HomeMy WebLinkAboutMINUTES - 05082001 - D.4 DA
THE BOARD OF SUPERVISORS
CONTRA COSTA COUNTY, CALIFORNIA
Date: May 8, 2001 Public Comment
On this date, the Board called for Public Comment. The following people
addressed the issues affecting the Latino population in the County.
Mary Rocha, Contra Costa Latino Leadership Council, 3022 Rio Grande
Drive, Antioch;
Maria Alegria, Contra Costa Latino Leadership Council, 3718 Brazil, Pinole;
Mary Rosas, 171 Sandpiper Drive, Pittsburg;
John Marquez, 5061 Buckboard Way, Richmond.
The Board CLOSED Public Comment.
THIS IS A MATTER FOR RECORD PURPOSES ONLY
NO BOARD ACTION WAS TAKEN
AGENDA DATE _ D/ ITEM NO. -
BACKGROUND NOT AVAILABLE AT
THE TIME AGENDA PACKET COMPILED
INFORMATION FOR THIS ITEM PREVIOUSLY
FURNISHED
ORAL REPORT TO BE GIVEN AT BOARD MEETING
ERROR IN NUMBERING AGENDA ITEM
DELETED
DOCUMENTS ON FILE WITH
CLERK
_� PUBLIC COMMENT
THE LATINO
LEADERSHIP
COUNCIL OF
CONTRA COSTA
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A STATUS REPORT FOR
PROGRAM PLANNING,
POLICY DEVELOPMENT
' AND ADVOCACY
LATINO LEADERSHIP COUNCIL
OF
CONTRA COSTA
The Latino Leadership Council was conceived in 1998 and established in 1999 in
' response to the declining level of community based agencies that served the
Latino population of the county. The LLC has worked diligently over the past two
years to forge relationships, consolidate resources, mentor emerging Latino
' leaders, and work collaboratively to address issues that affect Contra Costa
Latinos.
The enthusiastic volunteer participation of over 200 Latino Leadership Council
members has enabled the organization to make impressive progress in engaging
Contra Costa Latinos in the development of plans to improve the quality of life for
' Latinos and all community residents, cultivate proactive Latino leadership, and
preserve the community's language and cultural traditions.
' The Latino Leadership Council has brought together community members
through Leadership Summits that offered local Latino leaders the unique
opportunity to share information, collect data, and discuss issues related to
' advocacy and empowerment. The result has been the identification of
collaborative strategies, resources and action plans to benefit the Contra Costa
Latino community.
In late 2000, the Latino Leadership Council finalized its Strategic Plan, containing
goals and objectives related to improving the health and educational status of
Latinos in Contra Costa. A key activity in this plan was to develop this health
profile and ensure that key stakeholders are informed of the gaps, needs and
resources required to improve the health status of Contra Costa's Latinos.
The Latino Leadership Council is proud to present this important document that
can be used by policy makers, community organizers, health and education
professionals to address the issues of our community.
A/017 lac--'
' Mary Rocha, Chairperson
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TABLE OF CONTENTS
' Pages
Executive Summary I — II
' Section 1: Social and Demographic Profile 1 - 14
' Section 2: Deaths 16 - 24
Section 3: Maternal, Child and Adolescent Health 25 -30
Section 4: Chronic Diseases 31 -45
' Section 5: Communicable Diseases 46 - 54
Section 6: Mental and Behavioral Health 55 - 59
Section 7: Health Care Access and the Health Care System 60 - 65
Bibliography 66 - 68
Acknowledgement 69 - 70
1
1 ..
1
EXECUTIVE SUMMARY
The Latino community is the youngest and fastest growing population in Contra Costa. '
Present data show Latinos constituting about 15% of the county's overall population.
Latinos (47%) and Asian/Pacific Islanders (45%) have experienced the largest increase
in population over the ten-year period ending in 1998. '
In 1997, Latino children between the ages of 0-9 years old comprised over 17% of all
children in that age group throughout the entire county, while Latino children from 0-4 t
represent 18.3%.The Eastern portion of the county has the highest concentration of
Latinos, which is almost 22% of that area's population. Results of the 2000 Census will
probably show an increase in the Latino population in all age groups, especially children. '
As a young population, the Latino community shows a low mortality rate for heart
disease, stroke and cancer. However, the ranking for these causes of death is almost
identical for.the US population as a whole. This may show that the Latino community
benefits from its youth, however, over time, as the population ages, similar death rates
from these diseases may be evidenced.
Chronic disease is a concern for certain segments of the Latino population. Of significant
'
9 P P 9.
concern is the increased rate of hospitalization for Latinos of all ages.and for children
under age 15. Asthma hospitalization rates decreased at a statistically-significant rate for
all other race/ethnic groups, except Latinos.
In 1990 census year, Latinos made up'about 11.4 percent of Contra Costa's population;
a disproportionably higher percentage of Latinos (20.5%) were living below the federal
poverty line, however, Latinos had the highest rate of participation in the workforce in
1990 (72.7%), when compared to all other races and ethnic groups. They may be
categorized as 'the working poor."
Although Latinos have the highest employment rate, they have the lowest
insurance. coverage of any ethnic group in the county. This is also reflected '
in state data as well. The implications of this high uninsurance rate include:
less access to preventive services ranging from Pap smears, mammograms
and colorectal screenings; delays in receiving early prenatal care and
reproductive health services; and very low utilization rates for County-based
mental health services.
The results of Late or no access to preventive and diagnostic services are seen in a low '
immunization rate among Latino children, an increase in the cervical/uterine mortality
rates compared to other ethnic groups, and a high teen birth rate.
The Latina teen birth rate is of great concern in Contra Costa. In 1997, of the 424 births
to teen mothers, Latinas represented 41% of those births or 173 births. Children born to '
teen mothers are more prone to living under the poverty level and have a much higher
drop out rate. The main health status indicator of any population is its socioeconomic
level, demonstrating that these children's futures are at risk, given their reduced chance '
to attain an educationand being successfully employed. It is important to note that the
rate for teen births is increasing in this population, and as more and more children are
born to Latina teens, more resources will be required to serve the needs of this at-risk
group of children.
Latinas are less likely than white, Asian-American, and African-American women to
receive prenatal care in their first trimester. Only 79.1% of Latina pregnant women in the
county began prenatal care during the first trimester, compared to 90.8% of White
_ women, 80.2% of Black women, and 84.7% or Asian-American women.
Another important indicator for the future success of the Latino community is its
educational attainment. Without at least a high school education, the chances for
successful employment are reduced. As mentioned earlier, the single most important
indicator of health status is socioeconomic level.
. ' According to the Hispanic Community Foundation, "the overall educational attainment of
Latinos in the Bay Area is among the lowest of all ethnic groups in the State of
California." In Contra Costa, the picture is just as dismal. In the 1998-1999 school year
' Latinos comprised 27.2% of all high school dropouts.
Although the remaining students complete high school, this does signify that they are
eligible for college. About 25.9 percent of Latinos who graduated from high school had
taken courses that qualified them for entrance into the UC/CSU colleges and
universities. Asian/Pacific Islanders (60%) and white (49%) graduates were much more
' likely to have taken these courses than their Latino counterparts. Again, the
opportunities for successful employment are limited without the advantage of a college
degree. The cycle of low rates of health insurance and a high poverty rate will continue if
this issue is not addressed.
Almost one-third (30.6%) of all fatal injuries among Latinos are due to firearms,
compared to whites (23%), Asians (28.2%) and African Americans (51.9%). Latinos
have the highest percentage injury death from poisonings (22.2%) and the second
highest number of deaths for motor vehicle accidents.
' Latinos comprised._about 14 percent of the population but represented 19.7 percent of
homicide victims and the Latino adolescent/young adult death rate was twice that of the
white population in 1995-1996. This alarming rate must be addressed for the health and
' safety of the entire Latino Community.
To positively impact the health and education issues of the Latino population will require
enhanced outreach efforts especially in the area of preventive care and in publicizing the
availability of County health services. Bilingual outreach workers would validate the
viability of utilizing county services and provide greater access to identification of risk
factors within the Latino family structure. Increased support for existing organizations
that serve the Latino community would have a dramatic effect on reversing some of the
alarming trends that have been identified in this report.
1
I I
CONTRA COSTA LATINO HEALTH PROFILE
Section 1: Social and Demographic Profile
Key Findings:
s:
Population by Age, Race, and. Ethnicity
■ About 15% of Contra Costa's population is Latino. In 1997, Latino children
between the ages of 0-9 years old comprised over 17% of all children in that
age group throughout the entire county, while Latino children from 0-4
represent 18.3%. The Eastern portion of the county has the highest
concentration of Latinos, which is almost 22% of that area's population.
Results of the 2000 Census will probably show an increase in the Latino
population in all age groups, especially children.
■ As larger numbers and percentages of children age, it is important to
recognize the impact this will have on schools and service needs. The
Latino birth rate, per 1,000 population, was almost double that of the'county '
rate in 1995 and 1997.
Poverty and:Public Assistance
■ In 1990, (Latinos made up about 11.4 percent of Contra Costa's population;
a disproportionably higher percentage of Latinos (20.5%) were living below ,
-the federal poverty line.
■ About 25 percent of Latino children, between the ages of 0 and 11, were ,
living in poverty in 1990. .
• Latinos may be significantly underrepresented by CalWORKS data because ,
of their inability to qualify for these benefits due to their immigration status
and their concerns associated with "public charge" issues. ,
Employment/Labor Force
■ Latinos had the highest rate of participation in the workforce in 1990 ,
(72.7%), when compared to all other races and ethnic groups.
■ The majority of working Latinos were employed in the Technical, Sales and
Administrative Support (29.2%), Services (18.0%), and Operators,
Fabricators and Laborers (17.1%) occupations.
Education
■ The largest number of Latinos graduated from West Contra Costa Unified, '
9
Mt. Diablo Unified, Antioch Unified, Liberty Union. High School, and Pittsburg
Unified, in the 1998-1999 school year. '
1
CONTRA COSTA LATINO HEALTH PROFILE
■ In the 1995-1996 school year, Latinos represented 14.6 percent of the
school population and 27.8 percent of Contra Costa County dropouts. By the
1998-1999 school year, Latinos represented 14.6 percent of the student
population and 26.3 percent of the dropouts.
Population b Age, Race and Ethnicity
P Y 9 � Y
' Why is it important?
Age is perhaps the powerful indicator of the kinds of future health challenges that,
a community faces and needs to consider in allocating scarce resources. While
all age groups need access to affordable and appropriate primary care, different
' age groups have specific needs based upon their stage in the life course.
As one of the most ethnically diverse counties in the United States, it is important
to pay attention to the differences in disease, disability, and utilization of health
care services, so that appropriate health planning and services are designed to
meet the needs of each population group. Although there may not be dramatic
differences in health status, it is important to consider how the Latino population
is growing and how their needs as well as the assets they bring will shift and
change as the community's age distribution and socioeconomic changes.
What is the status of Latinos?
Contra Costa's overall population increased by 12.6 percent between 1990 and
1998 and is expected to increase by another 14.4 percent between 2000 and
2010. TheCentral County has the largest population followed by East County
and West County.
Contra Costa County is becoming more ethnically diverse. In 1998, about 38
percent of the population was non-white, compared to 30.6 percent in 1990.
Latinos (47%) and Asian/Pacific Islanders (45%) have experienced the largest
increase in population over the ten-year period.
West County is the most ethnically diverse region in the county with 65 percent of
the residents described as people of color. East County is the second most
ethnically mixed region in the county. The largest number (50,614) and percent
(22%) of Latinos live in East County and West County (41,271 Latinos which
represent 19 percent of the population).
The median age for Latinos is 25, which is significantly lower than the Contra
Costa median age of 33. About 23 percent of the Latino population was age nine
or younger, compared to whites (16.5%), African Americans (12.9%), and Asians
16.4%). Seventy-two percent of Latinos are under age 40. Seventeen percent of
children age nine and younger, who reside in Contra Costa, are Latino. There
i
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CONTRA COSTA LATINO HEALTH PROFILE
were 79,664 children age 0 to 4 in 1997 in Contra Costa, of which 18.3 percent
(14,365) were Latino, although Latinos comprised only about 15 percent of the
population. As a larger number and percentages of children age, it is important to
recognize the impact this will have on schools and service needs. The Latino
birth rate, aper 1,000 population, was almost double that of the county rate in 1995
and 1997.
Race/Ethnic Distribution Table 1 '
Contra Costa County/California, 1990 and 1998 (1)
(N=in78,639 1990 and N=903,477 in 1998)
Latino White African Asian/ American
American Pacific Islander Indian/Other
1990 1998 1990 1998 1990 . 1998. 1990 1998 1990 1998
Contra Costa '
County(Z' 11.49,, 14.9% 69.6% 63.5% 9.1% 9.1% 9.3% 11.8% 0.8% .7%
California 29.4% 31.0% 52.1% 48.5% 7.0% 7.5% 10.9% 12.1% 0.6% 0.9%
1.Source:State Census Center,Department of Finance,Census
2.Source:Contra Costa County United Way/Hospital Collaborative Community Assessment,Northern California
Council for the Community, 1999(for 1998 only)
Race/Ethnic Distribution as a Percent of Total Population
Contra Costa County, 1998. Table 2
O12% 131% [315e
„ - 17 Latino
■White �.
®African American
ElAsian/Pac. Is.
❑Am. Ind./Other
063%
Source:Contra Costa County United Way/Hospital Collaborative Community Assessment 1999(for 1998 only)
See Section Three-Maternal Child Health for birthrate data.
Page 3.
1
CONTRA COSTA LATINO HEALTH PROFILE
Race/Ethnic Distribution as a Percent of the Regional Total
Contra Costa Count , 1998 Table 3
Total Latino White African American Asian/ Am.Ind./
Pac.Is. Other
Central 331,864 35,509 10.7% 254,543 76.7% 9,293 2.8% 31,195 9.4% 1,327 .4%
Count
East 235,416 50,614 21.5% 152,550 64.8% 9,181 3.9% 20,952 8.9% 2,118 .9%
Count
South 113,108 9,727 8.6% 91,731 81.1% 791 .7% 10,632 9.4% 227 .2%
Count
West 223,089 41,271 18.5% 78,527 35.2% 58,449 26.2% 43,279 19.4% 1,561 .7%
County
Total 903,477 137,121 15.2% 577,351 63.9% 77,714 8.6% 106,058 11.7% 5,233
rSource:Contra Costa County United Way/Hospital Collaborative Community Assessment,Northern California Council for the
Community, 1999.
Contra Costa County
Population by Race and Age
Race b Age Cohort and Age Com osition of Each Race, 19972 Table 4 .
County
0-9 r. 10-19 yr 20-29 yr 30-39 yr. 40-49 yr. 50-64 yr 65+ Total
28,051/ 16,120/ 20,804/ 23,786/ 16,138/ 11,134/ 7,260/ 123,643/
Latinos 22.7% 13.1% 16.9% 19.5% 9.1% 9.1 5.9% 100%
101,832/ 81,360/ 77,474/ 117,869/ 75,473/ 76,555/ 87,340/ 617,903/
Whites 16.5% 13.2% 12.5% 19.1% 12.2% 12.5% 14.1% 100%
African 14,875/: 14,989/ 11,336/ 15,195/. 13,962/ 9,845/ 6,703/ 86,905/
Americans 12.9% 18.1% 13.7% 18.4% 16.9% 11.9% 8.1% 100%
Asian/Pac. 18,502/ 17,072/ 14,729/ 21,244/ 20,123/ 13,258/ 8,042/ 112,970/
Islander 16.4% 15.1% 13.1% 18.8% 17.8% 11.7% 7.1% 100%
734/ 773/ 1,001/ 1,245/ 1,101/ 843/ 459/ 6,156/
Other 11.9% 12.6% 16.3% 20.2% 17.9% 13.7% 7.5% 100%
.163,994/ 1 130,314/ 125,344/ 179,339/ 126,797/ 111,635/ 109,804/ 947,227/
Total 17.3% 10.9% 13.22% 18.9% 13.4% 11.8% 11.6% 100%
' Source: United States Census Bureau,"Population Estimates for Counties by Age,Race,and Hispanic
Origin,Annual Time Series:7/1/1990 to 7/1/1999 [WWW Document] URL:
http://www.census.gov/population/estimates
i
t
Z County population totals differ between databases.The U.S. Census Bureau is the only organization that
provides population estimates by race by age and by county.The Contra Costa United Way/Hospital
Collaborative provides ethnic data by Contra Costa regions.
Page 4
CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa County
Population by Race and.Age Cohorts
Age by Race as a Percent of Each Age Cohort, 1997 Table 5
Race 0-9 yr. 10-19 yr 20-29 yr 30-39 yr. 40-65+. .
Latinos 28,051/ 16,120/ 20,804/ 23,786/ 34,532/ ,
17.1% 12.4% 16.5% 13.2% 9.9%
Whites 101;832/. 81,360/ 77,474/ 117,869/ 239,368/
62.1% 62.4% 61.8% 65.7% 68.7% .
African Americans 14,875/ 14,989/ 11,336/ 15,195/ 30,510/
9.1% 11.5% 9:1% 8.5% 8.8%
Asian/Pac.Islander 18,502/ 17,072/ 14,729/. 21,244/ 41,423/
11.3% 13.1% 11.8% 8.8% 11.9%
Other 734/ 773/ 1,001/ 1,245/ 2,403/
.4% .6% .8% 7% .7%
Total 163,994/ 130,314/ 125,344/ 179,339/ 348,236/
100% 100% 100% 100% 100%
Source: United States Census Bureau,"Population Estimates for Counties by Age,Race, and Hispanic
Origin, Annual Time Series:7/1/1990 to 7/1/1999 [WWW Document] URL:
http://www.census.p,ov/i)onulation/estiiiiates
Contra Costa County
Population by Race and Age
Race by-Age Cohorts 0-4 and 5-9), and by Race, 19973 Table 6
0-4 yr. 5-9 yr
Number Percent Number Percent
Latinos 14,365 18.3% 13,686 16.3%
Whites 49,494 62.3% 52,338 62.1% .
African Americans 6,522 8.2% 8,353 7.7%
Asian/Pac.Islander 9,000 11.3% 9,502 11.3%
Other 283 .4% 451 .5%
Total 79,664 100% 84,330 100%
Source: United States Census Bureau,"Population Estimates for Counties by Age,Race,and Hispanic '.
Origin,Annual Time Series: 7/1/1990 to 7/1/1999 [WWW Document] URL:
http://www.census.,gov/population/estimates
County population totals differ between databases.The U.S. Census Bureau is the only organization that
provides population estimates by race by age and by county.The Contra Costa United Way/Hospital
Collaborative provides ethnic data by Contra Costa regions.
