Promoting Language Access, Health Literacy and Cultural Competency to Improve Health Equity

Sarah de Guia, Executive DirectorInstitute Of Medicine, Roundtable on Health Policy

Integrating Health Literacy, Cultural Competency, &Language Access ServicesOctober 2015

Together we’re stronger!

CPEHN’s Key Policy Areas

Presentation Overview• California’s diversity shows why language access,

cultural competency, and health literacy are key.

• Promoting change by:– Codifying language access standards– Engaging community to provide culturally

appropriate notifications– Creating consumer-friendly prescription labels

• Concluding thoughts

Race/Ethnicity of Medi-Cal Enrollees

47%

9%

12%

21%

11%

LatinoAfrican AmericanAsian/Pacific Is-landerWhiteOther/Unknown

Source: Medi-Cal Managed Care Performance Dashboard, September 2015 - http://www.dhcs.ca.gov/services/Documents/MMCD/September172015Release.pdf

Limited English Proficient Population Enrolled in Medi-Cal

English Proficiency Covered by Medi-Cal

Speaks English Very Well 19.6%

Speaks English Well 26.8%

Speaks English Not Well/Not at All 34.7%

Source: 2014 California Health Interview Survey

Race/Ethnicity of Covered California Enrollees

Race/Ethnicity # of Enrollees % of Respondents to Race/Ethnicity Questions

African American 23,520 2.4

American Indian Alaska Native

3,080 0.3

Asian 217,800 22.3

Latino 276,800 28.4

Native Hawaiian/Pacific Islander

2,320 0.2

White 385,130 39.5

Total Enrollment 1,307,750 -

Source: Covered California Data Book, June 2015 - http://hbex.coveredca.com/data-research/

Top Non-English Languages by Covered California Enrollees

• Spanish: 12.8%• Chinese: 3.6%• Korean: 2.0%• Vietnamese: 1.3%

Ability to Access Primary and Specialty Care by English Proficiency

English Proficiency Difficulty Finding Primary Care

Difficulty Finding Specialty Care

Does Not Have Usual Source of

CareSpeaks English Very Well

5.4% 13.7% 18.7%

Speaks English Well

6.6% 8.7% 20.4%

Speaks English Not Well/Not at All

3.8% 16.7% 27.2%

Source: 2014 California Health Interview Survey

Health Status by English Proficiency

English Proficiency Fair or Poor Overall Health

Speaks English Very Well 15.9%

Speaks English Well 20.3%

Speaks English Not Well/Not at All 43.9%

Source: 2014 California Health Interview Survey

Importance of Health Literacy, Language Assistance, and Cultural Competency

• Majority enrollees in Medi-Cal and Covered California are communities of color.

• Over one-third of enrollees are LEP.

• Communities of color and LEP patients face barriers to care and more health disparities.

Creating Language Access Standards: Overview of California Law

Medi-Cal Program

•Translation Thresholds:•3,000 per county•1000 per zip code•1500 per contiguous zip code

•Interpretation Services:•Anytime in any language

Commercial health plans and insurers

•Translation Thresholds:•based upon enrollment•Interpretation Services:•Any language during business hours

•Requires collection of demographic data

Creating Language Access Standards

Engaging Community as Experts in Culturally Appropriate Messages

Advised the State on translations of Medi-Cal application

Advised Covered Cal on marketing materials to communities of color

Ongoing review of materials from state agencies

Furthering Community Engagement

Key opportunities:

•Rapid response by organizations

•Involved in founding of Covered California

•Partnerships with legal organizations

Legislative and Administrative

wins

•Diversity provisions in Covered California Board•Consumer workgroup (AB 1296)•Notices are regularly reviewed by advocates

Limitations: •No funding, mostly volunteer work•Notices are still very complex

Creating Consumer-friendly Prescription Labels

Key opportuniti

es• Background data pointed to a crisis

• Committed leaders

• LEP concerns raised early on

Legislative and

Administrative wins

•Passage of SB 492 (Corbett) •Inclusion of LEP focus and support to study the issue•Passage of AB 1073 and new regs to review translations

Limitations

•Reluctance to adopt standard instructions in English

•Strong industry, different culture

Next Steps

Enforce current laws: Ensure plans and insurers are meeting current language access and data collection requirements.

Engage consumers of color and LEP consumers: Create alternative methods for surveying LEP consumers about their needs and experiences.

Develop a culturally appropriate workforce: Better address cultural competency through workforce opportunities and needs.

Utilize community partners: Work directly with communities to develop materials with culturally appropriate messages.

Thank you! For more information:

Contact us at: (510) 832-1160www.cpehn.org