To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: From your perspective, is health care a civil and/or human right?

Health Care is a Human Right for All
By Alexis Guild, Migrant Health Policy Analyst, Farmworker Justice

Farmworker Justice believes that our nation’s farmworkers deserve quality healthcare that is affordable, accessible and culturally appropriate. The right to healthcare goes beyond access to health services. It also encompasses safe housing and working conditions and access to healthy food.

Healthcare is internationally recognized as an essential human right. According to the Universal Declaration of Human Rights, to which the U.S. is a signatory,

Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. (Article 25, Section 1)

Farmworkers are some of the most marginalized workers in the United States. They have fewer worker protections than other sectors and endure low-wages and isolation. Many are also food insecure. Their plight is invisible to most of us but that does not exclude them from the need for basic healthcare.

Take, for example, the issue of basic hygiene in the workplace. Everyone should have access to toilets and hand-washing facilities, and clean drinking water at work. Farmworkers are no exception. This is a matter of basic human dignity, in addition to disease prevention. The health benefits of proper sanitation for farmworkers -- especially in reducing the risk of heat stroke, pesticide poisoning, urinary tract infection, and parasitic disease -- have long been recognized. Nevertheless, the U.S. Occupational Safety and Health Administration (OSHA) had for many years refused to issue any regulations concerning sanitation in agricultural fields. It was finally forced to do so by order of a federal court, which castigated OSHA’s 14 years of “intractable…resistance” as a “disgraceful chapter of legal neglect.” (Farmworker Justice Fund, Inc. v. Brock, 811 F.2d 613, 614 (D.C.Cir. 1987).

Healthy farmworkers benefit all of us. The Affordable Care Act (ACA) is a positive step for the healthcare of farmworkers. Provisions such as the Medicaid expansion and dedicated funding for community and migrant health centers will help create better health outcomes for many farmworkers and their families. Furthermore, the SHOP (Small Business Health Options Program), which provides tax credits to eligible small businesses, may encourage small growers to provide health insurance to their workers. But more needs to be done. Undocumented farmworkers will only marginally benefit from health reform and will continue to encounter enormous barriers to healthcare.

Healthcare is a human right for all, regardless of income, race, color or immigration status. While our nation reaps the rewards of their labor, farmworkers earn low incomes for physically grueling and hazardous work. They are deserving of fair, decent treatment and our respect. All farmworkers and their families have the right to healthcare. Farmworker Justice supports the empowerment of our nation’s farmworkers to lead safe and healthy lives.

This post originally appeared at Harvesting Justice. Views and opinions expressed are those of the author and Farmworker Justice.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: From your perspective, is health care a civil and/or human right?

Health Care is Always a Human Right
by Christine Soyong Harley, Policy and Programs Director, National Asian Pacific American Women’s Forum

When I was two years old, while my parents were on a date night, I found one of my grandmother’s sleeping pills and swallowed it. When my parents called to check in, my uncle told them that I was “acting funny.” My father tells me that after rushing home, they found me limp and unresponsive; I couldn’t even lift my head. They had to rush me to the hospital to have my stomach pumped. For some reason, my father’s light-hearted way of telling this story never conveyed the reality of that evening. Then, a few years ago, my mother told her version, and I could feel the fear of a first-time parent, not sure whether her only daughter was going to survive. For the first time, I could imagine what it must be like to be a parent when your child’s life is in danger. Fortunately, my parents can speak English, are US citizens, and could take me to the hospital. But for many in this country, that isn’t the case.

Fast forward thirty years and I’m sitting in a room full of women leaders from around the country who are participating in the We Belong Together campaign. We’ve descended on Atlanta, Georgia after the passage of HB 87 and are listening to women and youth tell us how this law, one of several anti-immigrant “papers please” laws that have been passed by states, has drastically impacted their lives. The law has led to widespread racial profiling and harassment by local police officers, and the women were sharing their stories of being afraid to take their children to school, to call the police to report a crime, and of being forcibly separated from their children and families.

As we listened to these women, one story stood out for me. Alicia told us about her daughter, who at the age of 1, began to experience seizures. Georgia’s law makes it illegal to drive without a license, so Alicia told us that the only time that she risks driving is when she must take her daughter to the hospital during a seizure or other serious illness. One time, while driving her daughter to the hospital, she was caught in a police check-point and it was only due to a stranger’s sympathy and willingness to drive, that she was able to get her daughter the health care that she needed.

Listening to Alicia, it is crystal clear that health care is a critical, basic human right and one that no person in this country- indigenous, citizen, or immigrant- should ever be forced to go without. At the National Asian Pacific American Women’s Forum (NAPAWF), we believe that health care, including access to women’s comprehensive reproductive and preventive health care services, is a human right. That is why we support the Health Equity and Accountability Act (HEAA), which builds on the Affordable Care Act to reduce barriers to health care for hard to reach populations and bring us one step closer to universal health care.

We know that some API communities are disproportionately less likely to have health insurance coverage and that many API women suffer from disparities in accessing preventive care services. As a result, some API women experience extraordinarily high rates of preventable diseases. Additionally, when approximately 60% of the API community is foreign-born, and many households speak English “not well,” we know that API patients with limited English proficiency struggle to communicate with health care providers. This affects their quality of care as well as their ability to understand prescription instructions and communicate about sensitive reproductive health matters.

These are health disparities that we have the resources, knowledge, and technology to prevent. No one should have to die from a preventable disease. No patient should have to worry that the language they speak will prevent them from telling their doctor what hurts. No parent should have to worry about being arrested for driving their infant child to the hospital for life-saving treatment.

At NAPAWF, we believe that health care is a human right and we are fighting to ensure that API women and other communities receive the health care they deserve.

Views and opinions expressed are those of the author and National Asian Pacific American Women's Forum.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: From your perspective, is health care a civil and/or human right?

Secure the Blessings of Liberty to Ourselves and Our Posterity
by Sergio Eduardo Muñoz, Senior Policy Analyst, Health Policy Project, NCLR

Is health care a civil right? The Department of Justice thinks so, if their closing argument in defense of the Affordable Care Act (ACA) was any indication. In what was his last point to the Supreme Court, the U.S. Solicitor General (SG) directly linked access to affordable quality health care with the pursuit of the “blessings of liberty,” that civil rights aspiration memorialized in the Preamble of the Constitution. This blunt reminder of the real human costs of repealing health care reform was exactly right. And frankly, much-needed after a troubling three days.

But let’s back up. First—don’t let anyone tell you that because the words “health care” aren’t in the founding documents, it can’t be a civil right. The Court has dismissed that argument conclusively and repeatedly. More fundamental, however: What is a civil right? At its core, it’s those non-political rights that the Constitution determines crucial to life. Not the literal act of breathing (although health care is rather important for that too), but the everyday interactions we all share with each other as we navigate society and try for the American Dream. The act of American living—that’s what civil rights protect. They make sure that we all have the equal opportunity to make the most of ourselves, our families, and our communities, without unfair barriers.

In that light, health care is inseparable from the realization of those other civil rights and liberties already formally acknowledged. As the SG noted, if you are one of the millions who suffer from a debilitating chronic condition, perhaps made worse by racial and ethnic health disparities that aren’t getting better, and skittering on the edge of bankruptcy like any of the one in four Americans who were without health insurance last year, securing those blessings of liberty is practically impossible. The rights to equal treatment or assembly are of limited comfort if you’re too sick to exercise them.

The mere existence of a civil right to health care, however, is not enough for its vindication. If words on paper were all it took, we wouldn’t still have shocking examples of racial discrimination, or health disparities that still stubbornly leave Latinos with worse access to care than non-Hispanic whites for 63% of official measures. Care which, for Latinos, the same studies reveal is worse for 39% of standard measures, regardless. Indisputably, recognized or not, civil rights must be constantly enforced. Governments often can’t, or won’t, do it alone.

This is where health care reform comes in. Civil rights that don’t have the support and attention of the American people tend to wither and die. Civil rights taken for granted suddenly become vulnerable when advocates move on. There was a reason that Martin Luther King Jr. presented health equity as the unfulfilled promise of the civil rights era—the inequity is stark, and it affects everyone. Only through constant advocacy has the health safety net gradually been strengthened to ameliorate health disparities, and it still has yet to protect us all.

Let’s not forget that at its core, the ACA is in large part civil rights legislation, aimed at curbing discrimination in the health care market that we as a society and democracy decided was no longer permissible. Most states may have outlawed overt racial and ethnic discrimination in health insurance, but effective enforcement against such discrimination was difficult prior to the ACA, and discrimination against women or those with pre-existing conditions was entirely permissible before health care reform ended these unfair practices. It’s not a coincidence that a decision striking down the ACA could have grave ramifications for other civil rights law. These types of general welfare laws are cut from the same cloth, aimed at protecting many of the same at-risk groups.

