HRSA News Room - New York Medical College

	U.S. Department of Health & Human Services Health Resources and Services Administration HRSA Press Office: (301) 443-3376 http://newsroom.hrsa.gov

Remarks to the New York Medical College's
Graduate School of Health Sciences

Prepared Remarks of Eugene Migliaccio, Dr. P.H.
Director, Division of Immigration Health Services, Health Resources and Services Administration

Conference on "Developing a Strategic Plan for Meeting the Health Care Needs of the Growing Immigrant Population in New York's Suburban and Urban Communities"
Valhalla, New York

March 23, 2001

Introduction

Thank you for the invitation to be with you today. This conference is appropriate and timely, following so closely as it does the release of census data that shows the decisive influence of immigration on our nation during the 1990s.

The benefits of our increasingly multicultural society are, at the same time, obvious and subtle.

Some of us believe that the contributions of hard-working immigrants have been a major reason behind the drive in the economy and the energy in our culture.

Earlier panelists spoke of the population increase in New York City. Many experts are convinced that this influx of immigrants from Latin America and the Caribbean, Asia, and the former Soviet Union is the source of the region's renewed strength and vitality.

And the story of New York City’s resurgence is just one of many that have occurred in cities across the country.

That’s the obvious benefit. Immigrant labor and creativity is a major factor in our economic prosperity.

The other benefits of immigration and our increasing diversity are more subtle, but no less important. Simply put, our multicultural society makes living in the United States more interesting.

And immigrants make us proud. Proud that we were fortunate enough to be born in a country that is the dream destination for people from every nation on earth. Who among us can look upon the swearing-in ceremonies of new citizens and not be moved? Their faces reflect the world and all the colors of humanity. What greater compliment can they pay us as they wave their tiny flags and beam with smiles that say, “I want to be like you, I want to share the freedoms that you enjoy.”

Large-scale immigration into the United States continued unabated through the end of last century and shows no sign of letting up. Census data show that new immigrants, combined with children born to recent immigrants, accounted for nearly two-thirds of U.S. population growth in the 1990s, about 20 million people.

The benefits of our multicultural society are evident to most of us. But the arrival of immigrants also brings special challenges to our public school systems, to housing and infrastructure, and to health care delivery.

Challenges

Often, immigrants arrive in the United States with few resources. Sooner or later they fall ill and need medical attention.

Our charge is to protect public health. And the best way to do that is to see that everyone in the United States has access to appropriate health care. That is HRSA’s mission. It is a mission that extends even to individuals detained by the Immigration and Naturalization Service.

One branch of HRSA, the Division of Immigration Health Services, has a partnership with the INS to provide medical care to detainees. This partnership between INS and the U.S. Public Health Service began in 1891 here in New York at Ellis Island.

On January 1, 1892, a 15-year-old lass from Ireland named Annie Moore, accompanied by her two brothers, entered history and a new country as the very first immigrant to be processed at Ellis Island. Millions more soon followed. Each of these immigrants passed under the watchful eyes of U.S. Public Health Service physicians before being admitted to this country.

Presently, two Service Processing Centers in the New York area -- in Queens and Elizabeth, N.J. -- treat undocumented immigrants detained from international flights that land at the JFK and Newark airports.

Every year during the past decade, the INS admitted between 350,000 and 440,000 new immigrants through ports of entry around the country. Of those, between 100,000 and 140,000 came through one of the nation’s busiest airports: New York’s John F. Kennedy.

Our doctors deal with a bewildering mix of people. Let me give you a one-day snapshot of these sites. On March 14, at the Queens site, there were 196 undocumented immigrants from 45 countries. The most from one country – 18 -- were from Sri Lanka; 16 were from China, 13 from Albania, and 13 from Bangladesh. The rest were from all over, speaking dozens of different languages.

On the same day, at the Elizabeth site, there were 297 undocumented immigrants from 55 countries. Patients at the two sites typically were treated for respiratory, dermatology, muscular-skeletal, gastroenterology, and behavioral health problems.

By telling you this, I don’t mean to imply that these undocumented immigrants are representative – either in country of origin or in illness – of the immigrants who live in your communities. But the Immigration Health Service sites are instructive.