Page 5 ,
CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa County
Live Birth Rate by Race, Per 1,000 Population
1994 and 1997 Table 7
1995 1997
Race/Ethnicity Number 'Population Race- Number Population Race-
of Births. Specific of Births Specific
Rate Rate
Latino 2,725 110,298 24.7 2,934 118,900 24.7
White 6,847 580,118 11.8 6,556 586,271 11.2
Black 1,434 79,829 18.0 1,337 83,362 16.0
Other 1,477 97,070 15.2 1,467 107,681 13.6
Total 12,483 867,315 14.4 12,294 896,214 13.7
Source: California Department of Health Services: Birth records, 1994 and 1997"[WWW Document]
URL http://www.dhs.ca.gov/hisp/applications/vsq
Employment and Work Force
Why is it important?
The unemployment rate is one traditional measure of the economic health of a
community. Unlike many other measures, unemployment is collected on a
monthly basis at the county and at the state level, making it easier to track trends. . .
over time. In order to be officially classified as unemployed, a person must be
available for work and must actually searched for work within the previous four
weeks.
However, this measurement is more difficult to attain for a workforce who may be .
more casually employed, as day workers or domestic workers, for example. A
high proportion of the Latino population in Contra Costa is employed.in these
areas, which makes it more difficult to use the standard definition of
unemployment. Therefore, unemployment statistics may under-represent the
actual percent the Latino population that is unemployed.
What is the Latino employment status in Contra Costa?
Unemployment rates in both Contra Coast Count and.California have declined
Y
between 1995 and 1999. In California, whites have the lowest rate of
iunemployment and African Americans the highest. Contra Costa's
unemployment rate was significantly lower than the State in 1999. The Latino
unemployment rate in California decreased, as did the rate for all ethnic groups
in the state.
Latinos had the highest rate of participation in the workforce in 1990 (72.7%);
when compared to all other races and ethnic groups. The majority (78.2%) of
working Latinos were employed full-time (35 or more hours per week). Among
Page 6
CONTRA COSTA LATINO HEALTH PROFILE
c
Latinos, unemployment rates were highest for persons 16 to 19.years (17.9%)
and lowest for persons between the ages of 25 to 64 years (5.8%).
i
The majority of working Latinos were employed in the Technical, Sales and
Administrative Support (29.2%), Services (18.0%), and Operators, Fabricators
and Laborers (17.1%) occupations. In 1990, minorities comprised 27.9 percent
Of the work force but were significantly over represented in the Services (39.7%),
Operators', Fabricators, and Laborers (38.2%), and Farming, Forestry, and
Fishing (50.8%) occupations. ,
Unemployment Rates (percent at year end)
Contra Costa/California, 1995 to 1999 Table 8
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nx•=,ic=.a••.:,a. sF ..�.',:�^ya•,.. ,y,.. ... ....."r`^x':,x :.•<i;",;,, Ft6Y�.:.�>.e::;..?l%»
.1s'� .a:,�:z:A"•aouazsa,L'•a _
Source: U.S Department of Labor, Bureau of Labor Statistics.
i
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CONTRA COSTA LATINO HEALTH PROFILE
1
Contra Costa County Table 9
Labor Force Participation b1f Race and Unemployment Rates b Race, 1990
Universe: Persons 16
Years and Over Total Hispanic White Black Asian/PI NatAmer Other
Civilian Labor Force 427,902 45,170 308,551 32,650 38,429 2,602 500
Civilian Labor Force
Participation Rate 68.8% 72.7% 68.6% 62.9% 71.2% 70.1% 70.2%
Employed 406,507 41,949 296,412 28,505 36,809 2,362 470
At Work Full.Time
(35+Hours/Week) 314,771 32,795 227,785 22,229 29,907 1,718 337
%of employed 77.4% 78.2% 76.8% 78.0% 81.2% 72.7% 71.7%
At Work Part Time
(1-34 Hours/Week) 83,629 8,044 63,381 5,327 6,197 571 109
Unemployed 21,395 3,221 12,139 4,145 1,620 240 30
Unemployment Rate 5.0% 7.1% 3.9% 12.7% 4.2% 9.2% 6.0%
16-19 Years Old 13.9%. 17.9% 10.3% 32.0% 15.9% 34.1% 0.0%
20-24 Years Old 9.5% 9.1% 7.6% 24.4% 8.9% 5.6% 15.5%
25-64 Years Old 4.1% 5.8% 3.3% 10.2% 3.2% 7.6% 4.6%
65 Years+ 3.5% 9.3% 3.2% 3.6% 5.1% 13.0% 0.0%
Not in Labor Force - All
Persons 191,411 . 16,728 139,268 18,776 15,356 1,071 212
Source: U.S. Bureau of the Census, 1990 Census of Population and Housing, Summary Tape
FileAB
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CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa County
Occu ationaI Group by Race/Ethnicit , 1990 Table 10
Persons 16 Total Latino White Black ASian/PI Nat. Other Total
Years and Amer. Minority
Over
Total Of All
Occupations 427,902 45,170 308,551 32,650 38,429 2,602 500 119,351
Managerial
And
Professional 142,332 7,481 114,126 7,137 12,926 538 124 28,206
Executive,
Managerial 76,167 4,075 61,633 3,633 6,508 268 50 14,534
Professional
Specialty 66,165 3,406 52,493 3,504 6,418 270 74 13,672
Technical,
Sales&
Administra- ,
tive Support 147,099 13,170 105,839 12,309 14,724 911 146 41,260
Sales 56,436 4,215 44,544 3,042 4,271 310 54 11,892
Administra-
tive Support 72,864 7,643 48,585 8,060 8,012 484 80 24,279
Services 45,803 8,144 27,600 5,162 4,491 326 80 18,203
Farming,
Forestry And
Fishing 5,813 2,393 2,858 191 324 37 10 2,955'
Precision
Production,
Craft And
Repair 44,695 5,878 32,998 2,701 2,663 369 86 11,697
Operators,
Fabricators
And Laborers 39,989 7,694 24,430 4,457 2,989 371 48 15;559
Unemployed
(Last Worked
1984 Or
Earlier) 2,171 1 410 700 693 312 50 1,471
Poverty and Public Assistance
Why is it important?
Poverty is a key social indicator. Poverty has been associated with higher
mortality rates from chronic disease and violence and is generally associated '
with poorer health status. Poverty limits access to health care services,
nonviolent neighborhoods, and high achieving schools. Impoverished people are
more likely to be homeless, be composed of families headed by a female, have ,
less education, rent as opposed to own a home, and be people of color. In 1993,
the US Census Bureau estimated that the number of people living below the
federal poverty level in Contra Costa increased by 34 percent, from 57,867 to
77,797. As of 1993, the poverty rate for Contra Costa County was 9 percent, up
Page 9
CONTRA COSTA LATINO HEALTH PROFILE
' 4
several percentage points from the 1990 level of 7.3 percent. The new census
data, to be released by March 2001, will help determine if Contra Costa's thriving
economy decreased poverty levels for Latinos in the 1990s.
What is the status of Latinos in Contra Costa?
Although the number of welfare recipients is a declining In Contra Costa County
there are still disparities in poverty and public assistance rates among ethnic and
racial groups. Latinos represented about 15 percent of the general population in
1997, and about 15 percent of CalWORKs recipients. African Americans had a
disproportionately higher percentage of CalWORKs recipients (40.7% of all
CaIWORKS) recipients when compared to their population numbers (9% of the
Contra Costa population in 1997 was African American). Latinos may be
' significantly underrepresented by CaIWORKS data because of their inability to
qualify for these benefits due to their immigration status and their concerns
associated with "public charge" issues. That is, until very recently, use of any
"Public" programs could affect an immigrants ability to obtain citizenship so
Latinos, and other immigrant groups, have avoided enrollment in these programs
(CalWORKS, Medi-Cal, Health Families, etc.).
In 1990, statewide, 23 percent of Latinos lived below the poverty line. According
to the 1990 census,7.3% of Contra Costa residents lived below the 100% .
poverty line, which, for a family of four, was approximately $16,000. In 1990,
' Latinos made up about 11.4 percent of Contra Costa's population; a
disproportionably higher percentage of Latinos (20.5%) were living below the
federal poverty line. About 25 percent of Latino children,between.the ages of 0.
' and 11, were living in poverty in 1990. Lower educational levels (see "Education"
:in this report) and language barriers limit job opportunities, which places Latinos
at a higher risk for living in poverty.
4 Northern Council for the Community,"Health, Social and Economic Indicators Report for Contra Costa
County, 1999
' Page 10
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CONTRA COSTA LATINO HEALTH PROFILE
Public Assistance Recipients (CaIWORKS)
Contra Costa County
Characteristics of Recipients 16 Years and Older, 1997 and 1999 Table 11
Characteristics 1997 1999 Percent Change 1997-1999
Number Percent Number Percent
Latino 2,180 15.3% 1,650 15.2% -24.3%
White 5,300 37.1% 3,760 35.9% 29.1%
African Americans 5,810 40.7% 4,640 41.8% -20.1%
Asian/Pacific Islander 880 6.2% 640 5.9% -27.3%
American Indian 40 3.2% 30 3.2% -25.0%
Filipino 150 1.1% 110 1.0% -26.7% '
Male 2,750 19.3% 2,070 19.1% -24.7%'
Female 11,620 81.4% 8,760 80.9% -24.6%
16-20 years 3,030 21.2% 2,280 21.1% -24.8% ,
21-44 years 10,240 71.8% 7,720 71.3% -24.6%
45-54 years 880 6.2% 660 6.1% -25.0%
55+ 220 1.5% 170 1.5% -22.7%
Total Recipients 14,270 100% 10,830 100% -24.1%
Source:California Department of Social Services;U.S Bureau of Census. _
Latinos Below the Poverty Line
Contra Costa County
By Race and Age, 1990 Table 12 '
Number of all Persons Number of Latinos Below Percent of Latino Below
Below Poverty Level by Poverty Level by Age Group Poverty Line by Age
A e
Group Group
Age Number Number Percent
0-5 8,442 2,296 27.2%
6-11 7,437 1,882 25.3%
12-17 6,015 1,543 25.6% �.
18-64 31,475 5,895 17.7%
65+ 4488 296 6.6%
Total 57,857 11,912 20.6% '
Source: U.S.Census Data, Database C90STF3A, 1990.Total population 1990=803,732;total Latino
population=91,282
*The 1990 poverty line,for a family of four, was approximately$16,000
Education
Why is it important? ,
The Latino population in Contra Costa is younger than the population as a whole.
The educational statistics tell us a great deal about the community's future. For
example, individuals who do not graduate from high school are less employable,
more likely to have lower lifetime incomes, and more likely to become dependent
upon public support. In addition, persons with less than a high school education
are more likely to engage in compromising health behaviors, and to have overall
poorer health outcomes.. '
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CONTRA COSTA LATINO HEALTH PROFILE
How are Latinos doing?
! According to the Hispanic Community Foundation, "the overall educational
attainment of Latinos in the Bay Area is among the lowest of all ethnic groups in
the State of California." In Contra Costa, the picture is just as dismal. In the 1998
S to1999 school year Latinos comprised 27.2% of all high school dropouts.
African Americans (52.7%) and Latinos (64.0%) had the lowest high school
: graduation rates in Contra Costa County in 1996-1997. In the 1995 to1996
school year, Latinos represented 14.6 percent of the school population and 27.8
percent of Contra Costa County dropouts. By the 1998-1999 school year, Latinos
represented 14:6-percent of the student population and 26.3 percent of the
dropouts.5
About 22 ercerif'of Latinos who graduated from high school had taken courses
P g 9
that qualified them for entrance into the UC/USC colleges and universities.
.' Asian/Pacific Islander (60%) and white (49%) graduates were much more likely
to have taken these courses.
The largest number of Latinos graduated from West Contra Costa Unified, Mt.
Diablo Unified, Antioch Unified, Liberty Union High School, and Pittsburg Unified,
in the 1998 to1999 school year. Latino students who graduated from Antioch
Unified (45%) were much more likely to have completed all course required for
UC/USC entrance than those who attended either Pittsburg Unified (9%) or Mt.
Diablo Unified (15%).
The California Department of Education (CDE) reports the average Dropout Rate
t for California at 11.7%. Because there are current data collection procedures and
' difficulties associated with collecting quality graduation rates and dropout data,
according to the CDE, the figures available do not allow for an accurate student-
by-student count for dropouts. Accord ingly,'dropouts and graduation rates don't
' match. The average High School Graduation Rate for the State is reported to be
68.5%. White students have a higher graduation rate estimated at above 85%.
' For Latinos; however, the figure is significantly lower and is estimated.to be
48%.s
5 The Latino Coalition for a Healthy California reports that, "In California,Latinos have a lower 4-year
high school completion rate(56.7%),than Whites(76.7%),African Americans(56.7%)..." . page 6.
6 The State of Latino Education in the San Francisco Bay Area,June 2000, by the Hispanic Community
IFoundation
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CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa County
High School Dropout Rates by Race and by School Year '
1994-1995 and 1998-1999 Table 13
Ethnic Group 1994-1995 School Year 1998-1999 School Year
Enrolled/ Dropouts/ Enrolled/ Dropouts/
% of Enrolled % of Dropouts % of Enrolled % of Dropouts
Latino 5,697/ 274/ 7,428/ 260/
14.6% 28.5% 16.7% 27.2%
23,141/ 431/ 25,180/ 304/
White 59.3% 44.8% 56.6% 31.8%
African American 4,796/ 171/ 5,349/ 287/. '
12.3% 17.8% 12.0% 30.1%
Asian 3,442/. 38/ 4,134/ 57/
8.8% 3.9% 9.3% 6.0%
Filipino 1,562 39/ 1,782/ 28/
4.0% 4.0% 4.0% 2.9%
Native American 224/ 8/ 320/ 6/
.6% .8% .7% .6% ,
Pacific Islander/Other 174/ 2/ 314/ 13/
.4% .2% .7% 1.4%
Total. 39,036/ 963/ 44,507/ 955/
100% 100% 100% 1.4% '
Source: California Department of Education,Educational Demographics Unit."Graduation rates in
California Public Schools,by County, by Ethnic.Group, 1994-1995 and 1998-1999"[WWW Document]
URL http://www.cde.ca.gov '
High School Completion Rates, Public Schools
By Race/Ethnicity.
Contra Costa County, 1996-1997 Table 14 .
High School Graduation - Number Percent ,
Latino 1,052 64.0%
White 4,990 81.0% .
African American 835 52.7%
Asian 824 93.2%
Filipino 342 87.9%
Native American 32 82.1%
Pacific Islander 38 84.4% ,
Source: California Department of Education. "Graduation Rates in California Public Schools,
by County,By Ethnic Group, 1996-1997."
Page 13
CONTRA COSTA LATINO HEALTH PROFILE
In the 1995-1996 school.year Latinos represented 14.6 percent of the school
population and 27.8 percent of Contra Costa County dropouts. By the 1998-1999
L school year, Latino's represented 16.7 percent of the student population and 26.3
percent of the dropouts, which represents a slight decline in the actual number of
Latinos who dropped out of school (274 versus 260).'
Another measure of school success is whether a graduating high school senior
has met the entrance requirements for the University of California (UC) or the
' California State.University system (CSU).8 As can be seen on the following table,
the percentage of UC/CSU eligible-Latinos graduating from Contra Costa schools
is 325 of a total of 1,251 graduates. Although this 26% figure is higher than the
' Latino State average of 22%, it is still unacceptable.
About 25.9 percent of Latinos who graduated from high school had taken
1 courses that qualified them for entrance into the UC/USC colleges and
universities. Asian/Pacific Islanders (60%) and white (49%) graduates were
much more likely to have taken these courses than their Latino counterparts. The
' largest number of Latinos graduated from West Contra Costa Unified, Mt. Diablo
Unified, Antioch Unified, Liberty Union High School, and Pittsburg Unified, in the
1998-1999 school year. Latino students who graduated from Antioch Unified
(45%) were much more likely to have completed all course required for UC/USC
entrance than thosewho attended either Pittsburg Unified (9%) or Mt. Diablo
Unified (15%).
' The Latino Coalition for a Health California reports that,"in California,Latinos have a lower 4-year
Y P Y
high school completion rate(56.7%),than Whites(76.7%),African Americans(56.7%)..."page 6.
s The State of Latino Education in the San Francisco Bay Area,June 2000,by the Hispanic Community
Foundation
Page 14
1
CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa County
Number of 12th Grade Graduates (Public Schools) ,
Com letin all Courses
(Q�Required for U.C. and/or C.S.U. Entrance Table 15
�, ... a. .. iM�.MMi .. .9.... .. ...a'':S•:YCn1X:z '.�• c.
9'
.;<� �EE.«.:E,�:.° �t�.�i�.� ��.. � � CiC� �t.�S��nr��laC�tRe. U�I'QliACA c
Latino White Black Asian/Pacific
Islander ,
District #of Y #of #of #of
Grads 3 v Grads 3 Grads 3 En Grads 3
o � rr o U .SCA ^ v � v � a
y V U 0 0 U U 0 U a; V Cj U
U C7 � � C7 � C7 �
Acalanes Union H.S. 54 26 878 584 9 6 177 141
Antioch Unified 208 94 629 362 121 63 42 26
CC County.Ed.O. 2 . .0 7 0 2 0 0 0
John Swett Unified 23 6 62 13 27 1 29 .7
Liberty Union H.S. 117 29 423 142 11 1 8 3 ,
Martinez Unified 30 11 223 94 10 4 12 6
Mt. Diablo Unified 274 41- 1,406 539 86 16 190 123
PittsburgUnified 112 10 121 16 97 6 20 7 ,
San Ramon Valley 79 27 1,084 685 22 7 156 103
Un.
W.Contra Costa Un. 352 81 378 102 510 109 306 150
Contra Costa Total 1,251 325 5,211 2,537 895 207 947 566
California Total 95,438 21,103 134,229 54,563 22,065 5,799 34483 19,824
By District and Ethnicity 1998-1999
Source: California Department of Education,Educational Demographics Unit."Graduation rates in California Public
Schools,by County,by Ethnic Group, 1994-1995 and 1998-1999" [WWW Document] URL http://www.cde.ca.gov. '
. Page 15 '
CONTRA COSTA LATINO HEALTH PROFILE
Section 2:'Deaths 771
' Key Findings:
1 Leading Causes of Death
■ The Contra Costa County Latino mortality rate (death rate) declined
between 1995 and 1997.
