Summit planners identified three interrelated cutting edge issues related to the health of communities of color. Collectively, how these issues are resolved will impact access to and the quality of health care experienced by every ethnic / racial community in California and ultimately, by all Californians. These issues also profoundly affect how ethnic physicians practice medicine and serve their communities and patients. The afternoon Policy Advocacy Workshop subsequently discussed the policy issues raised during the morning session and made recommendations on how the Network of Ethnic Physician Organizations could become effectively involved in public policy advocacy.

Language Access
Alice Chen, MD, MPH, Asian Pacific Islander American Health Forum

Dr. Chen reported that language access in health care is a growing issue in California as the number of limited-English-proficient (LEP) individuals is increasing much faster than the numbers of bi-lingual providers who can communicate with them. Furthermore, this issue disproportionately impacts physicians of color who tend to serve non-white and LEP patients at rates far greater than their white counterparts.

The rationale for ensuring language access is compelling. The inability of physicians to communicate accurately and effectively with their patients results in increased medical error, reduced patient compliance, inadequate informed consent, and longer and less productive physician-patient encounters. While helping to bridge a language gap, the use of friends and family to interpret physician-patient encounters frequently leads to inaccurate information exchange, violations of patient confidentiality, and potential psychological trauma to young children who are required to deliver difficult news to a parent.

At present, systems for providing interpreter services to low-income LEP consumers is far from adequate. In general, the high cost of interpreter services must be borne by physicians who are operating within the constraints of Medicaid reimbursement rates. Unlike several other states, California's Medicaid program does not reimburse for the cost of interpreters.

There are, however, emerging technologies and strategies. Remote simultaneous interpretation and the use of videoconferencing are two strategies that can extend the availability of interpreter services at a reasonable cost. Additionally, the Alameda Alliance has decided to cover the full cost of professional medical interpreters and arranges for their use.

Ethnic physicians have an important role to play in promoting the adoption of public policies that will extend the availability of trained interpreters to all LEP residents of California. Their voices will be critical in communicating the importance of language access and in ensuring that the resultant systems are equitable and cost-effective.

Institute of Medicine Report on Disparities in Health Care Services
Carolina Reyes, MD, Vice-President, Planning and Evaluation, The California Endowment

Dr. Reyes discussed disparities in the delivery of health care services focusing on the findings of the Institute of Medicine report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care." Dr. Reyes served as a member of the IOM Committee that conducted the research captured in the IOM Report.

Dr. Reyes reported that while "health interventions have improved the overall health of the majority of Americans, minorities have benefited less from these advances." Disparities in health status have multiple underlying causes including variations in the social determinants of health and access to care. The IOM report, however, also found that minorities in America tend to receive health care that is of lower quality. The report identified unfavorable differences in utilization rates by race for the following medical procedures: