Example 1: Grant application to The Vicki Scott Foundation to improve healthcare access

Cover Letter

2506 Crestline Circle
Lawrence, KS 66047

People for Universal Health Care

September 22, 2000

Kansas State Health Department
Attn: Grant Committee
618 N. Bay Country
Topeka, KS 67525

Dear Sir or Madam:

The mission of our organization is to improve the health and well-being of children in Marshall County, Kansas through education and improved community programs. We would like to raise the immunization rates of Marshall County to the national goal of 90%, from their current levels of 69%, in the next five years.

We are interested in immunization rates in Marshall County because there is little or no system to ensure that the children of that community receive proper immunizations. Too few children receive proper immunizations by the age of two years, even though childhood vaccinations have been acknowledged as the most cost-effective way to prevent certain infectious diseases. Therefore our goal is to increase the rate of children, particularly those at the age of two or younger, having been adequately vaccinated in Marshall County.

We believe that we have the capacity to carry out this initiative because we have a strong history of success in child and youth services, as well as health and wellness services. Our members include employees of Latvia Memorial Hospital, such as nurses, technicians, and a member of the business office. Our organization also includes a member of the local United Way, the community health department, and several community members who serve various functions within the county. Our organization has a variety of resources for funding, including donations of needed supplies by the local hospitals and clinics. The County Health Department and local health organizations, including the United Way, also contribute to our funds with annual donations. Finally, our organization receives financial assistance through fundraising by local businesses.

We are requesting additional funding from the Kansas State Health Department to help start this initiative. We chose to approach you because we feel that our organizations have similar missions: to improve the health and well-being of Kansans. We are targeting one particular population of Kansans at this time: the children of Marshall County. Thank you for your time and consideration.

Sincerely,

Julie Vu
Executive Director

Community Grant Application

I. STATEMENT OF THE COMMUNITY PROBLEM AND CONTEXT

STATEMENT OF THE COMMUNITY PROBLEM OR CONCERN

State the community problem or concern to be addressed.

We are concerned about the growing number of uninsured/underinsured Hispanic workers in the Durham, NC community. This community has issues of access related to language barriers, the lack of health insurance, and the lack of transportation to the clinics currently available in the area. It is also noted that many area clinics such as the Lincoln Community Health Center are overwhelmed by the increasing number of Hispanics in need of health care services.

Document evidence of the problem, including data on the scope or level of the problem. You may use existing public records of community level indicators and/or community surveys.
Document evidence of community concern about the issue, including information from people affected by the problem, those responsible for addressing it, and reports from the media.
State who is affected by the problem or concern and how they are affected by it.

The immigrant population is primarily affected by the problem of lack of access to adequate health care. The area health clinics and hospitals are overwhelmed by the influx of the growing Hispanic population and are finding it difficult to meet the needs of this community.

DESCRIPTION OF THE COMMUNITY

Describe the geographic area that defines the community including the location and physical boundaries, total population, and other relevant characteristics.

Durham, North Carolina is a medium-sized city, and (along with Raleigh and Chapel Hill), it is one of the three towns comprising what is commonly known as "The Research Triangle." Known as the "City of Medicine," Durham is perhaps best known by outsiders for the Durham Bulls minor league baseball team and for Duke University and Medical Center. Durham is also home to two other colleges, North Carolina Central University (the nation's first publicly supported liberal arts college for African-Americans), and Durham Technical Community College. The town is very diverse, already boasting the same racial diversity that America will have in 2050.

It is also a city that is growing very rapidly. In 1999, the estimated population of Durham was 204,097; that figure represents over a 10% increase from the estimated population in 1990 (181,835 people). While the town was founded primarily with money from tobacco over a hundred years ago, it is now a major center for research and development, with major corporations such as IBM and Glaxo Wellcome having a home in Research Triangle Park, most of which is a part of the city of Durham. Indeed, trying to cope with the booming growth that has hit the area is one of the largest challenges facing area planners.

Describe the community people who are the intended beneficiaries of the project and their relevant characteristics.

Our project is being developed to serve the needs of Hispanic residents of Durham County, including those who have come to this country illegally. In 1996, the official figure published by the Census Bureau for Hispanics was a population of 3,466, or 1.8% of the population. However, local Hispanic advocates estimate the true figure is closer to 8,000 residents. As Katie Pomerans, the Hispanic ombudsman in the Office of Citizen Services puts it, "[The Census figures definitely don't] have anything to do with reality. They're grossly undercounting, and it makes no sense."

Any way you count it, the number of Hispanics in the county is on the rise. The Census Bureau states that the Hispanic population of Durham grew by 11% from 1995 -- 1996, and the number of Hispanic children in schools jumped by 25% during the same time period.

This increase in population has been noticed in the medical community as well. Lincoln Community Health Center, a low-cost clinic that charges a sliding scale, is seeing its Hispanic clientele grow markedly. For example, in just the two years from 1994 and 1996, the percentage of the patient population that was Hispanic tripled, from 2.7% to 7.1% of the clinic's visitors. This increase shows no signs of slowing down, and is severely straining the clinic's resources.

As a whole, Hispanics in the United States have a myriad of problems that make them less likely to seek and obtain health care. Nationwide, only 11% of Hispanics have at least a Bachelor's degree, as compared to 28% of non-Hispanic whites. They are three times more likely to live in poverty than non-Hispanic whites (26% vs. 8%); 34% of Hispanic children live in poverty.

Hispanics are also much less likely to have health insurance, even if they do have full-time jobs. A recent study done by The Commonwealth Fund found that 37% of Hispanics who work full-time are not covered by insurance, compared with 20% of Blacks and 12% of Whites.

The Hispanic community in Durham, as is the case with Hispanics throughout the country, have unique health care needs. Not the least of these is actually having the resources to get them in the door of a medical office. As The News and Observer, one of the local newspapers, reported last summer, "The number of immigrant Latinos seeking medical attention is growing, but several barriers -- including a language gap and lack of transportation -- haven't made it an easy trip to the doctor's office."

Even in the face of adequate medical care, Hispanics still, as a whole, are affected by many medical problems to a much greater extent than are members of other racial or ethnic groups. For example, high blood pressure, diabetes, obesity, and tuberculosis are all health concerns which occur in Hispanics more frequently than in other populations. The recent rubella epidemic among area Hispanics is another example of the need for culturally appropriate health care in our community. Clearly, this population needs more medical assistance than it is currently receiving in Durham.

ANALYSIS OF THE PROBLEM OR SITUATION

Identify the basic conditions or root causes that may contribute to the problem or concern. Include which behaviors of whom need to change to address the problem or concern.

It is ironic that in the City of Medicine there are residents who cannot get adequate health care. Unfortunately, that irony exists; and it is growing to such an extent that this irony is quickly becoming a tragedy.

The booming Hispanic population is at the root of this problem. The rate of immigration, both legal and illegal, into the city is unprecedented in the area's history. Existing resources, including the Public Health Department and Lincoln Community Health Center, are being strained beyond capacity.

