Systemic Racism, Disparities and Health: The Impact of COVID-19 on Latino Health

0:00 good afternoon everyone thanks for joining us i'm sherry crew director of communications at the national institute for health care management foundation nickam on behalf of nickham thank you all for coming coming to the line today to explore a critical topic at a time when millions of people are facing so many unprecedented challenges to creating a safe and secure life our goal today is to offer information and insight on the impact of systemic racism inequality and other factors on the health and well-being of latinos living in the united states especially as those issues relate to the pandemic our expert speakers will then offer some actionable paths

0:46 for change this webinar is the second in the nickham series exploring the links between systemic racism and health inequity among black latino and other underserved communities in the united states while every community in the nation is at high risk for colvid19 latino people make up just 18.5 percent of the u.s population but have 29.5 percent of kofit 19 cases latino people from all different parts of the world are enduring a covid19 hospitalization rate in the united states that is 4.6 times that of white americans with latinas comprising 44 percent of pregnant women with the virus

1:32 we know at least some of the factors contributing to these crisis level disparities poor access to care and health insurance coverage racism poverty medical system bias language barriers immigration status and over-representation and dangerous front-line worker jobs all play a role the challenges to making meaningful change are significant but the prestigious panel of speakers we have with us today are going to make the connection between understanding and exploring these issues and effective actionable solutions that can be implemented at the community state and health industry level i'm discussing methods policymakers advocates and healthcare providers can

2:20 use in the communities they serve but before we hear from them i want to thank nickim's president and ceo nancy chockley and the nikhil team who helped convene today's event in addition you can find biographical information for all of our speakers along with today's agenda and copies of their slides on our website we also invite you to tweet during the webinar using the hashtag latinohealth we will also take as many questions as time will allow after all of our presentation i am now pleased to introduce our first speaker dr lisa kakari stone dr kikari stone is an associate press professor of health policy

3:05 at the university of new mexico and the director of the tree research center an initiative dedicated to behavioral health equity she has worked decades in public health to advance health equity for diverse racial under-resourced rural border latino and immigrant populations she is going to share an overview of how racism and other forms of inequity affect health among latino people living in the u.s and key policy issues dr kakari stone thank you sherry thank you nickim for organizing a much needed conversation and event i also appreciate the co-speakers on the call today mostly thanks to all of you who have joined

3:51 you are on the call on webinar because you do care you care about our latino populations and racial and ecwid equities i wanted to just mention briefly that i we have a national research center of excellence taking a second for the slide transdisciplinary research equity engagement center want to acknowledge the national institute of minority health health disparities who has funded our center and one of 12 national research centers of excellence in the nation together with our diverse communities in the southwest african-american latino american and alaska native immigrant border we are working to find solutions together

4:38 just want to mention latinos are a diverse population i also want to acknowledge inclusion i know the last seminar was dedicated to african-american blacks encoded that we are a multi-racial population of peoples the fastest population grows with u.s latinos is from venezuela dominican republic and guatemala and honduras four in five latinos are u.s citizens as sherry mentioned while we make up just over 60 million of the population we represent 18.5 percent of the u.s but we have a disproportionate impact of 30 percent of the coronavirus this slide illustrates

5:25 the diversity in geography as we consider actionable path moving forward latinos make up an increasing portion of colder deaths in particular state hot spots california and florida as you see the increase in deaths were mostly in july i want to also point out my colleague blake pursar with our tree center ran some data for us as part of a new grant we received to do analysis and determine the impact of policies under adverse racial and ethnic minority communities in the chart u.s called illustrator this chart and slide illustrates um

6:13 took the top 102 counties in the united states that comprise the majority of latino and then did an analysis of confirmed cases here the strongest predictor of confirmed cases in these counties was obesity uninsurance unemployment percent immigration and limited english proficiency as we look at the number of death rates similar predictors including poverty and a high percent immigrant limited english proficiency i want to mention here latinos and three of our four states in the u.s mexico border region had a high percentage of covert cases and deaths well in excess of the proportion of the