■ The leading causes of death for Latinos was diseases of the heart and
malignant neoplasms (cancer).
Injury Deaths
' ■ From 1995 to1997, in Contra Costa, 769 residents died from fatal injuries.
' ■ 420, or 54.7 percent of these deaths were classified as deaths from
unintentional injuries. Motor vehicle accidents (37.9%) and poisoning/drug
overdoses (24.3%) were responsible for 62.2 percent of these deaths.
.� ■ Latinos had the largest number of deaths from poisonings (22.2%) and
second highest percent (23.1%) of deaths from motor vehicle accidents.
' Firearm Injuries and Deaths
More Californians die from gun injuries than from car crashes. In 1996, there
' were 4,045 gun-related deaths and 4,022 motor-vehicle-related deaths.
There were 21,985 shootings which either resulted in death or
' hospitalization in California during 1995 and 1996. The gun-related death
rate among Latinos in California is 15.2 per 100,000 population.
■ In California in 1997, 71 percent (1,835) of homicide victims were murdered
' with guns. Of these, 48 percent were Latino (884), 29 percent (530) were
black and 15 percent were white.
' In 1995; the number of firearm injury hospitalizations totaled 183, of which
138 were assaults, 11 self-inflicted, and 29 unintentional.
■ In Contra Costa County, from 1995-1996, almost one-third (30.6%) of all
fatal injuries among Latinos was due to firearms
' Suicide
■ In 1995-1996, there were 168 suicides in Contra Costa County.' Whites comprised 85 percent of all suicides followed by Latinos (6%). Firearms
were used in 52 percent of all suicides.
r
' Page 16
CONTRA COSTA LATINO HEALTH PROFILE
Adolescent and Young Adult Deaths
■ The Latino adolescent/young adult death rate w twice that of the white
y g as
population in 1995 to 1996.
Injuries and violence are the dominant health problems of this age group. In
Contra Costa County, unintentional injuries, homicide, and suicide combined
accounted for 71.8 percent of the deaths in the15 to 24 age group. ,
Homicide
■ Of the 1999 arrests for homicides and murder (totaling 33 and 38,
respectively) Latino adults comprised 36 or 51%. However, there were no
juvenile arrests for homicide reported for 1999., which may reflect effective i
youth programs and adolescent violence prevention efforts.
■ In 1994 to 1996, in Contra Costa County, 85 percent of all homicide victims ,
were male. Latinos comprised about 14 percent of the population during this
time period but represented 19.7 percent of the homicide victims.
The majority of premature deaths can be prevented. Approximately half of all
causes of mortality in the United States are linked to external (non-genetic) risk '
factors such as smoking, diet and exercise, alcohol use, microbial agents, toxic
agents, firearms, sexual behavior and accidents. The three leading underlying or
"actual' causes of death—tobacco, diet and exercise, and alcohol use—are all ,
rooted in day-to-day behavioral choices.
Leading Causes of Death
The top three leading causes of death, heart'disease, malignant neoplasms and
stroke were the same for Contra Costa, California and the United.States. ,
Residents of Contra Costa had lower mortality rates for nine of the eleven
leading causes for death (higher mortality rates for strokes and malignant
neoplasms) when compared to Californians in general (Table 16).
1
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CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa County, California, and the United States
1 Leading Causes of Death, 1995-1997 Averages Table 16
Deaths per 100,000 Population Contra Costa California United
County States
Heart Disease 199.2 209.9 280.7
Mali nant Neoplasms 180.4 158.5 204.9
Stroke 60.8 50.8 60.1
UnintentionalIn'uries 24.0 28.2 35.5
Pneumonia and Influenza 34.5 35.0 19.0
' Chronic Obstructive Pulmonary Disease 34.5 34.9 39.2
Acquired Immune Deflciency Syndrome 11.8 12.9 16.4
' Chronic Liver Disease/Cirrhosis 10.6 10.9 9.6
Suicide 9.6 11.0 11.9
Diabetes Mellitus 16.0 16.6 22.6
Homicide 9.3 9.7 8.7
' Source: Community Wellness&Prevention Program,CCCHSD;Centers for Disease Control,Monthly
Vital Statistics. Report.Volume 45, 11(S).
' How are Latinos in Contra Costa doing?
The Latino mortality (death rate) declined from 346/100,000 population In 1995 to
297.7/100,000 population in 1997 (Table 17). Contra Costa Latinos had
'. significantly lower mortality rates for six of the top eleven leading causes of death
.(Asians had lower mortality rates for liver disease). The leading cause of death
for Latino males and female was diseases of the heart and malignant neoplasms
(Table 18).
Contra Costa County
Total Deaths by Race and Rate, 1995 and 1997 Table 17
Race 1995 1997
Number Rate per 100,000 Number Rate per 100,000
Population Population
Latino 357 346.0 349 297.7
White 4,950 425.4 5.013 397.8
African American-- 688 787.5 635 677.5
Other 325 302.0 353 274.2
Total 4,950 425.4 6,350 404.2
1 Source: California Department of Health Services: Mortality Records, 1995 and;.1997" [WWW
Document] URL http://www.dhs.ca.govfhisp/applications/vsq
1
' Page 18
CONTRACOSTA LATINO HEALTH PROFILE
Leading Causes of Chronic Disease Death
By Sex, Race/Ethnicity and Rate/100,000
Contra Costa County, 1990-1992 . Table 18'
Latinos Whites African Other
Americans
Male Female Male Female Male. Female Male Female
Diseases of the 74.01 58.24 243.19 134.41 226.03 197.90 . 102.8 75.97
Heart '
Malignant 57.95 51.61 213.11 210.33 202.29 142.69 87.25 55.77
Neoplasms
Cerebrovascular 14.66 18.43 47.76 80.0 47.49 55.21 27.64 22.63
Disease '
Chronic 2.09 5.16 37.13 46.68 16.14 11.04 12.09 5.66
Obstructive
Pulmonary Disease ,
Liver Disease 10.47 5.9 13.25 9.7 14.25 8.49 2.59 2.42
Diabetes Mellitus 6.98 5.9 9.19 11.64 21.84 21.23 8.64 8.89
Source: Community Wellness&Prevention Program,CCCHSD ,
Injuries and Violence
Why is it important? ,
Adverse social and economic conditions lead to violence. Violence results in
premature death, serious injury and disability in populations. These are the '
concern of public health agencies and advocates. The public health model
suggests that efforts to preven.t.violence, like those to prevent injury and '
infectious diseases, should consider the interaction between host, agent and
environment. The host for violent injury is the person who is at risk of harming or
being harmed by himself or herself or another person. The agent for violent injury '
is the weapon, be it a gun, knife, fist, foot, broken bottle or baseball bat. The
environment for violent injury has three components: physical, economic, and
social. Examples of the physical environment of violent injury are dark streets, '
abandoned buildings, bedrooms,bar rooms and work sites. The economic
environment of violent injury includes limited social, recreational and educational
activities, high levels of poverty and unemployment, particularly among young ,
males.
Injuries are significant and preventable public health problems. From 1995 1
to1996 combined, 769 Contra Costa County residents died from fatal injuries.
Unintentional injuries, or-accidents, accounted.for 54.7 percent of these deaths
(Table 19). ,
Page 19 '
1
CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa County
Unintentional Injury Deaths
' 1995-1996 Combined Table 19
1%
22%
M
I :.66 ; ■Unintentional Injury
®Homicide
' 55% 0 Suicide
❑Other
22%
Source: California Department of Health Services,Vital Statistics Section.
Motor vehicle accidents (37.9%) and poisonings/drug overdoses (24.3%)
' accounted for 62.2 percent of all unintended deaths in Contra Costa County from
1995-1996 (Table 20).
' Contra Costa County
Unintentional Injury Death by Cause, 1995-1996 Table 20
17%
1, ■Motor Vehicle Accident
38%
7% : ' El Poisoning/drug overdose
' ®Falls
1441/16 _ ' M Drowning
❑Other
24%
Source: California Department of Health Services,Vital Statistics Section.
1
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CONTRA COSTA LATINO HEALTH PROFILE
What is the status of Latinos?
Firearms are the leading cause of injury death among Latinos, whites and African ,
Americans, however, the proportion of deaths ineach group attributable to
firearms varies. Almost one-third (30.6%) of all fatal injuries among Latinos are
due to firearms, compared to whites (23%), Asians (28.2%) and African ,
Americans (51.9%). Latinos have the highest percentage injury death from
poisonings (22.2%) and the second highest number of deaths for motor vehicle
accidents (Table 21). '
Contra Costa County '
Leadincai Causes of In'ur Deaths, by Race/ Ethnic it , 1995-1996 Table 21
Fire Arms Motor Vehicle Poisonings Other Total
Accidents
# % # % # % # % Number
Latino 33 30.6% 25 23.1% 24 22.2% 26 24.1% 108
White 107 23.0% 95 20.4% 90 19.4% 173 37.2% 465 '
African 80 51.9% 21 13.6% 23 13.6% 30 19.5% 154
American
Asian/Pac 11 28.2% 19 48.7% 2 5.1% 7 17.9% 39 '
Islander
Source: California Department of Health Services,Vital Statistics Section.
In 1995-1996, firearms were responsible for 230, or 29.9 percent of fatal injuries
among Contra Costa residents, including 136 homicides, 88 suicides, and 3
accidental deaths (Table 22). Latinos made up 14.3. percent of.firearm victims
(Table 23).
Contra Costa County '
Classification of Firearm Deaths, 1995-1996 Table 22
3% ,
m �....
" ■Homicide
° g .
El Suicide
=' ,F:... 59% ❑Unintentional
' 1
Source: California Department of Health Services,Vital Statistics Section..
Page 21 ,
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CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa County
' .Firearm Deaths by Race/Ethnicity, 1995-1996 Table 23
N. o
5% 14% ®Latino
' 0 White
RF
r.4-35% ffi.K4-E iMR
pAfrican American
__. 46% ❑AsiaNPac.
Islander
.1
Source: California Department of Health Services,Vital Statistics Section.
Suicide
' From 1995-1996 combined, suicide accounted for 168, or 21.8 percent of injury
deaths. Whites accounted for the highest percentage of suicides (85%), followed
by Latinos (6.0%) (Table 24).
' Contra Costa County
Suicide Deaths By Race/Ethnicity, 1995-1996 Table 24
5% 4% 7%
®Latino
M W hite
El African American
Now ❑Asian/Pac.
Islander
84%
' Source:California Department of Health Services,Vital Statistics Section.
1
' Page 22
1
CONTRA COSTA LATINO HEALTH PROFILE
Adolescent/Young Adult Death
Why is it important? ,
Injuries and violence are the dominant preventable health problems of adolescents
..and young adults nationwide: 50/100,000 and 20/100,000 respectively. Injuries and
violence kill and disable many adolescents before they reach age 25. Unintentional
injuries include all non-violent injuries, such as, falls, poisonings, motor vehicle injuries,
burns, drownings, and unitentional shootings. Motor-vehicle crash injuries are a major ,
cause of death and disability in this age group (15 to 24 years). We do not expect
adolescents to die, so monitoring leading causes of death for this group can lead us to
potentially life-saving interventions:
How are Latinos in Contra Costa doing? '
The Latino adolescent/young adult death rate is twice that of the white population
in Contra Costa, and well over 20% higher than the Healthy People 2000 Goal. '
Young Latinos bear a disproportionate share of violence-related morbidity and
mortality (Table 25).
Contra Costa California '
Adolescent/Young Adult Deaths Ages 15-24; Rate per 100,000
By Race/Ethnicit , 1995-1996 Table 25 ,
Latino White African Asian Total Healthy People 2000
American Goal
107.5 58.7 209.6 63.8 84.3 85.0 ,
Source: California Department of Health Services,Department of Vital Statistics. .
Injuries, including violence, are the dominant health problems of adolescents and '
young adults. In Contra Costa County, unintentional injuries, homicide, and
suicide combined account for 71.8 percent of the deaths in the 15 to 24 age
group (Table 26). ,
Contra Costa County ,
Adolescent/Young Adult Deaths, Ages 15-25, by Cause, 1995-1996 Table 26
Cause of Death Number Percent
Unintentional Injury(include 59 32.1%
motor vehicle accidents)
Homicide 55 29.9%
Suicide 18 9.8%
Cancer. 13 7.1% '
Ill-Defined Symptoms 5 2.7%
All Other Causes 34 18.5%
Total 184 100%
Source: California Department of Health Services,Department of Vital Statistics.
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CONTRA COSTA LATINO HEALTH PROFILE
' Homicide
What is it?
Homicide or murder, is an intentionally inflicted fatal injury to another person,
excluding deaths by law enforcement officers in the completion of the their
duties.
' Why is it important?
Homicide is the leading cause of death for young adults ages 15 to 34. Homicide
perpetrators and victims are overwhelming male. Homicide is strongly correlated
to poverty.
What is the status of Latinos in Contra Costa?
' Of the 3,530 homicides in California in 1995, 1,615 of the victims were Latino, or
.46%. Of the. 1,615 deaths, 1,148 deaths were caused by handguns.
The 1994 to1996 homicide rate in Contra Costa County was 12.7 deaths per
100,000 population or almost twice the national goal set by Healthy People 2000
(7.2/100,000).
Eighty-five percent of all homicide victims were male and two-thirds of those
killed were youth and young adults ages 15 to 24 (32%) and 25 to 34 year olds
'
(33.1%). African Americans were significantly over-represented in homicide.
While making up only 9.1 percent of the county's population, African Americans
accounted for 50.3 percent of homicide victims. Latinos comprised about 14 ..
percent of the population but represented 19.7 percent of homicide victims (Table
' 27).
' Contra Costa County
Homicide Victims by Race/Ethnicity, 1994-1996 Table 27
' 4% 20% In Latino
❑White
50% ■African American
Y,.. 26%
Asian/Pac.
Islander
1
' Page 24
1
CONTRA COSTA LATINO HEA LTII PROFILE '
Section 3: Maternal, Child and Adolescent Health
Prenatal Care ,
What is it? '
Prenatal care is pregnancy-related health care provided to a woman during
pregnancy. It is recommended that a woman start receiving prenatal care in the ,
first trimester (first three months) of her pregnancy.
Why is it important? '
The use of timely, high-quality prenatal care can help prevent poor birth
outcomes by identifying treatable medical conditions (e.g., diabetes, hyper- '
tension and sexually transmittable diseases), which may endanger the mother
and/or fetus, or by identifying preventable risk factors such as the use of alcohol, ,
tobacco, and other drugs. It follows, therefore, that appropriate prenatal care can
reduce the high costs to the families for treatment of an unhealthy baby and
benefit by providing a healthy start for him/her.
Some reasons for late entry into prenatal care include lack of culturally
appropriate pregnancy testing sites, uninsurance, young age of the mother, and
multiple previous pregnancies. Domestic violence, cultural beliefs, drug abuse, ,
single parenthood, and poverty also create barriers for women to receive timely
prenatal care. '
Early entry into-prenatal care can consequently reduce the high cost to families
for the treatment of poor birth outcomes and benefit the child by providing a '
healthy start for him/her.
How are Latinas doing in Contra Costa? ,
■ In 1997, 79.1% of Latinas received prenatal care in their first trimester. This
rate is significantly lower than the Healthy.People 2.010 objective of 90.0%. ,
■ Latinas are less likely than White, Asian-American, and African-American
women to receive prenatal care in their first trimester. Only 79.1% of Latina
pregnant women in the county began prenatal care during the first trimester,
compared to 90.8% of White women, 80.2% of Black women, and 84.7% or
Asian-American women. ,
■ Between 1993 and 1997, Latinas were increasingly likely to receive prenatal
care in their first trimester (73.7% versus 79.1%)although their early entry ,
into the medical system was significantly below that of Whites (90.8%) and
Asians (84.7%).
Pace 25 '
CONTRA COSTA LATINO HEALTH PROFILE
' Current efforts in Contra Costa
■ Community Health Outreach Workers have been hired in the past two years
to improve enrollment into publicly sponsored health insurance programs,
such as Medi-Cal.
■ Efforts are underwayto increase the knowledge of Latinos on their eligibility
9 9 Y
for publicly sponsored health insurance programs, regardless of their
documentation status. An example of this pregnancy-related Medi-Cal.
1 ■ Recent changes in policy in the Contra Costa County Employment and
Human Services require that eligibility workers provide a Presumptive
Eligibility designation, permitting the applicant to receive immediate care
through Medi-Cal, rather than waiting for a determination from Medi-Cal.
Contra Costa County
First Trimester Entry into Prenatal Care
By Race/Ethnicit , 1993, 1995, and 1997 Table 28
Latina White Black Asian/Pacific Other Total
Islander /Unknown
1993 1,959/73.7% 6,200/90.1% 1,172/75.2% 1,192/84.1% -77/81.1% 10,600/84.1%
1995 1,943/71.5% 5,973/88.1% 1,125/78.6% 1,216/83.8% 74/86.0% 10,331/82.9%
1997 2,321/79.1% 5,652/90.8% 1,072/80.2%. 1,201/84.7% 318/85.0% 10,564/86.0%
Source: Contra Costa County Health Services Department
Contra Costa County
Late or No Prenatal Care by Race/Ethnicity*
1993, 1995 and 1997** Table 29
' Latino White African Other Total
Year American
' Number/ Number Number Number Number/
Percent Percent Percent Percent Percent
1993 170/ 176/ 141/ 58/ 545/
31.2% 32.3% 25.9% 10.6% 100%
1995 180V 226/ 85/ 67/ 563/
31.9% 40.1% 15.1% 11.9% 100%
1997 122/ 109/ 63/ 56/ 350/
34.9% 31.1% 18.0% 16.0% 100%
Source:Contra Costa County Health Services Department.
*Late prenatal care is-defined as prenatal care that begins in the third trimester.
**Data not available by race and by region
1
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CONTRA COSTA LATINO HEALTH PROFILE '
Teenage Births
What is it? '
The teen birth rate is defined as the number of live births to mothers._< 14, 15 to
17 and 18.to 19 years per female population of that age group. Percent of teen ,
births is defined as the number of births to mothers' ages <_ 14, 15 to 17 and 18
to 19 years, per 100 live births.
The number of teen births is not the same as the number of teen pregnancies.
The Guttmacher Institute found that 51% of teen pregnancies end in birth, 35% in '
abortion and 14% in miscarriage. Thus, the teen pregnancy rate may be about
double the teen birth rate.
