Arizona Health Disparities Center newsletter

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AHDCONNECTION
Arizona’s Leading Health Disparities Resource Volume 1, Issue 1, July 31, 2008
Director’s Spotlight
By Susan Gerard, Director of ADHS
I am very pleased to announce the release of
the inaugural edition of AHDConnection, the
quarterly informational newsletter for the Ari-zona
Health Disparities Center (AHDC), a part of
the Arizona Department of Health Services
(ADHS). The AHDC serves as Arizona’s central
source of information and resources related to
minority and vulnerable population health and
health disparities. This newsletter will serve as an
informational tool and resource for ADHS staff.
Health disparities continue despite advances
in health care and technology. Even after control-ling
for economic and health insurance status,
differences still occur in diagnosis and treatment
of certain health conditions, utilization of preven-tive
services and health outcomes. We can each
do our part by making a commitment to learn
more about health disparities, understand the cul-tural
groups we serve and share best practices.
I hope you will find the information provided
within interesting and relevant to the populations
of Arizona. ♦
(This article was completed before Susan’s departure from
ADHS. Thanks for her support and we wish her the best in the
future.)
Community Story
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Art and Performance
As Healing
By Catherine Traywick, Feature Writer of
ASU in the Community
When Dr. Olga Davis, an Arizona State
University (ASU) professor of Human Commu-nication,
wanted to raise community awareness
of sobering health issues like HIV/AIDS, men-tal
health and substance abuse in the African-
American community, she opted against the
standard academic fare of educational pam-phlets
and informative lectures. Instead, she
evoked her theatrical roots, setting the ASU
Downtown Phoenix campus abuzz with a rous-ing
showcase of
art and perform-ance,
from the
lyrical stylings
of acclaimed
local poets and
storytellers to a
trio of African
dancers who
stomped, smiled
and swirled to
the beat of a
dozen drums.
(courtesy of the Office on Women’s Health, DHHS)
Davis, whose interest in the relationship
between race, gender and health led her to be-come
part of a research team, the Southwest
Interdisciplinary Research Center and ASU
Foundation, saw an opportunity to combine her
two fields of study into one educational, engag-ing
celebration using visual and performance
art to examine “cultural processes in risk and
resilience” in minority groups (continued page
2).
Inside This Issue:
Art and Performance as Healing - Page 1
Make Connections to Address Health Disparities
- page 2
Cultural Blindness - Page 3
Health Disparities Legislative Update - Page 4
RWJF and PCH Speaking Together - Page 5
Rates of HIV/AIDs by Race/Ethnicity - Page 5
AHDC 2007-2008 Community Projects - Page 6
Buzz - Page 7
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Make Connections to Address Health Disparities
By Zipatly Mendoza, Office Chief of AHDC
Art and Performance as Healing - continued from page 1
The spirited result, which kicked off African-American History
Month in February 2008, united an eclectic blend of artists and per-formers
with local healthcare professionals in an effort to engage the
community regarding health issues specific to African-Americans.
Davis believes that this artistic approach to addressing such
weighty topics is a highly effective way of engaging, not only the Af-rican-
American community, but persons of all backgrounds.
“The expression of public art is sometimes a better or alternative
way of educating,” she said. “Performance art has a way of dispelling
boundaries of race, gender, sexuality, class…It’s a way of universally
connecting humans to humans.”
Opera singer Freeman Milton Davis II, who performed a selection
of African-American spirituals for the event, agrees. “Arts have been
touted as the universal language,” he said. “It can bring people to-gether
to see things on an equitable plane.”
Through creative writing, painting, photography, video collages,
spoken word, music and dance, the showcase highlighted health dis-parities
and celebrated resilience in the African-American community.
But conceptualizing the concept of “health disparities” -- let alone
translating it into a living piece of art -- was difficult for many of the
artists involved. To overcome this, Davis worked closely with some of
the artists, helping them to better understand both this concept and the
interrelation of art and health.
“I had them reflect on this social, political and cultural issue of
health disparities,” she said (continued page 3).
Arizona
Health Disparities Center
Mission:
To promote and protect the health
and well being of the minority and
vulnerable populations of Arizona
by enhancing the capacity of the
public health system to effectively
serve minority populations and
reduce health disparities.
Vision:
Health equity for all
We envision a state where each
person has equal opportunity to
prevent and overcome disease and
live a longer, healthier life.