As we close National Minority Health Month, we should remember that the struggle to realize the civil right that is health care will not end, regardless of what happens to the ACA and its implementation. More legislation like the Health Equity and Accountability Act of 2011 is needed, and efforts to help those still unfairly discriminated against in our health care system—immigrants most blatantly—must not let up.

If we continue to show why health care is crucial to the fundamental concerns behind our constitution, the movement for health equity will continue to grow. This is the basic flow of civil rights history—illustrating how certain ideals are universally applicable, and not just the special interest of a minority. And just maybe, if health care reform continues, our posterity in the not-so-distant future will no longer have to pin all of their hopes and dreams upon whether an underwriter deigns to grant them a policy.

That’s why we’re doing this. If we’re going to continue to insist that we structure our entire health care system around private health insurance, our oldest ideals demand that it be equitably available to all. That’s the America that we strive for; those are the blessings of liberty we want for our children.

So is health care a civil right? You better believe it. Your other civil rights might depend on it.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: From your perspective, is health care a civil and/or human right?

Health As a Fundamental Human Right
by Anjela Jenkins, Policy Analyst & Law Students for Reproductive Justice Legal Fellow, National Latina Institute for Reproductive Health

This blog post is part of the Health Equity and Accountability Act (HEAA) Community Working Group’s Blog Carnival entitled, Health Equity Can’t Wait!, to celebrate April as National Minority Health Month. And you can join us on Twitter, using hastag #HealthEquityNow, Friday, April 27 from 3-4 EDT for a Tweet Storm on health equity.

The National Latina Institute for Reproductive Health (NLIRH) works on behalf of 20 million Latinas in the U.S., striving to ensure that all of our mothers, sisters, aunts, and friends can live healthy and dignified lives in a just society. But why are health and health care so important to dignity, justice, and other social justice goals?

Health is a fundamental civil and human right—it’s difficult to realize and fulfill other human rights without the ability to become healthy, stay healthy, or obtain the care one needs to maintain one’s health.

For example, the right to work, including for fair pay and without discrimination, is a highly regarded human right and, some might say, civic duty. But living with chronic disease or pain can make it difficult to obtain or hold down a job, much less stay on any career track. Latin@s often work in high-risk, low-pay, and minimal-benefit jobs. As a result, they are likely to face illness and injury related to work—negative effects that too often go ignored by employers. But that’s not all: the lack of benefits, such as paid sick days, can mean that a woman risks her job when she has to miss work for a medical appointment or to stay home sick. Being unjustly fired from or partly or completely disabled by a job can make it hard to find subsequent employment.

Another human right, too often ignored in the U.S. particularly in relation to communities of color, relates to human dignity. Although one’s ability to work is relevant to one’s ability to live with dignity, a crucial consideration to human dignity is striving for economic security for all and ensuring that everyone has a basic minimum, without regard to whether or where they work. For those who have employer-provided health insurance—less than 40% of Latinas in 2008—premiums have been rising and paying deductibles and medical bills has been a struggle. For those who are uninsured, which includes about one-third of Latinos, the costs are insurmountable. When a person delays needed medical care, the condition for which she seeks attention may worsen, making treatment more expensive and time-consuming and placing even greater burdens on her job and her finances.

NLIRH recognizes that Latin@s in the U.S. face numerous barriers to obtaining the health care we need—from geographical limitations and immigration status issues to pocketbook problems and language barriers, it is difficult for us to get in to see a healthcare provider. This, combined with hard and low-paid work, can create or worsen health conditions, putting health just out of our reach. Getting or staying healthy is crucial to Latin@s’ overall wellbeing, which is why health and healthcare are fundamental civil and human rights.

This post originally appeared on the NLIRH blog Nuestra Vida, Nuestra Voz. Views and opinions expressed are those of the author and the National Latina Institute for Reproductive Health.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: From your perspective, is health care a civil and/or human right?

Redefining Health: Community Prevention As a Human Right
by Ben Simons, Program Coordinator, Prevention Institute

Good health is precious. Access to high quality, affordable and culturally sensitive health care is something that we all deserve--regardless of income or family circumstance. However, access to health care is not enough to guarantee our health. In fact, research shows that access to health care only accounts for around 20% of health outcomes. The other 80%--the bulk of what makes us healthy, or unhealthy--is shaped by the social, cultural, economic and physical environments and realities of our daily lives.[1] Health care access is vitally important and should go hand in hand with efforts to ensure that we secure the right to good health by improving the places where we live, work, and play in order to support health and safety in the first place.

When a pedestrian is hit by a car while crossing an unsafe street, they have a right to be promptly taken to a state-of-the art hospital and receive the highest quality of care, without the fear that medical bills will bankrupt their family. Even better, though, would be for the streets in that pedestrian's community to be made safer for walkers and bicyclists, reducing the likelihood of crashes occurring, and thus preventing injury and the need for medical care in the first place. Not all communities are created equal, however, and some community environments are much more supportive of health and safety than others, often based on the socio-economic status of the inhabitants. Research done by the Alameda County Department of Public Health has shown that a child growing up in the affluent neighborhoods of the Oakland hills can expect to live 15 years longer than a child growing up in the lower-income "flat land" neighborhoods in the city. This disparity in life expectancy is a stark reminder that inequities in the social, environmental, and economic conditions have a profound impact on our health, and even longevity.

Health providers and clinical institutions play an essential role in securing our good health--not just by providing high quality and affordable care, but also in addressing the underlying causes of poor health and inequities in their communities. When faced with multiple children showing up at a community clinic with very similar symptoms, providers not only have the opportunity to treat each individual child but also to ask their patients and themselves: Why are these conditions occurring so frequently? What are the potential underlying causes? A doctor might find that these children all live in a nearby low-income housing development with substandard housing conditions. Equipped with this information, the course of treatment broadens and can also include partnerships with local housing rights activists and legal aid organizations in order to improve local housing. This revised course of action not only treats the individual symptoms, but also prevents the underlying cause in the first place. Such was the case for St. John's Well Child and Family Center, a federally qualified community health center in Los Angeles--just one of the many ways that community health centers can both provide high-quality medical care, while supporting community prevention and health equity.

In order to capture existing innovative successes bridging clinical care and prevention in the community as a whole, Prevention Institute has developed the concept of a Community Centered Health Home (CCHH). By integrating clinical service delivery with community prevention, communities are able to reduce demand for resources and services; improve health, safety, and equity outcomes; and provide medical providers with skills and strategies to change the social circumstances that shape the health of their patients. To learn more about how your community can advance health equity using this model, join us for a webinar on Thursday, May 10th from 11:00am - 12:30pm PST. This will be a unique opportunity to learn more about this approach and hear from those that are doing this work in their communities.
Health care providers have a unique opportunity to treat those that are already sick or injured while also using their expertise and authority to build environments that prevent illness, injury and inequity in the first place. This work will help move our country closer to a vision of health--not just health care--as a basic human right.

This post originally appeared at Prevention Forum. Views and opinions expressed are those of the Prevention Institute.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: From your perspective, is health care a civil and/or human right?

Access to Quality, Affordable Health Care is a Human Right
by Aurelia Aceves, National Urban Fellow, Community Catalyst

As a visiting fellow at Community Catalyst for the past eight months, I must have learned in my first week that the organization views access to quality, affordable health care as a human right. In fact, it was a consistent and underlying theme in the organization-wide meetings I attended and the interviews I had with staff to discuss their work in specific issue areas.

I did not come to Community Catalyst with an understanding of the complex health policy environment challenging our health care system. My background knowledge was rooted in my own experience with health insurance coverage and visits to the doctor—both things I never questioned or had to worry about as a child or young adult. I took my experience for granted at the time and was unable to fully contextualize it until my fellowship here opened my eyes to the inequities in the health care system and the direct impact on people’s lives. Before I came here I did not realize that I belong to the ethnic group, Latino, most likely to have uninsured children and adults (in addition to a considerable number of underinsured individuals, too).

Spend just one day at Community Catalyst and you will see that its work aims to alleviate the roadblocks and inequities many people face – such as those in the Latino community - to acquire and maintain quality and affordable health care. Access to quality, affordable health care is a human right, because every human being deserves to be in charge of their own well-being. My well-being should not depend on the guiding hand of the free market, but should be based on the decisions I make to protect and maintain my health. By granting people access to quality, affordable health care, we empower them to be advocates for their own health.