7:00 state populations again pointing to the importance and urgency of considering state policy and geographic inequalities as you see if you look under arizona latinos represent 32 percent of the population but are well over 40 percent of the cases same is true with california with a large percent of latinos and then almost 50 percent of the cases in texas as well i want to highlight this slide of what accounts for this as we think about actionable steps moving forward why are latinos so disproportionately impact by covet in fact racial inequalities that are

7:46 pre-existing that represent broader underlying structural and systemic barriers include racism and discrimination this impacts not just individuals but multiple generations of families and their health and well-being how do we define and think about structural racism because how we name and frame a problem is how we move forward in terms of actions racism is an intersectional connection system of oppressive forces that determine health outcomes including historical cultural institutional interpersonal they advantage certain population including non-latino whites

8:32 and produce cumulative and chronic adverse outcomes we look at this at the structural institution and individual level i'm going to highlight just a few predictors of these intersectional vulnerabilities as we think about structural i'm going to be talking a little bit about what we need to think about in terms of policies health welfare and immigration policies institutional forces including poverty wealth employment and housing and discrimination here this slide shows from the evan urban institute the significant importance of not just poverty but of wealth by race and ethnicity

9:18 both measures of both average and median wealth are important because it's how latinos are able to prosper compared to other groups what it shows here is that uh african americans are 10 times more likely to not have the at least whites are 10 times more likely to have wealth than african americans and on the right here as we think about latino families white non-hispanic families are eight times more likely to gain efforts from wealth this is important in the time of covet because your assets and any savings you have could be immediately depleted the next slide illustrates the share of

10:03 latinos who are work have lost their jobs due to colbit as you see latinos who are non-citizens are almost 70 percent have lost their jobs and his latinos who are members or citizens just almost 50 percent what does this mean for the daily lives of intergenerational families the chart on the right again from the urban institute shows about almost 47 percent of non-citizen latino family members have had to cut back spending on food and 40 of hispanic citizens you'll see other impacts of financial impact on latino families including savings household purchases

10:51 and credit card debt this next slide shows that latino workers are essential workers are vulnerably exposed in their frontline jobs at grocery stores cleaning and sanitation services food delivery so these exposures matter in a 21 state study with almost 10 000 workers in animal slaughtering processing plants latinos represented fifty percent of the new hobit cases we also want to consider the vulnerability of crowded crowded and substandard housing conditions a quarter of latinos live in multi-generational households

11:37 this could also be a resiliency factor but as we look at economic impact more family members and adult children are moving back into the household maybe making it more difficult to isolate after they're exposed and their working conditions i want to mention the border colonias in the southwest these are unincorporated areas that have crowded and poor housing conditions and inadequate water and sometimes sewage we also have the influx and increase of both deaths and cases of covet at ice detention centers these make it dangerous for families who have no choice to be exposed finally i want to mention our current at

12:22 our current political and policy environment latinos in a research poll by pew center have indicated and reported that they see their conditions in the u.s have gotten worse we can see the structural violence that occurred in el paso last year as well as the increased incarceration of migrants and families impacting the stressors and lives of latino populations moving forward i want to just mention ongoing this ongoing discrimination financial stressors anxiety has had an influx and exasperated pre-existing mental health conditions

13:09 i want to mention the importance of street race those who would say they're discriminated against because the color of the skin have also impacted men reporting that their mental health conditions are worse those who are latinx and arab and for mexican women it's associated with lower physical health policy matters as we saw with affordable care act we saw a decline in uninsurance rate particularly the biggest inroads with american indian alaska native and latino communities we went from 32 percent in 2010 we went from 30 almost 33 in 2010 down to 19 in 2018.