Contact:
Arizona Health Disparities Center
Bureau of Health System
Development and Oral Health
Arizona Department of Health
Services
1740 West Adams
Suite 410
Phoenix, AZ 85007
602-542-1219
602-542-2011 fax
http://www.azminorityhealth.gov
The Arizona Health Disparities Center
(AHDC) is excited to announce the creation of a
new newsletter, the AHDConnection – Arizona’s
Leading Health Disparities Resource. The purpose
of the newsletter is to serve as a communication
mechanism to ensure stakeholder participation in
building the capacity of the State to address health
disparities.
AHDC within the Bureau of Health Systems
Development and Oral Health seeks to build the
capacity of the State through education, training,
advocacy and coalition building. The AHDC pro-vides
workshops and presentations on CLAS,
health literacy and related health topics to public
health professionals and community groups.
AHDC provides technical assistance on CLAS
and cultural competency. AHDC provides com-prehensive
weekly email news on various health
topics, community events, and funding opportuni-ties.
The AHDC works to further professional de-velopment
among Arizona (continued page 4)
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Art and Performance as Healing - continued from
page 2
“Many of them connected through story. They’re
communicating their life experiences, their relation-ships,
through their visual and performance tal-ents.”
For Ramona Wright, a painter whose work
was featured at the event, the process of tackling
these issues through art was a uniquely personal
learning experience which put her in touch with
her own resilience.
“At first it was difficult to conceptualize this
notion of ‘health disparities’…until I realized that
I had already done so in many pieces of my
work,” she said. “I realized that my art was part of
a healing process.” For Wright, art not only
helped her endure and cope with her own health
problems such as depression, arthritis and fi-bromyalgia,
but also created a venue for her to
educate and engage others.
And, judging by the energy and involvement
of the audience, who raucously applauded every
performance and enthusiastically discussed “art as
healing” in between courses of heart-healthy soul
food, those artists may have succeeded.
Certainly, by the end of the night the relation-ship
between art and health was common knowl-edge
among the crowd and a cause for celebrat-ing.
“Art is what makes us healthy, vibrant, living
beings!” announced storyteller and writer Almeta
Whitis to a cheering audience. “If there is no art,
there is no life!”
(http://community.uui.asu.edu/features/art.asp).
Cultural Blindness:
The Misguided Belief of Treating
Everyone the Same
By Veronica Perez, Advisor for Cultural Compe-tency
& Health Literacy of ADHS
“I don’t see color or culture – only the person.”
This statement has very good intentions. But
think about this: if you don’t see color or culture,
and someone you are trying to reach identifies
strongly with their color or culture, are you really
seeing the person? This is referred to cultural blind-ness,
a stage along the continuum toward cultural
proficiency.
Individuals and organizations with this philoso-phy
believe that they are doing the right thing by
treating everyone the same, often functioning on the
belief that culture should not make a difference in
how services are provided. Culturally blind agencies
view themselves as unbiased and are characterized
by the belief that there is equal effectiveness when
all people, regardless of culture, are served the same
way. While this view is well-intended, it can lead to
services that are so ethnocentric that they become
useless to all but the most assimilated cultures.
Culture refers to patterns of human behavior that
include values, beliefs, traditions and languages that
connect racial/ethnic, religious or social groups. Cul-tural
patterns and ideals are learned early in life and
each of us belongs to many cultures over time. Cul-ture
changes and is adaptive, but it can be difficult
for us to recognize and change our own cultural
practices. This lack of awareness has a major impact
on how we relate to individuals who have a culture
different from our own.
Cultural blindness often results in poor public
health outcomes. Culture drives our decisions, including decisions about our health. A culturally competent
public health professional is one who is aware of values and beliefs that drive one’s own behavior and the
behaviors of populations being served. Health promotion, disease prevention, and disease management pro-grams
have been shown to be more successful when they take into consideration the influence of culture
among the population being served. In this stage, an individual is at status quo, which is not good enough to
improve health outcomes. But there is a significant opportunity to recognize weaknesses, make improve-ments,
become more aware, and reach out to those marginalized groups more efficiently. Understanding
where we are on the continuum helps us understand what to do to make progress toward becoming culturally
proficient.
For more information , visit http://www11.georgetown.edu/research/gucchd/nccc/index.html. ♦
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Make Connections to Address Health Disparities -
continued from page 2
Department of Health Services (ADHS) employees
by providing monthly brown bag sessions. The goal
of the brown bag series is to bring awareness of
diverse cultures and health beliefs/practices to
ADHS employees. Additionally, AHDC serves as a
vehicle within ADHS to promote policies that ad-dress
and reduce health disparities among disparate
populations.