Community Catalyst believes that people have the right to a healthy life no matter their income level, race, ethnicity, age, primary language, sexual orientation, sex, gender identity, or geography. A family should not spiral into debt to pay for a family member’s life-saving medical procedure or medication. The same-sex partner of an employed person should not be excluded from receiving family health care coverage based on sexual orientation. Children should not have to forgo necessary medical attention because their parents cannot afford it. My grandparents, whose primary language is not English, should not receive lower quality care because a hospital does not make it a priority to hire diverse staff members including people who speak languages other than English.

These unfortunate circumstances that occur all too often contribute to health disparities that cost this nation $1.24 trillion between 2003 and 2006 according to a recent report. The cost includes, but is not limited to, unnecessary medical care expenditures like preventable hospitalizations and forgone wages and productivity associated with premature deaths.

There is no doubt that the Affordable Care Act provides unprecedented opportunities to address health disparities in this country, and people have already begun to benefit from the law. Community Catalyst has created a video to illustrate this point. Though staff at Community Catalyst believe access to quality, affordable health care is a basic human right, they understand improving access to health care is only a component of addressing health disparities. Community Catalyst’s joint initiative with The Robert Wood Johnson Foundation Roadmaps to Health is a great example of the organization’s systems approach to address health disparities. The initiative provides funding to organizations from coalitions and/or networks that work to alleviate the social and economic factors that influence poor health in their communities.

Health care is not the sole determinant of a person’s or community’s health, so change must occur throughout society in terms of increasing access to healthy foods, closing racial and ethnic gaps in employment rates and educational attainment, and establishing safe neighborhood initiatives. This work is a joint effort requiring investment across all sectors and communities so that the benefits can span just as wide. The Affordable Care Act’s small business tax credit provision is a great example of how the law incentivizes cross-sector efforts to ensure access to quality, affordable health care for everyone. This law is a major achievement for human rights.

This post originally appeared at The Community Catalyst blog. Views and opinions expressed are those of the author and Community Catalyst.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: From your perspective, is health care a civil and/or human right?

Health Equity Can’t Wait: Why? Because Health Care is a Basic Human Right!
by Lacy Langbecker, MSW, Field Student/Intern, Wisconsin Alliance for Women's Health

Yesterday, we blogged on our health equity agenda and what we were doing in Wisconsin to raise awareness and support for the Affordable Care Act (ACA) as means for doing so. But some might wonder why advocates for health care reform believe it is so crucial for the wellbeing of communities all across the country, Wisconsin included. To that we say: health care is a basic human right, and the status quo is not working for women and families.

But, we can tell you what IS working: health care reform provisions that have already taken place so far. Earlier this month, we shared some promising statistics about health care access for racial and ethnic minority young adults. The statistics show, thanks to a provision in the ACA that allows young adults to stay on their parents insurance until their 26th birthday, 1.3 million minority young adults now have health insurance, including:

• 763,000 Latinos
• 410,000 African Americans
• 97,000 Asian Americans
• 29,000 American Indian/Alaskans

Insurance rates among minorities will increase with the implementation of health care exchanges in 2014, as well, which is why we support its implementation, because access to quality health care services is a basic human right. It is a basic human right to have access to the same quality, lifesaving, and affordable health care services as your peers.

However, this is not the case for many women. Low income women are at risk of lacking access to preventive cancer screenings. Women of color are more likely to be uninsured than their white peers and less likely to have access to cancer and other preventive screenings. As a result, 9 more black women die from breast cancer than white women, per 100,000, annually, a startling, unnecessary and unjust statistic.

Additionally, there is about a 33 year difference in life expectancy between the longest and shortest living racial and ethnic groups – which is why access to health care is, and should be considered, a basic human right. That’s 33 years less time with your children, friends and family. A 33 year difference in life expectancy is just one reason why health equity can’t wait.

Stay tuned tomorrow, for our final day of the Health Equity Can’t Wait blog carnival.

This post first appeared at Raising Wisconsin Women's Voices blog. Views and opinions expressed are those of the author and Wisconsin Alliance for Women's Health.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. From Wednesday, April 25 through Friday, April 27, each day the NCLR blog will feature posts written by our staff and other health, consumer, civil rights, and provider advocates committed to promoting health equity.

Welcome back to the second day of the Health Equity Can’t Wait! blog carnival. In the spirit of National Minority Health Month—a nationwide campaign form our friends in the Office of Minority Health—members and friends of the Health Equity and Accountability Act (HEAA) Community Working Group are taking to the blogosphere to talk about the opportunities and challenges we face in realizing a country where everyone has an equal opportunity to be healthy and thrive.

We’re tackling a different theme each day—check out what our earlier bloggers had to say. Yesterday, guests wrote about the ways that their organizations and communities are taking action to advance health equity. Today’s posts consider health equity from a civil rights framework.

In 1966, Dr. Martin Luther King, Jr. declared, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Despite the many advances in our health care system since that time, including the implementation of Medicare, Medicaid, and the Children’s Health Insurance Program, as well as the enactment of the Affordable Care Act in 2010, wide disparities in the quality, availability, affordability, and accessibility of private and public health services continue to plague our health care system. As long-standing disparities persist, a civil and human rights–centered discussion of health care is necessary to understanding the challenges and opportunities for advancement.

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Read how our participants tackle the question: From your perspective, is health care a civil and/or human right?

Access to Quality, Affordable Health Care is a Human Right by Aurelia Aceves, National Urban Fellow, Community Catalyst

Health Care is a Human Right for All by Alexis Guild, Migrant Health Policy Analyst, Farmworker Justice

Health Care is Always a Human Right by Christine Soyong Harley, Policy and Programs Director, National Asian Pacific American Women’s Forum

Secure the Blessings of Liberty to Ourselves and Our Posterity by Sergio Eduardo Muñoz, Senior Policy Analyst, Health Policy Project, National Council of La Raza (NCLR)

Redefining Health: Community Prevention As a Human Right by Ben Simons, Program Coordinator, Prevention Institute

Health As a Fundamental Human Right by Anjela Jenkins, Policy Analyst & Law Students for Reproductive Justice Legal Fellow, National Latina Institute for Reproductive Health

Health Equity Can’t Wait: Why? Because Health Care is a Basic Human Right! by Lacy Langbecker, MSW, Field Student/Intern, Wisconsin Alliance for Women's Health

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Earlier posts:
What is your organization or community doing to advance a health equity mission?

Working Toward Health Equity Together by Quynh Chi Nguyen, Program and Policy Associate, and Aurelia Aceves, National Urban Fellow, Community Catalyst

Promoting the Health Care Law Today because Health Equity Can’t Wait by Sinsi Hernández-Cancio, Director of Health Equity, Families USA

Farmworker Justice: Advancing Health Equity through Education and Advocacy by Alexis Guild, Migrant Health Policy Analyst, Farmworker Justice

Maryland Has Said—Now is the Time for Health Equity! by Leni Preston, Chair, Maryland Women’s Coalition for Health Care Reform

United We Stand: Achieving Health Equity for All by Kellan Baker, MPH, MA, Health Policy Analyst, LGBT Research and Communications Project at the Center for American Progress; Patrick Paschall, Esq., Policy Advocate, National Gay and Lesbian Task Force; and Harper Jean Tobin, Esq., Policy Counsel, National Center for Transgender Equality

Health Equity is a Matter of Reproductive Justice by Natalie D. Camastra, Reproductive Justice Public Policy Fellow, National Latina Institute for Reproductive Health

Making the Healthy Choice the Easy Choice: Eliminating Health Disparities by Jeffrey Levi, Ph.D., Executive Director, Trust for America's Health

African American Elder Health Disparities by Delane Sims Founder/Chair, Senior Moments

Our Communities Count: Advancing Health Equity by Improving Data by Rebecca Spence, Reproductive Justice Fellow, Asian Pacific Islander American Health Forum

Health Equity Can’t Wait: Supporting A Health Equity Agenda In Wisconsin by Lacy Langbecker, MSW, Field Student/Intern, Wisconsin Alliance for Women's Health

P.S. Save the date! On Friday, April 27 from 3:00 to 4:00 p.m. EDT, help us cap off National Minority Health Month by joining our Twitter chat! Follow the hashtag #HealthEquityNow to be part of the conversation. We’ll be re-tweeting and sharing your thoughts! New to Twitter? Create an account or check out some frequently asked questions to get started.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: How does race/ethnicity intersect with other identities in ways that compound barriers to health care and lead to health disparities, and how do you approach these concerns?

