Tuesday, October 31, 2017

Health of Latinos in New York City gets mixed scorecard



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.







Monday, October 30, 2017

In Chile, the world’s first mobile shelter for the homeless makes its debut

A HIGH-RANKING Vatican official, known to be a conservative in doctrinal matters, recently confided to a visitor that—even as Pope Francis continues to come under fire for a perceived lack of clarity when it comes to Church teaching—what really is winning him over is the Pope’s steadfast love of the poor, his insistence that a Christian’s first duty is to love his or her neighbor who is suffering.

This duty to love the poor—the mentally or physically disabled, the outcast, the stranger, the homeless, the person at the margin of society—was the theme of Pope Francis’s first Apostolic Exhortation, Evangelii Gaudium, the “Joy of the Gospel.”

“Works of love directed to one's neighbor,” the Pontiff wrote, “are the most perfect external manifestation of the interior grace of the Spirit… [and] there is an inseparable bond between our faith and the poor. May we never abandon them.”

More and more, local Churches around the world are taking their cue from this papacy’s deeply pastoral emphasis, developing more programs that allow those who have much to share their bounty with those who are deprived.

On that front, Archbishop Fernando Chomali of Concepción, Chile has launched a unique initiative: a mobile shelter—called Alberguemóvil La Misericordia, the “Mercy Mobile Shelter.” The archdiocese raised money from local businesses, automotive designers,
 and trade unions to outfit a passenger bus with four beds, a couple of showers, and other amenities. The mobile shelter pulls up every evening at the city’s Independence square and opens its doors for the homeless.

Volunteers make sure the visitors are taken care of and graciously received into an atmosphere that treats them in accordance with their human dignity, offering them kindness and respect. “More than providing a service,” said Archbishop Chomali, “we deliver dignity.” He insists that the unique mobile shelter is not merely a “favor” to the city’s homeless, but that it represents “a labor of justice.”

He continued: “They say that we are a developed country, but there are people on the street,” and it is a Christian’s duty to make up for the gap that separates rich and poor. That perspective echoes Pope Francis’ insistence that, ultimately, the Church is called to help “eliminate the structural causes of poverty and to promote the integral development of the poor.”
 
That major effort, says the Pope, goes hand-in-hand with “small daily acts of solidarity in meeting the real needs which we encounter.” The Mercy Mobile Shelter does its part and does so remarkably effectively. One of the mobile shelter volunteers, Natalia del Pino, a university student, said that the shelter team welcomes the homeless “with simple warmth,” adding that “it’s not hard to enter.” Undoubtedly, the Mercy Mobile Shelter will be a particularly strong draw on cold nights.

Luz Clarita, who takes advantage of the shelter’s hospitality, reports: “Here, they tell us stories. And they listen to us.” Ana, another visitor, stresses: “we feel very fortunate and give thanks to the Archbishop.” A local news show reported that the Mercy Mobile Shelter “connects a great number of people who are ready to help” with homeless men and women, who are “seeking just a few hours of comfort, a hot shower and some sleep.”

The concept of a mobile homeless shelter may well catch on in major cities across Chile and beyond its borders. One can even imagine such an approach in major urban centers in the United States. The Mercy Mobile Shelter also has great symbolic value in impressing upon passers-by to do something personally to relieve the plight of the poor.

Again, as the Pope has written, “almost without being aware of it, we end up being incapable of feeling compassion at the outcry of the poor, weeping for other people's pain, and feeling a need to help them, as though all this were someone else's responsibility and not our own.”

The Pope makes the case that, as the poor “know the sufferings of Christ … [we] need to let ourselves be evangelized by them.” In Concepción, Chile, the Mercy Mobile Shelter is a modest flagship for the fundamental thrust of this papacy.

Archbishop Chomali’s groundbreaking initiative makes manifest the message of the Church’s first World Day of the Poor, scheduled for Nov. 19, 2017, with Pope Francis proclaiming: “We are called, then, to draw near to the poor, to encounter them, to meet their gaze, to embrace them and to let them feel the warmth of love that breaks through their solitude. Their outstretched hand is also an invitation to step out of our certainties and comforts, and to acknowledge the value of poverty in itself.”

The “Mercy Mobile Shelter” video is only available in Spanish.