Grant Proposal the Saint Anselm\'s

Grant Proposal

The Saint Anselm's Cross Cultural Center has a multi-faceted programming dynamic offering essential information and services to mainly a Vietnamese immigrant culture though the center serves other populations and provides services as needed to other immigrant groups and families. One of the core programs within the center that has a serious need for expansion is the community and family health portion of the center. The center currently holds three community health fares annually but would like to expand the program to offer it on a more regular basis, to respond to increased community need for health provision of services in the challenged economy and for the sake of offering services more frequently so people in need of community access for health services are offered more opportunities to seek such care and apply for community services on a more need centered basis. Currently the 3 health fairs offered in the year has an astounding community response, with 200-400 individuals attending each fair. The center would therefore like to spread out the health fair and be able to offer it twelve times per year, on a monthly schedule to better serve the community. The health fair itself has limited cost as many providers and other community health volunteers bring with them supplies and other materials they need to provide the many types of medical screening done by the center volunteers and others are supplied by various donations to the center. Yet, these resources are limited, as is the time of the volunteers, and if more of these materials were provided by the center could offer volunteer positions to individual health care providers who do not have the physical resources to provide them through links to employers or other community aide agencies. We would also like to expand immunization offerings to be included at health fares and provide screening specific to children, like lead paint testing. The most significant and possibly costly addition we would like to provide at our center health fairs is an expansion of the health fair concept to include a common health problem clinic, concurrent with the fair, which we would hope to also offer monthly. Individuals could be seen free of charge for minor health problems, on a first come first serve basis for the duration of the health fair. Issues such as common rashes, parasitic infections, ear infections in children and other common minor illnesses could be treated with exams and if needed prescriptions for attendees of the fair.

Community Health Fair is one of our Health and Wellness Program's activities designed to help low-income, un-insured or under-insured people to access health services. For every health fair, we usually have 2 health presentations by medical specialists to raise community's awareness about nutrition, prevention and early intervention of common diseases.

With the collaboration of the local doctors, medical centers, community clinics, and especially the support of Orange County health Care Agency, we provide from 10 to 12 different medical screening tests for 200 to 400 clients at each fair.

The 3rd health fair falls in the winter. We will provide FREE flu shots for the residents.

Services of most interest are: Cholesterol Test, Bone Density Test, Glucose Test, Stroke Screening. (St. Anselm's Cross-Cultural Community Center Website, Community Health Fair Day)

CalOptima is the main financial contributor for the current health care fair offerings, but has expressed the need to cap the service as it stands unless the center is able to find another comparable financial partnership.

Statement of Need

Vietnamese, Koreans, Hispanics and Middle East immigrants from the surrounding neighborhood all present in the numbers of around 200-400 at current health fair offerings. Seeking screening and information on services and programs they are eligible for. Though the center and the health fair has an open door policy and will serve anyone, in need of low cost or free medical screening. This population, surrounding the center in this very community is at high risk for falling through the cracks with regard to access to health services. Health disparities for minority populations are extreme. Asian-Americans have higher rates of death from cancer, while Hispanic populations are particularly plagued by diseases related to obesity, diabetes, cardiovascular disease and some select cancers. Information specific to Vietnamese populations are particularly troubling, regarding death rates for certain types of cancer.

Liver, Stomach, Cervical Cancer Common in Vietnamese. Vietnamese men have the highest incidence and death rates of liver cancer of all Asian-American groups studied. Liver cancer is very common in Vietnam, where chronic infection with the hepatitis B virus is widespread. Because many Vietnamese in the U.S. are recent immigrants, they may be more likely to have this risk factor for liver cancer, the report says. Vietnamese women have the highest incidence and death rates for cervical cancer of all Asian groups studied. Screening for cervical cancer with a Pap test is less common among Vietnamese women than it is among several other Asian groups. About 70% reported getting a Pap test within the past 3 years. Lung cancer is more common among Vietnamese men and women than it is among the other Asian groups included in the report. Stomach cancer is also common among both men and women of Vietnamese descent. (American Cancer Society Website)

Data is not available in California for disease profiles regarding immigrants of Middle Eastern descent.