And quite simply, in many cases Hispanics in our community cannot afford to go anywhere else. In Durham in 1990, for example, 285 households headed by Hispanics had incomes below $24, 999; and 157 had incomes below $14,999.

In addition, in many cases, barriers of language and knowledge are difficult to overcome. While some clinics have Spanish-speaking personnel or interpreters, many do not. Additionally, the very people who do not regularly seek medical care in the community are the same people who are unaware of the resources already available in the community (for example, STD hotlines in Spanish and disaster assistance).

ORGANIZATIONAL CAPACITY TO CONDUCT THE PROJECT

Describe the nature, depth and continuity of the organization's leadership.

Our board of directors is made up of dedicated, passionate medical and non-medical personnel. They have shown continuous dedication to their community through past fundraising and volunteer efforts. Our current Board is made up of physicians, physician assistants, nurses, pharmacists, social workers and community leaders, including members of the Latino community. Important posts in the clinic will be filled as follows.

Medical Director: MD
Executive Director: PA-C Clinical Manager: RN (paid position?)

Describe other resources and assets of the organization.

PEOPLE

We have already 50 volunteers offering at least two hours per month to staff the clinic as follows, per night:

2 clinicians	3 nurses
2 medical technicians	1 administrative assistant
2 non-medical assistants (including security)
2 translators

Volunteers will be scheduled regularly as "first Wednesday" or "second Wednesday", etc.

Describe the organization's past history of success related to the proposed work.

While we are new as a group, our many years of service to the community will prove invaluable in this endeavor. Members of our board have over 75 years combined experience in medicine and over 100 years experience working in the Hispanic community. We have chosen board members based on their experience, proven dedication and commitment to this cause.

Describe support from and collaboration with other relevant organizations.

Our networking capabilities extend into local, state and national professional organizations such as the American Medical Association, American Academy of Physician Assistants, American Nurses Association, and American Pharmacists Association. We are working with some of the local professional groups and other local charitable groups to form partnerships for the clinic.

Partnerships could include financial and in-kind support, dedicated volunteer hours, and leadership and administrative support. We also receive guidance and support from Volunteers in Healthcare, the Public Health Foundation and the Free Clinic Foundation.

II. PROJECT VISION, MISSION, AND OBJECTIVES

VISION AND MISSION

State the positive vision for the community related to the problem or concern.

Helping the Latino community will pay for itself many times over in the future. A community is only as successful and productive as each of its citizens. By helping some, we're helping all.

State the mission of the project or initiative.

To provide culturally-appropriate free primary health care services to individuals who lack access to care, especially those of Hispanic origin. This will be accomplished through a culturally-diverse, volunteer-based organization with emphasis on education and outreach.

OBJECTIVES

State the overall objective(s) for the community project or initiative.

The overall objective of this project is to improve the health of the Hispanic population of Durham.

III. PROJECT IMPLEMENTATION/ METHODS OF INTERVENTION

TARGETS OF CHANGE AND HOW REACH THEM

Identify primary targets of change.

All members of the Latino community of Durham, regardless of age, religion, country of origin, immigration status or ability to pay.

Indicate how targets will be reached by the intervention.

Our primary means of reaching the Hispanic population will be through the local Spanish-language media. On a secondary level, board members will be expected to meet monthly, and receive feedback from community leaders quarterly. Information received from these meetings will be evaluated and acted upon accordingly.

MOBILIZING HUMAN AND MATERIAL RESOURCES

Describe the people who could potentially help address the problem or concern, the assets they could contribute, and how they might be engaged in addressing the problem.

Any members of the community who are willing to donate their time and help improve the health status of the Latino community. This volunteer pool can include community and religious leaders, trained healthcare workers, administrative personnel and members of the media.

Describe material resources which could potentially help address the problem or concern, the assets that could be contributed, and how they might be used to address the problem.

We will be looking for in-kind donations of new and used medical equipment including exam tables, medical supplies and pharmaceuticals. We will also be in need of office and record-keeping materials. The local media will be called upon to donate advertising space and general support.

Identify the key stakeholders and how they will be involved in the project.

There are many people who will be affected by this project. Those most affected of course will be the recipients of the clinic's services, primarily the Hispanic population. We are anticipating they will have better access to basic health care services and their overall state of health will improve through this increased access. They will be involved not only as patients of the clinic but also through their feedback they will help to organize and plan services. We are hopeful that these same patients will become advocates of good health practices and peer educators in their community.

Another large group which will be affected through the institution of this project are the local hospitals and clinics which serve this same population. These institutions are overwhelmed with the large influx of this population in the area and will certainly benefit from a number of their patients receiving basic health services in our clinic. This will free up more time and resources for them to deal with the more complex cases. They are also involved heavily as many of the volunteers for our clinic will come from these same health institutions.

Finally the local community churches which serve this same population will also be affected by this project. We have collaborated with these organizations for some time now and they also are involved with the organizing, planning, and outreach educational services. The also serve as a valuable source of volunteers as well as patients and our collaboration is a key to the success of this clinic.

TARGETS, BEHAVIORS, AND STRATEGIES FOR INTERVENTION

Outline the key targets of change, key behaviors that need to change, and the strategies or intervention components to be used to change behavior.

There are several groups we see as key targets of change. Broadly, the Durham health care community needs to address this overwhelming problem of the migrant Hispanic population’s difficult access to healthcare as a separate and more comprehensive issue. Though each individual institution has taken steps to address the issues on an individual level, the numbers of these patients are becoming overwhelming and need to be addressed on the community level. Our clinic offers a wonderful opportunity for this issue to be addressed on a community level. Also this clinic tackles the issues of language barriers, the lack of health insurance, and the lack of transportation to the other health services currently available in the area. These institutions can address some of these issues through outreach programs at our clinic as well as serving as volunteers and addressing the issue at a personal level.

Secondly, the Hispanic migrant community itself must change. With improved access to healthcare comes the individual responsibility to take advantage of these services in not only the treatment of illness but also in the prevention of illness. Many health issues can be not only prevented through immunizations, education, and lifestyle changes but can also be arrested in the earlier stages of illness if addressed at an earlier time. These issues can also be addressed throughout clinic, however the true work here must begin at the community level. Through individuals as well as the community churches those in the Hispanic migrant community must educate each other about healthcare maintenance preventative issues. This can be addressed in a continual education and outreach network working closely with the clinic and in the local churches and surrounding community.

IV. EVALUATION PLAN

OVERALL EVALUATION

Describe what "success" will look like for the project or initiative.

Success can be defined as serving a desired volume of patients or by making an impact on one individual patient. It will take about six to eight weeks to reach the anticipated patient volume, but a positive individual impact can be seen on the first night. We expect to see 500 patients in the first six months.