Why is it important? ,
Teen mothers typically have more difficultycompleting their education, have. ,
fewer employment opportunities, and are more likely to require public assistance
and to live in poverty than their peers. The younger the teenage.mother, the
more likely she is to have poor pregnancy outcomes,such as pre-term delivery:.,
and low birth weights infants. '
Teen mothers are at high risk for poor health outcomes, and having another '
pregnancy while still in their teens. In addition, teen mothers are less likely than
their peers to get married or stay married. Infants born to teen mothers are at
greater risk of child abuse, neglect, and behavioral and educational problems at ,
later stages. Adolescence is a time of increased vulnerability to social influences,
which may seriously compromise the health of young people. This time is
characterized by experimentation, risk-taking, and increased dependence on '
peers: Youth are at significant risk for unplanned pregnancies and sexually
transmitted diseases. Unintended pregnancies are serious and costly. With an
unwanted pregnancy, a mother,.moreover a teenagers, is less likely to seek ,
prenatal care in the first trimester, and is more likely to expose the fetus to
harmful substances such as tobacco or alcohol.
How are Latinos doing in Contra Costa?
Of the 424 births to teen mothers in Contra Costa, 173 babies were born to '
Latina teenagers. This represents 41% of all births to teen mothers in the county.
The 173 babies born to Latina teen mothers represents about 6% of the total
births to Latinas in the county. Latinas comprise about 15 percent of females age ,
10 to 14 years, and 17 percent of females age 15 to 19 in Contra.Costa in 1997.
A May 25, 2000, presentation by the Contra Costa County Health Services,
Family, Maternal and Child Health Epidemiologist, Chuck McKetney, supports '
these findings.
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CONTRA COSTA LATINO HEALTH PROFILE
School-age mothers (under 20 years old) accounted for 8.7 percent of all Contra
Costa births and 13.5 percent of all Latina births in 1997. Only African American
' teens had a higher percentage of teen births (19.7%) than Latinas. The percent
of births to Latinas, as a percent of all births to girls 18 years and younger,
increased between 1995 (33.0%) and 1997 (40.8%).
Summary of Maternal Data by Race
1997 Table 30
Race #of Low Birth Weight Births to Prenatal care Late or Late or No
Births (Number/Percent of Teen Started in First No Prenatal Care
Total) Moms Trimester(%) Prenatal (Number/Percent of
' <18 Care Total)
Latino 2,934 150/19.4% 173 79.1% 4.2% 122/34.9%
White 6,556 347/44.8% 106 90.8% 1.7% 109/31.1%
' Black 1,337 152/19.6% 101 80.2% 4.7% 63/18.0%
Other 1,467 1.25/16.1% 44 84.8% 3.8% 56/16.0%
Total 12,294 774/100% 424 86.0% NA 350/100%
' Contra Costa County
Birth to Teen Mothers (<18 years old) by Race/Ethnicity
1993-1997 Table 31
1993 1995 1997
Race # % # % # %
Latino 139 33.0% 159 36.9% 173 40.8%
White 102 24.2% 118 27.4% 106 25.0%
Black 141 33.5% 128 29.7% 101 23.8%
Other 46 9.3% 26 6.0% 44 10.4%
' Total 421 100% 431 100% 424 100%
Source: Contra Costa County Health Services Department
Contra Costa County
Population by Race and Gender (Female Only)
Race by 4 a Cohorts 10-14 and 15-19), and by Race, 1997 Table 32
10-14 Females 15-19 Females
Number Percent Number Percent
' Latinas 5253 14.7% 4605 16.5%
Whites' 21979 61.4% 15,881 56.9%
African Americans 3691 10.3% 3554 12.7%
Asian/Pac.Islander 4624 12.9% 3614 12.9%
Other 247 .7% 245 .8
Total 35,794 100% 1 27,899 100%
Source: U.S.Census Bureau,"Population Estimates for Counties by Age,Race,and Hispanic Origin",
Annual Time Series: 7/l/1990-7/l/1999.
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CONTRA COSTA LATINO HEALTH PROFILE '
Infant and Neonatal Mortality
What is it? ,
Infant mortality is the death ofa child less than one year of age. The infant
mortality rate is presented.as the number of deaths to children less than one year
old per 1,000 live births.
Why is it important? ,
Infant mortality has long been considered a sentinel indicator for the health status '
of a community. When service systems are intact and utilized, fewer babies die.
High. infant birth weights typically indicate problems of service access, .poverty,
and substance abuse, among others. Among other things, it signifies the overall
health status of mothers and their ability to access prenatal care.
Early and continuous prenatal care improves birth outcomes. Women who ,
receive prenatal care in their first three months of pregnancy have better
pregnancy results than those that receive care after that, or little or no care. .
What is the status of Latinos in Contra Costa?
Almost 20 percent of low birth weight births were to Latinas in 1997, up from 14.4 '
percent in 1995. Even so, Latinas had the lowest percentage of low birth weight
births (5.10/6) and the third lowest.infant mortality rate (6.0). However, infant birth
weight is only one indicator for Latino infant health, and other factors, such as.
neonatal mortality and morbidity must also be reviewed to get an a full '
understanding of Latino infant health.
Contra Costa County
Post Neonatal Mortality by Year and Mother's Race/ Ethnicity, 1992-1994
N=101 and rate/1000 Table 33
Latino White African American Asian /Pacific Totals&Annual
Islander Rate Average
Year Number Rate Number Rate Number Rate Number Rate Number Rate
1992 N/A* N/A* 22 3.1% 7 4.3% 7 4.8% 36 2.8%
1993 8 3.0% 15 2.2% 4 2.5% 6 4.5% 33 2.6%
1994 6 2.3% 16 2.4% 9 6.1% : 1 0.7% 32 2.6%
Source: Contra Costa County Health Services Department.
*Deaths may have included Latino.Latino not listed as a category in the 1992 State Data for Contra Costa
County. ,
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CONTRA COSTA LATINO HEALTH PROFILE
' Infant Mortalityb Ethnicity
Y Y
Contra Costa County, 1995
' Rate/1,000 Table 34
Latino White African American Asian/Pacific All Race/Ethnic
Islander Grou s
' Year Contra CA Contra CA Contra CA Contra CA Contra CA
Costa Costa Costa Costa Costa
1995 5.5% 6.0% 4.4% 5.7% 18.1% 13.5% 1 5.4% 5.3 6.3% 6.4%
' %
Source: California Department of Health Services,death records and birth cohort records.
Neonatal Mortality
' By Year and Mother's Race/Ethnicity ..
Contra Costa County, 1993-1994 Table 35
Latino White African American Asian/Pacific Islander
Year Number Percent Number Percent Number Percent Number Percent
1993 8 3.0% 21 3.0% 9 5.7% 3 2.3%
1994 6 2.3% 21 3.1% 5 3.4% 7 4.7%
' Source: Contra Costa County Health Services Department
1
1 `
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CONTRA COSTA LATINO HEALTH PROFILE ,
Section 4: Chronic Diseases
Chronic disease refers to a wide range of diseases and conditions that can be
disabling and may lead to death. Many are preventable or controllable through
diet or exercise. The information presented in this section is almost all about '
"mortality," or the cause of death. Information about "morbidity," or the cause of
illnesses is much harder to uncover. Oftentimes we may not seek any medical
care when are sick. This is especially true for Latinos, who has the highest rate of
uninsurance of any ethnic group in the state and in Contra Costa. Only hospitals
are.able to tell us about morbidity, through their statistics about hospitalization '
and discharges. Such statistics give us some indication of the importance of
certain diseases and conditions, but they are only the tip of the iceberg for
understanding the real picture of the diseases that affect Contra Costa's Latinos. '
In "Section 1: Social and Demographic Profile," it is demonstrated that Latinos
are a distinctively youthful population. Due to its young age, health status '
research should be more appropriately directed at studying both morbidity and
mortality trends. It is important to recognize that research and reports focus on
mortality trends almost to the exclusion of morbidity trends, perpetuating an . '
information gap identifying the health care needs of Latinos. When compared to
whites and African Americans, Latinos have lower mortality rates for the top six
leading cause of death due to chronic disease in Contra Costa County (Table '
36).
Contra Costa County ,
Leading Causes of Chronic Disease Death
By Sex, Race/Ethnicity and Rate/100,000/1990-1992 Table 36
Latinos Whites African Asian/Other '
Americans
Male Female Male Female Male Female Male Female
Diseases of the Heart 74.01 58.24 243.19 134.41 226.03 197.90 102.8 75.97 '
Malignant Neoplasms 57.95 51.61 213.11 210.33 202.29 142.69 87.25 55.77
Stroke 14.66 18.43 47.76 80.0 47.49 55.21 27.64 22.63
Chronic Obstructive 2.09 5.16 37.13 46.68 16.14 11.04 12.09 5.66 ,
Pulmonary Disease
Liver Disease 10.47 5.9 13.25 9.7 14.25 8.49 2.59 2.42
Diabetes Mellitus 6.98 5.9 9.19 11.64 21.84 21.23 8.64 8.89 '
Source: Community Wellness&Prevention Program,CCCHSD
Diabetes '
What is it?
Diabetes mellitus is a disease that involves inadequate insulin production or
inadequate sensitivity of cells to insulin and results in inhibition of the regulation
of blood glucose levels. Diabetes is the seventh leading underlying cause of '
death in the United States, with more than 45,000 deaths per year directly
Page 31 ,
CONTRA COSTA LATINO HEALTH PROFILE
' attributable to diabetes. While diabetes accounts for a large number of deaths, it
is estimated that mortality statistics understate the true impact of diabetes
because people die of diabetes-related complications rather than the disease
itself. Consequently, diabetes is often underreported as the underlying or even
contributing cause of death. In fact, national estimates show that diabetes is
' listed on the death certificates of only about half of the decedents who had
diabetes.
' Why is it important to measure?
' Nationally, older persons and certain racial/ethnic groups suffer disproportion-
ately higher rates of diabetes compared to the general population. Among these
ethnic groups, Mexican Americans have a much higher incidence rate than most.
other populations. Due to lack of adequate resources for health care, Latinos
' also develop a disproportionate share of complications caused by diabetes.
Latinos are, on average, twice as likely to develop Type II diabetes as non-Latino
white Americans.
Diabetes leads to a variety of disabling and life-threatening complications. Some
of the major complications associated with diabetesinclude heart disease,
blindness, and renal failure. Diabetes can also lead to poor circulation and
sensation in peripheral tissues, which resulting infection, injury, and amputation.
Some of the risk factors associated with diabetes incidence are lack of physical
' activity, obesity smoking and hypertension. Diabetes is a chronic illness requiring
continuous health care. Since patients deliver the majority of diabetes care
themselves, patient education and social support is often lacking or consistent
' among older Latinos.
' What is the status of Latinos in Contra Costa?
Because of the limited access to the health care system, it is difficult to
' accurately diagnose and report diabetes in the Latino community. Also, deaths
from diabetes are underreported and, if diabetes is a contributing factor to the
death of a Latino, the cause of death may be attributed to a related cause.
' Statewide about 18 percent of Latina women age 55 and over had diabetes. In
Contra Costa County the largest number of persons, of all races, were 55 years
or older (Table 37).
1
Paae 32
CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa County
Adults Diagnosed (estimated) with Diabetes by
Gender, Race, and Age Group* Table 37 '
Female Male
Race Total All 18-34 35-54 55+ All 18-34 35-5455+
Number Ages Ages 1
Latino 3,900 2,500 400 900 1,200 1,400 100 700 700
White 20,500 11,300 1,200 3,500 6,600 9,200 500 500 6,000
African 3,100 2,300 300. 900 1,100 900 Na 200 700 I American
Asian/Pac. 2,800 1,500 200 . 400 800 1,400 300 300 800
Islander '
Total 30,300 17,500 2,100 5,600 9,700 12,800 900 3,800 8,100
Source:.Contra Costa County United Way/:Hospital Collaborative Community Assessment,Northern
California Council for the Community, 1999.
*Based on the 1996 county population and prevalence rates in the 1984-93 CA Behavioral Risk Factor ,
Surveys
Asthma '
What is it?
Asthma is a chronic disease involving inflammation of the airway that.makes
breathing difficult. Common symptoms include shortness of breath, .tightness of
the chest, wheezing and coughing. Asthma is one of the three major disease '
categorized as chronic obstructive pulmonary disease (COPD). The two others
are bronchitis and emphysema.
Why is it important? '
Nationally, asthma morbidity and mortality have been increasing since the 1970s. ,
An estimated 14 million Americans suffer from asthma. Almost 2 million
Californians, including a half a million children, suffer from asthma and over one-
have million Latinos in California suffer from asthma. Asthma is the leading '
chronic childhood disease and the leading cause of hospitalization among
children in California. Despite dramatic reductions in air pollution over the last 30
years, many Latinos continue to live in communities.that.fail to meet the federal '
air quality standards. COPD was the sixth leading cause of death among Contra
Costa residents in 1998.
In 1996 the Regional Asthma Management and Prevention Initiative RAMP
g 9 (RAMP)
was created out of the grave concern about the increasing prevalence and
severity of asthma among children and adults across the country, and a lack of
coordinated effort at the regional level to understand and address this problem in
Northern California (RAMP counties include Alameda, Contra Costa, San
Francisco and Solano).
Page 33 '
' CONTRA COSTA LATINO HEALTH PROFILE
What is the status of Latinos in Contra Costa?
' Data on the prevalence of asthma was not available locally but hospitalization
rates for asthma provides an indication of asthma morbidity by measuring a
' severe, though infrequent outcome, of this disease. From 1994 -1996, 4,149
Contra Costa residents were hospitalized with a principal diagnosis of asthma
compared to 2,981 in 1994 -1996. In the 1991 -1994 time period Latinos, whites,
_ 1 and Asians had comparable asthma hospital discharge rates, for all age groups,
while the African American rate was three times that of the other groups. Latino
children, ages 0-14 had the second lowest asthma hospitalization rates in Contra
' Costa County in from 1991 -1994.
Between 1991 -1994 and 1994 -1996, the hospital discharge rate for whites in all
' age groups and for children under 15 years declined significantly. In the Latino
population, the "all ages" hospitalization rate increased from 114/100,000 in 1991
-1994 to 142/100,000 in 1994 -1996. Latino children, under age 15, experienced
an 11.8 percent increase in hospitalizations associated with asthma over the
same time period (Table 38).
' Table 39 lists the ten Contra Costa zip codes that had the highest age-adjusted
hospitalization rates for asthma for 1994-1996. Not surprisingly, the majority of
these communities are located in either West or East County. MediCal was the
' payer source for 27 percent of the all ages asthma hospitalizations and the
primary payer source for 38 percent of admissions for children under the age of
15. Compared to Contra Costa County, Alameda (60%)and San Francisco (53%)
had a much higher percentage of children using MediCal as their source of
' health insurance when hospitalized for asthma (Table 40).
Asthma hospitalization data are both limited and powerful (Table 41). These data
only identify those patients so acutely affected they had to be hospitalized for
their condition. They do not reveal how many people have asthma, how many
visited an emergency room due to asthma or howmany people died from
asthma. Asthma is classified as an ambulatory care sensitive condition, which
suggests the vast majority of, if not all, hospitalizations for asthma, could be
avoided.::Various research.:.studies have associated high rates of ambulatory
sensitive conditions to a variety of conditions, including: lack of access to'health
care, poverty, and high level of indoor and outdoor pollution.
Of significant concern is the increased rate of hospitalization for Latinos of all
ages and for children under age 15. Asthma hospitalization rates decreased for
all other race/ethnic groups, except Latinos (the decrease in the Asian "all ages"
rate is probably not statistically significant). Latinos and African Americans are
most likely to reside in the ten zip codes that have the highest asthma
' hospitalization rates. Latinos are more likely to be uninsured (in 1999 33.4% of all
Latinos in the U.S were uninsured) and therefore less likely to have access to
health professionals to treat their asthma on an outpatient basis.
1
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CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa County
Asthma Hospital Discharge Rates and Hospitalization Rates/100,000 '
1991-1994 and 1994-1996 Table 38
1991-1994 1994-1996 '
Race Asthma Asthma Asthma Asthma
Hospital Hospitalization . Hospital Hospitalization
Discharge rates for Discharge rates for
Rates(all Children Ages Rates(all Children Ages
ages) 0-14 ages) 0-14
Latinos 114 187 142 =209
Whites 112 185 84 120
African Americans 375 704 348 539
Asian/Others 119 209 125 144
(1)Source: 1991-1994:Contra Costa County United Way/Hospital Collaborative Community Assessment,
Northern California Council for the Community, 1999. '
(2)Source: Regional Asthma Management and Prevention Initiative,URL: www.rampasthma.org
Contra Costa County
Age-Adjusted Asthma Hospitalization Rates by Zip Code,
1994-1996 Table 39
Zip Code Town/Cit Rate/100,000 '
94804 Richmond 315
94801 Richmond 247
94502 Concord 214
94806 San Pablo 202
94805' Mira Vista 186
94547 Hercules 182 '
94565 Pittsburg176
94509 Antioch 171
94565 Pinole 135
94513 Brentwood 131
Source: Regional Asthma Management and Prevention Initiative,
URL: www.rampasthma.org
Payment Type by County
Asthma Hospitalization, 1994-1996 Table 40
Payer Source.... Contra Costa Alameda San Francisco Solano ,
All Children All Children All Children All. Children
Ages <15 Ages <15 Ages <15 Ages <15
Medicare 18% 0 15% 0% 23% 0% 13% 0%
MediCal 27% 38% 44% 60% 39% 53% 23% 25%
HMP/PPO/Private 46% 57% 33% 36% 31% 40% 59% 70%
Insurance
Other 8% 1 5% . 8% 4% 1 8% 1 7% 5% 4% ,
Source: Regional Asthma and Prevention Initiative,URL: www.rampasthma.org
1
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CONTRA COSTA LATINO HEALTH PROFILE
' Patient Days, Length of Stay And Costs by County
Asthma Hospitalization, 1994-1996 Table 41
County Total Patient Average Length Median Cost per Cost per Day
Das of Stay Case
Contra Costa 10,873 3.53 $5,645 $2,741
' Alameda 21,354 3.08 $7,110 $2,636
San Francisco 13,466 3.72 $5,887 $2,495
Solano 4,420 3.41 $10,384 $4,528
Source: Regional Asthma and Prevention Initiative, URL: www.rampasthma.org
' Coronary Heart Disease
' What is it?
Coronary Heart Disease (CHD) is a condition that develops when the coronary
arteries become narrowed or clogged and cannot supply enough blood to the
heart. Blood carries oxygen and nutrients the heart needs to function. If the heart
does not receive enough oxygen-carrying blood, the person may experience a
pain called angina. When the blood supply is cut off completely, the result is
destruction of the heart tissue and is called a heart attack.
' Why is it important?