13:56 however i want to mention a recent study conducted by georgetown university the number of uninsured children now exceed 4 million wiping out a sizable share of the gains in the coverage we made with the aca and you can see a decline especially an increase in an insurance rate especially after 2016. moving forward policies do matter matter state mitigation policies as well as local potential policies that require social distances close businesses keep people being safe from being spreading exposures here it just shows the timeline of the four border states and we've conducted an analysis and you can see that the policies

14:43 implemented by arizona were not as consistent and regular as as well as in texas and have impacted a consistent high in here in texas of flux new mexico had the most consistent social distancing and mitigation policies and has been able to keep their latino covert rates in cases low finally i want to move towards why policy matters in terms of immigration we have a current public charge issue where department of homeland security and department of health and human services have moved to include tanf's and social but other social benefits as part of the public charge issue creating a killing effect on access to care

15:29 the deferred action for childhood arrivals was upheld recently by the supreme court but how those are being determined is not following the law we have a new section 1557 of the aca that undermines the title uh title vi of the civil rights act around language access all this has increased barriers to access to care and increase fear of latinos especially latino immigrants seeking health care services how do we move about this solutions moving forward i want to highlight well so there's time for the other speakers and my colleagues but if we need to think about universal coverage for all children

16:14 at the state and the federal level children is the place where we can prevent and keep children safe and healthy over the lifespan medicaid buy-in should be an option for all and unauthorized immigrants with state policy and actions could be allowed to buy into medicaid we need to continue to protect the gains we've made with the affordable care act rescind the public charge rule and make sure there's protection for daca if we think about the role of here on the right box of the health care system and hospitals federally qualified health centers and the safety net they have the option to tackle implicit bias and anti-discrimination mobile access points could be implemented for mental health resources

17:01 especially in geographically remote areas and areas where there's more ice presence i want to mention the importance evidence shows us that community health workers or promotoras they salud play a huge role in improving access to care especially for the most vulnerable so we look in the third box covid 19 policies and mitigation poli are critical here a sheriff we have to be able to track equitable federal assistance disbursements and also we could gain coverage by covering social determinants of health i'm going to end with just communities need to be centric to solutions intersectional partnerships with latino-based organizations are critical and on the

17:48 right we need to continue to have non-discrimination laws at the state federal and local level and invest in housing developments thank you for your time and i look forward to the discussion it is important that we continue the fight towards racial and economic justice and our vote counts thank you so much dr kakari stone for giving us an extraordinarily comprehensive national picture of the issues impacting latino health and the policies and solutions to bringing about progress our next speaker dr jane delgado is the president and chief executive officer of the national alliance for hispanic health dr delgado is a highly respected and

18:34 well-known activist writer thought leader and commentator who has dedicated her career to transforming health just this week the association of american medical colleges honored dr delgado as one of 10 hispanic pioneers in medicine a clinical psychologist dr delgado was the author of more than 10 books including 2020 understanding depression and enjoying life she is going to address how a lack of inclusion systemic racism poor access to health care and mental health coverage affects latino health and methods for moving forward dr delgado is dr delgado able to join us

19:26 hello hello yes doctor okay i'm sorry i'm i thought i was talking to myself okay we can hear you now okay so thank you lisa and thank you sherry you know this is a very important time for all of us and i want to thank everyone who's here uh listening to this presentation because this is a time when we can move from what the past was which was ignore or false assumption to inclusion and this is important for all of us and i think that part of what you need to see is who we are the national alliance for hispanic health and you need to understand that we are a non-partisan health organization for research service and advocacy

20:13 throughout the americas so we actually fund programs in latin america we also do not accept funding from tobacco or alcohol or sugar sweetened beverages and this is uh makes us really advocate best health for all now you see the name hispanic in our name well about six years ago we changed our mission from improving the health and well-being of hispanics to best health for all because we realized in order to help everyone we had that by helping everyone we also helped hispanics and what you need to know is that a person's values when they speak to you are very

21:00 important and these are our organizational values throughout the alliance that i lead i also want to know that we have a research arm at usc and we also focus the alliance and programs and diabetes cancer and are part of nih's all of us activity with that there's you need to know that what we value are three things people science and culture those are three things that are the underpinning of everything that we do at the alliance when we talk about how come we're having