As we are a new project, our original goals for "success" are modest. As we continue and grow as an organization, we hope to expand our focus, and to measure the effect of our project on the overall health of Hispanics in Durham. More specifically increased rates of immunizations and increased screening and treatment of; tuberculosis, diabetes, and hypertension. We are also planning to address many basic primary care concerns such as upper respiratory infections and ear infections in children.

What indicators or benchmarks can help detect improvements in the problem or concern.

As addressed above one simple indicator we can follow in order to evaluate the success of our program is the immunization rates of both children and adults. It is also possible to measure or compare screening rates for tuberculosis, diabetes, and hypertension through percentages within those at risk in the patient population. Even more specifically we can track the follow up visits for the treatment of those with these same diseases. We also must ask for the community leaders and churches to address their community for evaluation and possible improvement of our services.

PROCESS EVALUATION

Indicate how implementation of the intervention will be monitored. Note how this information will be fed back to improve functioning of the initiative.

The indicators mentioned above will be monitored on a monthly basis. Also monitored will be the number of new and return patients. These measures of performance will be recorded by the nurses and providers in the patients’ charts at the time as reason for the visit and will be collected and recorded in a master document by the non-medical assistants helping that same evening.

For at least the first year following the implementation of the project the Board will meet monthly to discuss any problems as well as the progress of the clinic. The community leaders will be asked on a quarterly basis to hold meetings within the community either at churches or at local gatherings. This will be for both informing the people of the services available to them as well as requesting feedback from the community, which will be presented at monthly Board meetings for evaluation and possible implementation.

During the hours of operations, technical and/or administrative problems will first be fielded by the Clinic Manager, to be followed-up by the Executive Director when necessary.

Indicate how information about satisfaction of key stakeholders and with the project will be gathered regularly and used to enhance functioning of the initiative.

As discussed above there will be monthly Board meetings to discuss any problems encountered as well as progress of the clinic on a monthly basis for at least the first year of operation. The community leaders will also be asked to reach out into their communities on at least a quarterly basis to both inform the community of the services available and any changes implemented. Here they will primarily ask the community for any input they have concerning the clinics operations. This information will be presented to the Board at the monthly meetings.

Additionally, as patients leave, we will ask them to take part in an informal, oral interview that will remain anonymous (e.g., their names will not be attached to their answers). Those surveyed will be asked a short list of open-ended questions that have been reviewed by an expert in Hispanic studies and an epidemiologist.

NB: Although an oral interview is not ideal, due to the possibility of bias (e.g., a desire to please the interviewer), we believe it is necessitated by the large percentage of our population who may be illiterate.

Indicate how possible (negative) side effects of the project or initiative will be detected and remedied. Note how this information will be used to minimize those side effects?

Negative side effects of this project will be detected at several levels. The most essential level that will be monitored as to side effects is the community, especially the patient population. Information from these oral interviews mentioned above, both positive and negative, will be reviewed by our Board of Directors on a monthly basis, and adjustments will be made accordingly. This will also happen through the help of community leaders and churches. Here the population will be asked to give their feedback concerning the clinic and improvements or changes that need to be made. This information will be channeled back to the Board, which will try to implement as many changes as possible to improve services.

Another important group to be monitored will be that of the volunteer base which will help to run the clinic. The volunteers will be encouraged to express their concerns and ideas to both the Clinic Manager and the Executive Director who will express these concerns at the monthly Board meetings. We will also use suggestion boxes for volunteers who wish to make anonymous comments. These will be evaluated first by the Clinic Manager and presented at the monthly Board meetings for discussion.

OUTCOME EVALUATION

Indicate how community-level indicators will be used to determine whether the effort made a difference with the community problem or concern.

Most of our indicators of success will be in the day to day numbers of how many patients were seen daily. We will also track specific major public health issues, such as:

The number of children immunized at our clinic
The number of women receiving well-woman exams
The number of patients screened/treated/educated for HIV and other sexually transmitted diseases
The number of patients receiving screening and/or treatment for diabetes, hypertension and tuberculosis
The number of prenatal referrals that occur at our clinic

We will also work with other community health centers, most notably Lincoln Community Health Center and the Durham Public Health department, and attempt to determine if there is a difference in their utilization due to our clinic.

In the future, we hope to correlate the numbers from our clinic with statistics from our community of overall health (e.g., the rate of STD's; the rate of immunization in the community, et cetera). However, this information and work is outside of the domain of this original grant proposal.

V. PLAN FOR FINANCIAL SUSTAINABILITY

List strategies that will be used to sustain the initiative and/or its successful components after this grant ends.

While the startup grant which we are applying for today is crucial to get our program on our feet, it is our goal that the program will eventually be entirely sustained through the use of local resources. To that end, our financial sustainability plan includes all of the following:

United Way funding. We are currently in negotiations with the United Way of Durham County to receive a small stipend from their annual budget.
Funding from local churches. Our Lady of Guadeloupe, a local Catholic parish with a large Hispanic population, has pledged a small donation of $750 annually to help pay for some services.
In-kind donations. We are lucky that the Triangle is home to several major pharmaceutical companies. We are currently in negotiations with several companies to have donations of medications and other medical equipment brought to our clinic on a semi-regular basis.
Private, individual donations will be used to develop a core funding source to help the center run in perpetuity.
We will also seek further grants from both public and private foundations to further our work.

VI. OVERALL SIGNIFICANCE AND PROSPECTS FOR SUCCESS

In one paragraph, state WHY this project should be done: a) at all, b) in this community, c) at this time, and d) by this organization.

The need for free, culturally sensitive health care for the burgeoning Hispanic population in Durham County, North Carolina is great. By all accounts, it will grow substantially in the coming decade. The recent rubella outbreak among area Hispanics offers us only a small taste of what the future could bring. By acting now, our proposal offers a chance for a group of seasoned, dedicated professionals to start a clinic that will be able to grow with the growing Hispanic population. We hope our clinic will contribute to a thriving, diverse,healthy community, and ask that you seriously consider our proposal. Thank you.

VII. APPENDICES

Appendices

Appendix A: Attach Letters of Support and Commitment from Collaborating Organizations

Father Mark O'Reilly
Our Lady of Guadeloupe Catholic Church
123 Guess Road
Durham, North Carolina 27704
Telephone (919) 477-6789
E-mail: fathermark@yahoo.com

July 4, 2000

Dear friends:

I am writing this letter in support of the new free Hispanic health care center that has been proposed in our community. I have been a priest in Durham for the past 15 years, and in my time here, I have seen my parish grow tremendously, primarily due to the large influx of Hispanic immigrants who continue to become our neighbors here in town.

As a priest, I am privy to many of their difficulties, and it strikes me time and again how many of these problems are due to a lack of adequate health care. Many do not have money to go to the doctor. Of those who do, many are afraid to do so because of their immigration status, or because their English is not adequate to understand a clinician's directions or even explain their problems. Many of these people I have accompanied to local clinics and served as their translator; but if I did this for every person who needed this in my parish, I would no longer have time for anything else.