Coronary Heart Disease is the number one killer of both men and women in the
United States. Each year, about 500,000 Americans die of heart attacks caused
by CHD. Many of these deaths could be prevented because modification of
certain aspects of lifestyle can reduce the risk of getting CHD. Risk factors for
CHD include high blood pressure, high blood cholesterol, smoking, obesity,
physical inactivity and diabetes—most of which can be controlled. Risk factors
that cannot be changed or controlled include gender, family history of CHD, and
' age.
From 1995 -1996, a total of 3,500 Contra Costa residents died form heart
disease, including 1,763 men and 1,737 women. The three-year average
mortality rate for coronary heart disease (82.9.100,000) is below the California
State rate and the national goal of 100 deaths/100,000population (Table 42).
Contra Costa/California
Deaths Due to Coronary Heart Disease
Three-year-Averae, Age-Adjusted Rate/100,000, 1994-96 Table 42
Location Rate
' Contra Costa 82.9
California 100.6
Healthy People 2000 Goal 100.0
Source:California Department of Health Services,County Health Profiles, 1998
Page 36 .
CONTRA COSTA LATINO HEALTH PROFILE
What is the status of Latinos in Contra Costa? '
White males (305.2/100,000) and African American males (285.9/100,000) had
hospitalization rates for Coronary Vascular Disease (CVD) at rates significantly
higher than the state rate of 190.2. Latinos had by far the lowest hospitalization
rates, of any ethnic group, for CVD. These rates correlate closely with Latino low
mortality rates due to diseases of the heart (Table 43).
Contra Costa and California ,
Ischemic Heart Disease Discharges Age, Race, and Sex-Adjusted
Hospitalization Rate/100,000, 1989-1991 Table 43 '
Latino White - African American Asian/Other
Male Female Male Female Male Female Male Female
Contra 162.9 112.6 305.2 187.9 285.9 286.7 223.2 190.6
Costa ,
California 190.9 184.2 322.6 219.1 298.9 190.9 140.6 137.5
Source:Northern CA Council for the Community,"Contra Costa United Way/Hospital Council
Collaborative Community Assessment," 1999
Cerebrovascular Disease
What is it? '
Cerebrovascular disease, otherwise known as stroke, is a disease condition
involving an injury to or death of brain cells caused by low blood flow or bleeding
in an area of the brain. A clogged blood vessel or a blood clot carrying oxygen
and nutrients to the brain bursts. Without oxygen, nerve cells in the brain can't
function and start to die within minutes. The most common circulatory system
problem resulting in strokes is atherosclerosis. '
The 1994-1996 Contra Costa mortality rates for stroke (28.1/100,000) and
statewide (26.3/100,000) are higher than the national goal set by Healthy People
2000. The Latino mortality rates, for both men and women, were also below '
those of the county-and statewide rates (Table 44). .
Page 37
r
CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa/California
Deaths Due to Cerebrovascular Disease (Stroke)
Three-year Average, Age-Adjusted Rate/100,000, 1994-96 Table 44
30 <. , . ,,,:..:
_ r...
=��r�g•�.(�:rs.�i•.�..£R��h'.1�',.�,`'.ee��i:. '.'��..a., a�
1 .
25 r.
'< .
�:—...'• ���:e�� ga` :ate, :E 'a.
20
:
: F
.•
•
SEA
�:.�
.10
5
0
Contra Costa California Healthy People 2000
Goal
Location
Source: California Department of Health Services,County Health Profiles, 1998
Why is it important?
Stroke killed an estimated 159,791 people in the United States in 1997 and is the
third leading cause ofAeath, ranking behind diseases of the heart and all forms
of cancer. Stroke is the leading cause of serious, long-term disability in the
United States. Stroke occurs in all age groups, in both sexes, and in all ethnic
subgroups. However, the risk of stroke generally increases with age. Stroke is
the most preventable of all medical catastrophes. In fact, a better understanding
of the causes of stroke has helped Americans make lifestyle changes that have
cut the stroke death rate nearly in half in the last two decades. Some of the most
aimportant treatable conditions that, if unchecked, can cause a stroke are high
blood pressure, cigarette smoking, heart disease, diabetes, and transient
ischemic.attacks (TIAs).
What is the status of Latinos in Contra Costa?
Latinos in Contra Costa have significantly lower hospital stroke discharge rates
when compared to all other races and ethnic groups (Table 45).
Page 38
CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa and California
Stroke Discharges Age, Race, and Sex-Adjusted
Hospitalization Rate/100,000, 1989-1991 Table 45
Latino White African American Asian/Other
Male Female Male Female Male Female Male Female
Contra 68.9 51.5 92.3 98.9 170.9 2174 82.9 91.7
Costa
California 83.1 85.2 99.3 105.2 163.7 200.5 75.6 90.5
Source:Northern CA Council for the Community,"Contra Costa United Way/Hospital Council '
Collaborative Community Assessment," 1999
All Cancer
What is it?
Cancer is not just one disease, but also a group of diseases. Cancer is a disease
consisting of the uncontrolled reproduction and spreading of cells. Malignant
neoplasms are cancers that spread to other parts of the body. Most types of
cancer cells form a lump or mass called a tumor. Many cancers can be cured if
detected early and treated. Other cancers can be prevented through lifestyle
changes.
Why is it important?
About 1,220,100 new cancer cases are expected to be diagnosed in 2000. Since
1990, approximately 13 million new cancer cases have been diagnosed. These
estimates do not include carcinoma in situ (noninvasive cancer) of any site
except urinary bladder, and do not include basal and squamous cell skin
cancers. Approximately 1.3 million cases of basal and squamous cell skin
cancers are expected to be diagnosed this year. A large number of risk factors
have been associated with different kinds of cancer. Some of these risk factors,
such as a person's genetic profile or age, cannot be altered or controlled.
In 2000, about 552,200 Americans are expected to die of cancer—more than
1,500 people a day. Cancer is the second leading cause of death in the US,
exceeded only by heart disease. In the US, 1 of every 4 deaths is from.cancer.
Female Breast Cancer.
What is it 2
Breast cancer is the most common type of cancer among women in the United
States; in 1993 it accounted for 183,000 new cases and 46,3000 deaths.
Approximately one of out every nine women will develop breast cancer at some
point during her lifetime. Mortality increases with age, as 54% of deaths from
breast cancer occur among women who are 65 years of age and older. Until the
1980s, breast cancer incidence rates were steadily on the rise. Researchers
attributed this increase to the modern reproductive patterns of women who
Page 39
CONTRA COSTA LATINO HEALTH PROFILE
delayed their first childbirth and had fewer children. The introduction of
mammography screening is believed to have contributed to the decline in breast
cancer mortality.
Why is it important?
Breast cancer can be diagnosed and treated early. It is important to make
9 Y P
Latinas aware of the incidence of breast cancer in the community, and the need
for awareness and regular examinations. Since it is unknown as to how genetics
and behavior-related risk factors interact in the incidence or mortality of breast
1 cancer among women, preventive efforts aimed at screening and early detection
are critical. Studies show that breast self-examination, medical screening, and
regular mammograms are Important for early detection. Yet, Latlnas tend to have
less access to these services, primarily due to language barriers and a lack of
health insurance.coverage.
What is the status of Latinos in Contra Costa?
Women of all races, who reside in Contra Costa County, are equally likely to
have their breast cancer diagnosed while it is in its.earlier stages (Table 46).
Latinas have the low breast cancer incidence rates at both the county
(97/1.00,000) and statewide level (68.2/100,000). Only Asian women have lower
breast cancer incidence rates than Latinas (Table 47).
Contra Costa County and California
Breast Cancer Cases and Early Stage Diagnosis, 1997 Table 46
Contra Costa California
Total Cases Percent Early Total Cases Percent Early
Stage Diagnosis Stage Diagnosis
Latinos 50 72.0% 2,551 64.0%
Whites 668 72.0% 17,413 72.0%
African Americans 64 70.0% 1,329 61.0%
Asian/Pacific Islander 58 72.0% 1,735 73.0%
Source:California Cancer Registry,CA Department of Health Services
Contra Costa County and California
Breast Cancer Incidence by Race/Ethnicity
Five Year Average, 1990-1994 Table 47
Contra Costa California
Number Rate/100,000 Number -.Rate/100,000
Population Population
Latinos 170 97.0 NA 68.2
Whites 244.7 125.3 NA 117.6
African Americans 195 103.4 NA 98.2
Asian/Pacific Islander 170 75.4 NA 61.8
Total(all races) NA 118.8 NA 105.4
Source: Cancer Incidence in the San Francisco Bay Area, 1988-1994. Union City,Ca: Northern
California Cancer Center,Perkins,C.I.et al. (1997)
1
Page 40
t
CONTRA COSTA LATINO HEALTH PROFILE
Cervical Cancer
What is it?
Invasive cancer of the uterine cervix, commonly known as cervical cancer,
accounted for 13,500 new cases and 4,400 deaths among woman in the United
States in 1993. Nationwide, Latinas had the highest incidence rate/10,000 for
cervical/uterine cancer (16.2) and second highest mortality rates (3.4/10,000).
Cervical cancer accounts for over 470 deaths per year in the state of California
and is the second most common cancer among females between the ages of 35
to 44. Higher rates of cervical cancer have been observed among Latina, Native
American, Southeast Asian, and Hawaiian females. '
Why is it important to measure?
Risk factors associated with cervical cancer include sexual activity with multiple
sexual partners, sexually transmitted diseases, and early onset of initial sexual
intercourse. Other risk factors include cigarette smoking, nutritional deficiencies,
and factors related to low socioeconomic status are at higher risk for cervical
cancer, primarily due to lack of access to health care services and a lack of
knowledge about health risk behaviors.
Access to timely Pap smears, the principal screening test for cervical cancer, has
been shown to greatly increase the likelihood of early cancer detection and
improved survival rates. Studies estimate that between 37% and 60% of cervical
cancer deaths could be prevented by full use of the Pap smear and another 10%
have not had the test in the past five years. In California, Latinas are the group
least likely to be screened for cervical'cancer. Nationally, Latinas have a much
higher incidence of cervical cancer and higher mortality rates from this disease
than all other races, except African Americans (Table 48).
What is the status of Latinas in'Contra Costa/California?
Latinas in California age 45 and over have a significantly higher incidence rate of
cervical cancer than white or African American females. This rate is two and one-
half times higher than the incidence rate for white females (Table 49). According.
to the California Cancer Registry, the age-adjusted rate cervical cancer incidence
among Latinas is highest among the 65 and older age group. In addition to the
high incidence of cervical cancer, Latinas also experience higher.cervical cancer
mortality rates when compared to white females, but have lower mortality rates
than African American females.
About fifty percent of women in all racial/ethnic groups have their cervical/uterine
cancer diagnosed in its early stages (Table 50). Even so, the percent of Latinas
who reported never having had a Pap smear increased from 12.1 percent in
Page 41
CONTRA COSTA LATINO HEALTH PROFILE
1987 to 14.1 percent in 1994, which may be a contributing factor to their higher
cervical/uterine mortality rates (Table 51).
United States
Cervical/Uterine Cancer Incidence and Mortality Rates/10,000 1989-1993 Table 48
25
NOW
sgtr '.s.. 3reu`•,:':a^z^".,.. s °.- �� a''r..i
20'' i'h, u a�c, R, n xt.- nuc•�as •c..s°..
ra}9.j
7nn•� ""tP.i.,. 3.1°niY�"2:'��%.,.. .�.. :.. .,Ys'e''.,'.x '' ex Sim.::
...15
,,y
«y.� >rec._....�::s'� � � •ICY F ...�
a.;,;, .s, ,. �:S:T�.p: -:ixe•.n- 'ew'K';° rac�:�i� as `'"`+"€
. 3""'! '��: F.�;=i.lti..i .s S''P' ! Y+d' r`�'.l'•.c�"F�1:4�Yr":��:.a::}.P3h�u�y.:a"w E tvbrtality Rates
inc idence Rate
fix.. ;s« ,.•mow. rye
NMI -
Q "�' .:: :
0
Latina White African Asian
American
' Source: National Cancer Institute, SEER Cancer Incidence and Mortality Rates
California
Cervical Cancer Incidence and Mortality by Race/Ethnicity and Age
1984-1993 Table 49
• Latina White African American
21-44 45-64. 65+ 21-44 45-64 65+ 21-44 45-64. 65+
Cervical Cancer 3.0 17.8 21.2 5.4 7.0 6.7 5:5. -11.3 16.8
Incidince/10,000
Cervical Cancer .4 4.4 7.7 .9 2.2 3.4 1.7 4.8 9.1
Mortality/10,000
Source: California Cancer Registry,Cancer Surveillance Section,Profiles Cancer in California, 1995
California
Cervical Cases and Early Stage Diagnosis, 1997 Table 50
Contra Costa California
Total Cases Percent Early Total Cases Percent Early
Stage Diagnosis Stage
Diagnosis
Latinos NA NA 535 52.0%
' Whites NA NA 750 51.0%
African Americans NA NA 109 50.0%
Asian/Pac.Islander NA NA 192 52.0%
Source: Contra Costa Health Services Department
1
Page 42
CONTRA COSTA LATINO HEALTH PROFILE
California
Percent of Women who Report Never Having a Pap Smear
1987 and 1994 Table 51
:'dti:`.'"�E;,:e::& ;::of.':�'.;�:aia::.+„i�•�.re«:?'' ^.':li';I:::bi::r..r.e�?''uY.».'..'3�:8�
Asians/Pac.
Islander ?17d
.'�:'r-w'�``•-?S�.``tea:�:•�:y�''.".'"�M':\��:' �. "�e26z�:.:.....•";:Y=:,w:.'�,
Africans, <<.< ,: •.
Americans 4099%
Mf, - .
-r•h= H;n�:., �-� �� >=�'r...�:::'� 1994
S �rZ:, viaiYRia:.. &�.c:...Sei.�lei. .3F.. �:. ��.
::..„,;..:�..._ �'�:. .aa�",+`i:ys ���`" ....,�.� �;;•,*fin „_,,, � ,r
,...:.....,. ;"` a, ." _. p 1987
Whites ..:.::.:-F•.L <�`:_ •::: sa,=..:, ^1 <>m
7., ��a :
i .,. \x.' .<••::un•L'P'7.:r, °`yc.a ..5.:•:.• :sa`,'•••�fi=. +tZ: e q\nim:
VEIN
LatinasMMAN
..&.. �,mi.:t�.•ao���$c.,``:i.`u•'�•i�iq:;:.;as.�`.Zss,w
F.:: :?..?.i..;.;F:..F?.:<e:<Fu<<Y. ..°a. •. •�» C::::::�.:;:�F3Y.:::i'u
0.00% 5.00% 10.00% 15.00% 20.00% 25.00%
Source:California Department of Health Services, "The Health Status of
Women", 1995
Colorectal Cancer
What is it 2
Colorectal cancer—or cancer of the colon or rectum-is the second leading
cause of cancer-related deaths in the United States. When skin cancer is
excluded, colo rectal.cancer is the third most commonly diagnosed cancer
for both men and women in the US. For men, colorectal cancer follows
prostate and lung cancers in frequency; for women, it follows breast and
lung cancer.
Risk factors associated with colorectal cancer include the following:
advancing age, history of inflammatory bowel disease, a family or
personal history of colorectal cancer or polyps, a personal history of
breast, ovarian or cervical cancer, a low fiber diet, and.high alcohol
consumption.
Why is it important?
Latino men have a colorectal cancer incidence rate of 35.5 per 100,000
and Latinas have an incidence rate of 24.3 per 100,000 (1988-1992 rates,
age-adjusted to 1970 US standard population). These rates indicate the
need for Latinos to access services to prevent, screen, and manage the
disease. Research suggests that colorectal cancer is on the decline for the
general population, in part due to increased sigmoidoscopic screening and
polyp removal, which prevents polyps from progressing to invasive cancer.
Unfortunately, according to the 1992 National Health Interview Survey ,
Page 43
' CONTRA COSTA LATINO HEALTH PROFILE
Results, Latinos are less likely than non-Latinos to report having had a
screening test for colorectal cancer. Low screening rates among Latinos
indicate a great need for providing education to Latinos about the
importance of early screening for, and detection of, colorectal cancer and
an equally great need for increasing Latinos access to these critical health
care services. -
What is the status of Latinos in Contra Costa?
Latino (51.1/100,000) and white (50.7/100,000) males have similar colon
cancer.rates while African American males have the highest rates
(60.5/100,00). Rates among Latino men and women, as well as Asian
men living in Contra Costa rates are higher than their statewide
counterparts (Table 52).
Contra Costa County and California
' Colon Cancer Incidence Rate by Race/ Ethnicity and Gender—
Five-Year Average, 1990-1994 Table 52
All Races Latinos Whites African Asian-Pac.
American Islander
Male Female Male Female Male Female Male Female Male Female
Contra 51.7 33.6 51.1 25.6 50.7 33.6 60.5 41.7 49.5 27.2
Costa
California 50.2 35.0 34.9 23.7 T 52.3 36.2 61.1 45.3 42.1 28.9
Source: Cancer Incidence in the San Francisco Bay Area, 1988-1994. Union City,Ca: Northern
California Cancer Center, Perkins,C.I.et al.(1997).
Contra Costa County
Colon/Rectal Cancer and Early Stage Diagnosis, 1997 Table 53
Contra Costa
Total Cases Percent Early Stage Diagnosis
Latinos 22* 59.0%
Whites 344 39.5%
1 African Americans 37 51.5%
Asian/Pacific Islander 32 47.0%
Source:California Cancer Registry,CA Department of Health Services
Excludes Latinas because there were.fewer than 15 cases reported
Lung Cancer
' What is it?
Lung cancer is caused by an uncontrolled growth of abnormal cells in the lungs.
The growing cells form a mass called a tumor, which can invade and damage
surrounding tissues and organs. Some of the common risk factors for lung
cancer include tobacco use, involuntary tobacco smoke exposure and
occupational exposure to hazardous substances, such as asbestos.
1 Page 44
CONTRA COSTA LATINO HEALTH PROFILE
Why is it important?
Lung cancer is the leading cause of cancer deaths for both men and women in ,
the United States. The American Cancer Society estimates that during the year
2000 there will be 164,1000 new cases of lung cancer in this country, and about
156,900 people will die form lung cancer. Although there has been some
progress in treatment methods, the five-year survival rate for people with lung
cancer is still only 14%. '
Although lung cancer is highly lethal, most cases can be prevented. More than
80% of lung cancer cases are thought to result from smoking. The longer a
person has been smoking, and the more packs per day smoked, the.greater the
risk for developing,a deadly tumor. Nonsmokers who breathe the smoke of.
others also increase their risk of developing lung cancer. Quitting smoking, at any
age, greatly lowers the risk of getting lung cancer.
