BILL ANALYSIS
AB 2354
Page 1
Date of Hearing: April 20, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 2354 (V. Manuel Perez) - As Amended: April 13, 2010
SUBJECT : Community Health Workers: Promotores.
SUMMARY : Requires the California Department of Public Health
(DPH), in consultation with the University of California (UC),
to conduct a comprehensive assessment of the current use of
promotores in supporting positive health outcomes throughout
California. Specifically, this bill :
1)Makes legislative findings related to the work of promotores
and community health workers (CHWs) and their success in
improving access to care and health outcomes and providing
culturally and linguistically appropriate cost-effective
prevention.
2)Requires DPH, in consultation with the UC, to conduct a
comprehensive assessment of the current use of promotores in
supporting positive health outcomes throughout California,
including, but not limited to, rural communities, and the
funding resources that support the work of promotores.
3)Requires the assessment to include all of the following:
a) An examination of promotores programs throughout
California that identifies best practices in at least the
areas of recruitment, hiring, training, compensation, scope
of work, supervision, program design and implementation,
successful programs, and resources;
b) The federal, state, and local agencies that operate
promotores programs, use or contract for promotores, or
provide resources to organizations, including, but not
limited to, nonprofit organizations, that support and
expand the work of promotores; and,
c) An examination of previous studies that evaluated
promotores programs and have identified model programs or
best practices.
4)Requires DPH to convene a technical advisory committee to help
AB 2354
Page 2
guide and design this assessment that includes the following
representatives:
a) Community-based organizations with experience in
training and hiring promotores;
b) County public health departments;
c) Foundations that support promotores programs;
d) Primary community care clinics;
e) Promotores or CHWs;
f) Universities and other academic institutions; and,
g) Other stakeholders DPH deems necessary.
5)Requires DPH to use federal funding, including, but not
limited to, funding from the federal Department of Health and
Human Services and its Health Resources and Services
Administration (HRSA) and funding from the federal Centers for
Disease Control and Prevention (CDC), to support the
development of this assessment.
6)Encourages DPH, as federal funding is awarded to the states
for health prevention efforts, to incorporate the use of
promotores for programs requiring outreach or involving
strategies that seek to increase access to care, health,
education, prevention, and the creation of healthier
communities.
EXISTING LAW :
1)Permits DPH to do all of the following in order to protect,
preserve, and advance public health: a) studies; b)
demonstrations of innovative methods; c) evaluations of
existing projects; d) provisions of training programs; and, e)
dissemination of information.
2)Permits DPH, in performing activities listed in 2) above, to
do all of the following: a) perform the activity directly; b)
enter into contracts, cooperative agreements, or other
agreements for the performance of the activity; and, d) award
grants for the performance of the activity.
AB 2354
Page 3
FISCAL EFFECT : This bill has not yet been analyzed by a
fiscal committee.
COMMENTS :
1)THE PURPOSE OF THIS BILL . According to the author, while it
has been documented that integrating promotores and CHWs in
health programs and strategies has been associated with
improvements in access to health care, health status, and
health screening behavior, DPH does not have a good grasp of
the diverse promotores programs operating in California, their
level of success or their funding sources. The author
maintains that as increased federal funding becomes available
to California, it is incumbent upon the state to have a
comprehensive statewide strategy to target resources and
invest funding to proven programs, successful models, and best
practices.
2)BACKGROUND . According to HRSA, CHWs, also known as community
health outreach workers, community health advocates, peer
health promoters, and, in Spanish, promotores/as de salud, 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. 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
AB 2354
Page 4
also notes that the Institute of Medicine recommends the use
of CHWs as part of a comprehensive, multi-level strategy to
address racial and ethnic disparities in health care.
3)HEALTH DISPARITIES . The term "health disparities" refers to a
gap in quality of health and health care across racial,
ethnic, and socioeconomic groups. HRSA defines health
disparities as "population-specific differences in the
presence of disease, health outcomes, or access to health
care."
In the United States (U.S.), health disparities are well
documented in the African American, Native American, Asian
American, and Latino populations. When compared to whites,
these communities of color have a higher incidence of chronic
diseases, higher mortality, and poorer health outcomes. Among
the disease-specific examples of racial and ethnic disparities
in California, cardiovascular disease ranks as the leading
cause of death among Latinos, accounting for 23% of all
deaths. In addition, adult African Americans and Latinos have
approximately twice the risk as whites of developing diabetes.
Communities of color also have higher rates of cancer,
HIV/AIDS, and infant mortality than whites.
Research indicates that the health of an individual is a
combination of heredity, environmental, behavioral, economic,
and structural factors. Research also suggests that
behavioral and environmental factors are responsible for 70%
of premature deaths in the U.S. For example, according to The
California Endowment, the neighborhood a person lives in
affects health through such factors as access to exercise
space; availability of healthy food; air and water quality;
and, proximity to health care services. As a result, while
actions to alleviate disparities for people of color must
include attention to quality and access to health care, it is
also really important to focus on the social, environmental,
and behavioral factors affecting health.
The demographic changes that are anticipated over the next
decade magnify the importance of addressing disparities in
health status. California groups currently experiencing
poorer health status are expected to grow - by 2020, the
Latino population is expected to grow to 43% and the Asian
American population is expected to increase by almost 13%.
The future health of California as a whole will be influenced
AB 2354
Page 5
substantially by the state's success in improving the health
of these groups.
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 U.S. According to CDC, Maryland
and Texas require health maintenance organizations and other
health care providers to use CHWs to reach priority
populations.
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.
5)FEDERAL HEALTH REFORM AND PREVENTION . On March 23, 2010,
President Obama signed the Patient Protection and Affordable
Care Act; P. L. 111-148, as amended by the Health Care and
Education Reconciliation Act of 2010; P. L. 111-152. The new
federal health reform law includes many provisions aimed at
disease prevention and promoting healthy lifestyles. The law
creates a $15 billion fund for programs designed to promote
prevention and wellness, such as efforts to address obesity
and to help patients manage chronic diseases. According to
the Prevention Institute, about a $.5 billion of this will
move directly to U.S. communities through community grants
that will be used to reduce chronic disease and injury rates
and promote equity. The law also establishes a National
Prevention, Health Promotion, and Public Health Council to
coordinate federal efforts to promote healthy living.
6)SUPPORT . According to the California Primary Care Association
(CPCA), promotores' foundation in the community serves to
ensure that community clinics and health centers are always
responsive to community needs and can tailor their services in
a culturally and linguistically appropriate manner. As a
AB 2354
Page 6
result, CPCA maintains that promotores are a vital resource to
community clinics and health centers in California.
7)PREVIOUS LEGISLATION .
a) ACR 75 (V. Manuel Perez), Resolution Chapter 125,
Statutes of 2009 declares October 2009 as California
Promotores Month in order to raise awareness of the
contributions of promotores and CHWs and encourages
policies and programs that enhance the status and
integration of promotores in the delivery of health care.
b) 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.
c) 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 encouraged DPH to
further promote this model of service through
administrative action. The veto message further stated
that the state should not single out in statute a specific
model of outreach for a specific community, when California
is the most racially and ethnically diverse state in the
nation.
REGISTERED SUPPORT / OPPOSITION :
Support
California Immigrant Policy Center
California Primary Care Association
Clinica Sierra Vista
Latino Health Access
Visi?n Y Compromiso
AB 2354
Page 7
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097