21:45 such a problem with hispanics and healthcare frankly this is not a new surprise for most people the reality is that we are the group that is most likely to be uninsured and the reason that we are uninsured and we are the purple where you can see for all groups not insured by age race and ethnicity although the aca did a lot for us a major determinant of whether or not we're insured is what state we live in states like texas and florida where there are a lot of hispanics where the total number of hispanics in texas and florida combined equal all the hispanics in california texas and florida did not do medicaid

22:31 expansion and as a result that really drives down the number of hispanics who actually have insured and some people say well you know i'm not too sure about these data and what they mean and i said well you know even if you look at it by gender what you still see is that hispanics which are the purple line are still under insured we have no insurance and it's a problem throughout the ages for men on top and for women on the bottom and then of course people like to talk about well hispanics are so diverse maybe it has to do with you know the country of origin when we looked at

23:18 those data from the census bureau we found a very important pattern that the group most likely not to have health insurance are people ages 18 to 64. across whether you are mexican puerto rican cuban central american south american or other hispanic this was the group that is least likely to have health insurance and yet this is a group where we can have a major impact on health issues now one of the things which is most amazing to me is that when people talk about health they try to think of it from their perspective but i like this picture with all the

24:05 windows because in fact the window you look out of of colors what you see and one of the things that most people don't realize is the size of the hispanic population so there are 59 million uh you know it's 0.6 you know you can say 60 million but you know i don't want to exaggerate so i'll just stick to 59.6 so there we go and what does that tell you people say well you know hispanics are are so diverse and they're of you know multiple races but you know you can all these groups are diverse there's no

24:50 group which is all the same if you talk to non-hispanic whites they're a very diverse group also yet for the purposes of our current systems we do aggregate them so i need to emphasize that our current systems are part of what we're using but that that system is changing because as we get better data we can get more specificity about the individual that is sitting in front of you and that is key because personalized medicine will make many of the current debates about if you're hispanic or latinx or if you're if you focus on the country of origin really looking at

25:36 who that person is and also the labels that we use are constantly changing because how people see themselves is constantly changing and a good example of this is that for a long time people use the the term of people of color and this was uh a an op-ed piece that recently appeared in in the washington post by a former congresswoman and what it basically says is i i don't want to be called a woman of color i am a black woman we are black women and the reason is because each community has their own heritage has their own

26:22 experiences and those experiences have an impact on their health and we know that because that's what epigenetics is about how the things which are around us change the way genes express themselves when it comes to the hispanic community in fact one of the problems that i see is that most people have very little knowledge of our history you know uh the culture sort of forgets that arrival and acquisition is part of the hispanic experience and most people in the northeast i'm sorry to say are not aware of the u.s mexico war or the treaty of guadalupe

27:09 hidalgo in 1848 and what that meant most people do not know that puerto rico was annexed in 1898 as part of the spanish-american war you know that history or even that florida was first founded by the spanish you know a lot of people don't know our history so our history is very diverse which in a way is different than the african-american community that can trace themselves to a common event that brought them here which was the horrific slavery so i think part of it is understanding the how people became part of the us what that history means and how that impacts their lives today

27:58 the next thing that that i always say is when you're talking about what's going on in institutions you really have to talk about how accurate is it what we know and frankly it's not very accurate for a long time what we used to do is use something in in health called reference man and this was reference man was used for looking at the estimation of radiation doses uh and it was first used in 75 and 2010 they were still looking for a modern reference man but that was you used to use for all sorts of things besides radiation cancer the effects of toxins and all sorts of things like that so really those data weren't very good

28:45 but needless to say even with bad data we always made assumptions so when these data came out that hispanics lived longer than that whoops then then non-hispanic whites it was people doing cartwheels trying to say that this could not be possible because of all the vulnerabilities that people know are part of the hispanic experience but somehow we lived longer and it was contrary to a minority model or myth about minorities that we actually live longer hispanics became even more controversial in how the health system would treat us when our rates of heart disease mortality