Immigrants are nearly always subject to economic disparities as the dismantling and rebuilding of an entire life is a significant financial strain and many immigrants migrate specifically to attempt to better a poor finical situation in their home nation. Many are political refugees seeking asylum in the U.S., a situation that creates barriers above and beyond those that already plague immigrants succeeding economically in the U.S. Many live in cramped conditions, as multiple family or friends share small homes to support one another. Extreme cultural and language barriers also bar immigrants from seeking medical care and other needed resources, including but not limited to employment, health care, health care insurance and even healthy foods, as varieties of fresh foods are often completely different in the U.S., than they are in other places and unknown are not always welcome to an individual with limited financial resources. Another issue that is specific to international immigrants is the issue of credential, while an immigrant may be of high rank and education in their home nation, e.g. doctors, lawyers, professors, nurses, ect…their professional credentials and educational attainments often do not transfer to the U.S., even if they are proficient in English communications. (Marquez NP) The community center therefore fills a void in the community by offering a hub for interconnectivity, health access, information and resource access and networking for social, personal and economic betterment. Additionally, language barriers are overcome by the fact that former immigrants are often on site volunteering at the center.

Why this project is necessary.

Healthcare access and/or lack there of has been on the radar of the government, healthcare stakeholders and the whole of the U.S. population for a very long time. There is a clear recognition that healthcare is a universal need, but actions of the healthcare system as well as the outcomes of having or not having quality accessible care for minorities has proven that the system does not seem to answer the problem with the idea that healthcare is a right, rather than a privilege.

…access to quality health care is essential to realizing our full potential as individuals, families, communities, and as a society. Our children learn more effectively when they come to school healthy and strong. Our workforce is more productive and our economy more robust when workers and their families receive quality health care. (Jenkins, and Ardalan 479)

Individuals and groups recognize that when healthcare is provided, equitably and even preventatively the whole of the community and therefore the economy is better served.

Affordability of care promotes not only good health, but also economic security. In addition, the affordability and quality of the health care that all of us receive improves drastically when our system prevents and treats health problems early and through regular, rather than emergency, care. (Jenkins, and Ardalan 479)

Yet, a timely question arises when we discuss the issue of continued and pervasive health disparities between the majority and minority populations in the U.S., especially considering the current state of the economy.

The future health of the nation will be determined to a large extent by how effectively we work with communities to reduce and eliminate health disparities between non-minority and minority populations experiencing disproportionate burdens of disease, disability, and premature death. (Office of Minority Health and Health Disparities Centers for Disease Control and Prevention NP)

Despite the recognition by many that healthcare is an essential need and that minority health is fundamental and important hospitals and clinics in both urban and rural areas, are closing, as a result of the failing economy. Speaking specifically of New York one expert stressed the inability of the state and local agencies to seek understanding of equitable access issues prior to closures of hospitals and clinics, and based entirely upon economic internal decision making procedures.

The growing number of New Yorkers lacking health insurance has been a persistent concern of government as well as the public. (309) In contrast, the distribution of health care resources came to the fore more recently. The New York State Commission on Health Care Facilities in the 21st Century, for example, recommended a series of hospital closures and downsizing, based primarily on financial considerations in 2006. (310) As described below, the State has consistently allowed hospitals and clinics to close with little regard for New Yorkers' health care needs. Particularly in New York City, the mismatch between health care resources and health care needs, violates all the elements of the state constitutional right to health care: universality, comprehensiveness, and equity. (311) The State has a clear obligation to address New Yorkers' health care needs more effectively and to ensure that comprehensive, quality health care is available and accessible to all New Yorkers. (Jenkins, and Ardalan 479)

Of course New York is not alone, as many urban and rural clinics and hospitals are being closed because the economy is failing and diversification of finances, and especially investment of the institutions in risky ventures, has created situations where even though there is a clear community need for the retention of the facilities they are being closed anyway, because they cannot pay operating costs. Another area of concern, specific to clinics and hospitals which run in part or completely on funding from non-profit and foundation grants, as such funding is clearly becoming scarce, as people and organizations tighten their belt during an economic slump and stop contributing.