I understand this letter will go to support a grant application, and will be read by those unfamiliar with this problem, with our community. Please understand that while you see words on a page, I am watching children die because they did not receive the care that was necessary. The need is urgent, and the time to act upon it is now.

I have the highest confidence in those who are running this new clinic. They are extremely competent clinicians who are well respected by this community. They can get things done. Most importantly, they are passionately dedicated to this cause. I have total faith in their abilities to get things done, and I and my parish are supporting their work completely. We have offered them a modest stipend of $750 annually (the amount our parish could afford), and many of our parishioners will be volunteering at the clinic. I urge you to support their efforts as well. If I can be of any further service, please do not hesitate to let me know.

Yours in Christ,

Father Mark

Julie Nielson

Human Relations Department
Big Drug Corporation
Research Triangle Park, North Carolina 27707
Jnielson@gw.com

June 29, 2000

To Whom It May Concern:

We are writing in support of the new free clinic that is being proposed in our area. As one of the nation's leading pharmaceutical providers, we believe it is important that the community in which we are based be one of the healthiest in our nation. It is to that end that we have pledged our support to this new clinic. It is part of our mission to "give something back" to the community that graciously houses us.

Although we have not yet finalized the specifics of our donation to the new clinic, we hope to be a regular benefactor, probably through donations of our products. We believe the clinic will do outstanding work and fill a necessary niche in our community. We hope that you will join us in supporting this worthy endeavor.

If you have any questions, please feel free to contact our office at (919) 383-1234.

Sincerely,

Julie R. Nielson

Human Relations Associate
Big Drug Corporation

Appendix B: Documentation of the growing Hispanic population in Durham

December 21, 1997
The News & Observer
Estimate alarms Hispanic advocates
By NED GLASCOCK; STAFF WRITER

RALEIGH -- The U.S. Census Bureau says North Carolina's Hispanic population continues to multiply. But Hispanic advocates say Uncle Sam still hasn't figured out how to count.

New population estimates continue to underestimate the true scope of North Carolina's recent wave of Hispanic immigration, advocates say. They worry that the apparent underestimation could mislead policy-makers about the level of state and local resources needed to address the influx.

The Census Bureau estimates that 134,384 Hispanics lived in the state in July 1996, an 11 percent increase over 1995 and 73 percent more than in the 1990 census.

However, the new figure falls far below the estimate of 205,000 made by state health officials in 1996, said Katie Pomerans, Hispanic ombudsman in the Office of Citizen Services, a wing of the state Department of Health and Human Services.

"A lot is at risk," Pomerans said. "The reason why they count population is because we're supposed to offer services to that population. You plan for growth that way - for the number of schools you need, the number of parking spaces you need. But nobody knows the actual figure, even after they count it."

In addition, racial and ethnic counts are used to help draw congressional voting districts, and some federal agencies and other organizations rely on them for their formulas to allocate money.

In the Triangle, the apparent discrepancy between official figures and reality is pronounced in Durham, where estimates by local Hispanic groups put the population about 8,000. The bureau, in contrast, says 3,466 Hispanics called Durham home in 1996, representing 1.8 percent of the county's population.

"It definitely doesn't have anything to do with reality," Pomerans said. "They're grossly undercounting there, and it makes no sense."

Although the Census Bureau says Durham's Hispanic population grew by 11 percent from 1995 to 1996, the number of Hispanic children in the Durham public schools jumped by 25 percent over the same time frame, from 562 to 705, she said.

Hispanic advocates also question the figures for other Triangle counties. The Census Bureau reported: - 11,227 Hispanics in Wake County, or 2.1 percent of the county's population. That figure is a 15 percent increase from the year before and a 103 percent rise since 1990.

2,508 Hispanics in Orange County, or 2.3 percent of the population. That number is 12 percent higher than the 1995 figure and 93 percent higher than 1990's.

Overall, Hispanics make up a tiny fraction of the state's population - 1.8 percent of the state's 7.3 million residents in 1996, according to the bureau. Still, even that percentage is on the increase: In 1990, Hispanics made up 1.2 percent of North Carolina's population.

Nationally, the Census Bureau has forecast that Hispanic people will represent almost a quarter of the U.S. population by the year 2050, up from one-tenth currently.

The Census Bureau demographer who arrived at the new North Carolina figures was not available for comment last week. Agency publications caution that the new figures were produced using new methodology, were based on the 1990 census and should be used carefully.

"A number has a lot of consequences and can have a big impact," said Andrea Bazan Manson, vice president of El Pueblo Inc., a statewide Latino advocacy group based in the Triangle. Manson said the group often uses estimates of 250,000 to 300,000 for Hispanics in the state. "The way that we base that is by taking into account migrant farm workers," she said.

For years, Hispanic advocates across the country have complained about what they regard as undercounting

Whether the census data for North Carolina are accurate or not, the trend of growth in Hispanic numbers is undeniable and can still help guide policy-makers, said Susan Brock, a migrant health coordinator with the nonprofit N.C. Primary Health Care Association.

"[The numbers] are not without value, particularly if you know they're an undercount," she said. "I don't know that any data [are] perfect."

Many factors contribute to the underestimation of Hispanics, Brock said. Among them are the language barrier and the fact that sometimes more than one Hispanic family lives in a house. Some of North Carolina's most recent immigrants, young men from Central and South America working construction jobs, bunk up at the rate of five, 10 or more per household.

In addition, undocumented immigrants are reluctant to come forward and be counted.

Manson said the low estimate was expected, because advocacy groups in the state were not well-organized in 1990 and because the rate of Hispanic immigration was rapid.

"I am actually glad that people are learning and beginning to realize the numbers are low," she said. "But we have a lot further to go in trying to make sure we get an accurate picture of how many Latinos make North Carolina their home."

Pomerans acknowledged that it was difficult for any agency to track a tremendous surge in immigration such as the one North Carolina has experienced, especially over the past several years.

"We have to just hope that with the next census, it's better done," she said. "A lot of that depends on the help of the community and educating people about the importance of responding to the census."

February 22, 1998

The News & Observer
Spanish lessons (Part A) (First of two parts)
By Ruth Sheehan and Ned Glascock; Staff Writers

Lured by the prospect of good jobs in a humming economy, Latino immigrants have flocked to the Tar Heel State in record numbers this decade, literally helping build the new North Carolina as they forge new lives.

But this historic demographic shift is placing a large burden on state and local governments - a burden for which nearly every agency and branch of government is ill-prepared and under equipped.

Although Latinos remain a small fraction of North Carolina's overall population - about 2 percent - the U.S. Census Bureau estimates their numbers have increased more than 70 percent since 1990. Hardly a town has gone unchanged.

Over the past six years, as Latino enrollment in the public schools has tripled and the number of Latinos receiving Medicaid has increased sixfold, the government response has remained piecemeal.

