BILL ANALYSIS
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Date of Hearing: June 30, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
ACR 75 (V. Manuel Perez) - As Introduced: May 19, 2009
SUBJECT : Promotores and community health workers.
SUMMARY : Declares October 2009 as California Promotores Month
in order to raise awareness of the contributions of promotores
and community health workers (CHWs). Specifically, this
resolution :
1)Makes legislative findings related to health care delivery;
outreach to individuals and families; barriers to health care
access; California's uninsured population; the work of
promotores and CHWs; the success of promotores and CHWs in
improving access to care and health outcomes; the work of
Visi?n y Compromiso ("Vision and Commitment"; VYC); and, the
lack of recognition and educational and employment
opportunities offered to CHWs and promotores.
2)Endorses the work of promotores and recognizes the leadership
provided by VYC, and various others for their dedication to
and collaboration with promotores and CHWs.
3)States the Legislature's support for promotores' continuing
efforts to increase their presence and support the well-being
of California communities.
4)Finds that the Legislature considers policies and programs
that enhance the status of promotores in the delivery of
health care, encourage health delivery systems to integrate
promotores where appropriate, and provide incentives and
funding for staff, where appropriate, to encourage program
development and integration.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS RESOLUTION . According to the author, CHWs and
Promotores play a critical role in promoting community-based
health education and disease prevention, particularly in
communities that have been historically underserved. The
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author states the CHW/Promotor model utilizes a unique
strategy that focuses on healthy living and disease prevention
and is a cost-effective and successful model that facilitates
the delivery of health services and education in communities
that may have limited access to care, such as poor, working
poor, uninsured, and underinsured communities, particularly
communities of color. The author further states that
according to the federal Centers for Disease Control and
Prevention (CDC), integrating promotores and CHWs into health
programs is associated with improvements in access to health
care, pregnancy and birth outcomes, health status, health- and
screening-related behaviors, and reduced health care costs.
The author contends this resolution is needed to introduce the
CHW/Promotor model to the Legislature, and that the work of
promotores and CHWs is vital to our communities and should be
honored and celebrated.
2)BACKGROUND . CHWs, also known as community health outreach
workers, community health advocates, peer health promoters,
and, in Spanish, promotores/as de salud or promotores/as, are
generally community members who work in community settings to
connect health care consumers to providers and to promote
better health among groups that have traditionally lacked
access to adequate health care. CHWs live in the communities
in which they work, understand what is meaningful to those
communities, communicate in the language of the people, and
recognize and incorporate cultural buffers, such as cultural
identity, spiritual coping, and traditional health practices,
to help community members cope with stress and to promote
better health.
CDC states many health programs are turning to CHWs and
promotores for their unique ability to serve as "bridges"
between community members and health care services. CHWs can
build partnerships with formal health care delivery systems
and provide a community-based system of care and social
support that complements the more specialized services of
health care providers. Importantly, CHWs also inform
providers about the community's health needs and the cultural
relevancy of interventions by helping providers and health
care systems build their cultural competence. A growing body
of literature supports the role of CHWs in strengthening
existing community networks for care, providing community
members with social support and education, and facilitating
access to care. CDC also notes that the Institute of Medicine
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recommends the use of CHWs as part of a comprehensive,
multi-level strategy to address racial and ethnic disparities
in health care.
3)DISPARITIES IN HEALTH AND HEALTH CARE ACCESS FOR LATINOS . A
February 2003 Commonwealth Fund study found that Latinos who
speak primarily Spanish report poorer health status, are less
likely to have a regular doctor, less likely to have seen a
doctor in the past two years, and more likely to lack
insurance than English-speaking Latinos, Caucasians, or
African-Americans. Spanish-speaking Latinos have the most
difficulty of any group in understanding information at their
doctor's office and with understanding instructions for
prescription medication. In October 2002, the Commonwealth
Fund also reported that there is a link between increased
cultural competence and the elimination of racial and ethnic
disparities in health care.
4)USE OF PROMOTORES AND CHWS . In 1993, CDC established a
database which documents the role of CHWs. Although CDC
reports the database has not been consistently maintained, it
has documented more than 200 programs, representing about
10,000 CHWs. CDC also reports that a national study has
estimated that there are actually at least 600 programs and
12,500 CHWs throughout the United States (U.S.). According to
CDC, Maryland and Texas require health maintenance
organizations and other health care providers to use CHWs to
reach priority populations.
The Department of Public Health (DPH) identifies the promotores
model in Request for Applications for some chronic disease
programs, including those for asthma and diabetes and that
promote healthy eating and physical activities through such
programs as California Project LEAN. The Office of Binational
Border Health used promotores to monitor disease conditions
among migrant farm workers. Other organizations within DPH,
such as the Rape Prevention and Education Program, recognize
the use of community health workers, including promotoras, for
outreach and education.