Surviving at the Intersections- Barriers to Health for API Women
by Shivana Jorawar, Esq., Reproductive Justice Fellow, National Asian Pacific American Women’s Forum

I am a woman, a first-generation American, and a person of color. I was raised by immigrant parents of South Asian descent who cared for me in the best possible way. As a person surviving at the intersection of many oppressions- sexism, racism, classism, and xenophobia- I know very intimately that a person’s wellbeing is impacted by the identities she carries. I also know that these identities can collude to create insurmountable predicaments.

This rings especially true in regards to health, one of the most basic human needs. When health care services are unaffordable, administered in culturally incompetent ways, and discriminate based on sex and gender, many people are shut out from receiving the care they need to live fully and with dignity. Shamefully, and unsurprisingly, it is the most vulnerable people who run up against the most barriers to health.

An Asian American or Pacific Islander (API) immigrant woman, for example, may be burdened by multiple structural discriminations. She may find that there aren’t any medical staff who can speak a language she understands. She may be further burdened by the sky-high costs of her doctor’s visit because her insurance company essentially charges her for being a woman- since pregnancy, domestic violence, and c-sections are considered “preexisting conditions.” Moreover, taboos around sex in her community may make her unaware of or reluctant to use contraception, elevating her risk for unplanned pregnancy.

And, of course, there is also interpersonal discrimination. She may not be given quality care or may be uncomfortable visiting a doctor’s office because of racist and anti-immigrant feelings toward her. She may even be burdened by a unique stereotyping faced by API community members- the myth of the model minority. That is, despite the fact that many API communities are struggling, we are lumped together under the blanket assumption that we are healthy, educated, and economically prosperous. As a result, many healthcare providers and policymakers are blind to the health concerns of API women.

At least in part due to the above barriers, API women can experience significant health disparities. For example, the rate of cervical cancer among Vietnamese Americans is five times higher than that for white women, representing the highest rate for any ethnic group.

Recognizing the tangled web woven by the multiple oppressions we face, and in an effort to keep API women from getting caught in it, the National Asian Pacific American Women’s Forum (NAPAWF) is working to ensure that healthcare is delivered to our communities in culturally-competent ways that do not discriminate based on race, class, sex, gender, or sexual orientation. This is why we support the Health Equity and Accountability Act, or HEAA, introduced by leaders of the Congressional Black Caucus, the Congressional Hispanic Caucus, and the Congressional Asian Pacific American Caucus, in collaboration with local communities and national health groups, to combat health care disparities. Building on the foundation of the Affordable Care Act, HEAA will improve the quality of care for immigrant women of color by making it easier to identify disparities through comprehensive data collection, ensuring workforce diversity, and making available culturally and linguistically appropriate health care services.

If we are to improve health outcomes for communities like mine, we need solutions that take into account that we are not one-dimensional people. We are multi-faceted, and we need solutions that address our needs as whole people, affected by each identity we carry.

Views and opinions expressed are those of the National Asian Pacific Women's Forum.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: How does race/ethnicity intersect with other identities in ways that compound barriers to health care and lead to health disparities, and how do you approach these concerns?

Clearing the Path to Health Equity Requires Removing Roadblocks for Immigrants
By Kara D. Ryan, Senior Research Analyst, Health Policy Project, NCLR

Amid the celebration of National Minority Health Month, as leaders have highlighted the promise of the Affordable Care Act and national action plans to promote health equity, the government research agency responsible for measuring these gaps in health care access and quality released updated data on the state of health disparities in the U.S. Overall, researchers find that Hispanics fare worse than non-Hispanic Whites on more than 60% of measures of health care access and nearly 40% for health care quality. More bluntly: compared to Whites, more Latinos (and other racial/ethnic minorities) are not getting the health care services they need, their treatment outcomes are poorer, and they’re suffering for it.

Unfortunately, this isn’t breaking news—as the agency itself points out, disparities between Whites and communities of color have been mostly stagnant over the time period for which data has been collected. Indeed, for years, Latinos’ uninsurance rate has hovered around 30%, making Hispanics nearly three times more likely than Whites to be uninsured. What’s more, even insured Hispanics are more likely than insured non-Hispanics to report having no usual source of health care—a key access measure—due to insurance or financial reasons. (For these and other key facts about Latinos’ access to the health system, check out our full slideshow, also available in Spanish).

The persistence of these gaps does, however, reinforce how much is riding on the sound implementation of health care reform and other strategies to promote health equity for Latinos and other underserved communities—and that requires us to take a closer look at how immigrants and their families access health care. More than nine in ten (92%) uninsured noncitizens are racial and ethnic minorities—and these are the Americans with the greatest chance of falling through the cracks left in the health system even after reform is in place.

Take Antoineta, an undocumented Latina who came to the U.S. as a child and has made her home in Los Angeles with her three U.S.-born citizen children. She has worked ever since she arrived, but has never been offered coverage through her job. Thanks to Medicaid, Antonieta can afford to take her kids to the pediatrician, but the high out-of-pocket cost of her own visits means she often skips care herself. “I need to be healthy in order to take care of and feed my children, but I have had to not go to the doctor so that I will have enough money,” she explained. “I am worried I might get sick because I know that no one is going to help me pay for the medical expenses, much less take care of my children.”

By any measure, immigrants like Antonieta are less likely than citizens to have access to affordable, quality health care; for example, nearly half (45%) of noncitizens were uninsured in 2010, compared to about one in seven (14%) of U.S.-born citizens. (See our slideshow on immigrants’ access to health care, also available in Spanish). Additionally, formal and informal barriers that block immigrant access often also spill over onto the lives of citizens—and much of this burden falls on our children. Look no further than the estimated 5.6 million citizen children—nearly 80% of whom are Latino—who live in “mixed-status” families with at least one noncitizen parent. One-quarter (25%) of citizen children living with an undocumented parent are uninsured, along with 14% of citizen children with a legal immigrant parent and 8% of children in all-citizen families. Rates of uninsurance among immigrant children are even higher; nearly half (45%) of all noncitizen kids living with an undocumented parent lack coverage. And even when these children are covered, their families’ health and financial stability may suffer when their uninsured parents cannot afford a trip to the doctor or pharmacy.

So what does this mean for health equity? Despite the new pathways to coverage created by health care reform, Antonieta will remain uninsured—and if her circumstances change, enrolling her kids in an affordable plan for which they are eligible will be more complex than for the average citizen family. Due to an unprecedented exclusion in the health care law, she is forbidden from buying a plan through the private health insurance exchanges that would cover her as well as her children. She will have to find child-only plans and claim the prorated tax credits for which her citizen kids are eligible—also having to overcome any privacy concerns she might have about having her status information shared with other agencies, despite assurances of protection. After all this work, Antonieta will be in the same position she is today—taking calculated risks about when she should seek expensive medical care that she needs to remain healthy for her children.

The health care law promises to connect millions of uninsured Latinos with health coverage and care; yet many of our families will face a road that is uphill and littered with obstacles—or that is blocked altogether. Moreover, implementation decisions at the federal, state, and local levels matter to whether these obstacles will be surmountable to our families. We hail the visionary work of leaders who continue to lay a framework for a more just and equitable health care system. The road ahead is long, but we will work side-by-side with our partners for policy solutions that remove health care barriers for all Americans.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: How does race/ethnicity intersect with other identities in ways that compound barriers to health care and lead to health disparities, and how do you approach these concerns?

Health Equity At The Intersections: Latino/a and LGBT Health
by Veronica Bayetti, Policy Research Specialist, National Latina Institute for Reproductive Health, and Patrick Paschall, Esq., Policy Advocate, National Gay and Lesbian Task Force

This blog post is jointly written by Veronica Bayetti, Policy Research Specialist at the National Latina Institute for Reproductive Health, and Patrick Paschall, Esq., Policy Advocate at the National Gay and Lesbian Task Force. This post is part of the Blog Carnival “Health Equity Can’t Wait” taking place April 25-27, 2012.

As advocates committed to health equity, it is imperative that we always look at the whole picture because it is easy to work in our advocacy silos and only look at one aspect of a people’s lives: sexual orientation, or gender, or race. But as the brilliant late poet Audre Lorde once said, “There is no such thing as a single-issue struggle because we don’t live single-issue lives.” We cannot fully fight for social justice unless we sit with this reality.

We will never fully understand the struggle of someone trying to access an abortion if we do not also know how being a transgender man of color has affected his experience. We cannot know an immigrant’s struggle to access culturally competent and affordable health care if we do not think about how being queer has affected where she feels safe. If we do not look at the intersections, we paint an incomplete picture and we fail to see the very real ways that multiple marginalized identities play out in people’s lives.

In the groundbreaking report Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, the National Gay and Lesbian Task Force and the National Center for Transgender Equality found that Latino/a transgender people experience far higher rates of discrimination than the general population or than either the Latino/a or transgender populations as a whole. For example, twenty-three percent (23%) of Latino/a transgender people reported being refused medical care due to bias, and thirty-six percent (36%) reported having postponed care when they were sick or injured due to fear of discrimination.

