“Models for their community” — the impact of Florida’s promotores
Hispanic Heritage Month, which runs from Sept. 15 through Oct. 15, celebrates the influence and contributions of the Hispanic American community across the United States. Census data shows that Florida’s Hispanic/Latinx population has increased nearly 35% over the last decade, with over five million Hispanic/Latinx people living in the state today.
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However, health disparities still persist among these communities. For example, the 2019 Health Equity Profile from the Florida Department of Health found that Hispanic/Latinx people are 1.6 times more likely to receive an HIV diagnosis than non-Hispanic people.
Hispanic/Latinx communities are also disproportionately affected by social determinants of health, such as housing and education. The Health Equity Profile found that the median household income from 2015-2019 for Hispanic/Latinx communities ($49,226) was significantly lower than non-Hispanic households ($61,682). The number of Hispanic/Latinx adults without a high school diploma from 2015-2019 was almost three times the amount of non-Hispanic adults.
Solutions to improve these disparities are complex, however, as community demographics in the state continue to change over generations. Robin Lewy, director of programming at the Rural Women’s Health Project (RWHP) based in Gainesville, has witnessed these changes first hand in the 30 years she has worked at the non-profit.
According to Lewy, RWHP served a primary Mexican community in North Central Florida in the 1990s. Ten years ago, that population shifted to communities from Colombia and Venezuela. Today, RWHP primarily serves Guatemalans, Hondurans, and communities from other Central American countries.
Integrating health into the community builds trust in health systems
Lewy explained the difficulties of ensuring access to health care information for women and immigrant communities with limited English proficiency (LEP), particularly during the peak of the HIV/AIDS epidemic in the 1980s and 90s.
To work around the language barrier, RWHP created picture guides that provided information on treatment and where to access care. To get this information out to the community, RWHP utilized promotores, whom Lewy calls “the models for their community.”
Promotores de salud is the Spanish phrase for “community health workers.” According to the Centers for Disease Control and Prevention (CDC), promotores are lay community health workers who serve primarily Spanish-speaking communities. Lewy says working with promotores to hear feedback from the community helped RWHP develop health programming in a culturally competent context.
“People are sharing what they know. We want realistic options to real situations. So the idea of [HIV prevention] — you can’t just say, ‘Strap on a condom’ and walk away when you’re dealing with Latino women who will run into some challenges with their partners if they don’t know how to approach it correctly, or safely.”
Promotores also help disperse information to the community more effectively, Lewy said.
“We’ve started developing materials and moved on to saying, ‘Well great, now we need those who can present the information in a way that will be as broad as possible’ … So we started training community health workers. And that way, each one of them was taking on the responsibility of filtering out to a broader number of members within their smaller communities.”
Building community trust during COVID-19
As the COVID-19 pandemic reached Florida, information about masks, testing, and vaccines were rarely accessible in languages other than English, according to Lewy. RWHP and other equity-focused organizations’ requests for action from the state government were met with little response, an act Lewy described as a “blatant violation of civil rights.”
Instead, RWHP worked in collaboration with the University of Florida’s Equal Access Clinic Network, Florida Legal Services, and University of Florida MedLife to establish VIVIR-21, a resource offering language-accessible information on testing, vaccines, legal advice on housing and employment impacted by COVID, and more.
Lewy said the initiative fosters a dual responsibility for RWHP and its promotores.
“It’s a combination of — with the pandemic — trying to keep up with what’s emerging all the time through the CDC and our health departments, but also how it’s interpreted and what’s needed from the community.”
Working towards future health equity
Despite working towards health equity for three decades, Lewy said RWHP is continuing to develop new resources for its communities. One of these includes language access handbooks with common translations to help LEP members communicate with the appropriate authorities during emergencies.
RWHP also collaborated with the organization Alianza Americas to secure an $1 million grant from the Health Resources and Services Administration (HRSA) in late June 2021. The statewide program that resulted from the grant aims to improve COVID vaccination rates among underserved communities, including agricultural workers across Florida.
As of Sept. 21, the Tampa Bay Times reported that in May 2021, non-Hispanic whites were 80% more likely to be fully vaccinated than Hispanic/Latinx people. By Sept. 2021, that number dropped to just 6%, based on survey data.
Health equity initiatives continue at the legislative level as well. Hispanic Unity of Florida, based in Broward County, outlined several legislative priorities ahead of the 2022 session that focus on increasing health, economic, and educational outcomes for Florida’s Hispanic/Latinx communities. Among its health bucket list items are closing the Medicaid coverage gap, removing eligibility barriers to Florida KidCare enrollment, and increasing reimbursement for community nonprofits and places of worship.
Lewy said the work toward health equity is ongoing.
“We need to be cognizant of the fact that our country is shifting and shifts in five year cycles. We are blessed with the participation of new foreign-born community members in the country. And to [be cognizant] and to be respectful and recognize the value that they bring to us culturally, economically, intellectually, we must stay on our toes to be responsive to those shifts.”