The Texas Health Department uses promotoras to serve as liaisons
between the health care system and community residents, and as
guides to the health care system, and cites many examples of
the effectiveness of promotoras for:
a) Increasing utilization of perinatal care;
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b) Motivating people to walk for exercise;
c) Helping women who live in unincorporated, undeveloped
communities understand and enroll in the Women, Infants and
Children's Supplemental Nutrition Program;
d) Educating women about human immunodeficiency virus
(HIV)/AIDS risk factors and prevention, and providing oral
HIV tests and pre- and post-test counseling in the privacy
of their own homes in a culturally and linguistically
competent manner; and,
e) Demonstrating healthy cooking, leading physical activity
sessions, and other accessible activities designed to
prevent and control diabetes.
5)VISI?N Y COMPROMISO . VYC states it was established in 2000 in
collaboration with the University of California Riverside,
Ernesto Galarza Applied Research Center and is the only
statewide organization that provides ongoing leadership
development, capacity building, and advocacy for CHWs in
California. In 2001, VYC initiated the Promotora and
Community Health Worker Network (Network) to support
promotores and CHWs across California towards achieving
healthy and dignified living for immigrant Latinos. The
Network is composed of primarily Latino men and women who
provide low-income Latino communities throughout California
with culturally appropriate health information and education,
advocate for improved access to health care and service
delivery, and promote a statewide public policy agenda focused
on health care access and health promotion. The Network is
currently active in 10 California regions: a) San Diego
County; b) the Inland Empire (San Bernardino and Riverside
Counties); c) Orange County; d) Los Angeles including the San
Fernando Valley; e) the Central Coast including San Luis
Obispo, Santa Barbara, and Ventura Counties; f) the Central
Valley; g) Stanislaus County; h) Marin and Napa Counties; i)
the San Francisco Bay Area; and, j) Northern California.
Priorities are defined by each community through their
regional committee. Regional Committees organize local
activities, convene promotores and CHWs through quarterly
meetings and trainings, and provide leadership development
professional and personal growth opportunities for promotores
and CHWs. VYC states that by building the capacity of
promotores and CHWs, it strengthens the capacity of
communities to improve their health, organize, confront
obstacles to care, and inform health policy.
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6)SUPPORT . VYC, the sponsor of this resolution; other
organizations advocating for Latino and multicultural health;
the Bay Area Parent Leadership Action Network; Planned
Parenthood Affiliates of California, Inc.; the Family Violence
Prevention Fund; the Healthy Eating, Active Communities
Initiative; and, numerous individuals write in support of this
resolution that promotores or CHWs serve as bridges between
the community and the health care delivery system, and that
promotores connect government and policy makers to people in
the community. Finally, supporters argue that promotores
provide aid and support to those most in need in the present
time of mounting economic, political, and social challenges.
7)PREVIOUS LEGISLATION .
a) AB 2902 (Swanson) of 2008 would have required DPH and
the Office of Multicultural Health (OMH) to encourage the
use of CHWs to improve health outcomes for underserved
communities in public health programs and health care
services. AB 2902 was held in Senate Rules Committee.
b) AB 1963 (Salinas) of 2004 would have required OMH to
encourage the use of promotores and community health
workers to provide better health outcomes for rural and
underserved communities. AB 1963 would also have required
OMH to encourage the Healthy Families Program to utilize
and reimburse the use of promotores where the utilization
is cost effective. AB 1963 was vetoed by Governor
Schwarzenegger, whose veto message stated:
The Department of Health Services (DHS) [now DPH]
can further promote this model of service through
administrative action. Moreover, we should not
single out in statute a specific model of outreach
for a specific community, when we live in the most
racially and ethnically diverse state in the
nation.
Finally, this resolution also has an indeterminate
fiscal impact associated with requiring DHS to
revise its standards related to funding for local
programs.
8)DRAFTING QUESTION . On page 3, line 26, does the author
intend that the Legislature consider, rather than
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encourage , policies and programs that will enhance the
status of promotores?
REGISTERED SUPPORT / OPPOSITION :
Support
Visi?n y Compromiso (sponsor)
Arthritis Foundation
Bay Area Parent Leadership Action Network
Comite Civico Del Valle, Inc.
Family Violence Prevention Fund
Healthy Eating, Active Communities Initiative
Institute of Popular Education of Southern California
La Clinica de la Raza, Inc.
Latino Behavioral Health Institute
Latino Coalition for a Healthy California
Latino Health Access
Latino Programs, American Diabetes Association
Multicultural Health Awareness and Prevention Center, St.
Vincent Medical Center
Planned Parenthood Affiliates of California, Inc.
Youth Speak Collective Family Development Network
25 individuals
Opposition
None on file.
Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097