Additionally, nearly one in ten Latino/a respondents were HIV-positive (8.44%) and an additional 10.23% reported that they did not know their status. This compares to rates of 2.64% for transgender respondents of all races, .50% for the general Latino/a population, and 0.60% of the general U.S. population. This means that Latino/a transgender people are nearly four times more likely than the transgender population and over 16 times more likely than the general Latino/a population to be HIV-positive.

But the story doesn’t end there: one of the most striking statistics is that a staggering forty-seven percent (47%) of Latino and Latina transgender people reported having attempted suicide, compared to 1.6% of the general population. That makes Latino and Latina transgender people 29 times more likely to attempt suicide than the general population.

These statistics make it clear that it is not enough to focus on one group of people – whether it be Latin@s, LGBTQ folks, or any other group – without recognizing that there are many communities within them, each with their own struggles, their own celebrations, their own priorities. We cannot in good faith advocate for an end to cervical cancer, or advocate for safer immigration detention standards, if we don’t include LGBTQ people. We cannot fight for LGBTQ liberation if we do not stand in support of immigrant’s rights, or reproductive justice. These issues must be as inextricably linked in our advocacy as they are in people’s lived realities. Anything less will stop short of health equity.

This first appeared on the Task Force Blog. Views and opinions expressed are those of the authors and the National Latina Institute for Reproductive Health and the National Gay and Lesbian Task Force.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: How does race/ethnicity intersect with other identities in ways that compound barriers to health care and lead to health disparities, and how do you approach these concerns?

Addressing Disparities, Promoting Health Equity and Ending HIV/AIDS
By, Jeff Levi, PhD, Executive Director of Trust for America’s Health and Chair of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health

While we have made incredible strides in addressing HIV/AIDS over the past thirty years, the disease remains devastatingly prevalent in America, especially among gay and bisexual men. This population accounts for 57 percent of new HIV infections and a gay man, who is 18 years old, faces a two in five chance of becoming infected with HIV by the time he is 40, as noted by a Trust for America’s Health (TFAH) issue brief. In 2009, the estimated rates of new HIV infections among Black men and Latino men were six and a half times and two and a half times as high, respectively, as that of their white counterparts. Disparities are most severe among young Black gay and bisexual men.

The National HIV/AIDS Strategy (NHAS) provides a roadmap for national efforts to end the HIV/AIDS epidemic. The primary goals of the NHAS are to reduce HIV incidence, increase access to care, optimize health outcomes, and reduce HIV-related health disparities. The NHAS describes priority areas in need of interventions, outlines steps for a coordinated national response to the HIV epidemic, and identifies measurable outcomes. This strategy reinforces the importance of focusing efforts on those at greatest risk, and is paramount in addressing the prevalence of HIV/AIDS among gay and bisexual men, particularly among racial and ethnic minorities.

A critical step in achieving the goals of the National AIDS Strategy is increasing awareness of HIV status (or “serostatus”) among gay and bisexual men. Almost 50 percent of HIV transmissions come from the 20 percent of HIV positive individuals who are unaware of their status. Promoting HIV testing and early linkage to care helps suppress viral load, reinforces less risky behavior and helps prevent the transmission of HIV.

Increasing knowledge of serostatus requires routine HIV testing in the clinical setting, which can be accomplished through changes to guidelines and reimbursements. This is incredibly important because most individuals who do not know their status have actually had a recent interaction with the health care system but, unfortunately, were not tested. In order to reach the highest risk populations, including racial and ethnic minorities, there is a need to train providers on testing and creating culturally competent approaches to gay men’s health in general.

Representative Maxine Waters recently introduced important legislation that would promote increased HIV testing by removing cost as an obstacle. The Waters bill, Routine HIV Screening Coverage Act of 2012 (HR4470), would require all individual, group and federal employee health insurance plans to reimburse for HIV testing. This bill would be a significant step toward encouraging those who are unaware of their status to get tested.

As noted by the NHAS, HIV testing is just one piece of a comprehensive set of services that are needed to end the HIV epidemic. Expanded knowledge of serostatus must be complemented by a supportive environment for the gay and bisexual community. HIV prevention and treatment efforts, especially for racial and ethnic minorities, can be compromised by stigma and the social determinants of health, including access to stable housing, education, health care, and other key resources. Resources must be provided to mobilize the gay and bisexual community and promote gay men’s health at the national, state and local level.

We’ve come a long way in the battle against HIV/AIDS. However, we must remain vigilant: we cannot ignore the startling statistics of new HIV infections of gay and bisexual men, especially among Black and Hispanic men. By pursuing the comprehensive approach to prevention and treatment outlined in the National HIV/AIDS Strategy, we can begin to end the HIV/AIDS epidemic.

This post first appeared on The Huffington Post. Views and opinions expressed are those of the author and the Trust For America's Health.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: How does race/ethnicity intersect with other identities in ways that compound barriers to health care and lead to health disparities, and how do you approach these concerns?

Raising Our Voices for Health Equality
by Keely Monroe, JD Program Coordinator and Law Students for Reproductive Justice Fellow, National Women's Health Network

Last month we celebrated the 2nd anniversary of the Affordable Care Act (ACA) and all the gains we have made thanks to health care reform. This month, which is National Minority Health Month, we remember how far we still have to go in achieving health equity. With the glaring racial disparities we still face in the United States and the health challenges for so many women of color that these disparities reveal, health equity cannot wait. We must act now!

Malika Redmond, National Women's Health Network board member, and Keely Monroe celebrating the Countdown to Coverage campaign.

Health Equity is a founding principle in Raising Women’s Voices for the Health We Need (RWV) woman’s vision for quality affordable health care and we believe that the health care systems must actively address and work to eliminate racial, ethnic, gender and class disparities in health care. Communities of color have long suffered from lack of access to basic health services and this has resulted in dangerous and deadly health disparities. African American women are nearly four times more likely to die during childbirth than White women, reflecting differences in access to prenatal and maternity care. Vietnamese American women are five times more likely and Latinas twice as likely to develop cervical cancer as their white counterparts due to barriers to cancer screenings. And African American women have the highest breast cancer mortality rate of any race. We need a national commitment to health equity – it’s time to bring an end to these shameful disparities.

There is some good news on this front. The ACA includes important provisions that are helping us get on the right track toward health equity and RWV is sharing that good news, using our COUNTDOWN TO COVERAGE campaign. This campaign tells the incredible true story of how the new health care law is already helping millions of women, including women of color, get the services they need to stay healthy! You can learn about the health services and protections of the ACA from the COVERAGE CHECKLISTS we’ve posted on the campaign website.

Please take a moment today to learn about how the ACA IS HELPING WOMEN OF COLOR GET THE HEALTH CARE THEY NEED and putting this country on the road to health equity. During National Minority Health Month, help us spread the word about these advances for women of color by sharing the links to our WEBSITE and COVERAGE CHECKLISTS with a woman in your life. Remember, health equity can’t wait, and women of color stand to make important gains from the advances of the ACA.

This blog first appeared at the Raising Women's Voices for the Health Care We Need blog. Views and opinions expressed are those of the author and the National Women's Health Network.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: How does race/ethnicity intersect with other identities in ways that compound barriers to health care and lead to health disparities, and how do you approach these concerns?

Health Equity Can’t Wait Because Millions of Lives Are on the Line
by Sandra Yang, Health Equity Department Families USA

Every year, as I wait in my doctor’s office for my physical examination, I am reminded of all the possible health issues that I may face. I think about my mother having to take calcium supplements because of the increased risk of osteoporosis among Asian women. I look down at my stomach and remember that I am three times more likely to have stomach cancer than a white woman. My eyes meet the speculum on the table and I think of the possibility of cervical cancer. Each layer of my identity is associated with specific health risks.

Despite my concerns, I realize how blessed I am to have the opportunity to get screened for possible health issues, and if they are detected, to tackle them at an early stage. Plus, I do not have to worry about a large medical bill after my visit. However, this is not the case for millions of Americans, and many have faced life-threatening and even fatal consequences because of the lack of access to adequate health care. This leads to questions that I often ask myself, what causes these disparities, and how do we fix them?

There are many factors that contribute to the issue of health disparities, and these complex factors are like layers in an onion. On the outside layers we see physical characteristics, such as race and sex. Socio-economic status, geographic location, insurance status, age, gender, and sexual orientation exist on the inner layers. Each layer of the onion represents potential barriers to health care. These are many factors that lead to health disparities; therefore, in order to reach health equity, we need services that address all of the layers of the onion and peel away the obstacles between people and the high-quality, language-accessible, culturally competent care they need to maximize their health.