What is the status of Latinos in Contra Costa?
Although Latino lung cancer rates (35.4/100,00), in Contra Costa, are below
those of all other races, except Asians, they are the only ethnic group for which .
men and women have comparable lung cancer incidence rates (Table 54). In
fact, the Contra Costa Latina lung cancer incidence rate (35.4/100,000) exceeds
the Latina statewide rate (20.3/1.00,00) by 43.9 percent (Table 55).
Contra Costa County and California
Lung Cancer Rate by Race/ Ethnicity and Gender 1
Five-Year Avera e, 1990-1994 Table 54
Latinos Whites African American Asian-Pac.Islander
Male Female Male Female Male Female Male Female
Contra 35.3 35.4 68.0 44.8 107.1 41.7 43.6 20.0
Costa
California 41.3 20.3 77.5 50.0 110.6 49.1 51.7 21.5
Source:Cancer Incidence in the San Francisco Bay Area, 1988-1994. Union City,Ca: Northern
California Cancer Center,Perkins,C.I.et al. (1997)
Contra Costa County and California ,
Lung Cancer Rate b Race/ Ethnicity- Five-Year Average, 1990-1994 Table 55
Contra Costa California
Latinos 96 35.4 NA 30.8 '
Whites 2,014 56.4 NA 63.8
African Americans 206 74.4 NA 79.9
Asian/Pacific Islander 95 31.8 NA 36.6
Total 2,411 54.7 NA 57.9
Source:.Cancer Incidence in the San Francisco Bay Area, 1988-1994. Union City,Ca: Northern CA Center
Page 45 ,
CONTRA COSTA LATINO HEALTH PROFILE
Section 5: Communicable Diseases
AIDS
What is it?
AIDS (Acquired Immunodeficiency Syndrome) is caused by the Human
Immunodeficiency Virus, or HIV). Infection with this virus weakens and
progressively destroys the immune system—the body's ability to protect itself
from infection and disease—causing AIDS viruses, fungi, bacteria and parasites
that usually do not cause problems can make a person extremely ill if their
immune system is:damaged.
HIV is spread by sexual contact with an infected person, or by sharing needles
and/or syringes (primarily for drug injections) with someone who is infected. Less
commonly (and now very rarely in countries where blood is screened for HIV
antibodies), HIV may also be transmitted through transfusions of infected blood
or blood clotting factors. Babies born to HIV-infected women may become
infected before or during birth or through breast-feeding after birth.
Why is it important?
AIDS is one of the most serious public health problems of our time. It is a severe,
life-threatening condition that has reached epidemic proportions, with more than
641,086 cases and 385,000 deaths reported as of December 1997 in the United
States. Since the onset of the HIV/AIDS'epidemic 18 years ago, the virus has
infected more than 47 million people worldwide. Estimates suggest that more
than a million people in the United States are currently infected with HIV, and at
least 40,000 new infections occur each year.
1 In California,-HIV Infection without AIDS in not reportable. An individual who has
tested HIV positive is diagnosed with AIDS when one of two events occurs: either
the patient's CD4 count drops below 200 cells/,ul (or <14%); or the patient is
diagnosed with one.of 26 AIDS defining opportunistic infections or cancers.
What is the status of Latinos in Contra Costa?
' It is difficult to identify the number of HIV positive Latinos, as these numbers are
not reportable. However, there are several anonymous testing sites throughout
the county where data are collected regarding HIV positive results. However, the
high uninsurance rate in the Latino community creates more barriers to seeking
diagnostic services and treatment.
' Once a Latino is diagnosed with AIDS and seeks services, it is important to
consider the need for bilingual and bicultural services. According to the Contra
LCosta Health Department's HIV/AIDS Epidemiology Report for November 2000,
Page 46
CONTRA COSTA LATINO HEALTH PROFILE
of the 600 respondents receiving AIDS services in the county, 41 or 6.8% stated
that Spanish is their primary language.
As of August 31, 2000 cumulative data from 1982 it is estimated that
g ( )
approximately 4,900 Contra Costa residents have been infected with HIV. Of
these 2,139 (43.7%) have already been diagnosed with and reported to have 1
AIDS, 1,384 (28.2%) of these people have died of AIDS, and 755 (15.4%) are
living with and have been diagnosed with AIDS.
Of the 2,139 Contra Costa total AIDS cases Latinos
5.
comprised 10percent of
p
the total adult/adolescent cases and Latino children 33.3 percent of the pediatric-
cases (Table 56). Of the 755.Contra Costans.who are.living with AIDS, 11.8
percent were Latino adults/adolescents/children (Table 57).
Since the first years of the AIDS epidemic an increasing number of AIDS cases ,
are,injection drug users (IDUs). Presently, IDUs make up 27.1 percent (581) of
all AIDs cases diagnosed in the county (Table 58). Latino drug users diagnosed
with AIDS (as of 8/31/00) comprise 8.4% of all injection drug users diagnosed
with AIDS in Contra Costa. Women constitute 92% of those diagnosed with AIDS
who are infected through heterosexual contact. The mode of infection of the
heterosexual partner is most often drug use (50.7%) (Table 59). Latinas
comprise 9.1 percent of total AIDS cases in Contra Costa County (Table 60).
Contra Costa County ,
Total AIDS Cases Reported b Race/Ethnicit as of 8/31/00 Table 56
Race/Ethnicity Adult/Adolescent Cases/% PediatricCases(age Total/%.
1-12 years)/%
Latino 224(10.5%) 4(33.3%) 228(10.7%)
White 1,216(57.2%) 4(33.3%) 1,220(57.0%)
African American 636(29.9%) 4(33.3%) 640(29.9%)
Asian/Pac. Islander 42(2.0%) 0(0) 42(2.0%)
Native American 9(.4%) 0(0) 9(.4%)
Total 2,127(100%) 12(100%) 2,139(100%)
Source:Contra Costa Health Services,Public Health Communicable Disease Programs,
"HIV/AIDS Epidemiology Report",November 2000.
Contra Costa County
People Livingwith AIDS by Race/Ethnicity as of 8/31/00 Table 57
Race/Ethnicity Adult/Adolescent Cases Pediatric Cases Total/%
Latino . 86 3 89(11.8%) ,
White 390 0 390(51.6%)
African American 251 2 253 (33.5%)
Asian/Pac.Islander 21 0 21 (2.8%)
Native American 2 0 2(.3%)
Total 750 5 755 (100%)
Source:Contra Costa Health Services,Public Health Communicable Disease Programs,
"HIV/AIDS Epidemiology Report",November 2000.
Page 47
CONTRA COSTA LATINO HEALTH PROFILE
Race/Ethnicity 1 9 of Injection Drug Users
Diagnosed with AIDS as of 8/31/00 Table 58
Race/Ethnicity Male IDUs Female IDUs Number/Percent
White 150 31 181(31.2)
African American 218 126 344(59.2)
' Latino 42 7 49(8.4)
Asian/Pacific Islander 4 1 5(0.9)
Native American 2 0 2(0.3)
I Total 416 165 581 (100)
Source:Contra Costa Health Services,Public Health Communicable Disease Programs,"HIV/AIDS
Epidemiology Report,"November 2000.
1 :. ..Contra Costa.Summary or AIDS Patients Infected -
Through Heterosexual Contact as of 8/31/00
' (by mode of infection of their infected partner Table 59
Heterosexual Contact With: Male Female Total M
Injection Drug user 6 64 70(50.7%)
Bisexual male 0 27 27 (19.6%)
Hemophiliac 0 1 1 (.7%)
Transfusion Recipient 0 2 2(l.5%)
Under investi ation 5 33 38(27.5%)
Total 11 127 138 (10001,)
Source: Contra Costa Health Services,Public Health Communicable Disease Programs,
"HIV/AIDS Epidemiology Report,"November 2000.
Contra Costa County
Total Number of AIDS Cases for Women by Race as of 8/31/00*Table 60
Race/Ethnicity Number/Percent
Latina 30(9.1%)
White 103 (31.0%)
' African American 193(58.1%)
Asian/Pacific Islander 6(l.8%)
Source:Contra Costa Health Services,Public Health Communicable Disease Programs, "HIV/AIDS
Epidemiology Report,"November 2000.
*Total cases reported from 1985 to 8/31/00
t = .
1
' Page 48
Tuberculosis CONTRA COSTA LATINO HEALTH PROFILE
What is it? ,
Tuberculosis (TB) is a disease that is spread from person to person through the '
air. TB Is caused by bacteria called Mycobacterium tuberculosis. When a person
who has active tuberculosis coughs, sings, laughs, or sneezes, the bacteria
become airborne and be suspended in the air for many hours. People who have ,
close and prolonged contact with a person with infectious TB can breathe in the
bacteria and become infected.
Infection is different from disease. Once a person has been exposed to,someone t
with TB and has breathed in the TB bacteria, they may become INFECTED with
the TB bacteria. This does not mean they are contagious or sick. Usually
people's bodies can fight off the TB bacteria and keep it under control, at least for
a while. A person who has been infected can take TB medicine to help their body
kill the TB Bacteria and prevent development of active TB disease. If they do not
take preventive medicine, however, the bacteria may grow, overcome the body's
natural defenses, and cause the person to become sick with active TB disease.
When this happens, the person may become contagious and cause illness in ,
their family.and their community.A person with active TB disease will need to
take several TB medications for many months to become well and to not infect
others. People with active TB disease may have some or all of the following
symptoms: cough, weight loss, fevers, fatigue, night sweats, or loss of appetite.
Sometimes, a person with advanced TB will cough up blood-streaked sputum.
Other times, a person with active TB disease may have only mild symptoms. It is
important to remember that either person may be spreading TB bacteria to others
without even knowing they have TB disease.
Why is it important?
As a communicable disease, it is important to be aware of the prevalence of TB,
so that effective prevention efforts can be undertaken to prevent spread of the
disease. Because.the treatment for TB requires medications that must be taken
regularly, it is important that those with TB comply with.their prescribed treatment
regimen. An important aspect to TB prevention and treatment is the ability to
access primary care for diagnosis and.intervention. Because Latinos in Contra
Costa have the highest uninsurance rate of any group, it is imperative that the
-community be aware of this communicable disease and seek treatment
immediately.
What is the status of Latinos in Contra Costa?
The number of tuberculosis cases has remained relatively stable since 1988, ,
fluctuating around 100 cases per year. Asians/Pacific Islanders made up 68.8
percent of the foreign born cases of TB over the three-year period. Latinos,
Page 49
1
CONTRA COSTA LATINO HEALTH PROFILE
foreign born and US born combined, comprised about 14.8 percent of all TB
cases between 1996 and 1998 (Table 61).
The characteristics of persons with TB have changed over the years. TB among
people with HIV/AIDS increased from 13 cases before 1990 to 33 cases between
1993 and 1995. Among people with TB, 62.5 percent were injection drug users,
63.9 percent are African American, 76.4 percent were males, and 76.7 percent
were residents of West County.
Total Tuberculosis Cases Reported
1 By Race/Ethnicity and Gender
Contra Costa County, 1996-1998 Table 61
1996 1997 1998 Total Cases
1996-1998
us Foreign us Foreign us Foreign us Foreign
Born Born Born Born Born Born Born Born
Latino 3 7 0 21 1 7 4 35
White 13 3 12 4 10 5 35 12
' African 54 1 33 0 26 0 113 1
American
Asian/Pac. 3 . 33 2 32 3 41 8 106
Islander
Other/unknown NA NA NA NA 2 0 2 NA
Total 73 44 47 57 42. 53 162 154
' Contra Costa County, Health Services Department,Health Statistics
Chlamydia
' What is it?
Chlamydia is the most common sexually transmitted disease (STDs) in the US.
Sometime referred to the "silent epidemic," Chlamydia is asymptomatic in 70-
90% of the infections occurring in women, and at least 50% of the infections
occurring in men.
Why is it important?
Adolescents and young adults shoulder the burden of this disease with
-transmission rates exceeding 20% in some populations. Because Chlamydia is
' transmitted through unprotected sex, the incidence of this sexually transmitted
infection can give us an idea about the number of people who may be at risk for
other sexually transmitted infections, including HIV. If infected with Chlamydia, an
individual can be more susceptible to transmission of HIV Infection, in both males
and females. Research indicates that that those infected with Chlamydia have
three to five times higher risk of contracting HIV, if exposed.
California State law requires that all STDs, including Chlamydia, be reported to
the local health department by all health care providers, including private
' Page 50
CONTRA COSTA LATINO HEALTH PROFILE
physicians, hospitals, clinics, and laboratories that perform STD testing. In
practice, many STD diagnoses go unreported. Many people with Chlamydia, and
other STDs, are never diagnosed because they lack access to health care, do ,
not recognize their symptoms as an STD, or do not develop symptoms at all. For
these reasons, reported totals should be considered minimal estimates of the
true number of STDs in the community.
What is the status of Latinos in Contra Costa?
From 1995 to 1999 the number of reported cases of Chlamydia, in Contra Costa
P Y
County, has increased by 19.3 percent. Latinos account for only a small
percentage (about three to five percent) of the total cases reported each year, r
although the large number of cases whose race was identified as either..
"unknown" or"other" makes these data unreliable. In 1999, of those cases for
which ethnicity is known, about 59 percent were African American, 22 percent
white, and 12 percent were Latino. Latinos experienced a decline in total
Chlamydia cases from 1995 to 1998 but experienced a slight increase between
1998 and 1999 (Table 62). Chlamydia rates are four to five times higher among r
females than males (Table 63) and among adolescent's ages 15 to 19 years
(982.4/100,000 population) (Table 64).
An individual must have access to health care to be diagnosed. Given the high
1
Latino uninsurance rate, many cases of Chlamydia may go undetected. Efforts
to collect STD data by race should be dramatically improved in Contra Costa ,
County. Not knowing the race/ethnicity of two-thirds of the diagnosed cases of
Chlamydia could have a serious impact on the Latino population's health.
r
r
f
1
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CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa County
Chlamydia Cases by Race by Year of Diagnosis, 1995-1999 Table 62
1400 yF rov< ,, .:. ss 'e..
i Fr..Asa•.'-:€F sd°:.F'. •' :•�� ° '"" ,_ �,."a•.° ..
15, _.
1200 ? ; D
Latino
F.
`.gW. :c:Cyia�'.',.-eN,n'a�:.'•=�: M� -°'i'^.o,�n'n `.�':y '�R. =a'.ssn..•=;
1000 ' .. ..;.,<, �zu:. White
«�'�':F.�'�
800 y:"'« .-�,:. '��,.^ :�, t�.;+„ �a .. w . '�rQ-.:::: -,fir.
ig
; .r: p African American
600 �.:: ,, ., :
p Asian/ Pacific
400 az :..
�.. Islander
MI.
` ®Other/ Unknown
200 s
0
1 1995 1996 1997 1998 1999
Source: Epidemiology,Surveillance and Health Data Unit,Communicable Disease Control Section
' Contra Costa County
Chlamydia Case and Rate/100,000 by Gender by Year of Diagnosis,
1995-1997 Table 63
Male Female
Year Number/Rate Number/Rate
1995 225 (52.9) 1,199(271.5)
1996 183(42.7) 1,011 (226.3)
1997 261 (59.3) 1,165 (255.4)
Source:Epidemiology, Surveillance and Health Data Unit,Communicable Disease Control Section
rContra Costa County
Chlamydia Case and Rate/100,000 by Age by Year of Diagnosis,
1995-1997 Table 64
Year 15 to 19 Years 20 to 24 years All Ages
Number/Rate Number/Rate Number/Rate
1995 608(1108.9) 428(812.3) 1424(164.2)
' 1996 495 (866.3) 389(748.9) 1195 (136.1)
1997 573(982.4) 439(827.9) 1426(159.1)
Source:Epidemiology, Surveillance and Health Data Unit,Communicable Disease Control Section
j
1
1
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CONTRA COSTA LATINO HEALTH PROFILE
Vaccine Preventable Diseases (Immunization)
What is it?
Immunizations are given to children to protect them form infectious diseases that
were the leading causes of death for children prior to the development of the
vaccines. Each year, the Immunization Branch of the State Department of Health
Services (DHS) conducts a survey of students in kindergarten for each county. It
uses the immunization records to retrospectively estimate the percent of children
who were up-to-date when they were two years old.
Why is it important?
Vaccines are the first line of defense against such diseases as polio, measles,
pertussis, and hepatitis. Vaccines not only protect the immunized individual but
the community as well. When immunized levels in a community are high, the few
who cannot be vaccinated are protected because they are surrounded by
immunized persons and so are protected from being exposed to disease. '
What is the status of Latinos in Contra Costa County?
Children in.Contra Costa County are more likely to be immunized than their
r
California counterparts (Table 65). The percentage.of age-appropriate
immunizations varied greatly across racial/ethnic groups. African American '
(47.1%) and Latino (50%) children were the least up-to-date on their
immunizations (Table 66).
Low immunization 1rates are another indicator of poor access and uninsurance by
the Latino population. Every effort should be made to ensure that all children are
properly immunized against these very serious diseases. ,
Trend and Proportion of Kindergartners
Who Had Up-To-Date Immunizations at 24 months ,
California / Contra Costa Count , 1996 — 1998 -Table 65
Contra Costa California
1996 65.1% 57.3% ,
1997 68.6% 59.2%
1998 68.8% 62.9% .
Source:Contra Costa County Office of Education.
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CONTRA COSTA LATINO HEALTH PROFILE
California/Contra Costa County
Proportion of Kindergartners
Who had Up-To-Date Immunizations at
24 months by Race/Ethnicity, 1996 Table 66
�..
=-..r
.a�,? '""*:.e.` :.,•'.,a',w :a,'':,si;'.�;,;', `°z'.°.0 --�""se,�,;aut2'r- ;Ra e ..`,''.:'. s: �.
0/0
Asian
7
.
'L' :rAfrican '°,'..�,'.�. . �:� ate::
A'_ : ..
American IRECalifornia
Y•::'1 ..:
s` p Contra Costa
White
70 %
•- Latino = o
°;.'•`tri'... ":.`.'�.'° '.v4:;roy:<e;.r.;:4amnm4d" M";T:;
0.00% 20.00% 40.00% 60.00% 80.00%
Source: Contra Costa County Office of Education.
