestyle habits, years of neglect or overindulgence. Controlling or preventing them involves lifestyle changes such as eating better, getting more exercise and seeking and having access to regular quality medical care. Getting these messages across in a culturally appropriate way is essential.

One method of delivering the message about positive lifestyle changes is “Salud Para Su Corazón,” a comprehensive promotores outreach program that teaches heart healthy behavior. The program aims at reducing the incidence of cardiovascular disease in Hispanic elderly communities through outreach efforts using volunteer promotores de salud to disseminate educational materials, conduct community forums and media campaigns, and provide direct one-on-one assistance to individuals from Hispanic communities. Created by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, Salud para su Corazn began in 1994 as a pilot project in Washington, D.C., and later partnered with the National Council of La Raza (NCLR), the nation’s largest Hispanic grassroots organization, and the University of North Texas. Other participating organizations include the National Hispanic Council on Aging (NHCOA), a nonprofit, nonpartisan organization established in 1979 to improve the quality of life for the Hispanic elderly, their families and their communities.

A peer reviewed evaluation of the “Salud Para Su Corazon” program’s first year in 2001 reported on its effectiveness in seven sites and stated:

“Results demonstrated the effectiveness of the promotora model in improving heart-healthy behaviors, promoting community referrals and screenings, enhancing information sharing beyond families, and satisfying participants' expectations of the program. The main outcome of interest was the change in heart-healthy behaviors among families. The community outreach model worked well in the seven pilot programs because of the successes of the promotores and the support of the community-based organizations. Successes stemmed in part from the train-the-trainer approach. Promotoria, as implemented in this program, has the potential to be integrated with a medical model of patient care for primary, secondary, and tertiary prevention.”

Results of the program showed how effective these community workers can be in reaching the Hispanic community. Five of the seven sites reported that:

· 90-100% of the participants referred for blood cholesterol or high blood pressure screenings in 2001 actually were screened; and

· The majority of the families surveyed (95%) rated the information they received through the program as very important, including information on cholesterol and fat, blood pressure, weight control and serving size, physical activity, smoking and salt and sodium.

(Source: Preventing Chronic Disease, Public Health Research, Practice and Policy, Peer Reviewed Evaluation of Salud Para Su Corazon, National Council of La Raza Promotora Outreach Program, July 2005)

Other model programs by NHCOA include:

· The Health Promotion and Disease Prevention Program, which increases older Latinos’ ability and resources to manage their health conditions. It focuses on diabetes, cardiovascular diseases and cancers; and

· The Latino Diabetes Action Plan (LDAP): Diabetes Education & Awareness, which addresses the burden of diabetes within Latino communities by promoting diabetes control and prevention. The main component involves the establishment of Diabetes Resource Centers (DRCs) in selected affiliated community-based organizations. The program functions at the individual, family and community level by bringing diabetes and self-management education, support, health promotion and other services to Hispanic communities to improve the quality of life for those living with diabetes.

Many of the programs targeting the Hispanic elderly bridge cultural and language factors and address barriers to accessing health services experienced by the diverse population of older Latinos. The activities are designed to promote behavioral change, as well as changes in the health system. Representative Aguirre pointed out that while the current epidemic of diabetes and other chronic diseases in the Hispanic population is cause for great concern, they are diseases that can be controlled or even prevented through “lifestyle changes” and “good nutrition.”

Policy implications
Since health status is closely interrelated with economic status, it also is important to address economic security, including the role that eligibility and utilization of Social Security, SSI, Medicare and Medicaid play in accessing health care. In some communities, especially poorer ones, there are very few or no community health centers that offer bilingual services, or access to full quality care. At most, the nearest facility may be several miles away which can prove difficult for the elderly to get to.

The rewards for investing in health won’t be reaped overnight; it has taken us a lifetime to get to this point. The Hispanic community must take small steps to get better and healthier results. Making wise food choices most of the time has a big impact on overall health, body weight, blood pressure and cholesterol Setting new goals does not mean a change in one’s “cultural” diet, which means modifying the quantities and time of day that food is consumed may be all that it takes.

When asked if Hispanics can meet the goal of living long and living well, Representative Aguirre remains optimistic. “We can enjoy life by eating well, monitoring portions and exercising” she said.

Facts:

· The elderly Hispanic population was 2 million in 2002 and is projected to grow to more than 13 million by 2050.
· By 2050, the Hispanic elderly will be 16 percent of the total number of seniors in the United States.
· The Hispanic elderly will be the second most rapidly growing segment of the population between 1990 and 2020.

(Source: U.S. Administration on Aging, Department of Health and Human Services)

Areas for policy advocacy to improve quality of life for the older adult population include:

· Improve access of older adults to nutritious food;
· Improve transportation for older adults;
· Improve the health and safety of older adults;
· Improve older adults’ access to appropriate and affordable housing; and
· Improve the ability older adults to be active, productive and experience social interaction.

Resources:
National Alliance for Hispanic Health
Su Familia: The National Hispanic Family Health Helpline
1 (866) SU-FAMILIA or 1 (866) 783-2645
SuFamilia@hispanichealth.org
http://www.hispanichealth.org

National Latina Health Network
(202) 965-9633
www.nlhn.net*

National Hispanic Council on Aging
(202) 429-0788
http://www.nhcoa@nhcoa.org

American Heart Association
National Center (800) 242-8721
http://www.americanheart.org

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion - Healthy Aging: Preventing Disease and Improving Quality of Life Among Older Americans - At A Glance 2006
http://www.cdc.gov/nccdphp/publications/aag/aging.htm

National Diabetes Education Program
The U.S. Department of Health and Human Services’ National Diabetes Education Program (NDEP) is jointly sponsored by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) with the support of more than 200 partner organizations. NDEP creates products, resources, and materials that are copyright-free. Visit the Web site for materials in Spanish.
http://www.ndep.nih.gov/diabetes/pubs/catalog.htm#PubsHispLatino

Peer Reviewed Evaluation of “Salud Para Su Corazon” – a National Council of La Raza (NCLR) Promotora Outreach Program. Héctor Balcázar, PhD, Matilde Alvarado, RN, MSN, Mary Luna Hollen, PhD, RD, Gonzalez-Cruz Yanira, MPH, and Verónica Pedregón. Preventing Chronic Disease, Public Health Research, Practice and Policy, July 2005. www.pubmdcentral.gov.

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This article was written by the National Hispanic Caucus of State Legislators (NHCSL. NHCSL) is the preeminent organization representing the interests of 300 Hispanic state legislators from all states, commonwealths, and territories of the United States. Founded in 1989 as a nonpartisan, nonprofit 501(c)3, NHCSL is a catalyst for joint action on issues of common concern, such as health, education, immigration, homeownership and economic development to all segments of the Hispanic community. For more information visit www.nhcsl.org June 2006