29:31 also showed that we did better than non-hispanic whites and one of the problems i always sees when people look at what the goal should be for health they say well let's do what um let's go to the non-hispanic white standard and my response is no in rates of heart disease mortality let's go to the hispanic standard everyone should be better than the best and in this case we're the best it's a similar situation when it comes to what we know about population pregnancy related mortality ratios across all ages except 35 to 39 hispanics actually did not better than non-hispanic whites so what does this mean well it means

30:17 that you know as hispanics we live long and suffer and the problem with that is that our conditions depression diabetes arthritis and liver disease are things that are not looked at as carefully as they should as a result of that what you have is artificial intelligence and decision-making tools which create a system that does not include information about hispanics and that damages the outcome for people who go in there but also is really not a tool for the clinician you know i want to add that it's not just having good data it's also the analysis you have to also

31:03 go beyond the numbers so when nih first announced that you know from 2009 to 2016 they now had many more data on on hispanics i mean on non-hispanics you went from four to percent to 19 percent people were thrilled but when they really looked behind the data and they said what is going on here the data increase was for asian for african americans it only went from point five seven to three and for hispanics it went from 0.06 to 0.54 so you really had to look at more than just the big data but drill down finally what happens when people do not

31:49 look at all the data a good example is the american cancer society guidelines for the prevention and early detection of cervical cancer these just came out july 30th and they have their guidelines then at the very end they talk about the limitations for these guidelines and who are these guidelines limited for black hispanic and lower ses status women why because those popular populations are not optimally represented in randomized controlled trials let me say not optimally is an understatement those communities are not represented

32:36 adequately so where does that leave us well this leave us that we have a challenge if we're going to move from the idea of going from ignore to inclusion we really have to look at many things and these things are some things that are critical to change and it's not just about having a program it's about having leadership board staff and constituents that are inclusive about how accurate data about having meaningful analysis and a capacity that goes beyond the numbers like what i showed with uh with the cancer guidelines

33:21 and to understand that personalized and targeted is the way to go and i'm sure some of you are thinking well you know she's a psychologist isn't she going to talk about mental health well the bottom line is health is mental wellness and you can't have health without including mental health but mental health is something that you can talk to people when when there's a trusting situation when the trust which is earned over time and experiences you know when people come to me and says what can i do to gain trust and i said well you have to spend time on it and they go oh well that's not what they want to do you have to trust is gained over time not one moment but over experiences the role of

34:07 community health workers is key in mental wellness they are a big uh way to get people into mental health services culture and language need to be celebrated not just acknowledged and we have to go beyond translation in mental health language is more than just what you can ask you have to be able to listen to the people and with that i want to say my thank you to everyone who is out there for all you do to achieve the best health for all that's a real picture of our headquarters and yes that's a real rainbow it's not fake

34:53 so that's about all i can um say and i wish everyone all the luck and all the work that you do thank you so much dr delgado for that powerful and insightful presentation and shining a spotlight on some of the inadequacies and research and how groups are counted and assessed and and considered now i would like to welcome juan chaluha mr chaluha is vice president of commercial market analytics and chief financial officer at florida blue mr chaluha has more than 25 years of domestic and international experience in the health insurance industry under the leadership of pat garrity

35:38 florida blues president and ceo florida blue has become a leader in providing culturally relevant high quality care to the latino population in florida specifically through this anita medical centers as well as support as well as programs that support economic social and health causes in latino communities today mr chalua is going to talk more about florida views in florida blue's innovative strategies mr chaluha thank you very much i first want to thank the national institute for healthcare management for allowing me to participate in today's webinar focused on the latinx population uh which is um you know really

36:24 important to me of course i also want to thank lisa and jen for their contributions i was very insightful so i appreciate that i learned a lot during the last half an hour to that um i wanted to start my presentation by providing uh solutions what we're doing at florida blue solutions to address the needs of the hispanic community within florida first and foremost at florida our plan covers uh population in florida only so i'll be discussing our solutions for the florida population only and not outside of florida at this time and as you can see florida hispanic population is very

