THE NEW YORK CITY
Department of Health and Mental Hygiene just issued its first-ever report on
the state of mental and physical health of the city’s Latino population. Some
2.4 million strong—and representing more than 20 countries of origin—Latinos
account for almost one-third of the city’s population. Puerto Ricans account
for 30 percent of the Latino population, with Dominicans and Mexicans forming
the next two largest contingents.
The report notes that
a disproportionate number of Latino New Yorkers live in poverty — more than
half compared to one-third of non-Latinos. Far fewer Latinos earn a high school
diploma or go to college. More than 50 percent of Latinos in New York spend
more than 30 percent of their monthly income on rent, leaving insufficient
funds for food—particularly healthy foods, like fruits and vegetables—clothing,
and health care.
As a result, many
thousands of Latinos live in conditions and confront circumstances that are impediments
to good health and access to quality healthcare.
One of the report’s
most surprising findings is that Latinos as a whole have a lower premature
mortality rate than non-Latinos. Specifically, when it comes to the leading
causes of death—heart disease, cancer, and the flu—Latinos have lower death
rates than New York City’s non-Latinos. The study also reveals that Latinos are
less likely than non-Latinos to smoke and are more likely to have a mammogram
and flu shot. This is where the good news ends.
Sad to say, some 22
percent of Latinos do not have health insurance, compared with 9 percent of
non-Latinos and 13 percent of all New York City residents. Compared with their
fellow New Yorkers, Latinos are more prone to suffer from chronic conditions such
as obesity and diabetes.
Nearly one-third of
Latinos are obese, compared to 20 percent of the rest of the city’s population,
while 17 percent of Latinos struggle with diabetes—and many end up dying from
the disease—as compared to just 10 percent of non-Latinos. As measured by
Latinos’ reports of mice and cockroaches in the home—which, the report says,
are “known asthma triggers”—more than 50 percent of Latinos are at risk of
asthma compared to 31 percent of non-Latinos.
Illustrating cultural
differences across the Latino communities, the study shows that Puerto Ricans
are more likely to have negative health-related outcomes. Puerto Ricans are
outliers in terms of smoking ¬ – 25 percent report smoking vs 12 percent for
Latinos overall and 15 percent for non-Latinos – and are more likely to consume
one or more sugary drinks per day, which is a key contributor to obesity. The
prevalence of asthma among Puerto Ricans is nearly three times that among
non-Latinos in New York City.
The study also found
that Latino immigrants who have lived in the U.S. for more than 10 years are
more likely to suffer from “adverse outcomes” in health when compared to
Latinos who have immigrated more recently. What’s more, U.S.-born Latinos are
more likely than Latinos born abroad to consume one or more sugary drinks per
day. This finding too calls for further investigation to explain this striking
and curious discrepancy.
Given the report’s
findings, it is obvious that healthcare providers responsible for serving the
Latino community of New York City must take into account a host of
environmental, cultural, social, as well as mental and emotional factors, in
addition to strictly medical considerations. It is clear that the bulk of
Latinos are eligible for the provisions of Medicaid. Yet, that system as it has
been functioning traditionally has been falling short.
A unique experiment
underway in New York State is offering hope. Launched in 2015 with a five-year
mandate, the Delivery System Reform Incentive Payment (DSRIP) program is moving
Medicaid-provided medical care away from a fee-for-service model and toward a
Value-Based Payment (VBP) system. The DSRIP objective is to save New York State
tax payers billions annually through a reduction by 25 percent of unnecessary
hospitalizations.
That goal can be
reached by keeping patients healthier in the long-run—and patients are kept
healthier thanks to a closer relationship with, in particular, their primary
care provider, a bond that is developed, nurtured, and encouraged by the VBP system.
That system incentivizes doctors—aided by their staff and Community Health
Workers—to keep closer track of their patients, to get to know them better, to
take an interest in their family life, their living conditions, their job
status, their economic condition; in short, to become familiar with the
totality of their circumstances.
The new research
indicates that fewer Latinos (76 percent) report access to a primary care
provider than non-Latinos (87 percent), with only 57 percent of Latinos of
Mexican decent reporting such access.
Cultural competence is
a key requirement for the 25 so-called Performing Provider Systems (PPSs) in
New York State operating under the DSRIP mandate. Among them, Advocate
Community Providers (ACP), operating in New York City—and serving in particular
Latino, African American and Asian communities—is the only physician-led
network, in contrast with the other PPSs that are hospital system-based
corporations. A majority of ACP doctors work in the very neighborhoods where
their patients live; and they often share the same cultural background and
speak the same language. Those factors make possible the establishment of an
authentic, intimate patient-doctor relationship.
Through DSRIP, these
neighborhood physicians are transforming their practices to deliver better
quality, more efficient, more comprehensive care – which is essential to closing
gaps in access to care in underserved communities. The vision is that primary
care providers—a new, contemporary iteration of the old-fashioned family doctor
who is easily accessible to all people in the neighborhood—have a chance to
delve deeper into the lives of the people care for. They can discover, for
example, what kind of cultural factors distinguish Puerto Ricans from other
Latinos, cultural predispositions that make for certain behavioral patterns
that can adversely affect people’s health. These predispositions, or cultural
nuances—can be addressed, probed, even corrected, just as behavioral or
cultural traits among recent Latino immigrants that are beneficial for health
can be examined and held up as a model for other Latinos.
It is to be hoped that
the Report — “Health of Latinos in New York City”—will encourage city and state
officials to examine still more closely all the determinants—social, medical,
and cultural—that affect the health of New York City Latinos and, in future,
the factors that impact the state of health of other minority and population
groups in the city.
Genuinely close
attention paid to the health and wellbeing of people – rather than patients who
by definition are ill in some way or another – is the hallmark of truly smart
healthcare. The future of healthcare reform will be smart in the sense of
data-driven intelligence fueled by carefully kept, comprehensive individual
Electronic Health Records—as well as smart in the purely human sense, in the
form of both a common-sense and more studied understanding of what make
individuals behave the way they do, what circumstance they must cope with, and
how their health benefits or suffers as a result.
Thanks to its
visionary leadership and in collaboration with New York State Department of
Health officials, ACP has begun laying the groundwork to continue to support
this network of independent physicians even after the DSRIP program ends in
March 2020 through a for-profit entity, called, appropriately enough, Somos,
Spanish for “we are,” or rather: “we stand, as in ”we stand with the poor.”
For the sake of the
common good, the unique, transformative, indeed revolutionary DSRIP
formula—that turns doctors into community leaders—simply must find a way to
continue in a sustainable, commercially viable way.
Click here to download a PDF of the report.