Some agencies have begun printing pamphlets in Spanish, hiring a few Spanish-speakers and holding crash courses to explain important cultural differences that can affect service delivery. But there is no coordinated strategy.

"It is not as if this wave of immigration is some big surprise at this point," says Katie Pomerans, a liaison for the Spanish-speaking community with the state Department of Health and Human Services. "It's a fact. It's a reality. We are behind the curve, well behind the curve on this one."

Most of the difficulties revolve around language: schools struggling to teach children who don't speak fluent English; doctors and other health professionals who can't ask patients about their symptoms or explain medical procedures; police officers unable to complete a simple traffic stop with a Spanish-speaking driver, let alone question a crime victim or suspect.

Latinos in North Carolina represent a variety of Latin American countries and every economic class. But it is the wave of working-class migration mainly from poor areas of Mexico and Central America - and even other parts of the United States - that poses the biggest challenges for government.

Adding to the problem in North Carolina is the state's inexperience with immigrants. Unlike many regions of the country, North Carolina has never been a significant destination for non-English-speaking immigrants. And the answers for how to deal with this unprecedented influx of new residents - some legal, some not - have proved elusive.

Government agencies in North Carolina are playing catch-up, says Aura Camacho Maas, a member of the state Human Relations Commission and founder of the Latin American Resource Center in Raleigh.

"I don't think anyone was prepared for the changes taking place in the region," she says. "The first reaction from many different sectors was to ignore it. But I think we've evolved quite a bit from that.

"People are beginning to address those issues now. But it will take a while. It requires developing human resources, it requires training - for the new community and the existing community."

Government's struggle to match the rapid pace of change plays out in the classroom, the courthouse and the health clinic in nearly every community in North Carolina. Here is a collection of snapshots from the front lines.

Among schoolchildren: Mary Mason's specialty is language. But these days, she's preoccupied by the numbers.

As coordinator of the English as a Second Language program at Athens Drive High School in Raleigh, Mason sees the demand arcing upward in what is perhaps the most crucial interface between new Latino immigrants and the state: the public schools.

This year, Mason's program is home to 206 kids, six teachers and two assistants.

Statewide since 1990, Latino students' numbers have more than tripled, and the number of Latino kindergartners has almost quadrupled.

The Wake County public schools have nearly doubled their ESL teaching positions in the past year, and the pace is so frantic that some new ESL teachers are sent into the classroom while they're still training for certification.

"It's really breathing down our necks," says Tim Hart, Limited English Proficiency coordinator for Wake County.

"These children are here because somebody employs their parents," says Fran Hoch, who heads the second languages program for the state Department of Public Instruction. And they're not the children of migrants, she says. They're here to stay.

"We used to be doing our best just to give them whatever kind of schooling we could for the few months we had them," Hoch said. "Now they are part of our accountability. If we don't serve them, they become part of our dropout rate."

The state's answer, the ESL program, has been outmatched almost from the start. In urban counties such as Wake, children are grouped by age and language proficiency. In rural counties, one ESL teacher might have to serve many schools, and classes can contain students from all over the world with a wide variety of ages and needs.

The younger the child, the easier it is to pick up English - and the easier to learn a new language in a normal classroom environment. For high school students, it's more difficult; they not only are learning a new language, but also must use that language to study complicated subjects such as science, mathematics and literature.

Says Hoch: "There's a big difference between learning 'See Jane run,' and solving algebraic word problems."

The state does not track dropout rates for ESL students. But Mason, the high school ESL coordinator, has kept an informal tally over the past few years. The boys, she says, have the hardest time. Of the last 26 she's taught, only two had graduated by May.

"The prospects are not good for these kids," she says.

Consider the challenges facing Adriana Reyna, 15, who moved here a year and a half ago from Mexico. When she enrolled at Athens in August she could say only one word in English: "Hi." Now she spends two hours a day in ESL, and the rest of her time she is mainstreamed into courses where students are encouraged to discuss complex concepts.

Reyna has no idea what her classmates are talking about.

"I say nothing," she says. "I only listen."

On the job: Inside the cramped, concrete-block duplex in Durham, Tom O'Connor listens intently to the Honduran woman with the long brown hair.

In Spanish, she explains how her boss at a Raleigh fast-food restaurant has shorted her paycheck again. And although she's a full-time worker, she receives no health benefits.

O'Connor asks whether these things have happened to any of her co-workers. Her face creases with an expression that's part grin and part grimace.

"Solamente a los hispanos," she says. Only to the Hispanics. "Creo que es que somos hispanos." I think it's because we're Hispanics.

O'Connor takes notes. He will look into it.

As executive director of the non-profit N.C. Occupational Safety and Health Project, O'Connor's job is to be an advocate for ill-treated workers. More and more, his cases involve workers from Mexico and other countries south of the border.

But truth be told, neither O'Connor nor the state labor department has a handle of this segment of the work force.

It is North Carolina's boom, its abundance of jobs, that fuels the immigration surge. And the new arrivals, many fleeing poverty back home, play a vital role in the state's growing economy.

Anyone driving past a construction site need only look to confirm that Hispanics make up a large and growing percentage of the workers erecting the new subdivisions, office buildings and shopping malls that mark North Carolina as a player in the New South. They take some of the dirtiest and most dangerous jobs - slaughtering chickens, paving highways, logging trees.

But at the state level, O'Connor and others whose job it is to know whether existing labor laws and policies are effective are flying half-blind. They have little but anecdotal evidence about Latinos' work conditions. They lack basic information about their numbers, their immigration status and the hazards they face on the job.

Now, N.C. State University researchers - teaming up with O'Connor's advocacy organization, the state Department of Labor, labor activists and others - are undertaking an ambitious study of the state's Hispanic work force.

The preliminary results raise as many questions as they answer, says Jeffrey Leiter, a professor of sociology and anthropology at NCSU, who is helping lead the research.

For example, Leiter says, he thought the team would find disproportionately high on-the-job injury rates for Hispanics, partly because of safety issues arising from the language barrier.

But an unexpected pattern emerged from the information on large work sites the team pieced together from federal and state databases: In certain job categories, a surprisingly low percentage of Latino employees reported workplace injuries.

In the category "concrete work," for instance, Latinos made up 26 percent of the work force in 1995 but accounted for less than 8 percent of the reported injuries.

"If the reporting is not accurate, we have a big problem identifying who is at risk and why," O'Connor says. "We can't understand what the problems are and how to reduce injuries.

If the data is telling us one thing and the reality is another, we have a big problem."

Leiter's team of students and researchers will soon conduct field interviews to determine whether Hispanic workers are less likely to report injuries. Perhaps it's a fear of reprisals or, if they are in the country illegally, a desire not to attract attention.

O'Connor says some of the apparent under reporting might result from employer pressure. Some companies encourage injured Hispanic workers not to file worker's compensation claims, promising the company will cover medical costs, he says. Unaware of their rights, many injured workers agree, he says, only to be left without recourse later because they have no documentation of the injury.