In an age of easy and rapid transportation, health professionals must keep up not only with health problems in immigrant communities here in the United States, but with threats to public health in their home countries as well. The point is, we’re talking about global health and disease prevention. Because disease knows no borders!

Experience has taught Immigration Health Service doctors to look for diseases in undocumented immigrants that are not often found here – tuberculosis and malaria, for example. Your doctors should do the same when dealing with immigrant populations.

Now I’d like to tell you about how HRSA’s core programs can help immigrants living in your communities access health care and how we can help you improve the care you already provide.

Community Health Centers

Most of you are aware, I’m sure, that HRSA funds about 700 Community Health Centers across the nation. Typically they provide primary care, OB/GYN services, mental health and substance abuse services, dental care and some specialty care. The health centers, in turn, support hundreds of smaller community clinics.

There are five health centers in your seven-county area -- in Mount Vernon, Newburgh, Ossining, Peekskill and White Plains. These centers sponsor many affiliated clinics at other sites, some of which serve migrants and the homeless from different HRSA grants. Let me here congratulate Hudson River HealthCare Inc. in Peekskill and their Migrant Health Clinic in New Paltz for the excellent coverage they received in a March 13 story in the New York Times. We’re very proud to have you as a grantee.

Services at community health centers are not free, but patients are billed on a sliding scale according to what they can pay. Those without funds are referred to social service workers who try to find out whether they are eligible for medical coverage from other sources. No one is turned away.

Community health centers are the core of the health care safety net for the uninsured and the underserved. In 1998, 40% of the 8.3 million users of health center services were uninsured.

President Bush, as many of you know, wants to double the number of health center sites. His 2002 budget will ask for $124 million for more health centers, a downpayment toward that goal.

SCHIP

Another way HRSA can improve immigrants’ access to health care is by helping you reach out to families whose children are eligible to receive health insurance through the State Children’s Health Insurance Program.

As was mentioned by Cora Greenberg (Executive Director, Westchester Children's Association), New York’s program, called Child Health Plus, has done outstanding outreach.

Nationally, HRSA is about to launch a major new outreach effort to Hispanic families, because we know that Hispanic children are more likely to be uninsured than white or African American children. Almost a third of Hispanic children are uninsured, compared to 20 percent of African American children and 15 percent of white children.

Nationally, more than 3.2 million Hispanic children in this country are uninsured according to the most recent figures. In New York, almost 190,000 Hispanic children are uninsured.

Studies show two major reasons why Hispanic families don’t enroll in SCHIP or Medicaid. One, they don’t know about the program – probably because of language problems. Two, they’re afraid that participation in a federal program will brand them as a “public charge” and damage any future efforts to become U.S. citizens.

In response to this challenge, HRSA and the Health Care Financing Administration have developed a communication strategy in Spanish to help Hispanic families. We will urge them to enroll their children in SCHIP or Medicaid, and we will assure them that they can do so “con confianza” – in confidence, confidentially, with no impact on legal status or any naturalization process.

The campaign will include posters, colorful brochures, radio public service announcements, and wallet cards. HRSA will provide each state with a CD-ROM so they can customize materials for their own needs.

We’ll distribute materials through HRSA grantees and our partners in the National Council of La Raza, the National Alliance of Hispanic Health and other groups. It is our aim to have everything ready for distribution in mid-April. Once it’s ready, you can order materials by calling 1-888-ASK-HRSA. We look forward answering any requests you may have.

Culturally Competent Care

Now I’d like to discuss ways HRSA can help you improve the care immigrants receive.

First, I’d like to thank Dr. Gany (Dr. Francesca Gany, executive director of the New York Task Force on Immigrant Health) for her comments on providing culturally appropriate health care to diverse populations.

And I understand you received in your folders the national standards on cultural competence that were released in December by the HRSA’s parent agency, the U.S. Department of Health and Human Services.

Cultural competence has long been a central concern of our Bureau of Primary Health Care, which has stressed its importance to all of our grantees.

Already a number of communities are doing innovative things to make sure all residents have access to quality health care delivered by professionals who welcome and respect them and their cultures.