Disparities are often specific to race and gender but in cities where there are unusually high concentrations of minorities healthcare disparity should be part of a universal program fro elimination. Thus far this is only true of the rhetoric, and not true of the reality, and even more so as clinics and hospitals close in these areas. These closures leave these already at risk individuals with even fewer, if any options as for how to receive adequate and equitable preventative care.

…statistics document significant disparities for minority populations in health outcomes, such as quality of life, as well as mortality, processes, quality, and appropriateness of care, and the prevalence of certain conditions or diseases. ("CAM at Minority or Health Disparities Research Centers" 46)

Preventative care is particularly hard hit when clinics and hospitals are not easily accessed, usually due to distance, requiring the individual to wait a longer period and go a longer distance to receive routine or preventative care. In many cases the option become null and the individual simply enters the system through the doors of the ER, when they have waited as long as they could to receive care. Serious disparities can be found in some of the more serious sets of human disease; "HIV / AIDS, cancer, cardiovascular diseases, diabetes, adult and childhood immunizations, and infant mortality -- " ("CAM at Minority or Health Disparities Research Centers" 46) Yet other disparities also exist, and in general minority populations often receive far less care, for fundamental access and personal reasons and therefore have lower quality of life and a higher mortality rate for serious and chronic disease as well as an overall lower longevity.

The economy seems to be making an already bad situation far worse as clinics and hospitals close in many areas of the country. These closures leave minorities even more vulnerable to slipping through the healthcare cracks, as these clinics and hospitals may have been the only ones they ever had access to. Resolution of this problem is long in coming, despite a relatively long period of social and institutional awareness of it. It now seems that action will take even longer than was expected as many without care die or get sicker waiting for disparities to be resolved.

An example would be the number of people in California, by race in all age groups who die of diabetes and other endocrine related diseases.

Center for Health Statistics

Vital Statistics Query System

Death Records

DEATH BY RACE/ETHNICITY

AGE OF DECEDENT: ALL

RACE / ETHNICITY 1: ALL

GENDER: ALL

CAUSES OF DEATH: ENDOCRINE, NUTRIONAL AND METABOLIC DISEASES (Primary Disease in Category Diabetes)

ICD10 RANGE: E00-E88

DEATHS BASED ON RESIDENCE

PLACE OF RESIDENCE: CALIFORNIA

YEAR OF EVENT: 2007

RACE/ETHNICITY

NUMBER OF DEATHS

POPULATION

RACE-SPECIFIC RATE2

ASIAN

4,428,922

19.5

BLACK

1,066

2,263,690

47.1

HISPANIC

2,285

13,539,990

16.9

WHITE

5,198

16,423,530

31.6

AMERICAN INDIAN

68

224,927

30.2

PACIFIC ISLANDER

50

137,608

36.3

TWO OR MORE RACES

60

791,915

7.6

TOTAL

9,589

37,810,582

25.4

Another example that is specifically troubling for Asian-Americans is Cancer.

Center for Health Statistics

Vital Statistics Query System

Death Records

DEATH BY RACE/ETHNICITY

AGE OF DECEDENT: ALL

RACE / ETHNICITY 1: ALL

GENDER: ALL

CAUSES OF DEATH: NEOPLASMS

ICD10 RANGE: C00-D48

DEATHS BASED ON RESIDENCE

PLACE OF RESIDENCE: CALIFORNIA

YEAR OF EVENT: 2007

RACE/ETHNICITY

NUMBER OF DEATHS

POPULATION

RACE-SPECIFIC RATE2

ASIAN

5,076

4,428,922

BLACK

4,121

2,263,690

HISPANIC

7,988

13,539,990

59.0

WHITE

38,392

16,423,530

AMERICAN INDIAN

224,927

90.7

PACIFIC ISLANDER

137,608

TWO OR MORE RACES

791,915

40.5

TOTAL

56,254

37,810,582

1

Race/ethnicity results and queries are tabulated using the following race/ethnic groups: American Indian, Asian, Black, Hispanic, Pacific Islander, White, and Two or More Races. Hispanic origin of decedents is determined first and includes any race group. Second, decedents of the Two or More Races group are determined and are not reported in single race groups. In order to remain consistent with the population data obtained from the Department of Finance, the single race groups are defined as follows:

