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POL I CYCHANGE SARENE E DE D TO MAKECANCE RCAREACCE S S I BL ETO AL L RE GARDL E S SOFI MMI GRATI ON S TATUS
E XE CUTI VES UMMARY I ti snosecr ett hatpeopl ewhohavei mmi gr at edt ot heUni t edSt at esar esubj ectt oal lmannerof di sgr acef ult r eat mentandsubst andar dcar e. Thecondi t i onsi nwhi chpeopl ear ehel duponent er i ng t heU. S. t hr oughi t sbor derwi t hMex i coar enot or i ousl yshamef ul . Somewhatl esswel l -knownar et he waysi nwhi cht hi ssubst andar dcar eandi l lt r eat mentcont i nueaf t ert heper sonhasbegunl i vi ngi n t heU. S. Wi t hal loft hepol i t i caldi scour seabouti mmi gr at i on, l i t t l eawar enessi sgi vent ot heamount i mmi gr anti ndi vi dual spayi nt ax es. Speci f i cal l y, 50%t o70%oft heundocument edi mmi gr ant popul at i onpaysf eder alandst at et ax es. Despi t et hesecont r i but i ons, undocument edi ndi vi dual s cont i nuet of acedi scr i mi nat i on, r aci sm, anddehumani z i ngbar r i er st oqual i t yheal t hcar e–ser vi ces t hei rt axdol l ar shel ppayf or . Thesei nequi t i esar epar t i cul ar l ypal pabl ef ori ndi vi dual s, andt hei r f ami l i es, di agnosedwi t hcancer . Asdet ai l edi nar ecentar t i cl e“ Ar r est edAccess, ”af or ebodi ngamountofbur eaucr at i cr edt ape bar r i cadesaccesst oheal t hcar ef oranyonel i vi ngi nt heU. S. , wi t horwi t houtdocument at i on, whoi s notaci t i z en. OnaccountofTr umpadmi ni st r at i onchangest ol egi sl at i ondesi gnedt of ur t herr est r i ct accesst oheal t hcar e, manyi mmi gr ant sgaveuponpur sui ngt r eat mentorsuf f er eddel aysi ncar e, wor seni ngheal t hout comes. Peopl ewi t hser i ousl ong-t er m heal t hpr obl emssuchascancerf ace ex t r emeheal t hi nequi t i es. Al t houghmanyoft hesemeasur eswer er ever sedaf t ert hecl oseoft he Tr umpadmi ni st r at i on, t hehei ght enedwar i nesst heycr eat edr emai ns. Beyondt heobvi ousbar r i er s, suchasl ackofheal t h i nsur ancef orpeopl ewi t hout l egaldocument at i on, a numberofbar r i er sex i steven f ort hosewi t hl egal document at i on. Forex ampl e, evenaf t erf ul f i l l i ngal lt he r equi r ement st obe consi der edf or“ qual i f i ed” i mmi gr at i onst at us, t her ei sa wai t i ngper i odoff i vef ul l year sbef or esomeonewho i mmi gr at edi sact ual l y el i gi bl et or ecei vebenef i t s. Al t houghMi ssour iand Kansashavepr ovi si onal measur esal l owi ngf or cover ageofemer gency car e, mostnecessar ycancer t r eat ment sar enot consi der edemer gencycar e becauset heconsequences f orf ai l i ngt or ecei vet hat car emaynotbesuf f i ci ent l y acut e. Becausephysi ci ans ar eoat h-boundt opr ovi de car eonceadi agnosi shasbeengi venr egar dl essoft hepat i ent ’ sabi l i t yt opay, t hesei nsur ance bar r i er scausemanycl i ni csandhospi t al st oavoi ddi agnosi ngapat i entwi t houtcover age whenevercanceri sapossi bi l i t y, l eavi ngpeopl esuspendedwi t houtanyavenuesf ormedi calcar e. 2
CL ARI TYAMI DCHAOS : UNDE RS TANDI NG WHE REWEARE I naf i el dnot or i ousl ypl aguedwi t hunknownsaboutwhatmakesacancerl et halorhow t or educei t s l et hal i t y, t hesubst andar dcar eavai l abl et oHi spani candL at i noi mmi gr ant sar ar ei nst anceoft ot al cl ar i t yaboutnotonl ywhati scausi ngwor senedheal t hout comes, butal sowhatmustbedonet o r esol vet hem. Theur gencyoft hemat t eri ncr easeswi t ht heHi spani cpopul at i onoft heU. S. , whi chwas r epor t edat1 8. 7%i nt heAmer i canAssoci at i onf orCancerResear ch( AACR)2022CancerDi spar i t i es Pr ogr essRepor t . Notonl yhasl ackofcul t ur al l y-r esponsi vecar ebeenshownt ocont r i but et opoor heal t hout comes, i mpl ement i ngcul t ur al l y-r esponsi vecar ehashadposi t i ver esul t s.