37:11 diverse and is growing three times as fast as the rest of the rest of the population and the state uh out of the 22 million people that live in florida about 6 million are latinos 27 and they are mainly located in central and south florida and the origins of the the national population mostly again as cuban descent uh south and central american descent about 15 percent of those are mexicans about 21 of those are puerto ricans so um we we say also latinos we say that you know we're pretty diverse we do see

37:56 that different nationalities have a a little bit of a different feel within the latino population but uh overall if we're pretty diverse and as you can see in florida it's mainly uh 27 latinos so pre-populated state we live so we at tourer blue are in the local community we have 30 florida blue riddles retail centers across the state some of which are embedded in a ymca or walmart or paired with a clinic we have spanish-speaking associates in

38:43 person and on the phone and all of our materials are in spanish also we have hispanic member care specialists and sales agents who can help people who are uninsured get insurance our previous speakers spoke about the the issues we're having with uninsured uh after the affordable care act passed in 2014 and uh the the hispanic population is specifically affected by so um in this retail centers is one of our areas where we can help the uninsured get affordable uh insurance we can also uh help people

39:28 who have trouble affording the the health insurance we also are focusing on specific zip codes with the highest uninsured rates our community specialist in our retail centers provides services to both members and non-members so we're there for the population we're there for the community um we're trying to help people gain access to services and community resources sometimes people need assistance with medication grants food services transportation services etc and we connect them with those resources

40:14 i'm switching flights here we also do a lot of work in the hispanic community through our foundation health equity is one of our foundation's primary area of focus we believe no one's health should suffer because of social determinant or economic circumstances we are committed to helping ensure that all of florida's families and community members have both the access and opportunity to attain full health potential and are not disadvantaged due to environmental economic and social conditions so these i'm showing you in this slide

40:59 there are three examples of organizations and programs we have supported the hispanic service services council where we've provided 542 000 in grants in the hillsborough county uh we have a farm worker program where over the last five years we've provided over three hundred thousand dollars in grants and the hispanic unity since 2018 we provided three hundred thousand dollars in grants for that the foundation also strives to impact food security and mental well-being we want to make sure that all people at all times have physical and economic access to adequate amounts of nutritious state

41:47 and culturally appropriate food which are produced in an environmentally sustainable and socially just manner and that people are able to make informed decisions about what they eat what about what they they're eating that takes us then to uh our solutions our primary care solution salita's medical centers are the results of a partnership between flora blue and carrollte which is an international organization headquarter in colombia to bring an advanced primary care model to florida medical centers are focused on the specific needs of

42:33 of course the hispanic hispanic population the primary care model with native speak spanish speaking physicians and staff allows florida blue's hispanic population have convenient access to healthcare while experiencing a holistic engagement in the same style when i receive care in my country of origin it makes us latinos feel we're at home connected with our doctors this connected experience allows the latinx population to feel more comfortable when needing to get care and provides a culturally relevant experience the centers go deep into primary care

43:19 we've integrated with we've created specific products within florida blue that are integrated with the sanika medical centers that provide services to support our their patients which includes for example zero dollar copay for primary care and our urgent care benefits at that manage over all the plans uh specifically in the individual business for affordable care act the common goal here is to improve health outcomes patient satisfaction and lower health care costs under one roof we have comprehensive

44:07 primary care advanced urgent care onsite lab and diagnostics high volume specialist we offer virtual care including telehealth visits and chat capabilities wellness and disease management programs all under one group and all in spanish customized for the cultural and linguistic needs of the diverse hispanic population allowing for increased communication effectiveness which can improve health outcomes and reduce health disparities convenient and

44:53 culturally relevant the model incorporates community support including social networks social services and integration with social determinants of health initiatives as well as offers home-based care and unlimited tele-health access which has and i'll talk about that later coming uh in handy with the pandemic the creation of the sanita's medical centers took place to serve our hispanic population while understanding the dynamics of the affordable care act we started with three centers in miami-dade in 2014