a. "American Indian" race group includes Aleut, American Indian, and Eskimo;

b. "Asian" race group includes Asian Indian, Asian (specified/unspecified), Cambodian, Chinese, Filipino, Hmong, Japanese, Korean, Laotian, Thai, and Vietnamese;

c. "Pacific Islander" race group includes Guamanian, Hawaiian, Samoan, and Other Pacific Islander;

d. "White" race group includes White, Other (specified), Not Stated, and Unknown.

2

Death rates are per 100,000 population. Age-adjusted rates are calculated using the 2000 U.S. Standard Population.

Source: California Department of Public Health, Death Statistical Data.

2

Rates are per 100,000 population, age-adjusted to 2000 U.S. Population Standard.

Source:

California Department of Public Health: Death Records

State of California, Department of Finance, Race/Ethnic Population with Age and Sex Detail, 2000-2050. July 2007.

The development of a program such as this would build accessible resources in a challenged economy. The individuals this center serves are fundamentally challenged to begin with for a multitude of immigration related diseases and better health care options are essential to prevention and treatment referral, as well as access to publicly funded health insurance and food benefits.

Project Description

Increasing the opportunity of individuals to seek low cost health alternatives in a challenged environment and economy will improve the community as well as the lives of those within it. The community where the center is located is predominantly populated with lower income immigrants. The expansion of the health fair system to include 12 fairs per year and an onsite clinic will better serve the community as it will ensure that many of the individuals in the community do not fall through the cracks and fall victim to rapidly growing health disparities. Screening for preventable diseases as well as immediate response for potential deadly disease can be the result of the situation. The health clinic, if supported and funded could even be expanded to include minimal site hours, during times other than health fairs as much of the high cost of setting up the system is infrastructural and equipment related. Implementation will include an expansion of commitment from the individual who already provide services for health fairs and will also include the inclusion of local university and college health professions students, local retirees (who retain health licensures) and former immigrants who have been aided by the center and have now obtained health related credentials in the U.S. The expansion of the health fair will require a few additional man hours, supporting additional planning activities but the fair is currently well connected and well received by the community so service expansion on this end would be minimal, excluding increased supplies. The health clinic itself would have a single operative, with one exam table, and various diagnostic tools. The center can dedicate a single private office to the cause and will dedicate several file cabinets in the records storage room to secure patient records, applying all pertinent laws. Patients with critical illnesses or seeking more advanced, long-term care will be referred out to larger free clinics, and follow up will be provided on an as needed basis by the volunteer provider on site during the hours of the following health fair or if needed through referral services. The clinic will be first come first served so scheduling staff will not be required. The clinic will have a voice mail single line phone line that will be checked by center staff and referred daily to the appropriate staff member. The voicemail will also announce the next clinic opportunity or hours available and refer the individual to the center for resource alternatives.

The St. Anselms Cross Cultural Community Center is located at:

11277 GARDEN GROVE BLVD., 2nd Floor

GARDEN GROVE, CA 92843

714-537-0608

Evaluation of the program will be continual and be performed annually based on service statistics of all health fair participants, numbers of diagnostic screenings provided and number and case acuity of patients seen in the clinic. Additional learning information offered at the fair will be difficult to evaluate but is presumed to be effective, especially if offered in Vietnamese, when needed. The overall health data of returning participants will be subject to statistical analysis when waiver is signed, with all identifying information removed from health material. Number of clients signed up for federally funded resource programs including insurance and nutritional programs will be counted. Those who do not qualify will be offered minimal free clinic services at sliding scales with referrals to other free/sliding scale clinics being offered for more advanced health needs. The success of health fairs have been judged by number of participants and number of screening tests completed and this will be continued. Screening tests currently break down in the following manner.