Ensuring Immigrant Health

Speakers:

Len McNally, The New York Community Trust

Susan Downs-Karkos, The Colorado Trust

Gigi Barsoum, The California Endowment

This audioconference highlighted three philanthropic efforts to address immigrant health.  Len McNally of The New York Community Trust (NYCT) opened the call by highlighting NYCT's recent grants to improve health care for immigrants in New York. He provided an overview of the current picture of immigration in New York, noting that more than 3.5 million immigrants live in the New York metropolitan area: three million in New York City, 400,000 on Long Island, and 200,000 in Westchester.  Constituting 37 percent of the population, immigrants are major contributors to all aspects of New York City life. 

According to Len, immigrants in New York do not receeive adequate health care, which leads to higher rates of sickness and death.  Lack of health insurance is one of the barriers to care; it is estimated that only half of the region's immigrants have health insurance, primarily because they work in low-wage jobs that do not provide health insurance and because they cannot afford to pay insurance premiums. And while some immigrants are eligible for government-sponsored insurance such as Medicaid, many do not apply because they fear that it will affect their immigration status and lead to deportation. 

With a quarter of the region's immigrants speaking little English, cultural and language barriers also impede access to health care. They have difficulty describing their symptoms or providing a medical history, and often cannot understand outreach and application materials for state insurance programs.  It is particularly difficult for immigrants with serious illnesses who cannot communicate with their doctors about complex treatment protocols they must follow.

Cancer presents a special problem.  Lack of insurance and a poor understanding of the benefits of early detection contribute to immigrants having markedly lower rates of screening for breast, cervical, and colorectal cancers, all of which have excellent outcomes when diagnosed early.  And even when diagnosed with cancer, immigrants often delay care because of costs. The result is that breast cancer mortality is higher among immigrant women, prostate and colon cancer is more prevalent among Caribbean men, and oral cancers are a major problem among Asian immigrants.

In response to these needs, The New York Community Trust made three grants totaling $600,000 to improve immigrants' access to health care.  A grant of $100,000 to the Mayor's Fund to Advance New York City is helping improve health literacy for immigrants in the City.  Grants of $200,000 to the New York Immigration Coalition and $300,000 to the New York University School of Medicine's Center for Immigrant Health are also supporting a joint Portal Project to improve access to health care for immigrants in New York City, Westchester, and on Long Island. 

The name of the Portal Project emphasizes its goal of helping immigrants enter the health care system.  The project combines the resources of seven medical centers and eleven immigrant-serving agencies in New York City, Long Island, and Westchester.  The Coalition and the N.Y.U. Center are developing a joint oversight committee for the project, whose first step will be to develop a guide for immigrants.  The project team will develop two surveys: the 11 immigrant agencies will use the first survey to question their clients about their experiences and problems in seeking health care; medical centers will use a second use to assess their policies and procedures for serving immigrants.  The guides will include information on government insurance, reduced-fee payment policies, and practical steps to help immigrants get care at the medical centers.  The project will train community agency staff to use the guide in community health education sessions. In addition, the project will help the hospitals develop programs to train their staff to better serve immigrants.

The project will serve the entire region covered by The NY Community Trust and its affiliates.  The 11 immigrant agencies will focus on Korean, Latino, South Asian, Haitian, Arab, and Eastern European immigrants in the City and three suburban counties. It will survey immigrant agencies to help their clients report their experiences in seeking care at the participating medical centers.  It also will help the medical centers conduct internal reviews of how the project's training improves care.  Findings will inform a report with recommendations for improved referral systems from community-based agencies and simplified medical center intake and payment policies, which will be shared with all immigrant-serving agencies and health care providers in the region.  Additionally, with support fromThe Trust's Greene Fund for cancer treatment, the Center for Immigrant Health will be able to offer cancer outreach and treatment as part of the project

Next, Susan Downs-Karkos of The Colorado Trust discussed their work supporting immigrant and refugee families.  She noted that The Colorado Trust first began providing support for Colorado's growing immigrant population through its Supporting Immigrant and Refugee Families Initiative in 2000. The first phase of this ten-year (2000-2010), $16.7 million initiative focused on providing support to Colorado organizations that serve immigrant and refugee populations. While these immigrant-based organizations are trusted by immigrants and refugees themselves and provide them with much-needed assistance, Susan noted that increasingly, immigrant integration is being viewed as a two-way street.  This involves adaptation not only on the part of immigrants themselves, but also on the part of the community where they now live.

