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Chapter 8

On April 22 and 23, 1993, the Executive Planning Committee of the Surgeon General's National Hispanic/Latino Health Initiative met at the Madison Hotel in Washington, D.C., to review the findings from the Surgeon General's National Workshop on Hispanic/Latino Health and the five Regional Health Meetings. During the past year, the Committee had met three times to help guide the activities of the Initiative and, thus, to help create a unified Hispanic/Latino voice, TODOS, to alert the Nation's leaders to the barriers that Hispanics/Latinos face in receiving adequate health care. Members of the Executive Planning Committee also served as Work Group chairpersons at the National Workshop and as chairpersons to plan and coordinate the Regional Health Meetings. At each of the previous meetings, the Executive Planning Committee members worked with hundreds of other Hispanic/Latino leaders to identify, analyze, and prioritize the issues and concerns with the greatest implications for the health and welfare of Hispanics/Latinos throughout the country.

At this meeting, the Committee members were charged with their final task-- to determine which of the recommended implementation strategies will have the greatest impact for improving Hispanic/Latino health and to develop a summary report of the critical recommendations in each of the key areas:

• Access to health care
• Data collection strategies
• Development of a relevant and comprehensive research agenda
• Representation in the health professions
• Health promotion and disease prevention

The Surgeon General, Dr. Antonia Novello, challenged them to put their "collective reality" into words that can be "bureaucratically understood." She directed the Committee members to examine the needs expressed in the recommended strategies, looking for similarities across the board, and to determine the strategies that are most feasible and can best meet those broad- based needs. To guide their deliberations, the Committee members were asked to consider opportunities for action in developing the report and to determine the strategies that represent the best opportunities for action in the following areas: representation of Hispanics/Latinos and communication of their health needs, development of policy to improve access to health care, provision of resources to improve Hispanic/Latino health status, public- private partnerships to improve health care delivery, advocacy for Hispanic/Latino health needs, and legislation that mandates improved access and delivery.

During their deliberations, Committee members from different regions related the special health concerns that participants expressed at the Regional Health Meetings. For example, a special workshop on the health needs of migrant workers was provided at the Chicago meeting. In San Antonio, participants expressed concern about the health implications of environmental conditions along the U.S.-Mexican border. However, despite these unique concerns, the issues raised contained several recurring themes, for example:

• Universal access to health care for all persons residing in the United States is imperative if this Nation is to thrive. Without universal access, many people delay getting proper care until conditions become serious and costly to treat.
• Adequate infrastructure for providing health care must be developed in undeserved areas to ensure universal access.
• Resources and mechanisms must be developed for enlarging the pool of Hispanic/Latino health professionals to provide culturally competent care, particularly in undeserved areas. Repeatedly, Committee members echoed the urging of their colleagues in the regions that funding for Hispanic Centers of Excellence and the number of such centers be increased.

Working in small groups to address each area of concern (access, data collection, research, representation in the health professions, and health promotion and disease prevention efforts), the Committee members selected specific strategies that address these common themes and, when combined together, create a feasible and achievable plan of action. The final step in the preparation of the recommendations was to choose approximately five strategies in each area that the Committee members consider to be of highest priority for implementation.

In the development of the report, several issues emerged that cut across the areas of concern that the Initiative addresses. Because a number of the recommended strategies have implications for all the areas of concern, the group categorized them separately as "cross-cutting issues." These cross-cutting issues indicate that no one area of concern can be addressed in isolation; rather, progress in one area is dependent upon progress in the other areas. For example, health promotion and disease prevention cannot be adequately addressed in the Hispanic/Latino population without culturally sensitive research and data collection. Similarly, access to appropriate health care services cannot be achieved without Hispanic/Latino representation in the science and health professions and in decision-making positions.

The remaining sections of this chapter contain the recommendations developed at the Executive Committee Meeting. Presented first are the crosscutting issues. Next are the implementation strategies for each of the five critical areas of concern. These sections begin with a statement of the problems related to the area, then present the implementation strategies deemed of highest priority (listed as the summary of key strategies), and conclude with specific implementation strategies grouped by areas of opportunities for action.

This report is intended to guide the Hispanic/Latino national health agenda for years to come. Progress will not occur overnight. However, Hispanic/Latino leaders will continue to work together to tailor these strategies to solve key problems within their communities and to ensure that this plan of action for Hispanics/Latinos becomes a vital part of a national universal system of health coverage for all Americans.