“ Mul t i pl est udi eshavef oundt hatcul t ur al l yandl i ngui st i cal l yt ai l or edi nt er vent i onst oenhance upt akeofcancerscr eeni ngamongr aci alandet hni cgr oupshaveahi ghdegr eeofsuccess. I nonest udy, r esear cher sdevel opedamul t i componenti nt er vent i ont oi ncr easecer vi cal cancerscr eeni ngamongHi spani cwomenal ongt heU. S. -Mex i cobor der . Theappr oach—De CasaenCasa—combi nedpr evi ousl ysuccessf ulscr eeni ngst r at egi es( compr i sedof r emi nder s, i ncent i ves, one-on-oneeducat i on, andout -of -pocketcostr educt i on)wi t ha bi l i ngual , cul t ur al l yt ai l or ededucat i onalcomponent( whi chi ncl udedcommuni t ymember engagement , cul t ur al l yt ai l or edmat er i al , andcul t ur al l yt ai l or edmet hodofdel i ver y)anda navi gat i oncomponent( whi chf aci l i t at edscr eeni nganddi agnost i ct est i ngt hr oughdedi cat ed pat i entnavi gat or swhohel pedwi t hmaki ngappoi nt ment sf orscr eeni ngt est s, pl aced r emi ndercal l s, andpr ovi dedt r anspor t at i oni fneeded) . Accor di ngt ot hest udy’ sf i ndi ngs, i ndi vi dual swhor ecei vedi nt er vent i onwer e1 4t i mesmor el i kel yt obescr eenedcompar edwi t h t hosewhodi dnotr ecei vet hei nt er vent i on. ”
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CONS E QUE NCE SOFI NACTI ON Ast hepr obl em per si st s, t hepeopl ei taf f ect ssuf f ert he consequences. Sever alt ypesofcancerhaveamuchhi gher mor t al i t yr at er at i of orHi spani cpeopl e, andt hecompound ef f ect sofcancerdi agnoses, bot hcer t ai ndi agnosesand possi bl eonesbei ngdel i ber at el ywi t hhel dt oavoi dhavi ngt o pr ovi decar e, ar eex acer bat edbyt hesoci aldet er mi nant sof heal t h( SDOH)commont ot hei mmi gr antHi spani cpopul at i on.
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THEE XTE NTOFTHEDAMAGE& THENE E DF ORRE S E ARCH Despi t et hesever i t yanddur at i onoft heheal t hbar r i er sf or i mmi gr antHi spani candL at i nocancerpat i ent s, t hedear t hof r esear chf ocusi ngont hesepeopl e, ori ncl udi ngt hem atal l , cont r i but est ot hest agnancyoft hesepr obl emat i cpol i ci es. Accor di ngt ot heAACR2022r epor t , “ I thasbeendemonst r at ed t hati naccur aci esanddef i ci enci esi ndat acol l ect i ononcancer deat hsf orHi spani ci ndi vi dual sr esul t si nami sl eadi ngi nf l at i on ofsur vi valst at i st i csf ort hi spopul at i on, ”meani ngt hatt her ei s nor el i abl epi ct ur eoft heconsequencesoft hesex enophobi c pol i ci es. Asr epor t edbyabi ophar maceut i calcompanyci t edi nt he samer epor t , onl y7%oft hei rcancercl i ni calt r i al sachi eved pr opor t i onalr epr esent at i onofHi spani c/ L at i nopar t i ci pant s—a commonpr obl em amongcl i ni calst udi es, par t l yduet o wi despr eaddi st r ustofcl i ni calt r i al s. “ Thei ndi vi dual -l evelbar r i er sf orpat i ent si ncl udel ackof awar enessofcl i ni calt r i al s, l i mi t edheal t hl i t er acy, andmi st r ust oft heheal t hcar esyst em, aswel lasf i nanci albar r i er ssuchas cost sofcancert r eat mentandmedi cat i on, t r anspor t at i on, chi l dcar e, l ostwor k, andi nadequat eorcompl et el ackof i nsur ance, amongot her s. ” AACRCancerDi spar i t i esPr ogr essRepor t2022