Under the new Immigrant Integration phase of this initiative, which began in 2004, 10 grantee communities have brought together broad community coalitions to participate in this effort to help immigrants and refugees adjust to and become an integral part of their community. The coalitions include community members from health care, education, business, law enforcement, libraries, local government, faith-based organizations and immigrant-serving organizations, and immigrants themselves. With planning recently completed, communities are just getting under way with implementing their plans.

Finally, Gigi Barsoum of The California Endowment (TCE) discussed two of their projects focused on improving immigrant health.  In September 2004, The Endowment launched the Hmong Resettlement Health Project (HRHP) to address the health access challenges that Hmong refugees face.  Ten organizations received grants totaling $1.6 million over 18 months to (1) help Hmong refugees navigate the health care system and access health services and (2) strengthen the community's capacity to effect longer-term change that would improve the health of the Hmong community. 

Organizations were strategically chosen to serve the counties most impacted by the newest wave of migration – those in the San Joaquin Valley and the Sacramento Valley. To facilitate collaboration and coordination, HRHP hosted convenings of Hmong leaders, Hmong service organizations, public health officials, and government entities serving refugee populations to identify and address the challenges faced by the Hmong community and the incoming wave of refugees. Grantees helped refugees navigate the healthcare system by providing a basic orientation on the healthcare delivery system, providing information and referrals to health services, linking new arrivals with primary care providers, supporting transportation to health services, providing interpretation and translation services, and assisting enrollment for health insurance and health-related programs. 

Beyond providing direct navigation services to Hmong refugees, HRHP provided advocacy trainings to help the community identify and pursue their policy goals.  Legal advocacy and assistance was also provided to help refugees understand their health rights.  By coupling policy advocacy work with the provision of direct services, the hope is that communities can help secure more comprehensive and sustainable programs and funding.   

The second phase of the HRHP is focusing on building grantees' capacity for advocacy and systems change work that will improve language access, provider commitment, and policymaker engagement.  There is also greater emphasis on advancing the knowledge, skills, and experience of health providers and health systems to effectively serve Hmong communities.   

The second effort Gigi described is the California Immigrant Welfare Collaborative (CIWC).  This is a coalition of four immigrant rights groups: the Asian Pacific American Legal Center (APALC); National Immigration Law Center (NILC); Coalition for Humane Immigrant Rights in Los Angeles (CHIRLA); and Services, Immigrant Rights and Education Network (SIREN).

The collaborative was formed in 1996, with primary support from TCE, to coordinate a statewide response to the health and welfare challenges facing immigrants in California in the wake of passage of federal welfare reform. CIWC works directly in immigrant communities and with community-based organizations, service providers, and policy makers to advocate for the rights of low-income immigrants in California. As a coalition of four key advocacy organizations, CIWC is able to provide an integrated response to changes in laws and policies affecting immigrants' access to public benefits. 

Additionally, a non-profit media and communications firm called Cause Communications was funded by TCE to provide technical assistance to CIWC in developing their communications capacity and to pilot a model for partnering a communications firm with an advocacy organization.  Cause Communications is dedicated to helping nonprofits develop communications strategies.

Recognizing the particular communications challenges for organizations advocating on behalf of immigrants, TCE asked Cause Communications to provide technical assistance to CIWC to help them develop a strategic communications plan (beginning with renaming the collaborative) and enhance their own communications' capacity.  Cause Communications had previously conducted a media scan for TCE on how immigration issues, especially those relating to health, are portrayed in the media, and, therefore, was well-grounded in the issue.  By partnering a communications firm with an advocacy organization, TCE hopes to identify a replicable model for enhancing the communications capacity of advocates.