We cannot treat health care as if it were one size fits all. Because of my identity—a minority and a woman coming from a low-income background—not only am I more likely to face certain illnesses, but I am less likely to receive care. This is because minority women both have higher rates of chronic disease, including diabetes, heart disease, and stroke and are more likely to be uninsured. However, I am fortunate that I am living during a time that saw the passage of the Affordable Care Act because, for example, women can now receive preventive care with no co-pays, and come summer, the list of these services we can receive at no cost will grow.

This is why the health care law is crucial to the goal of health equity. The beauty of the law is that it fills in some of the gaps in access to care and coverage that feed into health disparities. The law addresses the layers of the onion to reach the core, helping Americans who have limited access to care get the care they need, including important preventive services. Health reform will increase access to critically important preventive care not only by requiring that all new insurance plans cover preventive services, but also that they provide them free of charge.

We need health equity now because people’s lives are at risk. If we ignore health disparities, minorities will continue to face higher rates of disease, fewer treatment options, and reduced access to care.

To cap off the week, we’re taking part in a Health Equity Can’t Wait! Twitter chat on Friday, April 27, from 3-4 p.m. EDT. Follow the conversation and join along using the hashtag #HealthEquityNow

This post first appeared on the Families USA blog, Stand Up for Health Care. Views and opinions expressed are those of the author and Families USA.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: How does race/ethnicity intersect with other identities in ways that compound barriers to health care and lead to health disparities, and how do you approach these concerns?

Eliminating Disparities in Maternal Health
by Christine Monahan, Health Policy Advisor and Kalahn Taylor-Clark, Director of Health Policy, National Partnership for Women & Families

How does race and ethnicity intersect with other identities (including sex, gender identity, etc.) in ways that compound barriers to health care and lead to health disparities?

Every mother and every infant deserve high-quality maternity care. Yet despite the fact that the United States has many of the best medical professionals and facilities in the world, our health care system is failing to meet the maternal health care needs of millions of women, and Black women are at particular risk.

The statistics are striking. According to the Centers for Disease Control and Prevention (CDC), Black women are more than three times more likely than White women to die from pregnancy-related causes. Infants born to non-Hispanic Black mothers are more likely to be born preterm and nearly twice as likely to have low birth weights as infants born to White mothers. And the preliminary infant mortality rate in 2010 for Black infants was more than twice that of White infants. Further, only 54 percent of Black babies have ever been fed breast milk, compared to 74 percent for White babies, 80 percent of Latino babies, and 81 percent of Asian American babies. So what’s the cause behind such troubling disparities and what is being done to combat them?

First, the problem of infant mortality among Black women cannot be dismissed as a result of lower educational attainment. College educated Black women also suffer an infant mortality rate that is more than double that of their White counterparts – 11.5 deaths per 1,000 births for Black mothers compared to 4.2 per 1,000 for White mothers. White women who dropped out of high school have a lower rate of infant mortality than college-educated Black women – 9.1 deaths per 1,000 births compared to 11.5, according to the National Center for Health Statistics.

Rather, health researchers suggest that a lifetime of stress related to navigating systems plagued by race and gender bias has the additive effect of wearing on the body. That is, when the body is stressed it produces a hormone called cortisol, which can work to induce labor. Beyond equalizing access to health care services, more must be done to combat these stressors for Black women.

Over the past eight years, The March of Dimes’ Prematurity Research Initiative has provided nearly $22 million to address these issues broadly, and in 2012 alone has provided grants totaling nearly $3 million for this work. Targeting funding through these types of initiatives could do a lot to address, head on, this troubling disparity.

Second, more than 22.4 percent of Black women – compared to 12.7 percent of White women – have no health coverage. Black women are also more likely to be without a usual source of care than White women. Consequently many Black women don’t have access to the health care they need before, during, and after pregnancy. Many are without:

1) Community resources and health care services that can help them stay healthy before pregnancy (for example, 7.5 percent of Black women compared to 3.3 percent of White Women have been diagnosed with diabetes – a condition associated in pregnant women with greater risk of pregnancy complications, birth defects, and spontaneous abortions or miscarriages);

2) Contraception to help them plan families and appropriately and safely space pregnancies (Black women face a significantly higher rate of unintended pregnancies);

3) Preconception and prenatal care to allow doctors to identify and treat any health issues early (Black women are more than twice as likely as White women to receive prenatal care starting in the 3rd trimester or not receive prenatal care at all); and

4) Postpartum care to assist mothers with breastfeeding (As noted earlier, Black babies are less likely to be breastfed. Research has shown that breastfeeding can reduce the rates of a range of chronic conditions, including obesity, type 2 diabetes, and asthma. Further, Black adults are likely to suffer from all of these conditions at higher rates than are Whites. Thus, it is possible that encouraging breastfeeding may help to alleviate some of the disparities that Blacks disproportionately face later in life.

The Affordable Care Act (ACA) contains a number of important provisions that will help us tackle these barriers. It makes significant investments in prevention (in both the health care and community settings) and expands affordable health coverage to millions of women. The ACA also specifically aims to improve conditions for pregnant women and new parents by providing comprehensive maternity coverage and supports for low-income mothers, and improving the infrastructure for breastfeeding. In addition, through the Strong Start Initiative, providers, states, and others have the opportunity to build public-private partnerships to reduce early elective deliveries, and to test innovative approaches to provide access to high-quality prenatal care. Targeted efforts through these programs will be imperative to reducing disparities in access to needed care services.

The National Partnership for Women & Families is committed to making sure the ACA delivers on these important protections, by working closely with both federal and state officials as they implement the law and combating efforts by opponents in Congress to undermine it.

This blog first appeared at the National Partnership for Women and Families blog. Views and opinions expressed are those of the authors and National Partnership for Women and Families.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: How does race/ethnicity intersect with other identities in ways that compound barriers to health care and lead to health disparities, and how do you approach these concerns?

Indigenous Farmworkers Face Unique Barriers to Healthcare
By Alexis Guild, Migrant Health Policy Analyst, Farmworker Justice

As a Peace Corps Volunteer in Guatemala, I lived and worked in an indigenous community where the women wore traditional dress and the primary language was Maya K’iche. Although many of my community members had lived and worked in the United States, I was unaware how dominant and diverse indigenous culture was in the United States, especially in the agricultural sector.

Did you know, for example, that indigenous Mexicans are the fastest growing farmworker population in the United States? In California, it is estimated that there are 165,000 indigenous farmworkers and their families. The most common indigenous languages in the United States – Mixteco, Triqui, and Zapotec – are from communities in southern Mexico. Indigenous Mexicans, like indigenous Guatemalans, come to the U.S. with distinct languages and cultural beliefs.

These distinct languages and cultural beliefs create barriers to healthcare that are more complex than the barriers experienced by non-indigenous Mexicans. For example, spiritual connections are very important in many indigenous cultures. Many beliefs about illness, such as the need to balance “hot” and “cold”, mal de ojo (evil eye), and susto (fright) are rooted in the supernatural. These beliefs are unfamiliar to many U.S. medical personnel. Indigenous farmworkers, therefore, may seek treatment of traditional healers (also known as curanderos) or herbalists (yerberos) along with clinical providers to diagnose illnesses and provide spiritual as well as physical relief.

Indigenous farmworkers also face discrimination within the Mexican community. In Mexico, there is rampant discrimination against indigenous people, which is carried over to the United States. Within the farm hierarchy, indigenous farmworkers are at the bottom. Their housing tends to be more overcrowded and their wages tend to be lower and working conditions more dangerous than their non-indigenous Mexican counterparts. This discrimination may be responsible for the higher rates of depression among indigenous farmworkers.

Language barriers are also more complex. Most migrant health centers, the primary source of healthcare for many migrant and seasonal farmworkers, have staff that speaks Spanish. Few, however, have staff that speaks indigenous languages. The diversity of languages makes it difficult to accommodate many indigenous farmworkers. Furthermore, these languages are traditionally not written and many indigenous workers are illiterate, compounding the difficulty of efforts to provide services to them. Health and safety information is not widely available and some healthcare terms, such as asthma and diabetes, do not have an equivalent in the indigenous languages. As a result of these differences, programs and services developed to meet the needs of Spanish-speaking farmworkers are frequently culturally inappropriate or linguistically inaccessible for indigenous workers.