I hope you find this issue helpful in learning
more about current activities, issues and events that
address health disparities. Furthermore, you can
help us right now in two ways: First, pass along a
copy of the AHDConnection newsletter. Second,
encourage colleagues and friends to visit the AHDC
website (http://www.azminorityhealth.gov) to learn
more about the Center. Thank you for your interest
in the Arizona Health Disparities Center. ♦
Health Disparities Legislative Update
By Pete Wertheim, Chief Legislative Liaison and Barbara Fanning, Legislative Liaison of ADHS
After 166 days and a looming State govern-ment
shut-down a few days away, the 48th Legisla-ture
2nd Regular Session finally adjourned on June
30, 2008. The following are brief summaries of
several noteworthy bills that passed during the 2008
session that will make a difference in the ongoing
efforts to address health disparities:
SB 1078 Infectious Diseases; Expedited Therapy
(Laws 2008, Chapter 12)
Until the passage of SB 1078, Arizona was one
of thirteen states that had laws prohibiting the use
of expedited therapy to combat the spread of com-municable
diseases. Expedited therapy gives medi-cal
providers the option to prescribe medications to
contacts of communicable diseases for treatment
without a physical exam. This practice is especially
helpful in getting early intervention to persons who
do not have access to health care services, but who
may have been exposed to a communicable disease.
As a result of the passage of this bill, certain
communicable diseases such as pertussis, scabies
and plague may be treated through expedited ther-apy
to contacts of infected persons to prevent seri-ous
infection and further transmission of the dis-ease.
SB 1078 may be one of the most important
public health measures to pass the Legislature in
many years.
HB 2521 Birth Defects; Folic Acid Supplements
(Laws 2008, Chapter 52)
This is an important bill that will help the Ari-zona
Department of Health Services (ADHS) and
its community partners do a more effective job in
preventing birth defects and assisting families of
children with birth defects.
Until its passage, statute only permitted ADHS
to administer the Folic Acid Distribution and Edu-cation
Program (FADEP) through local county
health departments. HB 2521 will now allow
ADHS to also contract with community-based or-ganizations
to provide these services. This expan-sion
will give the program a greater ability to reach
low- income populations that receive services in
community health centers and non-profit agencies
rather than their local health departments. This
will help eliminate the difficulty that FADEP has
had in the past reaching some of the most high-risk
populations in counties that do not have a strong
county health department presence in the commu-nity.
HB 2521 will also allow ADHS to share infor-mation
from the Chronic Disease Birth Defect Reg-istry
Program with the Arizona Early Intervention
Program at the Arizona Department of Economic
Security, so they may notify families of children
with birth defects of the available services and the
organizations that provide them.
The session also passed SB 1113 HIV-related
testing (Laws 2008, Chapter 13), SB 1329
AHCCCS; self-directed care services (Laws 2008,
Chapter 58) and SB 1418 tobacco cessation medi-cation;
coverage; AHCCCS (Laws 2008, Chapter
131) that related to health disparities.
For more health disparities legislative updates,
please visit: http://www.azminorityhealth.gov. ♦
Legislative Watch
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RWJF and PCH
Speaking Together
By Jana Granillo, Community Liaison of
Health Disparities, ADHS
In June 2008, the Arizona Health Disparities
Center had a chance to speak with Barbara Rayes
(Coordinator of Translation Services & Language
Education) and Irma Bustamante (Manager of Lan-guage
Services) of Phoenix Children’s Hospital
(PCH), our local leaders in the area of Language
Access Services (LAS) and quality improvement.
Imbedded in the conversation was the discovery of
so much.
First of all, KUDOS to PCH for their part in the
soon-to-be-released results of Speaking Together.
Speaking Together is “a national program funded
by the Robert Wood Johnson Foundation (RWJF)
and aimed at improving the quality and availability
of health care language services to patients with
limited English proficiency (LEP). Speaking To-gether
integrates quality improvement with lan-guage
services and brings together hospitals to pilot
new performance measures and test valuable tech-niques
for reducing health care disparities associ-ated
with language barriers.”
Because of PCH’s existing work in the area of
LAS and readiness, they were chosen for the RWJF
program. Of the 10 hospitals chosen nationwide, 2
were Children’s Hospitals in Seattle and Phoenix.