45:41 and currently there are 35 sanita's medical centers and primary care offices in south florida and the tampa and orlando metro areas serving over 200 000 florida blue members this is an example of a miami map and where all the clinics are located uh each clinic is located strategically located not only in hispanic areas mostly if miami's hispanic anyways but within three to five miles radius driving distance for each of the clinics so the sanita's medical center performance has experienced a great success and

46:26 that's what sets us apart from other provider and other health care systems patient satisfaction and net promoter scores for example are above average and demonstrates the strength of our leadership with our hispanic population while providing a favorable health outcome with 15 lower utilization hospitalizations and 5 reductions in emergency disease i'm particularly uh invested in this in this partnership with sanitas i i am part of the sanita's board of directors i am involved on a day-to-day basis of that

47:11 operations and it is something that has created uh great success amongst hispanics and being in florida i think it's very important to be able to offer some kind of solutions for our artists our latino population uh earlier we spoke about uh health disparities why not this is a a really good solution that has exceeded our expectations so the impact of cause it and our response

47:57 for our prior panelists the disproportionate impact of the coveted 19 on latinx communities highlight the health disparities that have on long existed and the importance of addressing the social economic and environmental barriers to be able to achieve you know health equity so in june guy well the parent of company of florida blue launched a 100 000 challenge to address health and racial inequities reshaping health access in a statewide challenge to identify solutions focused on addressing health access and literacy to

48:43 populations in florida experiencing high levels of health inequities to that end during the pandemic back in march anita quickly responded to the to the pandemic by offering free bilingual virtual care this is via myself mobile app or at their website through their website um they also responded by this designating specific locations to see patients who have responded who had respiratory symptoms while having other locations for non-profit related care both allowing us for an improved

49:28 opportunity to serve hispanics recovery related systems so i showed you a map two slides ago and for example in south florida we have 13 clinics we designated some clinics that were specific just for covet patients and other clinics that were non-coveted patients that way we increased the the availability of patients with those symptoms to go to the clinics and get care we optimized our ppe supply levels to protect the staff and patients as well as followed protocols for screening patients cleaning the facilities practicing social distancing handling

50:14 fixed staff this way sanitizers was able to provide uninterrupted services during the packaging and at the beginning when we were on lockdown constant communications uh outreaching our members and patients goes out to members via email text messages facebook and through their website and to that i wanted to thank you for allowing me to uh speak a little bit uh about our primary care model specifically serving the hispanic population 15 minutes is not too much to go too much into that with our our model but i'm i'm happy to to to host

51:00 uh you know additional questions or emails you you have my contact information be happy to provide more information if needed thank you thank you so much mr chillua for sharing solutions from the cenitas initiative and effective approaches for culturally sensitive care we have just a tiny bit of time left for questions we had many come in that combined several topics one of the topics that came up several times one you can take this first if you like because i know you have a flu vaccine program going on where you are and perhaps jane orly so you may want to join in we have consistent questions about um how can what strategies are being employed to increase flu

51:46 vaccination rates and then correspondingly hopefully deal with the covid19 vaccine in hispanic communities sure i can i can i can take that begin begin taking that question uh thank you appreciate the question it begins with education we continue to offer informational webinars to explain the importance of getting the flu shot uh through our partnership with walgreens pro blue is planning to sponsor drive-through clinics as well flu shots are available at no cost to florida blue members and non-florida non-florida blue members regardless if you have insurance uh blue members they also earn uh we have a reward service where they can earn money for their

52:31 deductibles and the copies or not by taking the true shot they can earn money through that program as well at the sanita centers there is a marketing property going on right now where where this employees and staff decisions have already been vaccinated and are the importance of like teams and they probably wear in their uniforms to show it uh there's also promotions during event planning strong social media education efforts add some meters as well as florida blue