Farmworker Justice is working with indigenous farmworker organizations and migrant healthcare providers to improve access to healthcare services. In California and Oregon, two states with the largest indigenous farmworker population, FJ staff provides training to indigenous farmworker promotores de salud (community health workers) on occupational health and safety. FJ is also facilitating partnerships between these organizations and migrant health centers to improve outreach and care for indigenous farmworkers and their families.

It is important for advocates and healthcare professionals to be respectful of the beliefs of indigenous farmworkers. The barriers they face are more complex than the general farmworker population and therefore require more thoughtful interventions.

FJ’s Health Equity Can’t Wait! blog posts have highlighted the challenges that farmworkers encounter in the United States. All farmworkers, regardless of cultural background, deserve respect and high quality healthcare. Farmworker Justice empowers our nation’s farmworker to lead better and healthier lives. Poco a poco, I am confident that we will be able to achieve health equity for all.

This post originally appeared at Harvesting Justice. Views and opinions expressed are those of the author and Farmworker Justice.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: How does race/ethnicity intersect with other identities in ways that compound barriers to health care and lead to health disparities, and how do you approach these concerns?

Chasing the Sunlight of Opportunity
by Kellan Baker, MPH, MA, Health Policy Analyst, LGBT Research and Communications Project at the Center for American Progress

In America today, an African American baby is still twice as likely as a white baby to die before her first birthday. More than 30 percent of Latinos in the U.S. are uninsured, compared to 12 percent of non-Hispanic whites. Despite advances in HIV prevention and treatment, gay and bisexual men and transgender women of color are still disproportionately likely to become infected with HIV and to die from AIDS.

Clearly, race and ethnicity matter in health. So do gender, poverty, and ability. So too do sexual orientation, gender identity, and other characteristics linked to discrimination or exclusion.

And according to Senator Daniel Akaka, who introduced the Health Equity and Accountability Act yesterday in the Senate to build on the advances of the Affordable Care Act, “glaring health disparities based on racial and ethnic identity alone…are further exacerbated by factors such as socioeconomics, geography, and sexual orientation and [gender] identity.”

Areas of intersection between sexual orientation, gender identity, and other disparity factors include mental health concerns linked to minority stress, such as depression, anxiety, and suicide; higher rates of smoking and other substance use; and greater risk of contracting HIV and other sexually transmitted infections. Fear of mistreatment from health care providers who are not familiar with culturally competent care for different minority populations also prevents many people from accessing vital health services and compounds the seriousness of conditions such as heart disease, cancer, and diabetes.

These health disparities do not occur in a vacuum. Like poverty, they feed off established social and economic structures that determine the distribution of power and resources. What’s worse, inequality turns diversity into disparity. For people who belong to multiple communities that experience health disparities, these disparities do not simply add up: They multiply.

Take the case of lesbian, gay, bisexual, and transgender (LGBT) communities of color. Despite our supposedly “postracial” America, discrimination still shadows people whose skin color doesn’t match the white faces that dominate boardrooms, statehouses, and the halls of Congress. Similarly, while things have improved for most LGBT people in the United States since the stigma, silence, and arrests that characterized the era before the rise of the LGBT rights movement, LGBT Americans and their families still face widespread discrimination in relationship recognition, employment, housing, and access to health insurance and health care.

Discrimination limits opportunity and choice. As a result, LGBT people of color may be more likely than either white LGBT people or straight and non-transgender people of color to be less healthy and experience greater disparities in health care access. They are more likely to live in poverty, to have trouble seeing a doctor when they need to, and to live in environments where the surgeon general’s goal of making the healthy choice the easy choice remains an unfulfilled promise. For too many Americans, each additional “disparity factor,” from having a disability to being a woman to living in a rural area, magnifies the health gap.

An important step in breaking the cycle of disparities breeding disparities is changing our lens from health disparities—a focus on what has gone wrong—to health equity—a focus on where we want to be. The U.S. Office of Minority Health defines health equity as the attainment of the highest level of health for all people. Achieving it requires not only valuing everyone equally but also taking concrete steps to address inequality, close disparities, and build a healthier society.

On April 2, the Department of Health and Human Services (HHS) kicked off National Minority Health Month with a health equity town hall in Washington, DC. The event featured Assistant Secretary for Health Howard Koh, Acting Assistant Secretary for Minority Health Nadine Gracia, representatives from other HHS offices of minority health, and DC-based community health leaders.

The speakers described numerous health equity initiatives at HHS, including expanding access to insurance coverage and preventive services under the Affordable Care Act, enforcing nondiscrimination protections in the health system, developing comprehensive cultural competency resources, and implementing the National Stakeholder Strategy for Achieving Health Equity and the National Partnership for Action to End Health Disparities.

Another major HHS initiative of particular importance for LGBT communities is improving data collection on health disparities. Currently, major public health surveys collecting data that can help identify racial and other disparities do not ask respondents about their sexual orientation and gender identity, rendering LGBT people almost invisible in the national fight for health equity. In response, HHS has developed a plan to begin including sexual orientation and gender identity questions on federally supported health surveys and eventually developing standards to guide the routine collection of high-quality data on the health of LGBT communities.

As Assistant Secretary Koh reminded the audience at the National Minority Health Month town hall, using Reverend Martin Luther King, Jr.’s memorable phrase, the shadow of health disparities continues to chill those who have been left out of the sunlight of opportunity. But just as no community experiences health disparities in isolation from other disadvantaged communities, no community struggles alone in the fight for health equity. All of us battling health disparities may have arrived in different ships, but we’re all in the same boat now, pulling together.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: How does race/ethnicity intersect with other identities in ways that compound barriers to health care and lead to health disparities, and how do you approach these concerns?

Health Care Equity Can’t Wait: Women with Compounding Barriers
by Lacy Langbecker, MSW, Field Student/Intern, Wisconsin Alliance for Women's Health

For the past two days we have been blogging on the importance of achieving health equity and eliminating disparities that exist between racial and ethnic minorities through health care reform. We have given the perspective on how this specifically affects women of different racial and ethnic backgrounds.

Because of the importance of this issue, we want to reiterate the importance of achieving health care equity for women – with minority women being even more likely than white women to be uninsured. But beyond women who are of a racial or ethnic minority, other barriers also affect the ability for women to become insured and some women face a combination of these barriers – referred to as compounding barriers.

Rural women. Rural women face unique barriers to health care. They are less likely to be able to get to their doctor’s appointments or to have access to a health care provider. In response, the Wisconsin Alliance for Women’s Health (WAWH) advocates for meaningful health care reform implementation because it creates incentives for providers to choose to work in rural settings. Health care reform also will increase the amount of community health centers – the main health care provider for rural women.

Women in the LGBTQ community. The LGBTQ populations also face unique barriers to health care. Women, in general, are less likely to access health care through their employer – making access through a spouse’s plan crucial to many women. This creates special difficulties for women who are part of the LGBTQ community, as many health plans do not cover unmarried domestic partners.

Racial and ethnic minority women. We have already discussed over the past two days the startling statistics that affect racial and ethnic minority women. This comes in the form of lower life expectancy, disparities in birth outcomes, and even the quality of care received.

Even more startling is the statistics when barriers are combined. For instance:

• LGB* African American women are least likely to have had a mammogram within the last two years
• LGB* adults are least likely to be insured
• LGB* African American adults are most likely to have diabetes
• LGB* Pacific Islander or Asian adults are most likely to face psychological distress
• LGB* Latino adults are most likely to abuse alcohol

What we advocate for. WAWH, as previously stated, works to raise awareness and support for health care reform implementation. Women who face compounding barriers such as the ones aforementioned have increased health care options with reform that can help to reduce disparities. In 2014, when health insurance exchanges are up and running, women who does not have access to insurance – be it a lack of insurance through their employer, lack of insurance through their partner’s employer or a variety/combination of reasons – will have access to quality insurance through the exchange or through Medicaid.

Further, health care reform requires a more robust method of reporting data. In order to continue to reduce disparities and attain health equity, we will need to have the necessary data to properly identify disparities. This means no longer using “umbrella” terms like Hispanic and reporting of sexual identity in the appropriate category by expanding the options used for reporting – like transgender*.

Beyond WAWH’s education and raising awareness efforts around health reform, Project Director Amy Olejniczak also launched the Wisconsin Adolescent Health Care Communication Program (WAHCCP) in 2010. Amy works to bridge the communication gap between all Wisconsin teens, including those of all genders, orientations and identities, and their health care providers. The success of her efforts and leadership contributions to the lesbian, gay, bisexual, and transgender community within the past year led to her being selected as a recipient of the 2011 Diverse & Resilient Adult Ally Award.

Healthy Equity Can’t Wait. Wisconsin women. Wisconsin rural women. Wisconsin LGBTQ women. Wisconsin Minority women. Wisconsin women with disabilities. Wisconsin women win with health care reform!