Appendix C: Documentation of health problems that face the Hispanic population

May 10, 1996

The News & Observer
Rubella outbreak hits Latinos hard Illness, fear twin foes in Chatham
By Ben Stocking; Staff Writer Page: A1

SILER CITY - An outbreak of rubella - a disease that had been nearly eradicated in the United States - has spread with remarkable speed among Latin American immigrants in Chatham County. Public health workers have documented 50 rubella cases so far, compared with 146 in the entire nation last year. To contain the outbreak, health workers have been going from home to home, business to business trying to persuade immigrants to be immunized. Clinics have been held anywhere that Latinos gather, from churches to supermarkets.

"Gaining their trust has been hard," said Maria Rangel-Sharpless, an epidemiologist with the state Division of Maternal and Child Health. "We've had to overcome a lot of obstacles."

Nearly four weeks into the outbreak, state and county health officials are confident that it is almost contained. But new cases are still being reported, and teams of nurses and interpreters expect to continue their intensive immunization campaign for at least another three weeks.

Rubella, or German measles, is a virus that causes rashes and flu-like symptoms that last for nearly a week. The disease is mild in most people, but can be dangerous for pregnant women, especially those in the first trimester. Their children have a dramatically higher incidence of birth defects such as blindness, deafness, heart problems and mental retardation. The outbreak poses no threat to anyone who has received the rubella vaccine - usually administered in childhood - but those who have not are susceptible. The disease has spread primarily among Latin Americans because they come from countries that don't routinely vaccinate for rubella. Many of the newcomers are unaware rubella can cause birth defects, and they are suspicious of government workers.

Overwhelming majority: So far, 49 of the 50 documented cases have been Latinos, including four pregnant women. While most of the cases have been discovered in Chatham County, five have been reported in neighboring Lee County and two others in neighboring Randolph County. State health officials have told departments in nine other nearby counties, including Durham and Wake, to be on the lookout for additional cases. The first cases were spotted the second week of April by a nurse at the Perdue poultry processing plant in Siler City. She noticed that two plant employees had developed rashes. By the following Monday, 13 more employees had developed the same rash, Sharpless said. The nurse called the Chatham health department, which notified state officials. They ordered blood tests that showed the workers had rubella.

Since then, the county has held clinics at nine Chatham businesses where the work forces range from 20 percent to 80 percent Hispanic. The first one began at 5:30 a.m. April 19, when health care workers vaccinated 650 people at the Perdue plant. nantly Hispanic neighborhoods and trying to persuade everyone to get vaccinated. Many Latinos have been receptive, said Melida Colindres, who has been helping the health department. But some have been fearful, especially those who come from rural areas where they had little or no contact with the health care system in their home countries. "We have had to go to their houses two or three times and really convince them that this is a health issue and that they needed the vaccine and that their children needed the vaccine," Colindres said.

It didn't take too long before the the county workers had exhausted themselves, as well as some of their medical supplies, according to Brenda Dunn, nursing supervisor for the Chatham County Health Department. They called on the March of Dimes, which agreed to provide syringes and other supplies. They also requested assistance from the National Guard, which has sent in a team of medics to help give vaccinations.

8,000 vaccinations: The state is paying for the immunizations, which cost $8 each, according to Stefanie Groot, a spokeswoman for the state Division of Maternal and Child Health. So far, about 8,000 people have been vaccinated. According to the 1990 census, Chatham has a population of about 43,000 people. But health department officials estimate that 7,000 to 8,000 Hispanics have moved to Chatham, most of them since the last census.

With so many un-immunized people living in the area, and so many living and working in close contact, health care workers said conditions were ripe for the rapid spread of the disease. Rubella passes through casual contact, as easily as a cold. "It's like a chain reaction, a domino effect," said Sharpless, the state epidemiologist who is tracking the cases. "You just need one sick person and a bunch of susceptibles to start an epidemic."

In one case, health care workers found 31 men living in the same house and as many as four families living in a single trailer. In such conditions, disease can spread very quickly. Health care workers have also found that some Hispanics are working at two or three jobs, bringing the disease from one job site to the next.

Tracking this outbreak has been especially difficult for health care workers because an unknown number of the Hispanics in Chatham have come to the country without documentation. Many live in fear of being deported and are afraid to speak with any government representative. Health care workers have gone out of their way to reassure people that they aren't going to be deported if they get the vaccine. "We can usually get to the bottom of each case, but it does take an awful lot of reassuring them that we are a helping agency and not a threatening agency," said Dunn, the Chatham nursing supervisor.

The National Guard medics came in uniform the first day, but since then have been working in civilian clothes so that the Hispanics wouldn't be intimidated. Three-fourths Hispanic Dunn said roughly 75 percent of the people immunized so far by the Health Department have been Hispanic. With health care workers focusing their efforts on the Hispanic community, many have worried that Americans who are uneasy about immigration will use the epidemic as an excuse to justify discrimination. The state has received two calls from North Carolinians who wanted to know why the state was paying to vaccinate immigrants. Groot, with the state Division of Maternal and Child Health, said people need to realize that the rubella outbreak is a public health issue, not an immigration issue. "We're here to serve anyone who needs medical assistance," she said. "Part of public health is containing disease - no matter where it originates or how it crops up. We need to contain it to protect everyone."

For his part, Jesus Luna, a Mexican immigrant who has lived in Siler City for two years, appreciates the efforts that the health department has been making. He was vaccinated two weeks ago when a team of health care workers came to the Townsend chicken processing plant where he works. "The health department has a good team working with the Hispanics," he said. "They told us it was very important to get vaccinated. People weren't aware of the danger.

October 12, 1997

The News & Observer
Minority health concerns heard
By CATHERINE CLABBY; STAFF WRITER

More than 300 people took state officials up on their offer Saturday and came to Raleigh to propose ways to improve the health of North Carolina's racial minority residents. But they didn't talk much about medicine.

Instead, in heated discussions in sterile meeting rooms at a Raleigh conference center they spoke long and loud about the social, economic and spiritual threats to people's well-being. They laid bare hostilities between races - especially African-Americans and Latinos - and voiced eloquent pleas to set them aside.

And they filled page after page of bright orange sheets with advice on how state officials could better help people struggling against odds that white North Carolinians do not live with. When they were done, they demanded action.

"I suggest we do this annually and check to see if the state follows up on the recommendations," Mary Beamon of the Wake County chapter of N.C. Fair Share suggested near the end of the day. "If they don't, we can reiterate them."

Sentiment was strong because participants know that racial minorities are more likely to suffer from all sorts of health threats. Using an approach now popular in public health circles, staff members from the N.C. Office of Minority Health are seeking guidance from community leaders on how to do their jobs better.

The men and women who arrived before breakfast at the Jane S. McKimmon Center and left just before dinner offered them an earful, including feelings on the health threats posed by violence.