As a result of their work in Summer 2008, a
Speaking Together Toolkit and Tools for Improving
Language Services Delivery have been released.
The toolkit has “how-to” advise for quality im-provement
in language services, including getting
support for LAS quality improvement. PCH’s focus
for the Speaking Together work was, and is, quality
improvement in communication for children with
diabetes.
Our interview with PCH revealed so much
more, centered around the question: “What is your
role in LAS and building capacity with health care
providers?” For the complete interview and high-lighted
best practices, please see link
http://www.azminorityhealth.gov. One thing nota-ble
from the interview was that Barbara Rayes will
once again be a part of the prestigious National Con-ference
on Quality Health Care for Culturally Di-verse
Populations. The conference will be held Sep-tember
21-24, 2008 in Minneapolis, MN. For more
information about the conference, please visit:
http://www.diversityrxconference.org.
If you have a success story and/or comments on
the RWJF toolkit, please contact Jana Granillo at
granilj@azdhs.gov or 602-542-1219. ♦
CLAS Standards
Emergent HIV/AIDS Rates
by Race/Ethnicity
Rates of HIV/AIDS prevalence and emergence
differ sharply between African-Americans and other
race/ethnicity groups. Currently the emergent HIV/
AIDS rate among African Americans in Arizona is
more than 4 times that of White Non-Hispanics.
The disparity observed in Arizona among Afri-can-
Americans is also seen across the country. The
CDC estimates that in 2006, African-Americans
were 13% of the total population in states with estab-lished
confidential HIV reporting and 49% of new
HIV diagnoses. As observed in Arizona, CDC also
reports a more pronounced racial disparity nationally
among women than men when African-Americans
are compared to other race groups. ♦
Rates of HIV/AIDS in Arizona, 2005
Source:
HIV/AIDS Annual Report Executive Summary in the State of Arizona – February 2008,
Bureau of Epidemiology & Disease Control, Arizona Department of Health Services, http://
www.azdhs.gov/phs/hiv/2008annualreportpage.htm
Differences in the Health Status by Race/Ethnic Groups, Arizona 2005, Bureau of Public
Health Statistics, Arizona Department of Health Services, http://www.azdhs.gov/plan/
report/dhsag/dhsag05/index.htm
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Data Speak
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The Arizona Health Disparities Center
(AHDC) with funds from the U.S. Department of
Health and Human Services, Office of Public
Health and Science, Office of Minority Health,
State Partnership Grant Program to Improve Minor-ity
Health Grant, awarded eight grants in Arizona in
2007-2008. The purpose of the grants was to sup-port
new or ongoing minority health collaborative
community projects/activities throughout the State.
The projects and/or activities were to further the
goals of reducing health disparities by:
♦ Targeting a major health disparity based on
available data;
♦ Enhancing access to care for vulnerable and
minority populations and/or:
♦ Enhancing cultural competency among
healthcare providers and the public health
workforce.
All grants were completed on June 30, 2008.
Below is brief summary of each project.
1. Arizona Board of Regents, University of Ari-zona:
The project was innovative in that it not only
focused on cultural competency skills and under-standing
of the public health (PH) professional em-ployed
along the U.S.-Mexico border, but training
to incorporate culture, traditional activities of daily
living, storytelling, kinship and the arts. This train-ing
and strategies for promoting resilience were
used to create training on cultural competency in
program planning.
2. Asian Pacific Community in Action: The pro-ject
was a randomized telephone-based survey de-signed
to gather information in critical health dis-parities
areas: hepatitis B, cervical cancer, breast
cancer and tobacco use. The result was an assess-ment
of health-related behaviors among Vietnam-ese
American families in Maricopa County to be
used for future intervention programs. The survey
mostly used validated BRFSS questions.
3. Coconino County Health Department: The pro-ject
was to implement a prescription drug discount
program designed by the National Association of
Counties (NACo) and Caremark RX, Inc. The dis-count
card program helped consumers cope with
the high price of prescription drugs. The program
offered significant savings of about 20% discount.
Cards were available at a variety of distribution
sites throughout Coconino County (i.e. health de-partment
and community organizations/partners).
4. Empowerment Systems, Inc.: The project was
an online educational program with a self-assessment
tool and culturally competent materials
targeting American Indian and Latino residents in
Maricopa, Pinal and Yavapai counties as well as
persons with disabilities and people living in rural
areas. The program raised awareness of Type II Dia-betes
and hypertension and provides available
resources.
