Demographic Changes, a View from California Implications for Framing Health Disparities: Workshop Summary (2010) / Chapter Skim
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4 How Have California Communities in Transition Framed Health Disparities for Action?
4 How Have California Communities in Transition Framed Health Disparities for Action?
Pages 33-58
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EAST PALO ALTO Luisa buada, R.N., M.P.H. Chief Executive Officer, Ravenswood Family Health Center South County Community Health Center, Inc.
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The unemployment rate is nearly 10 percent, whereas the average for the county is 4 percent. In the patient population served by the Ravenswood Family Health Center, 63 percent are uninsured and one-third prefer to communicate in a language other than English.
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Because of the community's growing interest in prevention, the Ravenswood Family Health Center established a 4-year collaborative called "Get Fit East Palo Alto." This collaborative helped to support a local farmer's market that opened in the spring of 2008. More recently, the clinic received a grant from the federal Office of Minority Health to create a project called "Multicultural Community Health Connections." African American, Latino, and Pacific Islander health navigators are working with the community on diabetes education and screening, with a particular focus on health education, nutrition, and avoiding chronic disease.
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In discussing the importance of framing, Abrica used an example from his own political career that involved, as he described it, "this whole blackbrown issue." When he was first elected to the city council, Abrica was the only Latino elected in a predominantly African American community. Despite this, he stated, no one in the media ever asked him the question "How is it that a Latino managed to get elected in a mostly African Ameri
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Abrica described East Palo Alto as having been a majority minority community for over 40 years. Today, however, although it is still a majority minority community, East Palo Alto is now predominantly Latino rather than African American.
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and the Ravenswood Family Health Center. In particular, given the 63 percent uninsurance rate in East Palo Alto, he wondered about the difficulty of accessing specialty care at Stanford Medical Center.
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He had criticized California governor Arnold Schwarzenegger for "balancing the budget on the backs of the cities in California." The governor decided to put some money into the San Joaquin Valley, which led to the formation of the Central California Partnership. This partnership, in turn, led to interest from foundations focusing on health disparities in the area.
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He is a member of the Hmong immigrant community in Fresno. Southeast Asians in the Fresno Area Yang began his presentation by describing several of the health disparities affecting the Southeast Asian community in the Central Valley (San Joaquin Valley)
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Regional Program Coordinator, Central California Regional Obesity Prevention Program Genoveva Islas-Hooker is the regional program coordinator for the Central California Obesity Prevention Program. She began her comments by pointing out that the three speakers on the Fresno panel represent the three largest ethnic and racial groups in the Central Valley: African Americans, Latinos, and Southeast Asians.
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This seclusion is what Islas-Hooker believes is at the root of preventing more Latinos from being actively involved in advocating for change. SOUTH LOS ANgELES Maxine Liggins, M.D.
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About two-thirds of the residents of South Los Angeles are Latino, and the number of African Americans in South Los Angeles has declined. South Los Angeles also has the highest percentage of residents under the age of 17, about 35 percent, which is the highest in all of Los Angeles County.
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TAbLE 4‑3 Health-Related Quality of Life Health-Related Quality of Life Los Angeles County SPA 6 % of Children in poor health per parents 12.7% 17.6% % of Adults reporting fair to poor health 20.6% 33.4% Average # of limited activities due to poor health 2.4 days 3.3 days Average # of unhealthy days in past month 6.4 days 7.9 days SOURCE: 2005 Los Angeles County Health Survey (http://publichealth.lacounty.gov/docs/ Key05Report_FINAL.pdf)
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Liggins summarized these comparisons by noting that the major cause of racial and ethnic health disparities is poverty, combined with a lack of access to affordable health care. TAbLE 4‑5 Years of Potential Life Lost Community Heart Disease and Stroke Rank 1-129 Los Angeles County 1,183 NA Compton 2,620 129 Florence 1,767 116 Marina del Rey 1,155 67 Santa Monica 749 26 NOTE: NA = not available.
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Because of real estate development, increased immigration, and the growth in the number of non-unionized jobs, the African American population slowly began to spread out of the South Los Angeles area. Veloz works with the South Central Family Health Center in SPA 6, the service planning area that Maxine Liggins described earlier.
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In response to this need, the Southside Coalition of Community Health Centers was formed in 2004. The Coalition consists of the seven federally qualified health centers that are located in South Los Angeles and was formed to evaluate best practices and share scarce resources.
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Often, even though the raw number of people in one racial or ethnic subgroup grows, their proportion relative to another racial or ethnic group may fall. In other words, the number of African Americans living in South Los Angeles may not have declined, but the demographic shift might instead be due to the rapidly increasing numbers in the Latino population.
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They view their life in South Los Angeles as transitory and believe that as soon as their economic status improves, they will move on. This is a mindset very different from that of the older, more established African American community in South Los Angeles.
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Additionally, she commented on the history of engagement from the perspective of the civil rights movement among individuals in the African American community and how that history of engagement is an inherent strength of the community. Given that South Los Angeles has two separate sets of networks made up of community organizations and other services -- the Latino network and the African American network -- Katz asked the panel to comment on the challenges and the efforts that are being made to engage people from the two networks to talk about health disparities and other issues.
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Similar to the Central Valley, the port of Oakland plays a role in feeding the rest of the United States, but in West Oakland, it is difficult to find fresh fruits and vegetables at the grocery store. Another interesting example of the importance of place was described by Douglas Fort in his comments about East Palo Alto.
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Another suggestion is to encourage African American kids living in South Los Angeles to learn Spanish. That would have a positive economic benefit for those children and would expand their perspective on their community.
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This is primarily due to obesity and chronic disease rates growing in the South and Southeast. In some ways, Iton said, racial and ethnic groups such as Pacific Islanders, African Americans, Native Americans, and Latinos are the "canaries in the coal mine" for the future of the United States.
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Public health needs to devote resources to building social, political, and economic power in these neighborhoods, Iton noted. However, public health also needs to move upstream and look at the causes of these upstream factors, such as the policies that have resulted in 175,000 African American men being in prison and therefore not being productive members of the economy.
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SOURCE: Bay Area Regional Health Inequities Initiative. Figure 4-2
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Douglas Fort offered an example from San Mateo County in California. He noted that the indigenous peoples of the city of East Palo Alto met with the county mental health directors, and in this way, several city nonprofit organizations were given funding to provide mental health care services to underserved clients.
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Los Angeles County Health Survey.
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