Dr. Paul R. G. Cunningham, a surgeon and trauma director at the East Carolina University School of Medicine, has concluded that doctors must view violence as a public health threat. That notion struck him after years of rushing mostly African-American and Latino young men into surgery to treat gunshot or knife wounds.

Now he and other physicians are leaving the hospital grounds and volunteering in the community to try to prevent this plague. "For a while I had become desensitized," he said. "We had failed."

Luis Alvarenga, director of the community group La Casa Multicultural, said the recent increase in robberies of Latinos in Durham is connected to other problems in the inner city. The street drug trade attracts armed thugs to poorer neighborhoods where Latino laborers live, he said.

"In every single neighborhood there is drug dealing going on," he said. "That is bringing this viciousness in."

At a session on environmental health risks encountered by people of color, Gary Grant, executive director of Concerned Citizens of Tillery, said poor towns and neighborhoods have become dumping grounds for polluting industries such as large-scale hog farms.

Caroline Whitehead Doherty of the N.C. Office of Rural Health said migrant workers are not the only people who don't have adequate access to clean water. Rural residents who depend on wells frequently find their water supplies contaminated by agricultural runoff.

"Not all of them can afford to buy water every month," she said.

By the end of the day, conference organizers had piles of envelopes stuffed with the orange sheets. Participants, who came from across the state, suggested everything from eliminating the food tax to putting counseling stations next to police substations in poor neighborhoods.

Some were concerned that Gov. Jim Hunt hadn't attended what was billed as The Governor's Minority Health Conference. Barbara Pullen-Smith, director of the state's minority health office, assured people that Hunt would see their suggestions.

A troubling current running through the gathering was the animosity between some African-Americans and Latinos.

Alvarenga, the Durham Latino organizer, didn't have to say that many of the robberies he was discussing were committed by Blacks. Several people knew.

Ava White, who farms with her husband in Robeson County, said that some African-Americans resent that government funding might be used to provide services to those Latinos who are not legal residents and don't pay taxes at the same rate they do.

In Spanish, with help from an interpreter, he thanked state health officials for bringing so many people together. He said much was accomplished by so much talk. But there was more work to be done.

"I think this is like a rising flame. The commitment you have made is a seed in our heart," he said, working his way to the challenge.

"It is important that tomorrow be different than today. The racial division must end. We don't do this for ourselves but for the future."

Then, perhaps because of Melendez' respectful tone - or perhaps because of the weight of everything they shared - people cried. White, Brown and Black.

Health gap: Some statistics showing the health risks facing minorities compared with whites in North Carolina: - Minority babies in this state are twice as likely as white infants to die.

The average life expectancy for minority adults is five years shorter.
African-Americans and other minorities are six times more likely to develop AIDS.
Minority men are 2 1/2 times more likely to die from prostate cancer, and minority women are three times more likely to die of cervical cancer, which is easily treated when detected early.
Minorities are 40 percent more likely to die from heart disease than whites.

Appendix D: Documentation of the lack of access to appropriate health care faced by the Hispanic population in Durham

March 24, 2000

The News & Observer
Access to health care unequal in N. Carolina
By Ned Glascock; STAFF WRITER Page: A8

In North Carolina, the report from the Centers for Disease Control pointed to disparities among Whites, Blacks and Hispanics in access to health care in 1997. For instance, 12.8 percent of White people surveyed reported having no health-care coverage, compared to 20.4 percent of Blacks and 21.4 percent for Hispanics. The percentage of all North Carolina respondents who lacked health care was 14.7 percent, slightly above the national median of 12 percent. The report also painted a portrait of Tar Heel health. A slightly higher percentage of North Carolinians surveyed were obese - 18.4 percent - than the national median, 16.6 percent. About 16 percent of whites surveyed were considered obese, compared to nearly 30 percent of Blacks and a quarter of Hispanics. Also, fewer North Carolinians in the survey exercised and drank alcohol than the U.S. median, but more smoked cigarettes. Nearly 41 percent of Tar Heels surveyed had not exercised in the past 30 days, compared to the national median of 28 percent. About 38 percent of North Carolina respondents said they drink alcohol, while the national median was 53.5 percent. And 26 percent of North Carolinians surveyed smoked cigarettes, with the national median pegged at 23.3 percent. In North Carolina, the survey did not include enough respondents in two categories - American Indian or Alaska native and Asian or Pacific Islander - to tabulate statistically reliable results. For Hispanics, a category of ethnic origin that includes people of any race, only 82 respondents were contacted in North Carolina, just above the cutoff of 50 required by the survey.

August 22, 1999

The News & Observer
FINAL WORD Page: A32

Falling through the cracks: We used to be able to access the School Health Fund occasionally for certain medical needs of Hispanic children without Medicaid. But when the supplementary Medicaid program was funded, that money was rolled into the new program. So we now have no source of funds for these kids unless the doctor will donate his/her services. Some will, bless their hearts. But it is very hard to get dental care, glasses, lab tests this way. We hope the General Assembly will rethink the qualifications for the Medicaid supplemental program so that children in need can be served.

Rose Gallagher

Migrant outreach worker Edgecombe County Schools

January 9, 1991

The News & Observer Report says Hispanics lacking in health care
By The Associated Press Page: A11

CHICAGO -- Hispanics lack medical coverage more than any other U.S. ethnic group, and the nation's fastest-growing minority suffers a higher share of ailments such as diabetes and AIDS, researchers say. Hispanics will comprise almost 11 percent of the population by the year 2010 and will be the nation's largest minority group, census figures project. Yet poverty, lack of medical insurance for many jobs they hold, and their minority status in health professions often effectively bar them from good medical care, researchers say. The situation gets even more bleak as Hispanics adopt U.S. culture -- including its smoking and eating patterns, said a report today in the Journal of the American Medical Association.

The issue is devoted entirely to the topic of Hispanic health. "Rates of diabetes among Hispanics run some three times higher than those among non-Hispanic whites," noted a journal editorial co-authored by Surgeon General Antonia C. Novello, the first Hispanic to hold that post. Dr. Novello wrote with two staffers at the U.S. Public Health Service. "Hypertension appears to be more prevalent," they said. "Hispanic children suffer disproportionately from lead poisoning and measles. Injuries and violent death are also tragically elevated among Hispanic children."

Certain cancers also strike Hispanics at higher rates than non-Hispanic whites, as do tuberculosis, alcoholism, cirrhosis and infection with the AIDS virus, according to the editorial and a report by the AMA's Council on Scientific Affairs. "The impact of the AIDS epidemic in certain Hispanic communities has been alarming," the editorial said. "Although representing only 8 percent of the total U.S. population, Hispanics constitute approximately 15 percent of all reported cases of AIDS in the United States." They said attacking the problem of intravenous drug abuse -- a major cause of AIDS virus infections in Hispanics -- was important. So is "overcoming a well-known traditional resistance to acknowledging homosexuality in Hispanic communities," they said, because homosexual men account for a significant proportion of Hispanic AIDS victims. Also recommended were developing cooperative efforts on the U.S.-Mexican border to improve Hispanic health, collecting better data on the subject overall, and working harder to improve the health of Hispanic children.

