cdc.gov/diabetes/pubs/pdf/ndfs_2003.pdf). The most common form of diabetes is Type II, which accounts for about 90 to 95% of all diagnosed cases of diabetes (Centers for Disease Control, National Diabetes Fact Sheet, www.cdc.gov/diabetes/pubs/pdf/ndfs_2003.pdf). Pre- diabetes is a condition often present prior to the development of Type II diabetes. In pre-diabetes, blood glucose levels are higher than normal, but not high enough to be considered diabetic. Pre-diabetes does not have to lead to the development of diabetes if a person diagnosed with this condition: Patients who work to control their weight and increase their physical activity can often prevent or delay the onset of diabetes. There are 41 million Americans who have pre-diabetes (Centers for Disease Control, National Diabetes Fact Sheet, www.cdc.gov/diabetes/pubs/pdf/ndfs_2003.pdf). There is extensive documentation regarding the correlation between diabetes and the increased death rates among Hispanics.

Diabetes has been increasing for years among Latinos, they say, not only among adults but also teenagers and young children. The diabetes death rate is at 10.4% for Hispanics because people with the disease often die from other conditions. In those cases, diabetes would not be listed on the death certificate as the cause of death, although it often is a contributing factor (American Diabetes Association, www.diabetes.org / ). Diabetes is an urgent health problem in the Latino community. The rates of deaths are almost double those of non-Latino whites. Disbursement of information to the Hispanic community about the seriousness of diabetes, risk factors and ways to manage the disease is essential. The proposed clinic would do just this.

The Pew Hispanic Center released an extensive study of young Hispanics, those aged 16 to 25 and their uneven assimilation into mainstream American society (pewhispanic.org/). The Pew Hispanic Center reports that Hispanics accounted for roughly 60% of the growth of America's uninsured between 1999 and 2008. By the end of this period, Hispanics represented less than 16% of the overall U.S. population but 31.4% of those who lacked health insurance at any given time, according to the Census Bureau ("Income, Poverty, and Health Insurance Coverage in the United States," www.census.gov/prod/2005pubs/p60-229.pdf).

According to the Pew Hispanic Report, "six-in-ten Hispanic adults living in the United States who are not citizens or legal permanent residents lack health insurance. The share of uninsured among this group (60%) is much higher than the share of uninsured among Latino adults who are legal permanent residents or citizens (28%), or among the adult population of the United States (17%)." (Pew Hispanic Center, http://pewhispanic.org/reports/report.php?ReportID=113

). The 2008 National Health Interview Survey (www.cdc.gov/nchs/nhis/released200906.htm) found that 34% of non-elderly (under age 65) Hispanics reported being uninsured, compared with just 14% of non-elderly non-Hispanics. About 43% of uninsured Hispanics reported that they had never been insured, compared with only 15% of the non-Hispanic uninsured.

The new health-care reform law prohibits illegal immigrants from receiving Medicaid. It also prohibits them from buying health insurance through the insurance exchanges that will be set up. Given that many illegal immigrants -- indeed probably most -- work in jobs that do not provide health-insurance coverage coupled with barriers to federal insurance and buying private insurance, there will be tens of thousands of Hispanics who will remain uninsured even after all of the provisions of the new health-care act have been put into effect.

There are also other barriers to Hispanics seeking health insurance. Accordin to the Pew Hispanic Center, those Hispanics who mainly speak Spanish, who lack U.S. citizenship, or who have had only short tenures in the United States are less likely than other Latinos to report that they have a usual place to go for medical treatment or advice.

Six-in-ten Hispanic adults living in the United States who are not citizens or legal permanent residents lack health insurance. The share of uninsured among this group (60%) is much higher than the share of uninsured among Latino adults who are legal permanent residents or citizens (28%), or among the adult population of the United States (17%).