1 1999 Expanded Retrospective SurveyResults by Count Table 67
County Total % Up % Up to % Up to % Up to % Up to % Up to
' Sample to Date Date Date Date Date Date
Size (All (White) (Hispanic) (African (Asian/PI) (Other)*
Races) American)
All figures are for Kinder arten students up to date with DPT4,Polio3,MMR.1 series at age 24 months
California 1 2072 63.9 68.3 60.4 55.1 70.9 72.2
Contra Costa 1 571 73.2 76.6 62.7 51.9 72.7 80.0
Source: www.dhs.ca.gov/ps/dcdc/izgroup
*Counties have own race designations for"Other". When available,statistics for the Native American
population are included.
r
t
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CONTRA COSTA LATINO HEALTH PROFILE
Section 6: Mental and Behavioral Health
What is it?
The National Institutes of Mental Health estimates that that 22% of all adults in
the United States suffer from mental disorders in any given year. Only half of
those individuals, or about 11% of Americans, seek mental health treatment in
any given year. In addition, the highest rates of diagnosable mental disorders are '
found among groups with the lowest socioeconomic status. Deinstitutionalization
and other factors has resulted in people with sever and persistent mental illness
ending up in jails and prisons, or on the streets. People with such mental '
illnesses are estimated to represent about a quarter of the homeless population.
According to Healthy People 2000 Review (1997) 22% of adult Americans will
have some form of diagnosable mental disorder during their lifetimes. '
Why it is it important?
Mental health problems in our society carry a stigma that creates barriers to
effective diagnosis, treatment and access to longer-term care. Insurance ,
coverage often is limited in relation to diagnosis and treatment, and for those
without health insurance coverage, mental health disorders often go untreated. If
some mental health problems go unchecked, they can worsen. Cultural factors . ,
play a role in affecting a person's attitude and response to mental health. Another
major obstacle to participation in programs related to behavioral/mental health
services is lack of a comprehensive and detailed information source about the ,
various Contra Costa programs that are available to the public.
What is the status of Latinos in Contra Costa?
Diagnostic and other mental health information is collected primarily by
institutions and providers of care. Thus, accurate information on the mental
health status of Latinos in Contra Costa relies, for the most part, on the idea that
mental health services are accessible and available. Hospitalizations for mental
health diagnoses are not an.accurate indicator of the mental he.alth status of the
Latino community because few Latinos have health coverage to provide
reimbursement to a mental health provider or institution, therefore a barrier exists
for those who may need this type of care. Also, as mentioned above, the stigma
associated with requesting and approaching mental health services also creates
a barrier for those with mental health needs. It is unfortunate that little
quantitative data are available in this area, as many health and social services '
providers recognize the need for these important services, but have little data to
support their experiences.
In January 2001, the Far East Community Health Partnership, comprised of a '
group of concerned health and social services providers located in Brentwood,
discussed the importance of mental health services and the needs in the Latino '
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CONTRA COSTA LATINO HEALTH PROFILE
community there. Because this report contained few quantitative data on mental
health, Kathy Radke (a member of the Partnership) volunteered to conduct an
interview with the Brentwood faith community. She met with Father Garcia,
Deacon Frank Bustos and Sister Presentacion of the Immaculate Heart of Mary
Catholic Church. Their congregations are about 43% Latino (30% monolingual),
and about 57%-Anglo.
Mental health issues that were mentioned as common include alcohol abuse;
depression especially in Latina women; domestic violence,elder abuse (mostly
verbal abuse) and child abuse—which is often exacerbated by alcohol. Parents
are very concerned about their children regarding drugs and gangs.
The interviewees had verylimited knowledge of in the communit and
9 Y
' had requested information about schools, after school programs, etc. However,
they often refer their congregants to Alcoholics Anonymous meetings that are
conducted at the Catholic church three nights per week.
rAccessible, culturally and linguistically appropriate mental health services are key
factors in reducing the barriers to improving mental health status. However, it is
' also important that the health and human services provider community be -
apprised of the services available and to assist Latinos better understand how to
access those services.
Self-Inflicted Injury Hospitalization
Mental Disorders Leading to Hospitalization
By Race/ Ethnicity
Contra Costa County and Bay Area, 1996 Table 68
Bay Area Contra Costa Count
Hospitalization Dx.Mental % Mental Hospitalization Dx.Mental % Mental
Disorder Disorder Disorder Disorder
Latino 94,542 3,487 3.7% 8,215 343 4.0%
White 417,516 27,634 6.6% 58,227 3,956 6.4%
African 74,830 6,642 8.9% 10,661 875 7.6%
American
Native American 1,494 120 8.0% 223 11 4.7%
Asian/Pacific 77,967 2,260 8.9% 5,253 195 3.6%
Islander
Other/Unknown 20,249 991 4.9% 2,744 100 3.6%
Source: OSHPD Patient Discharge Data, 1996.
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CONTRA COSTA LATINO HEALTH PROFILE
Drug (Non-Alcohol) Related Hospital Discharges
By Re ion, Race/Ethnicity, 1994 Table 69
Latino White African Asian/ Other Total
American Pacific
Islander
No. Percent No. Percent No. Percent No. Percent No. Percent ,
West 36 4.5% 262 32.5% 494 61.3% 10 1.2% 4 0.5% 806
Lamorinda 13 4.6% 238 83.5% 29 10.2% 3 1.0% 2 0.7% 285
South 5 2.0% 219 89.0% 8 3.3% 9 3.7% 5 2.0% 246 '
Central 33 7.3% 390 86.1% 1 23 5.1% 3 0.7% 4 0.9% 453
East 60 9.8% 410 66.8% 131 21.3% 8 1.3% 5 0.8% 614
Total 147 6.1% 1,519 63.2% 1 685 28.5% 1 33 1.4% 20 0.8% 2,404 '
Source: California Department of Alcohol and Drug Programs;OSHPD.
Universe: All hospital discharges in 1994 where at least one of the first nine(principal+8)diagnoses
involved drugs.
Alcohol Related (1) Hospital Discharges ,
By Region, Race/Ethnicity, 1994 Table 70
Latino White African Asian/Pacific Other Total
American Islander
No. Percent No. Percent No. Percent No. Percent No. Percent No.
West 59 8.8% 296 . 44.3% 296 44.3% 15 2.2% 3 0.4%. 669 '
Lamorinda 20 4.9% 364 89.4% 20 4.9% 2 0.6% 1 0.2% 407
South 8 2.0% 384 95.8% 1 0.3% 7 1.7% 1 0.2% 401
Central 30 6.3% 1 433 90.2% 8 1.7% 4 0.8% 5 1.0% 480
East 95 14.9% 457 71.9% 71 11.2% 8 1.2% 5 0.8% 636
Total 212 8.2% 1 1,934 74.6% 396 15.2% 36 1.4% 15 1 0.6% 2,593
Source: California Department.of Alcohol and Drug Programs;OPHPD.
(1)Universe: All hospital discharges in 1994 where at least one of the first nine(principal+8)diagnoses '
involved drugs.
County Mental Health Services
The Contra Costa County Mental Health Division (CCCMHD) provides programs
and services for adults, children, adolescents, people in crisis/emergency, and
criminal justice offenders. Additionally, the Mental Health Division has Latino
outreach and consumer empowerment programs. The Contra Costa Mental
Health Plan proposes to "provide mental health services to the Medi-Cal eligible '
and uninsured residents of Contra Costa County, within a culturally competent
context that permits their full access and benefit from treatment and other
supportive services". ,
The CCCMHD uses the number of Medi-Cal beneficiaries who use medically
necessary specialty metal health services as an indicator of service utilization.
The vast majority, 84.5 percent of Medi-Cal funded specialty mental health
services are for mental health outpatient and case management services.
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CONTRA COSTA LATINO HEALTH PROFILE
Contra Costa County
Medi-Cal Mental Health Services, 1996-1997 Table 71
Type of Mental Health Service Number Percent
Outpatient/Case Management 5,770 84.5%
Inpatient Residential 635 9.3%
'
Day Services 427 6.3%
Total 6,832 100%
Source: Northern California Council for the Community,"Contra Costa County", 1999
-, The CCCMHD'reports that the majority of consumers who access mental health
services are single or female heads of household between 25 and 56 years.
1 Clients are usually poor; a substantial number are unemployed or disabled. The
Mental Health Plan aims to develop and improve services to the following
populations: Asians, African Americans,-Latinos, and children under 18 years.
Based on the table below, it is highly likely that Latinos have a much greater
need for mental health services than their utilization numbers indicate. Although
Latinos comprise about 14 percent of the population, they represent only 5.6
percent of the persons who utilized Contra Cost's mental health programs in
1996 to1997. Barriers to mental health services are similar to those of acute care
services: cultural and language barriers,,immigration status, and social concerns.
Contra Costa County Table 72
' Medi-Cal Mental Health Services by Race/Ethnicity, 1996-1997
Race/Ethnicity Services
Number Percent
Latino 384 5.6%
White 3,122 : 45.7%
African American 2,070 30.3%
Asian 178 2.6%
Other/Unknown 1,078 15.8%
Total 6,832 100%
Source: Northern California Council for the Community,"Contra Costa County", 1999
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CONTRA COSTA LATINO HEALTH PROFILE
Domestic Violence Suspects (By Race/Ethnicity)
Contra Costa County
July 1, 1997 to June 30, 1999 Table 73
All Others Latino
African 6% u 18% '
American
26% m
White
50% ,
Source: Contra Costa County Sheriffs Office,Domestic Violence Unit,2000.
Domestic Violence Victims By Race/Ethnicity ,
Contra Costa County
July 1, 1997 to June 30, 1999 Table 74
All Others Latino
African 7% 15% ,
American '`
_.
23% '
White
55% '
Source: Contra Costa County Sheriffs Office,Domestic Violence Unit,2000. ,
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' CONTRA COSTA LATINO HEALTH PROFILE
Section 7: Health Care Access and the Health Care System
1 Barriers to Care
During the past decade the issue of health care access has been studied more
intently due to a number of factors, including: federal health care reform,
changing practices of employers' provision of health insurance, and the growth of
' managed care in both the private and public sectors. The number of studies
regarding access to care, at the county level is very limited. To address this
problem, it is assumed the Contra Costa County is consistent with state rates.
Access to health care has generally been conceptualized and o erationalized by
researchers as the absence of barriers to service, which usually fall within three
' broad categories They are: economic barriers, service barriers, and social
barriers. Economic barriers exist when a consumers' access to care is barred or
limited due to insufficient resources and/or insurance. Social barriers include a
variety of institutional biases and individual beliefs that result in limiting access to
health care for different populations (language and cultural barriers, immigrant
' status, lack of transportation, etc.). Service barriers can include a lack of needed
services, their accessibility, availability, or appropriateness (lack of Spanish-
speaking providers, hospitals that do not accept Medi-Cal, an inadequate supply
of primary care providers, among others).
Economic Barriers to Care
The cost of health insurance, lack of employer provided coverage-especially for
workers in low-income, low or no-benefit jobs, and high health care costs limit
access to services at the statewide and local level.
A major economic barrier to care is the lack of health insurance. People without
' health insurance are likely to forego or delay necessary medical care. Compared
to people with insurance, for example, uninsured men are more than twice as
likely to go without a blood pressure screening for more than two years and
' uninsured women are more likely to have skipped a Pap test, a clinical breast
exam, or a mammogram during the past year.
Health Insurance
Employment-based health insurance is critical to employees' ability to afford
health care for themselves and their families. Employment-based coverage
comprises more than 90% of all private of all private coverage.
' Only forty percent of non-elderly Latinos are covered by employer-based
insurance despite the fact that a full-time employee heads most Latino families.
Another 40 percent of Latinos obtain health insurance through their employers
' compared to Whites (70%), Asians (61%), and African Americans (55%). Latino
' Page 60
CONTRA COSTA LATINO HEALTH PROFILE
children's uninsurance rate 32% is three times that of whites 12% and Asians ,
(13%) children and double that of African American (16%) children.
Why is it important? ,
Medi-Cal has been credited with cushioning the impact of declining employment- '
based health insurance coverage. In 1989, Medi-Cal eligibility guidelines
expanded to include pregnant women and children under the age of one year to '
200% of the Federal Poverty Level. Yet even in 1993, while 20% of all women
ages 18-64 had no health insurance, only 12% obtained Medi-Cal. The low
utilization rate by Latinas is exacerbated by eligibility restrictions or perceived
restrictions to Medi-Cal based on immigration status. . ,
What is the status of Latinos in Contra Costa?
Many Latinos do not have information about where to seek care, nor do they
know about their eligibility for programs such as: '
■ CHDP Public Health and community-based clinics
■ Full scope Medi-Cal Programs for.Undocumented Children
■ Healthy Families California Children's Services (CCS) ,
■ Kaiser Permanente Care for ■ Programs offered by non-profit clinics (i.e.
Kids Insurance plan sliding scale fees)
■ CaliforniaKids ■ Emergency related services Medi-Cal '
■ Private insurance plans ■ Mobile health services & Su Salud Fair
Efforts are bring made by the Contra Costa Health Department and other. ,
organizations to provide appropriate information to the Latino community. '
However, low literacy levels and non-formal education, fear of deportation and
other factors make it difficult to seek out and gain trust with the uninsured
community.
California Table 75 '
Health Insurance Coverage by Ethnic Group, Ages 0-64, 1998.
California Uninsured Job-based Privately Medi-Cal Other ,
Insured
Latino. 40% 40% 2% 17% 1%
White 15% 70% 7% 6% 2%
African American 23% 55% 2% 19% 2%. ,
Asian/Pac.Islander 22% 61% 5% 8% 3%
Source: US Census Bureau,March 1999,Current Population Surveys
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CONTRA COSTA LATINO HEALTH PROFILE
California
'
Non-E derly Uninsured by Race, 1998 Table 76
Total Men Women Children
Latino 40% 48% 45% 32%
White 15% 17% 15% 12%
' African American 23% 28% 25% 16%
Asian/Pac.Islander 22% 24% 26% 13%
Source: US Census Bureau,March 1999,Current Population Surveys
The only data that was found at the local level regarding health insurance
coverage comes from a report prepared for the major providers of inpatient care
' for West County. The study estimated that about 18 percent of the West County
population was uninsured. The majority of households at risk for lack of
insurance are located in the southern part of the region (Richmond, San Pablo).
' The report also found that working people who do not have employer-based
insurance plans cannot afford to pay premiums, and are forced to rely on hospital
emergency room care when they or their families become ill. Medi-Cat's Share of
' Cost program often requires a co-payment high enough to create a barrier to
care. Some Latinos with Kaiser coverage also are concerned about high
emergency room co=payments.' In addition to lack of health insurance, other economic factors impact access to health care. The need to arrange for
childcare, obtain transportation, take time off from work and face lost wages are
formidable barriers for many low-income people.
Social Barriers
Social barriers include a variety of organizational and institutional biases and
individual beliefs that result in limiting access to care for certain populations. This
section briefly reviews some of these factors; they include: language and cultural
barriers, immigrant status and transportation issues.
Language and Cultural Barriers
By 1990, nearly half of the Latinos living in California were immigrants. As a
' result, the majority of Latino households (80.3%) are now Spanish-speaking.
Well over half (59.6%) Latino adults age 25 and older in California are:
immigrants.
' In publicly-funded programs such as Medi-Cal and Healthy Families, cultural
competency and linguistic access standards are critical to ensuring enrollment,
utilization and quality care for California's communities of color and immigrant
populations. It is estimated that two-thirds of eligible children for Medi-Cal and
healthy families live in immigrant families.
Eighty percent of those eligible for the Health Families Program are estimated to
g Yp 9 Y g
be from communities of color.
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CONTRA COSTA LATINO HEALTH PROFILE
Non-English speaking patients have been found to be less likely to receive
sufficient preventive health information or referral from their providers. '
In Contra Costa County, in 1998, no community information resource existed to ,
inform consumers about the language capabilities of health care providers.
In the absence of interpreters, non-English speaking adults must bring their
children, other family members or friends with them to medical appointments to '
translate for them. This means taking children out of school or scheduling
appointments after school. It also means the communication between provider ,
and patient is not confidential, possibly inhibiting patients from seeking care for. .
sensitive issues, such as reproductive and mental health.
Immigrant Status
Although Healthy Families and Medi-Cal together have the capacity to provide
coverage for up to three-quarters of California's 2 million uninsured children, a
variety of barriers exist that inhibit parents from completing these applications for
their children. A recent study by the University of California San Francisco's ,
Institute for Health Policy studies cited that about 11% of those parents who
requested applications for these programs did not complete the process because
of concern about the enrollment process' effect on immigration status. However,
because these parents requested an application, they have already
demonstrated that they were relatively unconcerned about immigration issues
and therefore may not be representative of other parents of unenrolled children.
A 1990 survey of undocumented women in San Francisco conducted by the
Coalition for Immigrant and Refugees found that the fear of deportation was the
primary barrier to seeking health services for the majority of Latinas and Filipinas
surveyed. Children of immigrant families are more likely to be uninsured, have
fewer referral services, and are less likely to seek out health care for fear of
deportation. The pervasiveness of these issues for undocumented immigrants
most likely makes them applicable to this population in Contra Costa County.
Service Barriers '
The health.facilities' location and types of services are important relative to
accessing care that is appropriate to the health care needs of the population or
service area-Transportation has been cited as an important factor for lower
income persons attempting to access health care in Contra Costa. The types of ,
services provided and by whom (ethnicity, gender and language are important
factors) often determine health care accessibility. It is important to note that a
health care institution's policies on accepting Medi-Cal as a form or payment is
also a critical factor to accessing care. John Muir Medical Center discontinued its
Medi-Cal contract in 1999.
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CONTRA COSTA LATINO HEALTH PROFILE
Medi-Cal Eligible By Race/Ethnicity
' Contra Costa and California, 1997 Table 77
Latino White African Asian Pacific Not Reported
American Islander
Contra CA Contra CA Contra CA Contra CA Cont CA
Costa Costa Costa Costa ra
Costa
' 17.4% 37.4% 35.5% 29.9% 29.5% 14.0% 7.8% 8.0% 9.6% 10.3%
Source: Data User's Support Group,Office of Statewide Health Planning and Development.
Why is it important?
The location and-types of services is important because the other sections in this
' profile demonstrate that access to care is a key factor to the health status of the
Latino community. A relationship with a regular primary care provider promotes
regular visits for preventive care. Evidence of lack of access to primary care can
be seen in the low immunization rate and the low prenatal care (during the first
trimester) rate for the Latino community. The suspiciously low rates reported for
sexually transmitted infections such as chlamydia, may indicate that fewer
Latinos approach the health care system, resulting in fewer diagnoses and
reports on these diseases.
' What is the impact on Contra Costa Latinos?