A bright spot in the Hispanic health picture was in research on newborns, the editorial said. Despite relatively low family incomes, poor health insurance coverage, and low use of prenatal care, Mexican-American newborns have relatively low rates of death and of low-birth-weights when compared to non-Hispanic Whites and to Blacks.

July 24, 1999

The News & Observer
Latinos face health obstacles
By JEN GOMEZ; STAFF WRITER

DURHAM -- The number of immigrant Latinos seeking medical attention is growing, but several barriers - including a language gap and lack of transportation - haven't made it an easy trip to the doctor's office.

"The key issue is the language barrier," said Mike McLaughlin, who conducted a study on Hispanic/Latino Health Issues through the N.C. Center for Public Policy Research. "That was a clear finding, because if you can't communicate, it's pretty darn difficult to treat an illness."

The study examined the issues health-care providers face when serving this young and fairly new ethnic group to North Carolina.

Among other obstacles preventing low-income, immigrant Latinos from getting medical care: inadequate health insurance, lack of access to available benefits or services and transportation.

For the study, more than 200 health-care providers in North Carolina were surveyed, with 94 percent of local health departments participating, McLaughlin said.

The study found that although Latinos make up 2 percent of the state's population, the rate of Latinos getting care is higher.

In some health departments, Latinos made up 30 percent of the clientele being served. In 1997-1998, Latinos comprised 22.6 percent of the total caseload at the Durham County Health Department.

The study was financed by the Kate B. Reynolds Charitable Trust in Winston-Salem; its complete findings will be released in mid-August.

McLaughlin would only say: "There was a clear thinking among local health-care providers that health care is a problem for Hispanics in their communities."

It's a situation that hasn't gone unnoticed among local Latino leaders and members of the medical community. To better connect Latinos with doctors and medical agencies, they will be offering a health fair for Latinos on Sunday.

More than 50 agencies and health-care providers will be there. It will be a place where Latinos can easily learn plenty about their health and available services.

"Health is a great concern for the Latino population," said Katie Pomerans, the Hispanic ombudsman for the state Department of Health and Human Services. "Of the calls I get, I would say more than half of them are health-related."

The fair will be from 3 to 6 p.m. in the gym and parking lot at Immaculate Conception Catholic Church, 810 W. Chapel Hill St. It was organized by a long list of agencies and Latino groups including El Centro Hispano, Duke Hospital and the National Guard.

A slew of services and information will be offered. Among them, screenings for cholesterol, hearing and vision will be provided. Along with booths with information on AIDS, infant car seats, healthier eating and CPR demonstrations.

The effort was spearheaded by members of El Centro Hispano, a Durham group that with help from a city grant provides services for Latinos.

Ivan Parra, director of El Centro, who regularly handles Latinos' questions about health care, said he hopes the fair will reach a large portion of the community.

"Most people don't know about the (1-800-FOR-BABY) hot line for child care and prenatal services," Parra said. "Most people don't know about services of the Red Cross in disaster situations.

"Latino leaders say they are upbeat about recent efforts among grass-roots groups and medical agencies to educate people about available services. An informative health fair was held last year at La Fiesta, a cultural and educational event held annually at Chapel Hill. Another one is being planned for the Sept. 18-19 festivities.

"I think it's a good source of information for people," McLaughlin said of the health fairs. "Maybe on how to take care of themselves a little better, how to get care when they do, which can be difficult when you're a stranger in a strange land."

Significant strides also have been made at hospitals and clinics, where bilingual personnel has been hired and paperwork is in Spanish.

Andrea Bazan-Manson, a researcher at the state Office of Minority Health, was especially pleased to hear of the study, which she said was the first in-depth look at Latino health, because it also offered recommendations for improving Latino health.

"I think the health-care systems in North Carolina have realized that this is a community that is growing and we need to start focusing on," Bazan-Manson said. "A lot of them don't know what kind of services they can get. The Latino community is becoming aware of the services and using them and also paying for them."

April 27, 1999

The News & Observer
Hispanics less likely to have insurance, study finds
By THE WASHINGTON POST

Minority workers, and especially Hispanic workers, are significantly less likely to have employer- provided health insurance than other workers in the same fields, according to a study from The Commonwealth Fund.

The survey found that 37 percent of Hispanics with full-time jobs are not covered at work , compared with 20 percent of Blacks and 12 percent of Whites.

"Perhaps the most important lesson learned from the analysis is that having a job does not equalize chances of obtaining health insurance coverage for minority workers," the report concludes. "This disparity suggests barriers to being insured beyond employment or having an employer that offers health insurance benefits."

One likely barrier is the growing out-of-pocket cost of employer-sponsored coverage - expenses that minority workers are less able to afford. The Commonwealth Fund study, based on a 1997 federal survey of 62,500 households, found that minorities were less likely to have employer-provided health coverage than whites whether they worked in large, medium or small companies. Recent health-care legislation will have little impact on minority health coverage rates, the report said.

"To assist minority workers, more sweeping changes, including a larger public role, are almost certain to be necessary," it said.

August 13, 1999

The News & Observer

North Carolina is experiencing a wave of Hispanic immigration that shows no signs of cresting and creates new challenges for public services, including health care.

This week, The News & Observer has teamed up with WRAL-TV and the N.C. Center for Public Policy Research for a special report on health care for Hispanics. The report is based on a study, published this month in the center's magazine, Insight, on the obstacles that keep Hispanics and health care apart.

On Saturday, tune into WRAL-TV at 7 p.m. for "30 Minutes," a weekly news magazine with host David Crabtree. On Sunday, see the Q section in The N&O.

Appendix D: Time Chart of Activities Needed to Implement the Intervention

	2000	2001	2002	2003	2004	2005
	SONDJFMAMJJA	SONDJFMAMJJA	SONDJFMAMJJA	SONDJFMAMJJA	SONDJFMAMJJA	S
1. Implementing Tracking System	X_____________	______________	______________	(65%) _________	______________	(90%)
2. Implementing Organizations to give out Information	X_____________	______________	______________	(65%) _________	______________	(90%)
3. Implementing Immunization Standards in Public Schools	X_____________	______________	______________	______________	______________	(90%)
4. Health Care Clinics offering Immunization Programs	X_____________	______________	______________	______________	______________	(75%)
5. Health Care Workers Go and Administer Immunizations to the People	X_____________	______________	______________	______________	______________	(50%)

Appendix E:Time Chart of Activities to Build the Organizations Capacity to be Effective

2000

2001

1. Focus Groups and Meetings

___

2. Accumulate Funds

___

3. Accumulate Equipment and Materials

___

4. Recruit Volunteers

___

5. Hire Remaining Staff

___

6. Volunteer and Staff Training

___

7. Creating Collaborations within the Community

___

8. Promotion and Advertising

___