*LGB is used because specific data is not available for the transgender populations – making reporting reforms important for the LGBTQ community.

This post first appeared at the Raising Wisconsin Women's Voices blog. Views and opinions expressed are those of the author and Wisconsin Alliance for Women's Health

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: How does race/ethnicity intersect with other identities in ways that compound barriers to health care and lead to health disparities, and how do you approach these concerns?

Why Do Poverty, Poor Health and Unequal Opportunity Persist in the Lives of So Many African Americans?
by Otis Pitts, JD, MPH, Operations Manager, The City of Hartford Health and Human Services

Why do poverty, poor health, and unequal opportunity persist in the lives of so many African Americans and to what extent are these trends a function of segregation, institutional or otherwise? Unfortunately, we have all struggled in our attempt to sufficiently articulate and explain this complex and sensitive relationship and why it results in such drastically different health outcomes in minority communities. Research on segregation and health has developed in number in recent years; however, studies and public health programming that specifically analyze and address segregation in the context of measurable social determinants and avoidable environmental health risks are in their infancy.

It has been frustrating to watch so many health professionals and policymakers wrestle with the well-documented relationship between segregation, opportunity, and health and that few lines of program and policy development have incorporated models to measure exposure to segregation and economic opportunity and subsequently include them as key factors in epidemiological analysis and public health interventions. In order to achieve meaningful progress in the field of health justice, public health professionals and researchers must devise consistent and reliable metrics to allow public health advocates and other champions of health equity to put forth compelling arguments tying unjust segregation to avoidable health outcomes. However, even once such quantifiable relationships between segregation and poverty are established, underserved communities will still need to address residual cultural issues that have resulted from decades of isolation and stigmatization in order to successfully access opportunity and pursue the American dream.

The major systemic impediments to good or improved health continue to include both the institutionalized legacy of racism and dramatic economic changes that have fallen with disproportionate severity on African Americans, but there are additional factors that our routine analysis has yet to account for. Such factors are perhaps most poignantly reflected in the disturbingly nihilistic attitudes among African American youth with respect to their own communities, well-being, and future. These unexplored factors are only amplified by racial mistrust and in turn contribute to the miserably low health services utilization we see in many African American communities. Concurrently, economic changes having nothing to do with race have aggravated the problems of segregated housing patterns and made isolation a permanent feature of African American life. Today many residents of predominantly African American communities have virtually no contact with mainstream American society or the traditional job market – a link more important than ever. In such communities, an ethic of hard work, investment in the future, and deferred gratification are not terribly compelling when community surroundings present few, if any, chances for legitimate and sustained employment that will support residents and their families. The mission of social justice requires us, advocates for health justice, to begin the hard work not only creating systematic policy change and opportunity, but also of fostering trust in communities that have no reason to believe the outside world cares about them. For far too long, there has been a disconnect between our public institutions and the daily struggles of the disadvantaged. Like the poor and isolated around the world, Connecticut’s vulnerable populations need predictability: specifically, predictably good outcomes for good behaviors. As such, it will take complex and aggressive public policies that create reliable systems that develop the trust and predictability among our communities to break the destructive cycle of poverty and unequal opportunity.

So what role should leaders in health justice play in this fight to end segregation and its adverse effects on predominantly minority communities in Connecticut? For those who find themselves living in environments marked by poverty and compromised opportunity, the American healthcare system offers meaningful engagement far too late in life as health destinies have already been shaped by social determinants and the law’s arm is not nearly long enough to reach overtly racist practices that occurred in the past, nor can it sufficiently address the complex economic and demographic changes that have devastated cities and towns across America. Thus, the segregated, underserved, and often isolated, urban poor need remedies that our healthcare and legal systems cannot produce alone: public and private investment to create opportunity – vocational training to help them learn new skills and navigate the modern job market; jobs that pay a living wage; and perhaps most important, a chance to move into, and create, racially and economically integrated neighborhoods where there are healthier cultural norms and more promising opportunities for everyone.

In closing, while it seems many attempts at intervention and public health programming are still struggling with the development of a pragmatic approach to measuring and addressing the public health consequences of segregation in African American communities, there are a number of encouraging and inspirational projects going on in Connecticut. Given the heightened awareness of social determinants and their impact on health, many studies and projects are now looking at how specific environmental exposures and social determinants are increased or compounded by the degree of racial residential segregation, and how such factors have health significance across racial/ethnic lines. The progress of groups like the Health Equity Alliance, a Connecticut initiative taking up the challenge of quantifying the health consequences of segregation, will be important to monitor as it presents a dynamic opportunity to apply powerful empirical evidence in our fight against injustice. Such data-driven projects are leading the way in their novel approach to collecting meaningful information that can be marshaled by public health professionals, community activists, and policymakers to redress unjust institutionalized policies and practices and to support the development of new policies necessary to alleviate the lack of opportunity that has crippled segregated minority communities for far too long.

This was first posted to the Health Justice CT blog. Views and opinions expressed are those of the author and Health Justice CT.

To wrap up National Minority Health Month, NCLR is proudly hosting a blog carnival with our friends and partners to celebrate recent progress toward eliminating health disparities for underserved communities—and talk frankly about the challenges that remain. Today, bloggers answer the question: How does race/ethnicity intersect with other identities in ways that compound barriers to health care and lead to health disparities, and how do you approach these concerns?

Why are women of color still dying in childbirth?
by Jasmine Burnett, Community Organizer, Raising Women’s Voices-NY, guest blogger for Community Catalyst

How does race and ethnicity intersect with other identities (including sex, gender identity, etc.) in ways that compound barriers to health care and lead to health disparities? How does your organization/community approach these concerns?

African-American women have been dying in childbirth at rates three to four times that of white women for more than six decades. That shocking statistic is where I begin the conversation with women of color about how the Affordable Care Act (ACA) can help address persistent health disparities. These disparities, I explain, must be approached from an intersectional frame of analysis that takes into account both race and gender.

I have given this presentation to such community-based organizations as the Caribbean Women’s Health Association, the Brooklyn Young Mothers Collective and members of Bronx Health Link network, as well as to members of the Black, Puerto Rican, Asian and Latino Caucus of the New York State Legislature. These audiences know about the problems of maternal mortality and morbidity from experiences in their families and neighborhoods. Still, they are outraged to learn that in 2008, African-American women in New York City had a maternal mortality that was seven times higher than white women.

Hispanic women also suffer from high rates of maternal mortality. They account for 24 percent of maternal deaths in New York City, more than twice the percentage for white women, even though the two groups of women account for the same percentage of live births in the city.

Both African-American and Hispanic women are suffering from a related problem: pre-term births, which can lead to infant mortality and morbidity. That point was underscored at an event Raising Women’s Voices-NY co-sponsored with the Brooklyn Perinatal Network on March 22. The event, which marked the second anniversary of the Affordable Care Act, was held at Brookdale Hospital in central Brooklyn, where the rates of pre-term births are extraordinarily high. Advocates, policy leaders, health providers and community representatives came together to focus on how some of the chronic health conditions neighborhood women experience – such as obesity, diabetes, hypertension, stress, and alcohol, drug and tobacco use – go untreated and lead to tragic pregnancy outcomes.

What can we do to address this problem? How can health reform, and the creation of the New York State health Exchange, help to address egregious disparities like maternal and infant mortality and morbidity?

The obvious starting point for change is recognizing that too many women can’t afford the health care they need. Women of color are disproportionately uninsured and underinsured. We stand to benefit enormously from the expansion of Medicaid and the offering of subsidized private insurance plans in state Exchanges like the one that Governor Andrew Cuomo has just created in New York State through an executive order. But there are also specific steps we can take in creating our state exchange that will begin to bring down the high rates of maternal and infant mortality and morbidity. Here’s the priority list we have at Raising Women’s Voices-NY:

• Offering affordable health coverage that can help reduce the current high rates of uninsurance among women of color.
• Requiring Qualified Health Plans to prioritize the reduction of maternal and infant mortality and morbidity as a health outcome that will be measured, tracked and used in determining whether a plan can continue to be offered in our state Exchange.
• Requiring Qualified Health Plans to include in their provider networks a strong complement of reproductive health providers qualified and experienced in serving women who are at risk of pregnancy complications.
• Including preventive services needed to help women plan and space healthy pregnancies in the Essential Health Benefits Package of services that must be covered by all Qualified Health Plans approved for offering in New York State’s health Exchange.
• Ensuring that such services are delivered in a manner that is culturally and linguistically competent and accessible to women with low literacy.

This first appeared on the Community Catalyst blog. Views and opinions expressed are those of the author and Community Catalyst.