WHATNOW?RE LDATAANDAF UTURE OFCHANGE I nt hewakeoft hedat acol l ect edaboutt heef f ect sofCOVI D-1 9ont hepopul at i onandt hevi vi d awar enessofhow i thadi nt er act edwi t hSDOH, ar enewedpushbeganf ormor edat aar oundr ace, et hni ci t y, andl anguage( REL )f ort hepur posesofheal t hequi t y. Accor di ngt o" How ToI mpr ove Race, Et hni ci t y, AndL anguageDat aAndDi spar i t i esI nt er vent i ons, ”a2022r epor tf r om t heHeal t h Af f ai r sFor ef r ont , heal t hcar eent i t i eswi t hmor eaccur at eRELdat ahadgr eat ersuccess r espondi ngt ocr i sesbyal l ocat i ngr esour cesi namannerconsi st entwi t ht heneedsofaf f ect ed popul at i ons. Publ i cheal t hent i t i eswi t houtaccur at edat ar i skmaki ngcr i t i caler r or st hatr educe t hei ref f ect i veness, ast hear t i cl er epor t ed: “ TheDepar t mentofHeal t handHumanSer vi ces( i ni t s Equi t yAct i onPl an)andt heOf f i ceofI nspect orGener alr ecent l yr epor t edt hati naccur aci esi n Medi car eandMedi cai d’ sRELdat ahi nder edt hei rabi l i t yt oassessheal t hdi spar i t i es. ” Col l ect i ngRELdat ahasi t sownchal l enges, especi al l yf orgr oupsl i kepeopl ewhohave i mmi gr at edt ot heU. S. ( evenwi t hl egaldocument at i on)andmayf earconsequencesf orhonest l y r epor t i ngt hei rdat a. I dent i f yi ngandut i l i z i ngi ndust r ybestpr act i cest oensur et hemostet hi cal andaccur at ecol l ect i onofdat apossi bl emustbeapr i or i t y. Themor eaccur at eandcompl et et he RELdat a, t hemor eef f ect i veheal t hent i t i eswi l lbe, andt hemor eet hi calpubl i cheal t hpol i ci es basedont hatdat awi l lbe. 5
¡ NIUNO MÁS ! : ADVOCATI NG F ORE QUI TABL E ACCE S S
“ I t ’ sourwayofsayi ng“ Notonemor ewi l lhavet ost r uggl et hr ought hechal l engest hatwe’ veseeni n ourcommuni t y. Thi si sourvi si onandhopef ort hef ut ur e–t hatwedon’ tseet hatanymor e. ” Thecampai gnki cksof fwi t havi deot hatt el l st hest or yofElCent r o’ sar duousheal t hcar enavi gat i on j our neywi t hcl i ent sdi agnosedwi t hcancert hatspansmor et hanadecade. I t ’ sahumani t ar i an pi ecet hatunder scor est het ol lt hati nequi t abl eheal t hcar epol i ci espl ayoni mmi gr ant s–who happent ohavecancer . “ I t ’ sl i t er al l yonepol i cywe’ r easki ngt hem t ochanget omakeaccessmor e equi t abl e, ”sai dAndr ade. L ear nmor eaboutElCent r oandt he¡ NiUnoMás!campai gn. ElCent r oi samemberoft heKansasCi t yHeal t hEqui t yL ear ni ngandAct i onNet wor k( t heL AN) , undert hel eader shi poft heHeal t hFor war dFoundat i onandi npar t ner shi pwi t ht heI nst i t ut ef or Heal t hcar eI mpr ovement( I HI ) , andt heKC Heal t hCol l abor at i ve( KCHC) . TheL ANact i vel ydevel ops compr ehensi vest r at egi esandact i onpl anst odi smant l emedi cal l yr aci stsyst emst hatci r cumvent opt i malheal t handper pet uat eheal t hi nequi t i esf orpeopl eofcol or . Wi t hmor et han50or gani z at i onspar t i ci pat i ng, t heL ANpr ovi desaf or um f orengagement , gi r dedby ashar edagenda, wi t heducat i on, t r ai ni ng, t ool s, andex per t i set omar kedl ychangesyst ems, pol i ci es, andst r uct ur es. Thegoali st oel i mi nat edi spar i t i esi nheal t hcar edel i ver y, whi l er eal i z i ng measur abl ei mpr ovement sst eepedi nequi t y-cent er ed, cul t ur al l yr esponsi veheal t hout comesf or al lheal t hcar econsumer s. Asf orcol l ect i ngRELDat acl oset ohome, sever alKC L ANact i ont eamsar ewor ki ngt obui l dcapaci t y ar oundt hi spr act i ce. Theul t i mat eai mi sf orKansasCi t y' sheal t hcar eecosyst em t ohavecompl et e, val i d, andr el i abl eRELdat at oi dent i f yandaddr essr aci alandheal t hi nequi t i es--t odr i vesyst ems changei npol i ci es, heal t hcar edel i ver y, educat i on, andgover nment .
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