The California Pan-Ethnic Health Network (CPEHN) applauds Governor Newsom for proposing historic investments to achieve health equity. While the Governor’s budget proposal is a great first step, we call on the Governor and Administration to work with local, regional and state leaders to prioritize action on the key health equity recommendations outlined below in order to improve health outcomes for ALL Californians.
Who we are: CPEHN is a statewide multicultural health advocacy organization. Founded over 25 years ago, CPEHN unites communities of color to achieve health and wellness, and to eliminate persistent health inequities. We derive our strength from our mobilizing arm, the Having Our Say (HOS) coalition which consists of over 30 community-based organizations across California working together to improve access to care and health outcomes as well as through our Behavioral Health Equity Collaborative (BHEC) and California Oral Health Network (COHN) partners.
The Stockton community mobilizes to reduce mental health disparities for the city’s most vulnerable population.
Advocates held the Stockton Reducing Disparities Public Hearing on December 11th 2018 from 10 AM- 3 PM at the historic Stockton Masonic Temple to showcase programs that reduce stigma for mental health and to bolster cultural pride among vulnerable population. Attendees also strategized how different stakeholders and community leaders should work together to reduce mental health disparities.
Stockton has gained much media attention since the city rolled out a pilot Universal Basic Income (UBI) in 2018, a bold program proposed by Stockton’s 27-year old mayor Michael Tubbs. This represents tremendous progress due to a deep economic and health disparities that exist even within the city, with Stockton City South underperforming compared to Stockton City North. Even with the progress the city has achieved, many still face barriers in accessing quality health care in Stockton and the greater San Joaquin County, especially for communities of color and LGBTQ population.
On Thursday, January 10th, Governor Gavin Newsom released his FY 2019-2020 State Budget. The $209 billion spending plan proposes an historic investment in health equity and health care quality, providing millions in funding to tackle disparities in pre-natal and post-partum care, chronic conditions and mental health. The budget also includes new funding to expand access to health care for undocumented young adults and improves affordability assistance in Covered California for low to middle income individuals earning between 250-600% of the Federal Poverty Level ($30,350 and $72,360 for a single individual) by strengthening and expanding subsidies.
CPEHN supports the additional investments proposed by the Newsom Administration that will prioritize the health of our most vulnerable communities. To view the full budget proposal click here.
Today, CPEHN sent a letter to the Governor thanking him for his bold vision and outlining recommendations in order to make the most of this opportunity. We believe that the California Surgeon General can provide much needed leadership to eliminate inequities that have existed for far too long. While California has instituted components of this work across state government, including the Office of Health Equity, statewide vision and implementation is sorely needed. In order to actualize this vision, we recommend the following considerations for the California Surgeon General:
CPEHN was proud to sponsor Senate Bill (SB) 1152 in 2017-2018. Thank you to author Senator Ed Hernandez and to all of our community partners who helped lobby for this bill. CPEHN stands committed to seeing a successful implementation of the law surrounding this important issue. Read below to find out more about the changes we will see this year.
Beginning January 1, 2019, all hospitals in California must develop a plan for safely discharging patients without homes. This law prohibits hospitals from engaging in previously reported tactics, such as discharging patients in hospital gowns, leaving patients at unsafe locations, and failing to make necessary mental health referrals.
Specifically, hospitals must do the following:
Attempt to secure a sheltered discharge location, resource permitting, or discharge a patient to the location of their choice.
Provide transportation to the discharge location, within 30 miles or 30 minutes of the hospital.
Offer the patient weather-appropriate clothes.
Offer the patient a meal.
Provide referrals to health and mental health resources.
Note for homeless services providers: The law directs hospitals to receive your agreement to discharge a patient to your facility. The law states a preference for this arrangement in order to best coordinate care. However, in order to protect the rights of the patient, if a patient specifically requests to be discharged to your facility, the hospital may do so regardless of your agreement or the appropriateness. If the patient has not specifically requested your facility and the hospital transports the patient there without your agreement, that hospital is in violation of the law and you should report the violation as directed below.
New UCLA/CHIS Data Shows Declines in Racial/Ethnic Disparities in Health Coverage
Additional Data on Mental and Oral Health, Marijuana Use, Voter and Civic Engagement, Highlights Disparities as well as Opportunities for Action
The UCLA Center for Health Policy Research released new data from the 2017 California Health Interview Survey (CHIS) findings. The largest single-state health survey in the United States, the 2017 survey includes responses from children, teens and adults in nearly 21,300 households on wide-ranging topics including health care coverage, mental health, marijuana use, adult dental coverage, voter registration and civic engagement.
CPEHN reviewed the findings and found important implications for the health and wellbeing of communities of color in California. Below are some highlights from the survey as well as recommendations from CPEHN for what local and state advocates should do to address remaining disparities for California’s communities of color.
Finding #1: The ACA has significantly reduced the uninsured rate in California by half, from an average of 14.8% in 2013 to just 7.4% in 2017, and has produced historic declines in racial disparities in health coverage rates (see table below). However, despite these gains, Latinos still have the highest uninsured rates in the state (12%) compared to all other racial/ethnic groups (4.4% - 7.3%). These findings are consistent with CPEHN’s analysis of newly released U.S. Census Bureau statistics.
