Health promotion in the Latino community

Promoting health in the community
Special team works to make sure immigrants, minorities get care
By Diana Montaño, JSONLINE.COM, July 20, 2009

When Lydia Lopez's son was first diagnosed with autism a little over a year ago, she refused to believe it. After bouncing around from specialist to specialist, Lopez, a native of Guadalajara, Mexico, living in West Allis, finally came to terms with the diagnosis.

But with no insurance and limited English, finding information about the condition or services available for her then-3-year-old son, Erik, became a daunting task.

Now, when she's not at her afternoon restaurant job, Lopez works as a promotora - a community health promoter - through a project launched by the West Allis Health Department. Using her own experience, she reaches out to parents facing similar challenges in a city still adapting to an influx of immigrants.

The Latino population in West Allis has increased dramatically in recent years.

In the 1996-'97 school year, Latinos made up 3.1% of all students enrolled in the West Allis-West Milwaukee School District, according to Shawne Johnson, assistant director of community health services at the West Allis Health Department. In 2004-'05, that number increased to 8.6%; by 2007-'08, the Latino student population was roughly 13.5%.

The demographic change has raised questions about how to best serve immigrant families when parents often don't speak English, are uninsured and unfamiliar with the health care system.

This scenario is not unique to West Allis. Throughout the state, the growing Latino population faces considerable health barriers. According to the Minority Health Program's 2005 Wisconsin Minority Health Report, 23% of Latinos were uninsured in 2005, compared with a statewide average of 6%. At the same time, diseases such as diabetes and HIV continued to disproportionately affect the Latino community.

At both the local and state levels, authorities and communities are trying new approaches to tackle health disparities. The Wisconsin Department of Health Services has recently concluded the first cycle of a "promising practices" program meant to support community-based interventions that close racial and ethnic health disparities by working to improve access to care in communities of color.

In West Allis, hospital, school and Health Department officials began to worry.

"We were concerned that they weren't accessing services," Johnson said of immigrant parents. "We wanted to make sure we were providing the same information, of the same quality, that other parents were getting."

Uninsured families often were not enrolling in public insurance programs, she said. Even if parents are undocumented, their U.S.-born children, as well as pregnant women - regardless of immigration status - are eligible for programs such as BadgerCare and WIC, the nutrition program for women, infants and other children.

Service providers began to translate documents and provide interpreters. The department put doctors, nurses and other providers through cultural-competence training. But according to Johnson, making health care more accessible to the Latino community couldn't stop at translation; it meant getting the community itself more involved.

So Johnson approached Lopez and a handful of other Latina mothers to participate in a health promoter training program. The program is run by Proyecto Salud, or Project Health, a collaboration between Aurora Walker's Point Community Health Clinic and CORE-El Centro, a community health center on Milwaukee's near south side. The women, along with community members from around the Milwaukee area, went through a four-month crash course in health issues ranging from depression to diabetes, and in services available to the Latino community.

Since graduating the training in December, five promotoras have been collaborating with the Health Department to do outreach at events informing community members of services. Also, they organized a women's group that meets the last Tuesday of each month.

On a recent Tuesday evening, the group screened part of "Unnatural Causes," a documentary that explores health disparities in the United States.

"We talked about how we become American," said Lopez, referring to changes in diet and lifestyle that often come with immigration, "and how it affects our health."

"In my country, if you're going to visit a friend or relative, you just drop by," said Alejandra Estrada, an expecting mother of two who came to the U.S. 10 years ago from Queretaro, Mexico. "Here, you have to tell them ahead of time. People are lonelier here."

Estrada, who is also a promotora, said that while depression is often a taboo in the Latino community, it is one of the issues the promotoras have begun to address in the women's group meetings. Proyecto Salud is working to compile a list of Spanish-speaking mental health providers in the area to whom the promotoras can refer people.

"They are a bridge between the community and service providers," Johnson said of the promotoras, who not only take information out to the community but also bring community information back to providers. "They are able to represent the community's needs and communicate them to us."
Pilot projects

At the state level, the Department of Health Services has begun to take note of community-based efforts addressing racial and ethnic health disparities. Last November, the department's Minority Health Program launched Wisconsin Promising Practices, a project that identifies and provides technical support to local programs working to improve health conditions in communities of color.

Last year, Proyecto Salud was chosen as one of two pilot projects. From November to June, the project received support documenting and evaluating its community health programs, including health promoter training.

"We wanted to identify successful interventions that impact health disparities," said Evelyn Cruz, a policy analyst with the Minority Health Program who heads Promising Practices, "so we could see what works, legitimize the work (local groups) are doing, and make their model available to others."

By legitimizing local community projects as evidence-based interventions, said Cruz, they are able to serve as a basis for policy change involving health care in communities of color.

A new set of community projects has been chosen for the second round of Promising Practices, which will run from July to January.

The groups selected to participate in the second cycle are the Health Literacy Initiative in Dane County; Madre, Hay Esperanza (Mother, There is Hope), which addresses postpartum depression in Dane County; and the Supporting Teen Families Program in Milwaukee.

"The local partners are effective because they know the community," Cruz said.

The West Allis promotoras agree.

For Estrada, the outreach wouldn't be as effective if it were done by people from outside the community.

"There's a stronger connection," she said. "We're going through the same thing; we've lived it. So they feel safer with us."

In the end, Lopez was able to get her autistic son into intensive therapy, and she is hopeful that his condition will improve.

Now, she reaches out to parents of children with disabilities, particularly autism.

"A lot of parents don't accept that their child has autism. They don't know that they can get therapy."

Therapy works best when a child is young, and many parents don't find out about it until it's too late, Lopez said.

"There are some who didn't know about the therapy, who have children that are 5 years old and still don't talk."

By reaching out to parents, Lopez said, "at least I can put in my little grain of sand."

For more information CORE El-Centro:www.core-elcentro.org West Allis Health Department: www.ci.west-allis.wi.us/health/health_services.htm