In Section 1, Social,and Demographic profile, the percentage of Latinos living in
East County is 22%, comprising a significant segment of the population in that
area. Also, Latinos living in East County have lower incomes, and less access to
transportation. The hospital table, below shows that only one hospital serves the
entire portion of East County, and unfortunately, that hospital is considering
withdrawing from participating in Medi-Cal. This could have an impact on low
income Latinos who are receiving Medi-Cal benefits (including pregnancy related
Medi-Cal) who may not feel that they have access to the only hospital located in
their area.
1
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CONTRA COSTA LATINO HEALTH PROFILE '
Hospitals
Contra Costa County and California, 1996* Table 78
Number of General Acute Care(GAC)Hospitals 15 601
Number of Licensed GAC Beds 2,470 101,544
Number of Licensed GAC Beds per 1,000 2.8 3.1
population
Number of GAC Discharges 70,283 3,130,538
Average GAC Occupancy 44.0 47.7 ,
Average GAC Length of Stay in GAC Hospitals 4.6 4.7
(days)
Source: Data User's Support Group,Office of Statewide Health Planning and Development. ,
*As of February 2001 there were only eight hospitals in Contra Costa County,therefore,there are actually
fewer hospital beds and services available.
1
Location of General Acute Care Facilities
Contra Costa County, 1999 Table 79
ERVIN .. ONTRA.COSTA'.
:.: HOSPITALS S G C CO
Name of Hospital Location Accepts Medi-Cal '
1. Doctors Medical Center(formerly San Pablo Yes
Brookside Hospital and Doctors of
Pinole)
2. Contra Costa County Regional Medical Martinez Yes '
Center(formerly Merrithew)
3. Sutter Delta Memorial Hospital Antioch (The hospital plans to
(formerly Sutter Memorial) discontinue participating in '
Medi-Cal)
4. John Muir Medical Center Walnut Creek No
5. Kaiser Richmond Medical Center Richmond Yes
6. Kaiser Walnut Creek Medical Center Walnut Creek Yes
7. Mt.Diablo Medical Center Concord No
8. San Ramon Regional Medical Center San Ramon ? r
Source: The Official United States Government Web Site for Medicare Information and Federal
Government Statistics;.Healthstreet Provider and Facility Search @www.healthstreet.com. ,
1
r
1
1
Page 65 '
Bibliography CONTRA COSTA LATINO HEALTH PROFILE
The Bay Area Health Summit"The Health Status of Latinos in 2000", 2000.
California Department of Alcohol and Drug Programs at http://www.adp.cahwet.gov/.
' California Department of Consumer Affairs at http://www.dca.ca.gov/.
California Department of Consumer Affairs, Medical Board of California, Physicians and
' Surgeons, Valid License at http://www.dca.ca.gov/and at http://www.medbd.ca.gov/.
California Department of Education, Educational Demographics Unit, Dataquest at
'
hftp://datal.cde.ca.gov/dataquesi.
California Department of Education, Educational Demographics Unit. Graduation Rates in
California Public Schools, by County. By Ethnic Group. 1996-1997 at
' http://www.cde.ca.gov/demographics/reports/.
California Department of Finance at http://www.dof.ca.gov/.
' California, Department of Health Services, Birth Records at http://www.dhs.cahwnet.gov/.
California Department of Health Services, California Cancer Registry, Cancer Incidence in the
San Francisco Bay Area, 1988-1994.
California Department of Health Services, Cancer Research Section-California Cancer Registry at
http://www.ca.gov/cdic/ccd/cancer.
' California Department of Health Services, Division of Chronic Disease and Injury Controlat
http://www.dhs.ca.gov/ps/cdic/cdicindex.htm.
California Department of Health Services, Office of Statewide Health Planning and Development
at http://www.oshpd.state.ca.us/fdd/.
' California Department of Health Services, Office of Statewide Health Planning and Development,
California Hospital Patient Discharge Data, 1996 at http://www.oshpd.cahwnet.gov/.
California Department of Health Services, Office of Statewide Health Planning and Development,
Data User's Support Group at http://www.oshpd.cahwnet.gov/.
California Department of Health Services, Office of Statewide Health Planning and Development,
Northern California Council for the Community Report, 1996.
California Department of Health Services. Vital Statistics Section. Advance Report: California.
Vital Statistics. California and United States Comparisons. California Births, California Deaths
and California Infant Death, 1999.
California Department of Justice, Criminal Justice Statistics Center, California Criminal Justice
Profile, 1997 and 1999 at http://caag.state.ca.us/.
California Department of Social Services at http://www.dss.cahwnet.gov/.
' California Employment Development Department at http://calmis.cahwnet.gov/.
1
' Page 66
r
CONTRA COSTA LATINO HEALTH PROFILE
California Employment Development Department, Labor Market Information at '
http://www.calmis.ca.gpv/.
California Rural Health Policy Council at http://www.ruralhealth.ca.gov/link.htm. r
Centers for Disease Control & Prevention, National Center for Health Statistics at
http://www.cdc.gov/.
Centers for Disease Control & Prevention, Epidemiology, Surveillance and Health Data
Communicable Disease Control Section Public Health Division at
http://www.cdc.gov/scientific.htm.
Centers for Disease Control & Prevention, Monthly Vital Statistics Report. Volume 45, 11(S). . '
Claritas Healthcare Solution Zip Code Data, 1998. Prepared by the Northern California Council
for the Community.
Claritas Health care Solutions Census Tract Data. Prepared by the Northern California Council r
for the Community.
Community Wellness & Prevention Programs at http://ccprevention.org/. '
Contra Costa County, Community Development Department, Regional Map at
http://www.co.contra-costa.ca.us/depart/cd/index.html.
Contra Costa County, Community Network at http://www.c4net.org/.
Contra Costa County Crisis Center Service Database, 1999 at http://www.crisis-center.org/. !
Contra Costa County Health Services Department, 2000 Community Wellness and Prevention
Programs Report. '
Contra Costa County Health Services Department, Brigid Simms, MPH Office for Service
Integration at http://www.i-qc.org/ccchdata.
Contra Costa County Public Health Division, Epidemiology, Surveillance and Health Data
Community Disease Control.
Contra Costa County Official Website at http://www.co.contra-costa.ca.us/. '
Contra Costa County Office of Education at http://www.cccoe.kl2.ca.us/.
Contra Costa County Sheriff's Office; Domestic Violence Unit, 2000 at http://wwW.cocosheriff.org
County Health Status Report, by Alameda County Public Health Department, July 2000. ,
Federal Bureau of Investigation, FBI Crime Indexes, 1999.
Federal Bureau of Investigation, Uniform Crime Reporting, 1998.
Forum on Child and Family Statistics at http://www.childstats.gov.
National Association for Public Health Statistics at http://www.naphsis.org .
National Center for Health Statistics at www.cdc.gov/nchs/.
1
Page 67 ,
CONTRA COSTA LATINO HEALTH PROFILE
Northern California Cancer Center, Cancer Incidence and Mortality, 1997.
' Northern California Cancer Center, Cancer Incidence in the San Francisco Bay Area, Prehn,
A.W. et al., 1997.
Northern California Council for the Community, Contra Costa County United Way/Hospital
Collaborative Community Assessment, 1999.
United States Bureau of the Census, Hispanic Minority Links at
http://www.census.6ov/pubinfo/www/hisphot2.html.
United States Bureau of the Census, State Census Statistics at http://ftp.census.govfindex.html..
'I United States Bureau of the Census, U.S Department of Commerce, Small Area Income and
Poverty Estimates, February 1999 at http://www.census.gov/hhes/www/sair)e.html.
United States Department of Finance, Demographic Research Unit, Intercensal Estimates of the
Population of California, State and Counties 1990-2040, Report 93P.
' United States Department of Finance, State Census Center at
http://www.igc.apc.org/ccchdata/dofstat.html.
' United States Department of Finance, United States Census, 1990.
United States Department of Health and Human Services, Death Records and Birth Cohort
Records at http://search.hhs.gov/.
United States Department of Health and Human Services, Office of Minority Health at
hftp://www.omhrc.gov .
' United States Department of Justice, State and County Statistics,1999. at http://wwwbsdoi.gov/.
United States Department of Labor, Bureau of Labor Statistics at http://stats.bl.s.gov/.
United States Government Official Web Site for Medicare Information and Federal Government
Statistics: Healthstreet Provider and Facility Search at http://www.healthstreet.com.
' Page 68
ACKNOWLEDGEMENTS
The Latino Health Profile was prepared by the Latino Leadership Council of Contra ,
Costa.
Authors,Editors and Contributors: ,
Consultants ,
Nancy Sherrick, MPA
Debra Mathias, MHSA
Latino Leadership Council
Maria Alegria
Franciso Dorado '
Eren Mendez
Fernando Peralta, Treasurer
Aleida Rios
Mary Rocha, Chairperson
Mary Rosas, Vice Chairperson
Lou Rosas ,
Latino Leadership Council Health Committee
Dr. Barbara Bunn McCullough
Blanca Brossa
Maria Castaneda
Francisco Dorado ,
Lorena Martinez-Ochoa
Eren Mendez
Mary Rocha ,
Student Intern ,
Esperanza Sanchez
Community Members and Expert Reviewers '
Lynn Baskett Jose Martin
Robert Benjamin Kathy Radke
David Carillo Elba Sanchez '
Ramona Gonzalez Lynn Seaton
Erika Jenssen Brenda Sharp '
Malcolm Kaiser Andres Soto
Nancy Kaiser Megan Webb
Annette Lerma '
Page 69 ,
1
ABOUT THE AUTHORS
1
Nancy Shemick MPA the principal consultant to the Latino Leadership Council for this
1 project, has over twenty years' experience working in Latino communities throughout the
United States and overseas. Her background includes serving as a Peace Corps Maternal
and Child Health educator as well as a trainer of Peace Corps Volunteers slated for
1 community health worker positions in Latin America and the Caribbean. Her work in the
Latino community now includes community clinics serving Contra Costa, San Francisco,
and Alameda counties. Her focus is in project management, strategic planning and
1 program design. She received her B.S. in Health Planning and Administration and her
Masters in Public Administration.
1 Debra G. Mathias, MHSA, is presently finalizing her doctoral degree in Public
Administration. She developed the primary and secondary data collection methodologies
for the Center for Health Administration at the University of Colorado, Denver. She is an
1 expert in research design and data analysis, data collection management, focus group
development and interviewing, and project management. She has conducted numerous
community health needs research and assessment projects for both private and public
' organizations that have resulted in identifying strategic business opportunities and in
specifying community health program needs.
i
1 The Latino Leadership Council and East Bay Perinatal Council are very thankful for the
support from the following foundations which provided grant funding for this project:
John Muir Mount Diablo Community Health Development Corporation in partnership
1 with the California Endowment, and the San Francisco Foundations.
1
1
1 Page 70
1
THIS REPORT MAY NOT BE COPIED OR REPRODUCED WITHOUT THE
WRITTEN PERMISSION OF THE LATINO LEADERSHIP COUNCIL:
440 RAILROAD AVENUE, PITTSBURG, CA 94565
$25.00 per copy ,
Printing courtesy of Kaiser Permanente-
Northern California '
141
BLACK DIAMOND PRINTING ,
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(THREE (3) MINUTE LIMIT)
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est'
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CHECK ONE:
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1. Deposit the "Request to Speak" form (on the reverse side) in
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4 . Give the Clerk a copy of your presentation or
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f.
REMARKS BY MARY ROCHA
CHAIRPERSON
LATINO LEADERSHIP COUNCIL OF CONTRA
COSTA
BEFORE THE CONTRA COSTA COUNTY
BOARD OF SUPERVISORS
MAY 89 2001
• GOOD MORNING MEMBERS OF THE BOARD OF SUPERVISORS,
COUNTY STAFF, LADIES AND GENTLEMEN. I AM MARY ROCHA,
CHAIRPERSON OF THE LATINO LEADERSHIP COUNCIL OF
CONTRA COSTA COUNTY.
• THE LATINO LEADERSHIP COUNCIL OF CONTRA COSTA COUNTY
WAS ESTABLISHED IN 1999 IN DIRECT RESPONSE TO THE
DECLINING LEVEL OF COMMUNITY BASED AGENCIES THAT
SERVED THE LATINO POPULATION OF OUR COUNTY.
• AS A RESULT OF OUR EFFORTS, WE ARE PLEASED TO PRESENT
TO YOU THIS MORNING, THE FIRST COMPREHENSIVE PROFILE
DOCUMENTING HEALTH AND EDUCATION ISSUES IMPACTING
CONTRA COSTA'S LATINO POPULATION.
• COMPLETED IN APRIL OF THIS YEAR, THIS HISTORICAL -- AND
FIRST OF ITS KIND REPORT -- WILL PROVIDE YOU, COUNTY
DEPARTMENT HEADS AND COUNTY ADMINISTRATORS,
CURRENT AND RELEVANT INFORMATION SO YOU MAY BETTER
ADDRESS THE NEEDS AND ISSUES OF OUR LATINO COMMUNITY.
• SOME OF THE HIGHLIGHTS OF THIS REPORT ARE:
• LATINOS HAVE THE LOWEST HEALTH INSURANCE COVERAGE
OF ANY ETHNIC GROUP IN THE COUNTY RESULTING IN LESS
I
}
ACCESS TO PREVENTIVE SERVICES SUCH AS PAP SMEARS,
r
MAMMOGRAMS AND COLORECTAL SCREENINGS.
• ASA COMMUNITY WE ALSO EXPERIENCE DELAYS IN RECEIVING
EARLY PRENATAL CARE AND REPRODUCTIVE HEALTH
SERVICES; AND VERY LOW UTILIZATION RATES FOR COUNTY-
BASED MENTAL HEALTH SERVICES.
• RESULTS OF UNTIMELY -- OR LACK OF -- ACCESS TO
PREVENTIVE AND DIAGNOSTIC SERVICES ARE FOUND IN A LOW
IMMUNIZATION RATE AMONG LATINO CHILDREN, AN INCREASE
IN CERVICAL/UTERINE MORTALITY RATES COMPARED TO OTHER
ETHNIC GROUPS, AND IN A HIGH TEEN BIRTH RATE.
• LATINA TEEN BIRTHRATE SHOULD BE OF GREAT CONCERN TO
YOU. IN 1997 LATINAS REPRESENTED 41% OF THE 424 BIRTHS
TO TEEN MOTHERS IN OUR COUNTY.
• AND LATINAS ARE LESS LIKELY THAN WHITE, ASIAN AMERICAN,
AND AFRICAN-AMERICAN WOMEN TO RECEIVE PRENATAL CARE
IN THEIR FIRST TRIMESTER.
• ANOTHER IMPORTANT INDICATOR FOR THE FUTURE SUCCESS
OF THE LATINO COMMUNITY IS ITS EDUCATION ATTAINMENT. IN
CONTRA COSTA COUNTY THE SITUATION IS DISCOURAGING.
2
• IN THE 1998-1999 SCHOOL YEAR LATINOS COMPRISED 30% OF
HIGH SCHOOL DROPOUTS.
• ON ANOTHER FRONT, ALMOST ONE-THIRD OF FATAL INJURIES
AMONG LATINOS ARE DUE TO FIREARMS AND LATINOS HAVE
THE HIGHEST PERCENTAGE OF INJURY AND DEATH FROM
POISONING AND THE SECOND HIGHEST NUMBER OF DEATHS
FROM MOTOR VEHICLE ACCIDENTS.
• LATINOS REPRESENTED ABOUT 14 PERCENT OF THE
POPULATION IN CONTRA COSTA, BUT REPRESENTED NEARLY 20
PERCENT OF HOMICIDE VICTIMS.
• AND THE LATINO ADOLESCENTIYOUNG ADULT DEATH RATE
WAS TWICE THAT OF THE WHITE POPULATION IN 1995-1996.
• TO POSITIVELY IMPACT THE HEALTH AND EDUCATION ISSUES
OF THE LATINO POPULATION WILL REQUIRE GREATER, MORE
FOCUSED OUTREACH EFFORTS ESPECIALLY IN THE AREA OF
PREVENTIVE.CARE AND IN PUBLICIZING COUNTY HEALTH
SERVICES.
• THE HIRING OF ADDITIONAL BILINGUAL OUTREACH WORKERS
WOULD BE A GREAT FIRST STEP.
• THIS WOULD IMPROVE THE IDENTIFICATION OF RISK FACTORS
WITHIN THE LATINO FAMILY STRUCTURE.
3
1
1
• TO ADDRESS THE ISSUES RAISED IN THE PROFILE WILL
REQUIRE ADDITIONAL FUNDING AND SUPPORT FOR
ORGANIZATIONS THAT SERVE LATINOS. THIS WOULD REVERSE
SOME OF THE ALARMING TRENDS CONTAINED IN THE REPORT.
• THANK YOU FOR YOUR TIME THIS MORNING. WE HAVE A COPY
OF THE PROFILE FOR EACH OF YOU AND FOR YOUR COUNTY
ADMINISTRATOR.
• WE LOOK FORWARD TO FORMALIZED DIALOG WITH YOU, YOUR
DEPARTMENT HEADS AND ADMINISTRATORS SO TOGETHER WE
CAN FIND SOLUTIONS TO TODAY'S PROBLEMS AND BUILD
POLICIES THAT FOCUS ON LATINO COMMUNITY SUCCESSES IN
THE FUTURE.
•
.1 - AS WELL AS OTHER MEMBERS OF THE LATINO LEADERSHIP
COUNCIL -- WILL BE PLEASED TO OFFER ANY CLARIFICATIONS
OR RESPOND TO ANY QUESTIONS YOU MAY HAVE.
4
LATINO LADERSHIP COUNCIL
of CONTRA COSTA
May 8, 2001
To: All Community Based Organizations, Business Groups, and Government
Agencies
From: Mary Rocha, Chairperson
Subject: Release of the "Latino Health Profile"
On May 8, 2001, the Latino Leadership Council of Contra Costa will release its county-wide
Latino Health Profile. This comprehensive profile -- nine months in the making --
documents health and education issues facing Contra Costa's Latino population. Completed
in April 2001 this historical first of its kind report will provide policy makers and service
providers current information so they may better address the needs and issues of the Latino
community.
The Latino Health Profile is available for $25.00 which includes shipping and handling.
Please complete the form below and mail it and your check made payable to: Latino
Leadership Council, 29 Tahoe Place, Pittsburg, California 94565.
-------------------------------------------------------------------
Please send copies of the Latino Health Profile at $25.00 per copy to:
Name:
Address:
City: State: Zip:
Phone Number: Contact
Name:
Amount Enclosed: $
(Profiles will not be sent without prior payment.)