More than 50 persons from across the State formed the Health Issues Subcommittee to discuss ways to improve the delivery of health care services to persons of Hispanic origin.  The subcommittee was made-up of persons from health care organizations, community-based organizations, and health care providers.

After a group process of determining health issues, problems and concerns, the following priority areas were identified: 1) language barriers, 2) cultural competency, 3) barriers to services, 4) lack of data, and 5) immigration and social issues.    The subcommittee noted that these five priority issues cut across the wide range of specific health and illness issues within the South Carolina Hispanic population, such as diabetes, hypertension, cancer, heart disease, prenatal care, occupational health and communicable diseases.  The consensus of the subcommittee was that rather than focusing efforts on specific health issues at this point in the process, the basic issues surrounding the five priority areas listed above must first be addressed from a systemic perspective so that appropriate quality care can be delivered.

Clearly, communication directly impacts the degree and quality of services provided to users and delivered by providers.  When parties do not communicate and understand at a level that guarantees quality service, it puts both the provider of services and the users of those services at-risk for health care system failure.  Such failures could range from misdiagnosis to death and could lead to costly litigation.  

Failure of health care providers and organizations to understand and consider cultural norms can impact the effectiveness of service delivery and the acceptance of services by a community.  Trust must be developed and nurtured by acknowledging differences and developing systems that accommodate differences.    

When persons seek health care services and are confronted at every turn with barriers that often keep them from obtaining services, they soon disengage from the process.  Common barriers identified  during these discussions included: 1) lack of knowledge by Hispanics regarding how to obtain insurance; 2) lack of insurance; 3) lack of knowledge regarding what services are available, when they are available, and to whom are they available.  Additionally, lack of transportation to access local services was identified as a major impediment to obtaining services.

Several cross cutting issues, such as lack of available data on Hispanics, immigration status and social issues also surfaced.  Additionally, across the state, public and private health services traditionally do not keep data by ethnicity, therefore, making epidemiological data not easily available on Hispanics/Latinos at the local or state level.  Even with immediate attention to this matter, it will be several years before good comparative data is available to health care providers, planners and policy makers to use in shaping health care policies affecting Hispanics.  

A persons’ immigration status affects every aspect of life.  For example, it was stated that some providers have concerns about serving the Hispanic population because they fear that they will not be able to recoup service fees, which goes back to a lack of knowledge by providers of what rights and services should be available to persons regardless of their immigration status.  Hospital staff and persons seeking services, oftentimes are not up-to-date on federal laws and what rights are afforded persons regardless of their immigration status in the United States.  Issues related to immigration include lack of current, reliable information regarding eligibility and access to public and private insurance, both on the part of the Hispanic/Latino population and health care providers.  Additionally, practices which violate the United States Department of Health and Human Services guidelines for providing Culturally and Linguistically Appropriate Services (CLAS) include requiring patients to pay for interpreter services, refusing to care for patients who do not provide interpreters, and not having forms and information in Spanish.

As a result of the work of the Health Subcommittee, there was consensus that educating health and human service providers is critical and that a plan must be developed outlining how to deliver services in a  culturally and linguistically appropriate manner.  The group agreed that a statewide comprehensive strategy, inclusive of community-based organizations and state agencies, including executive and legislative  leadership is needed to bring about necessary change.

Advisory Recommendations - Health:

1.  Active support by the Office of the Governor and all relevant health and human services state agencies,  hospitals, and other health care delivery organizations, for the statewide adoption and implementation of Culturally and Linguistically Appropriate Services (CLAS), as mandated by the United States Department of Health and Human Services, in accordance with Title VI of the Civil Rights Act of 1964, as amended (See Appendix).
   
2.  Active support by the Office of the Governor and all relevant health and human services state agencies,  hospitals, and other health care delivery organizations, for meaningful access to health care for Limited English Persons (LEP) through the statewide adoption and implementation of (Executive Order 13166, August 11, 2000).
   
3. That the responsibility for coordination and compliance with Recommendations 1 and 2  be coordinated through the joint work of the South Carolina Department of Health and Human Services (DHHS), the Department of Health and Environmental Control (DHEC), the South Carolina Commission for Minority Affairs (CMA), the Office of the Governor, and community based organizations.  
   
   Coordination is necessary to reach public and private health care providers who (1) receive federal funding or (2) see patients who receive federal funding. To this end:

•  Implement a continuous statewide educational program regarding (1) the National Standards on Culturally and Linguistically Appropriate Services (CLAS) in Health Care and (2) Executive Order 13166 (LEP).  The training should be targeted toward key state agency administrators, public and private health care executives and administrators, personnel from professional associations (e.g. medical, pharmaceutical, nursing, insurance, hospital associations). In addition to presenting CLAS/LEP standards, the program should present strategies and resources for increasing compliance.
  
  
• Conduct a statewide assessment to identify availability and distribution of resources needed for compliance with CLAS/LEP standards.
  
  
• Implement a statewide monitoring system to ensure implementation and accountability of CLAS/LEP standards.

4. That the South Carolina Commission for Minority Affairs serve as the clearinghouse for all information related to the Latino/Hispanic population and that the Commission receives from the following organizations such information that is needed to fulfill its responsibilities under these recommendations:

• South Carolina Department of Health and Environmental Control - Office of Minority Health  
  
  That information regarding health disparities and other relevant information be  compiled by the South Carolina Department of Health and Environmental Control - Office of Minority Health and be made available to the South Carolina Commission for Minority Affairs, upon request.
  
• South Carolina Department of Health and Human Services
  
  That information regarding health disparities and other relevant information be  compiled by the South Carolina Department of Health and Human Services and be made available to the South Carolina Commission for Minority Affairs, upon request.

• Budget and Control Board - Office of Research and Statistics
  
  That the Budget and Control Board -  Office of Research and Statistics compile and make available to the South Carolina Commission for Minority Affairs all health data related to the Hispanic/Latino population available through the 2000 Census and any subsequent updates.  

5. That the three organizations compile one comprehensive report related to the health and socioeconomic status, and other related matters regarding the Hispanic/Latino population in South Carolina, with the first publication being made available July 1, 2003, followed by revised publications on July 1, 2006 and  July 1, 2009.
   
6.  That both the South Carolina Commission for Minority Affairs and the Office of Minority Health be provided adequate funding to employ qualified bilingual personnel knowledgeable of the  Hispanic/Latino population and its culture.
   
7. That the Office of Minority Health continue its health initiatives with regards to migrant and seasonal workers, while continuing to expand it’s efforts to address the health needs of the growing Hispanic population.  
   
8. That the Office of Minority Health should continue to provide leadership and collaborate with community based and other organizations to  procure additional resources and external funding for Hispanic/Latino health initiatives.
   
9. That the findings of the South Carolina Statewide Hispanic Health Needs Assessment, published by the South Carolina Department of Health and Environmental Control and other reports and documents, be used to advance policy and implement initiatives to identify and address prenatal care access and other priority health needs of the Hispanic/Latino population.  
   
10. That the Office of the Governor support  the participation of state agencies in the South Carolina Hispanic Health Coalition, especially those agencies designated in the state budget as Health and Human Services providers.

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