Last month, the California Pan-Ethnic Health Network (CPEHN) convened over 200 community and healthcare leaders at our biennial conference Voices for Change: Mobilizing for Health Equity. At a time when we have seen attack after attack against the health and well-being of our communities, we came together to discuss how we can leverage our collective power to organize, advocate, and vote for equity.
To kick off the day, our keynote speaker, Maria Hinojosa, shared her inspiring personal stories around immigration, mental health, and being the first Latina in numerous newsrooms. Maria reminded us that we each have our own unique stories of resilience and that our stories have power.
“As people of color tell their stories, we build power, and we can change the larger narrative around us.” – Maria Hinojosa, Emmy-winning journalist
With Maria’s stories of resilience in mind, we shifted to the morning plenary where leading advocates discussed strategies for mobilizing around an intersectional health equity agenda. From reproductive justice, to LGBTQ rights, immigration, and climate change—the barriers that communities color face are multifaceted and complex. Panelists discussed all that is at stake for communities in the upcoming November midterm election, in 2020 and beyond. Zahra Billoo of CAIR-SFBA implored participants to ask themselves three guiding questions as we consider the sustainability of our work:
“Who is not at the table and how can you invite them? How can we work smarter not harder because this is a marathon? [And] how can we can make civic engagement and activism part of our community’s lifestyle?” - Zahra Billoo of CAIR-SFBA
The brief used statewide health data to examine health care access, and quality of care by race/ethnicity, payer and region with regards to diabetes management, a chronic condition that disproportionately impacts communities of color in California. Wealthy regions exhibited the widest disparities—with advantages among non-Latino whites and people with commercial coverage, whereas disparities were narrowest in rural and agricultural regions, but health and quality of care were lower overall in those regions, according to the new data.
The brief also explored the unique role CPEHN and other statewide advocacy groups have traditionally played in the advancement of state initiatives to address health equity; including through requirements on health plans to reduce health disparities, as well as broader system wide requirements on public and private entities to invest carbon cap-and-trade revenues in disadvantaged communities.
The article was co-authored by Cary Sanders/Director Policy Analysis and Sarah de Guia/Executive Director of CPEHN in partnership with Ninez A. Ponce, professor in the Department of Health Policy and Management, director of the UCLA Center for Health Policy Research and principal investigator of the California Health Interview Survey and researchers Michelle Ko/assistant professor UC Davis and Riti Shimkhada/research scientist UCLA.
Despite rising uninsurance rates nationally, a new report from the U.S. Census Bureau shows that California continued to make historic gains in the effort to reduce the state’s uninsured rate. According to the data released, California’s uninsured rate fell to a new historic low of 7.2 percent in 2017, which represents a decline of 10 percentage points from the pre-Affordable Care Act rate of 17.2 percent. The report highlighted California and two other states, Louisiana and New York, as states that saw a reduction in their uninsured rate in 2017, while 34 other states had uninsured rates that remained unchanged.
An analysis of the numbers by CPEHN showed California’s communities of color also continued to see gains in rates of health care coverage with a decline in uninsurance rates for Latinos, Asians, and Native Hawaiian Pacific Islanders, despite federal efforts to sabotage the ACA. These positive numbers are due in part to the proactive steps California has taken despite federal interference, to keep insurance premiums low and make consumers aware of their eligibility for low or no-cost health care coverage in Medi-Cal and Covered California. Covered California in particular was recognized nationally for its targeted outreach and media activities to reach Latinos, African Americans, Asian/Pacific Islanders and LGBTQ communities throughout the state.
Percentage of Uninsured Californians by Race/Ethnicity: 2016 and 2017
Mr. James was cold. An internal body temperature of 84.2 degrees Fahrenheit qualifies as severe hypothermia. When I first met him in the Emergency Department, his grey hair was poking out from under a warming blanket. Warm fluids were running through an IV into his veins and through a catheter into his bladder. He responded incoherently when I asked his name. His 67-year-old brain and body had frozen.
I ordered a battery of blood tests searching for the cause of Mr. James’ hypothermia. As I’d been taught in medical school, I considered infection, hypothyroidism, adrenal insufficiency, and carbon monoxide intoxication. All the tests came back normal.
It turns out Mr. James was cold from sleeping outside. Someone stole his blankets and the temperature dropped, a simple formula for hypothermia. He’d had three identical hospital admissions in the last year, each of which involved the same process: We warmed him up, gave him a few hot meals and a warm bed for the night, and then discharged him to the street with a taxi voucher to a homeless shelter. He walked out of the hospital and right back into the cold.
Discharged to the Street
As a resident, or doctor in training, one of my key roles is coordinating discharges from the hospital. Every time I sign a discharge order, I must select the patient’s destination from a dropdown menu of options including home and other levels of care such as skilled nursing facility. “Street” is not an option and yet this is where patients like Mr. James end up.