One of the best examples of cultural competence in health care delivery among our community health center grantees can be found nearby, in Brooklyn, at the Sunset Park Family Health Center Network.

The Sunset Park Network – with six full-service centers and many more affiliated sites throughout Brooklyn -- is revolutionizing the delivery of primary health care to a multi-ethnic, immigrant population.

They are committed to full access to health care in one of the world’s most diverse and complex communities. The staff is multicultural and multilingual; 80 percent of them live in Sunset Park. They deliver care in five languages: English, Spanish, Chinese, Arabic and Russian.

Each culture’s traditional approach to healing is considered when a new project or health care site is proposed. For example, staff added acupuncture to serve Chinese patients. It proved so popular to others that now it is offered to all patients.

Patient representatives with appropriate language skills lead newcomers through the registration process. Trained medical interpreters carefully aid communication between patient and provider. And Sunset Park makes an effort to build partnerships with ethnic-based community organizations in an effort to understand each new culture as it settles and grows in Brooklyn.

Sunset Park’s asthma clinic made a dramatic impact in an area where asthma hospitalizations among Hispanic children were almost four times the national average. Spanish-speaking staff educated patients and their families on how to manage the illness and made home visits to assess each child’s environment.

The result?

Among 50 patients with the worst cases, the clinic reduced emergency room visits by almost 60 percent and hospital admissions by more than 90 percent. Cost savings to hospitals just for this small group totaled $161,000 per year.

That’s a big impact. And it was made possible because Sunset Park staff reached out to needy residents in a language and a manner that encouraged them and their families to enroll and stay with the program.

In our own immigration clinics – we have a diverse workforce that mirrors the populations we serve. For the multitude of languages we rely on AT&T’s translation services to assist us with our medical exams.

Bottom line: If you need help building cultural competence into your operations, you may find that colleagues in nearby clinics can get you started. And HRSA’s professionals are certainly available whenever you need us.

Minorities/Immigrants in Health Professions

HRSA also has a longer-term strategy to help you provide more responsive care to immigrants: It’s about … increasing diversity in the health professions workforce.

HRSA invests more than $300 million annually in programs to increase the diversity of the health professions workforce and to make sure that those we train are willing to serve in places where services are scarce. Many of these programs offer loans and scholarships to deserving members of minority and underserved populations.

HRSA is dedicated to building a health professions workforce that reflects America’s diversity because we know that such a workforce will make America better by increasing all groups’ access to health care.

The need is obvious. Minorities total almost 30 percent of the U.S. population but only 15 percent of all medical school graduates in primary care specialties, 13 percent of dental school graduates and just 5 percent of medical school faculty.

Studies tell us that African American and Hispanic physicians are far more likely than other physicians to treat patients from their own racial or ethnic group. Additionally, they are more likely than white physicians to treat Medicaid or uninsured patients. I think we could infer that the same would be true for immigrant health professionals: that they would feel a close bond with the community that nourished them and would be more likely than non-immigrant professionals to serve immigrant groups.

Immigrant health professionals would have the additional benefit of being able to provide culturally competent care. The great majority of them, certainly, would speak the language and be able to navigate comfortably between the ancestral and U.S. cultures.

Conclusion

I conclude this morning by reiterating that the benefits of our multicultural society outweigh any downside in the challenges that large-scale immigration force us to confront.

That is not to say that the challenges raised by an increasingly diverse populations are insignificant. They are not. Consider these terms that the public has learned in recent years, the result of health threats to people and animals that cross not just borders, but oceans: Ebola … West Nile fever … mad cow disease … foot and mouth virus … the specter of bioterrorism.

The threats to public health are great, yes -- but so are our resources, our resolve, and most importantly what we as Americans stand for. As the great lady who greets new arrivals to the port of New York says ...

"Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me, I lift my lamp beside the golden door!"   Emma Lazarus (1849-1887)

We as health care professionals can and do make a difference on people's lives.

Let me close by congratulating Sheila (Smythe, dean of the New York Medical College’s Graduate School of Health Sciences) and her staff for putting together a fascinating conference, with still more to come this afternoon.

I look forward to working with all of you in the future. Thank you.