53:18 and uh like there are upcoming events that are two short events for the sanita's patients lisa do you see that as applicable with covid19 or jane uh this is uh jane i just wanted to say one of the things we're working with is with the science community to make sure that there is good representation of hispanics both in the development of a vaccine in the clinical trials and also you know there are a lot of treatments that will be coming online and to make sure that hispanics are included in those so that we can make sure that if a vaccine is developed

54:04 that is one that we know has been successful in our community see thank you um one of our last questions is about uh communication practices uh it's knowing that latin i'm sorry communication practices and ways that community health workers and others can help hispanic families latino families deal with upcoming festivities and and opportunities to be closed in a safe way with covid19 transmission but in a respectful manner i think that each of the community workers knows the community that they're working in and what are the options they have

54:49 for social distancing and still celebrating different kinds of events you know the one good thing is that hispanics are more likely to use a mobile than anybody else so how how we can do things on our mobile would probably be very helpful for many families to try to incorporate new ways to try to celebrate because we really need to protect each other and maintain that social distancing and make sure that we wear a mask and also so if you can to wear glasses so the two things are very important remember the virus enters through mucous membranes that's why your nose mouth and also your eyes are important to keep covered

55:37 so this is lisa i just want to mention that community health centers are the largest safety net network in our nation serving over 28 million and community health workers of promotores de san due working with these hunk printers and rural area migrant health centers and communities uh public mental health centers are all critical to serving our latino community currently just about 33 percent of latinos get their testing through these health centers so i think as trusted partners and current trusted organizations it's important that promoters be there in the community also uh we have to outreach and get the message out in spanish language radio and television and outlets in the way that our

56:22 communities get them and the message is not getting back in the 80s our first surgeon latina general antonia novello said the problem with the latino community in our efforts nationally and locally is they're having to do the 911 because they're not getting the 4-1-1 so definitely the spanish language outlets are critical well i let me just add something to that yeah i i also believe that when people want to reach our community they know how to reach it so i was very distressed this year when i had to put out press releases and do lots of interviews telling people not to drink bleach because that was not going to cure them so i think that there are ways to reach our communities and just like the people

57:09 who try to sell us and give us bad information reach us we have to use those very same methods to try to give people the best information possible because the internet our mobile phones have changed everything from the 80s and we have to amp up our game and do things in a way that really reaches all ages in every way repeatedly thank you very much jane we have two minutes i don't know if anyone can address this we've received several questions about the best way to gather correct data on hispanics given that we're using latino latinx hispanic and different terminology street um street race uh this term we have like

57:56 just a minute maybe lisa since she used street race yeah i responded to several questions uh and written answers thank you for those questions first of all the question was around you know what what's the term well i think um for the census purpose we have for enumeration hispanic but it certainly is acceptable and to be inclusive and understand that different latino communities whether it be by different distinct histories that dr jack geigel had mentioned or by national affiliation or length of stay here as well as generational status might go by latino latinx chicano mexicano mexican-american cubano i think that we need to honor that people need to be able to name who they

58:43 are that being said the covet data is available i responded to the cdc cover data tracking system by state and county now this does a general hispanic variable but there is not subpopulation analysis and that's something i left it out into a passport and a call to action is we need to push our local state and congressional and at the executive level in dc to collect the data by race ethnicity and sub-populations this is critical to be able to understand the impact on our communities thank you and just to add one closing thing it's less important what you call people

59:28 and what you do than what you do and also remember among african-americans among asians around every subgroup non-hispanic whites what they're called varies by what state they live in and their community so call people what they want but do what they need thank you so much dr delgado uh dr kakari stone mr chalua unfortunately we're out of time right now you've been an amazing panel uh thank you so much for taking time out of your schedule to be with us today and to our audience please take a moment to share any feedback about this event by completing a brie survey that you can find at the bottom of your screen also please check other resources on our

1:00:14 website um and in a few weeks you will receive an invitation to a third webinar in this series uh systemic racism and public health treatment bias then covet 19. again please do click on to our survey and don't forget to share your opinions thank you so much for your time and have a wonderful afternoon everyone