BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 2354
A
AUTHOR: V. Manuel P?rez
B
AMENDED: June 22, 2010
HEARING DATE: June 30, 2010
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CONSULTANT:
3
Tadeo/
5
4
SUBJECT
Promotores: medically underserved communities: federal
grants
SUMMARY
Requires the Department of Public Health (DPH) to assess
the grants available pursuant to the federal Patient
Protection and Affordable Care Act for funding
opportunities related to the use of promotores.
CHANGES TO EXISTING LAW
Existing law:
Permits DPH to protect, preserve, and advance public health
through studies, demonstrations of innovative methods,
evaluations of existing projects, provisions of training
programs, and dissemination of information.
This bill:
Requires DPH to assess the grants to promote positive
health behaviors and outcomes available pursuant to the
federal Patient Protection and Affordable Care Act for
funding opportunities related to the use of promotores.
Requires DPH, in consultation with the University of
Continued---
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California (UC), to include in this assessment, an
inventory of the existing programs related to the use of
promotores in California that are administered by the state
or a local government, and report on this to the fiscal and
health policy committees of the Legislature by April 1,
2011, with recommendations for attaining and maximizing
federal funding.
Requires DPH to rely upon past research about the efficacy
of promotores and does not permit DPH to conduct new
research.
Defines promotores to mean promotores de salud, also known
as community health workers, peer leaders, or health
advocates, who serve as a bridge between the community and
the public health care system by providing health
education, health promotion, prevention, informational
counseling and referral information, as well as resources,
in a manner that is culturally and linguistically
appropriate.
FISCAL IMPACT
According to the Assembly Appropriations Committee, this
bill will result in unknown, one-time costs of less than
$50,000 of General Fund monies to DPH to assess the
viability of pursuing federal health reform grants to
implement promotores programming in California and make
related recommendations to the Legislature.
BACKGROUND AND DISCUSSION
According to the author, it has been documented, in
California, that integrating promotores and community
health workers into health programs and strategies has been
associated with improvements in access to health care,
health status and health-screening behavior, however,
California has not had the opportunity to demonstrate its
success in the areas of outreach and prevention on a
statewide scale. The author adds that the state,
specifically DPH, lacks the data it needs to demonstrate
and showcase to the federal government all the successful
health prevention efforts it supports and the outreach
programs, proven models and best practices being utilized
in communities throughout the state, including rural and
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remote communities. The author argues that, with the
passage of the federal health care reform bill, there is no
better time than now to collect the necessary data to
prepare our state to compete for federal health care
funding.
Promotores de salud
Promotores are community members, sometimes referred to as
community health workers, who serve as liaisons between
their community and health, human and social service
organizations. They work with organizations and
institutions, formally and informally, as employees or
volunteers, to bring information to their communities. As
liaisons they often play the roles of advocate, educator,
mentor, outreach worker, role model, translator and more.
According to the Centers for Disease Control and Prevention
(CDC), many health programs are turning to promotores for
their unique ability to serve as bridges between community
members and health care services. Promotores 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. Promotores 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. The CDC points out that a
growing body of literature supports the role of
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 recommends the use of
promotores as part of a comprehensive, multi-level strategy
to address racial and ethnic disparities in health care.
Health disparities
The term health disparities refers to a gap in quality of
health and health care across racial, ethnic, and
socioeconomic groups. The Department of Health and Human
Services and its Health Resources and Services
Administration (HRSA) defines health disparities as
population-specific differences in the presence of disease,
health outcomes, or access to health care.
In the U.S., health disparities are well documented in the
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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
percent 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 percent of premature deaths in the U.S. 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 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 percent and the
Asian American population is expected to increase by almost
13 percent The future health of California as a whole will
be influenced substantially by the state's success in
improving the health of these groups.
Promotores in the health care system
In 1993, the CDC established a database which documents the
role of promotores and community health workers (CHW).
Although CDC reports the database has not been consistently
maintained, it has documented more than 200 programs,
representing about 10,000 promotores/CHWs. CDC also
reports that a national study has estimated that there are
actually at least 600 programs and 12,500 promotores/CHWs
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throughout the U.S. According to the CDC, Maryland and
Texas require health maintenance organizations and other
health care providers to use promotores/CHWs to reach
priority populations.
DPH identifies the promotores model in the request for
applications for some chronic disease programs, including
those for asthma and diabetes and those 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 promotores, for outreach and
education
Federal health reform and prevention
The Patient Protection and Affordable Care Act, as amended
by the Health Care and Education Reconciliation Act of
2010, includes many provisions aimed at disease prevention
and promoting healthy lifestyles. The law creates a $15
billion fund for community-based 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, at least 50 percent
of these moneys will move directly to U.S. communities
through community grants that will be used to reduce
chronic disease and injury rates and reduce health
disparities. The law also establishes a National
Prevention, Health Promotion, and Public Health Council to
coordinate federal efforts to promote healthy living.
There may be opportunities to use some of these funds for
projects involving promotores.
Prior legislation
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.
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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. This bill was never referred by the Senate Rules
Committee.
AB 1963 (Salinas) of 2004 would have required OMH to
encourage the use of promotores and CHWs 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. This bill was
vetoed by Governor Schwarzenegger.
Arguments in support
Proponents of AB 2354 state that promotores working in the
community serve to ensure that community clinics and health
centers are responsive to community needs and can tailor
their services in a culturally and linguistically
appropriate manner.
Proponents further state that in the current environment of
mounting economic, political and social challenges,
promotores provide support to those with the most need and
provide health care providers' access to communities that
they would otherwise have no access to.
PRIOR ACTIONS
Assembly Health: 11- 5
Assembly Appropriations: 12- 5
Assembly Floor: 50-26
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POSITIONS
Support: Clinica Sierra Vista
CommuniCare Health Centers
Community Clinic Association of Los Angeles County
La Cooperativa Campesina de California
Latino Health Access
Planned Parenthood Affiliates of California
Tiburcio Vasquez Health Center, Inc.
Vision y Compromiso
Oppose: None received
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