5. Maricopa Integrated Health Systems: The project
designed a bilingual coloring/activity book to help
children, especially Latino children aged 1-4 years in
Maricopa County, understand fire safety, burn pre-vention
and responding to emergencies. This book
helps meet American Academy of Pediatrics’ recom-mendations
on injury prevention during all Early,
Periodic, Screening, Diagnosis and Treatment
(EPSDT) visits. Materials were prescribed to fami-lies
in the MIHS Pediatric and Women's Clinic.
6. Navajo Health Foundation/Sage Memorial Hospi-tal:
The project sought to increase utilization of
AHCCCS by educating patients about benefits and
enrollment assistance. Its target population was Na-tive
Americans eligible for AHCCCS in Navajo and
Apache counties.
7. Regional Center for Border Health, Inc.: The pro-ject
was to invite participants with high-level health
risk appraisals and diabetes to complete a 6-week
evidence-based culturally appropriate prevention and
control curriculum on diabetes among Latino resi-dents
in Yuma County. The program provided
healthy eating cooking demonstrations and aware-ness
on the importance of mental health issues such
as depression.
8. St. Elizabeth Health Center: The project focused
on decreasing oral health disparities among minority
children through culturally and linguistically appro-priate
education and outreach materials in Pima
County. The program used community assessments
and education to identify need for access to oral
health care, assess current oral health and dental edu-cational
materials for cultural and literacy appropri-ateness
and monitor the number of children and par-ents
that access dental hygiene and/or treatment. ♦
AHDC 2007-2008 Community Collaborative Projects
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Editor’s Note:
The AHDConnection is published quarterly on
January 31, April 30, July 31 and October 31. We
are looking for community stories and other leads
that are related to efforts to reduce health dispari-ties
in Arizona. Because of space limitation, each
community story should not be over 500 words.
Ideas for community stories are also welcome.
Our deadline is the 15th of month prior to the pub-lication
date. Please email articles or ideas to the
editor at
chartrh@azdhs.gov. We
would like to get feedback,
suggestions, ideas, news or
events from you as well.
Thank you very much. ♦
Funding Opportunities:
Health Resources & Services Administration: Ru-ral
Health Network Development Planning Grant
Program
Deadline: September 15, 2008
Expected Number of Awards: 20
Estimated Total Program Funding: $1,700,000
National Institutes of Health: Improving Effective-ness
of Smoking Cessation Interventions and Pro-grams
in Low-Income Adult Populations (R01)
Deadline: November 24, 2008
Estimated Total Program Funding: $2,700,000
National Institutes of Health: Improving Effective-ness
of Smoking Cessation Interventions and Pro-grams
in Low-Income Adult Populations (R21)
Deadline: November 24, 2008
Estimated Total Program Funding: $1,500,000
Award Ceiling: $200,000
Publications of Interest
Closing the Mental Health Gap: Eliminating Dis-parities
in Treatment for Latinos
The study looked at more than 1,000 low-income
Hispanics from three metropolitan areas in the US.
It found that suicide is the third leading cause of
death among Hispanics ages 10 to 24 and that His-panics
who do see care “often end up with ineffec-tive
assistance.”
Language Access: Understanding the Barriers and
Challenges in Primary Care Settings
It summarizes findings from a 2007 survey of pri-mary
care clinicians, nonclinical staff, clinic man-agers
and administrators conducted by the Associa-tion
of Clinicians for the Underserved to learn about
language access barriers and challenges in provid-ing
care among association members.
Events of Interest
Addressing Health Care Disparities: Cultural Com-petency
Faculty Development Program
Dates: August 8-9, 2008
Location: San Francisco, CA
6th National Conference on Quality Health Care for
Culturally Diverse Population
Dates: September 21-24, 2008
Location: Minneapolis, MN
2008 International Conference on Medical Inter-preting
- Reducing Health Disparities by Ensuring
Language Access to all
Dates: October 10-12, 2008
Location: Boston, MA
For more information about funding opportunities,
publication of interests and events of interest, please
visit http://www.azminorityhealth.gov. ♦
Thanks for many people’s contributions to our
newsletter’s header. The winner is the social mar-keting
team at ADHS. The team members who
appear in the photo are (left to right) Sarah Low-ery,
Cori Lorts, Tanja James and Hazel Valdez. ♦
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Buzz