BILL ANALYSIS Ó
AB 916
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Date of Hearing: March 29, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 916 (V. Manuel Pérez) - As Introduced: February 18, 2011
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 (PPACA) for funding
opportunities related to the use of promotores. Specifically,
this bill :
1)Requires DPH to assess the grants to promote positive health
behaviors and outcomes available pursuant to PPACA for funding
opportunities related to the use of promotores in medically
underserved communities.
2)Requires DPH to report on this assessment to the fiscal and
health policy committees of the Legislature by April 1, 2012,
with recommendations for attaining and maximizing federal
funding.
3)Requires DPH to rely upon past research about the efficacy of
promotores and does not permit DPH to conduct new research.
4)Defines promotores to mean promotores de salud, also known as
community health workers (CHWs), 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.
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
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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, c) award
grants for the performance of the activity.
FISCAL EFFECT : This bill has not yet been heard by a fiscal
committee.
COMMENTS :
1)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 the Health Resources and Services
Administration (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.
The federal Centers for Disease Control and Prevention (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
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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 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
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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
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 PPACA; Public Law (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 $0.5 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.
PPACA also establishes a National Prevention, Health
Promotion, and Public Health Council to coordinate federal
efforts to promote healthy living.
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6)SUPPORT . The Western Center on Law and Poverty (WCLP) writes
in support of this bill that promotores provide culturally
appropriate health education and health services to
underserved populations. WCLP maintains that when combined
with morbidity factors, such as no usual source of medical
care, low income, place of residence and insurance status,
promotores provide a key point of access that California
should employ as we move to major coverage expansions by 2014.
WCLP argues that promotores are a culturally appropriate and
sensitive contact for many people who are traditionally
uncomfortable or unexposed to American medical practices and
can help guide underserved communities towards wellness.
7)PREVIOUS LEGISLATION .
a) AB 2354 (V. Manuel Pérez), of 2010 was substantially
similar to this bill. AB 2354 died in the Senate
Appropriations Committee.
b) ACR 75 (V. Manuel Pérez), 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.
c) 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.
d) 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
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is the most racially and ethnically diverse state in the
nation.
REGISTERED SUPPORT / OPPOSITION :
Support
Western Center on Law & Poverty
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097