Hispanic adults who are neither citizens nor legal permanent residents tend to be younger and healthier than the adult U.S. population and are less likely than other groups to have a regular health care provider. Just 57% say there is a place they usually go when they are sick or need advice about their health, compared with 76% of Latino adults who are citizens or legal permanent residents and 83% of the adult U.S. Population. (Hispanics, Health Insurance and Health Care Access, http://pewhispanic.org/reports/report.php?ReportID=113)

Recent immigrants, because of their youth, do tend to be healthier than Hispanics overall. (Young people are generally healthier than older...

Moreover, while young Hispanics will be generally healthy because of their age, they often work doing manual labor and so are more subject than the American population at large to be injured on the job. Although they should thus be eligible for benefits under workers' compensation, they may not be if they are not in the United States legally or if they are working off the books.
The Pennsylvania Commonwealth Fund 2002 report states that Hispanics are less involved in their health care than they would like and that Hispanics find it harder to understand instructions from their doctors, especially in terms of not fully understanding their treatment plans. These on-going plans in terms of medication, diet, and exercise are essential for diabetics to maintain the highest quality of life and to avoid long-term complications from diabetes (http://www.commonwealthfund.org/Content/Grants/2002/May/Evaluating-Strategies-to-Fill-Gaps-in-Health-Insurance.aspx),

Given the increasing growth of the Hispanic population in the United States, it is imperative that the American health system continue to develop cultural competence policies that address attitudes, knowledge and skills about cross-cultural education. Hispanics have demographic trends, historical traditions, traditional medicine knowledge, fundamental values and beliefs, legal status, language/communication needs that must be addressed.

The Pew Hispanic Center's 2007 Latino Health Survey (pewhispanic.org/reports/report.php?ReportID=91) explores not only their differential access to health care by different sub-populations, but also their sources of health information and their knowledge about diabetes. This is the most comprehensive national survey done to date on the issue and provides a snapshot of the ways in which Hispanics are currently accessing health carfe.

The survey finds that among Hispanic adults, the groups least likely to have a usual health care provider are men, the young, the less educated and those with no health insurance. (A similar demographic pattern applies to the non-Hispanic adult population that lacks a regular health care provider.) Four-in-ten (41%) non-citizen, non-legal permanent resident Hispanic adults state, that their usual provider is a community clinic or health center. Some 15% of Latino adults who are neither citizens nor legal permanent residents report that they use private doctors, hospital outpatient facilities, or health maintenance organizations when they are sick or need advice about their health.

An additional 6% of Latino adults who are neither citizens nor legal permanent residents report that they usually go to an emergency room when they are sick or need advice about their health while 37% of Latino adults who are neither citizens nor legal permanent residents have no usual health care provider. More than one-fourth (28%) of the people in this group indicate that financial limitations prevent them from having a usual provider.

The above conditions demonstrate how nurse-managed centers and free community clinics could play a crucial role in the delivery of diabetic preventative care.

Nurse-managed centers, working collaboratively with physicians, clinical nurse specialists and other health-care providers provide care for the uninsured. Federal and state funding along with corporate grants assist in providing primary, non-emergency-care services that vary according to the needs of the communities served.

Among those treated at nurse-managed centers are people of low income who cannot afford health insurance, the under-insured, homeless people and those who have immigrated to the U.S. without financial resources or English-language skills. The promotion of disease prevention and wellness are universal clinic goals, as health teaching is central to care delivery systems (Rose, 2009). In response to this problem, hundreds of communities across the country have found solutions by developing and supporting free clinics. The Free Clinic in Doylestown is an example of a successful clinic. Social worker Peggy Dator is the executive director and founder of the clinic. Dator said that this clinic, founded in 1994, was one of the first free clinics in Pennsylvania. From the start it was organized to meet the medical needs of low income uninsured and under-insured, adults and children residing in the central Bucks County community.

The Free Clinic of Doylestown provides free medical care to adults and children. Ms. Dator is the only paid full time staff and there are five nurse practitioners who volunteer in the clinic and two of which provide free care in their offices upon referral. Annually they serve 1,000 adults and children. To date they have served over 7,300 individuals and have provided almost 30,000 patients visits in their free clinic program (Dator, personal communication, 2010).

Another example of a free clinic is the "Diabetes Drive-Thru." This may conjure up…