Photo of “Encrucijada” characters Alicia and Don Juancho courtesy of The Colorado Health Foundation and Entravision Communications Corp.
Alicia’s entire life has been building to this one moment at the breakfast table. She’s finally admitting to herself that the colon cancer will take everything … her successful psychiatric practice, a comfortable home, her new love with Don Juancho.
Cue the tears. Sound up on the dramatic music. And cut.
On the Los Angeles set of “Encrucijada: Sin Salud No Hay Nada,” the title says it all: “Crossroads: Without Health, There Is Nothing.”*
Like most storylines in this emerging brand of Spanish-language soap opera, or telenovela, Alicia’s dramatic past and harrowing future are intertwined with more basic things, like the importance of visiting the doctor regularly, catching cancer in its early stages and planning for end-of-life care. Last year’s pilot season tackled everything from diabetes to melanoma to dental care — with each storyline crafted to deliver public health messages to a notoriously difficult-to-reach audience.
As a group, Hispanics remain one of the nation’s most uninsured, under-resourced and — increasingly — unhealthy segments of the population. Combine that with the seemingly unrelated fact that telenovelas are beamed directly into the living rooms of millions of them each week and the possibilities become “enormous,” said Dr. Michael Rodriguez, professor of medicine at UCLA.
“These telenovelas are happening every day, so there’s an opportunity to have numerous messages heard frequently, by different players, over a period of time.” And that, he said, “translates into behavior changes.”
On Wednesday’s PBS NewsHour broadcast, health correspondent Betty Ann Bowser goes behind the scenes on the set of “Encrucijada” in Los Angeles to hear more about the long-term vision for this emerging public health tactic … and, of course, to learn the fate of Alicia (scroll to the bottom if you want to know what happened to her).
In the meantime, Cara James, director of the Disparities Policy Project at the Kaiser Family Foundation, answered some questions about the status of the Hispanic health care gap and what — besides the creation of socially conscious soaps — is being done to close it.
What percentage of the Hispanic population remains uninsured today in the United States, and how does that compare with other groups?
Cara James: The Hispanic population has one of the highest uninsured rates in the country. About a third — 34 percent of the non-elderly Hispanics who are less than 65 years of age — are going without coverage. That’s more than double the rate for whites and much higher than any other population. The only group that comes close is American Indians and Alaska Natives, and they still are less than Hispanics. There are many reasons for that. Coverage in this country is largely related to people’s employment, and Hispanics tend to have a higher unemployment rate than other populations — particularly compared with whites and Asians. And when they do have jobs, they tend to work for lower-income employers, so the low-wage jobs are less likely to offer coverage. When it is offered, because they have lower wages, they’re less likely to be able to afford coverage.
What role does immigration status and legality play?
Cara James: There’s an estimate that about 11 million individuals in this country are here and they are undocumented. They’re not all Hispanic, but a large majority of them are. And our health care system currently bars undocumented immigrants from accessing Medicaid, and it makes it harder for them to purchase employer-based coverage. Even with health reform, they will still be barred from being able to purchase coverage through the private market and they still will be ineligible for coverage under Medicaid. They therefore tend to end up in the emergency room. And that’s some of the most expensive care that people can receive.
How big of a barrier is language to health care coverage?
Cara James: Language is certainly an issue, and not just for the Hispanic population. In this country, we have about 55 million people who speak a language other than English at home. That’s not necessarily a problem, but what we are more concerned about are the 25 million individuals who speak English less than “very well.” And the majority of the individuals — over 60 percent of the people who speak English less than “very well” — speak Spanish. So this makes it difficult. Our health care system is complex enough even if you speak English very well. And so navigating through a system where providers may not speak your language, where materials aren’t presented in your language, where you may not be able to get prescription medications with instructions in your language — it all just adds another layer of difficulty.
Even for individuals who do speak English perfectly well, there’s a challenge with regard to what we call “health literacy,” and that is being able to understand what your provider is telling you. We also know that Hispanics are more likely than blacks or whites to report that their provider sometimes or never listened to them carefully and explained things clearly.
What about location? How does that affect Hispanic health?
Cara James: Where you live matters. The distribution of the Hispanic population across the U.S. is not uniform across all 50 states. We do see a little more than half the population in three states: Florida, Texas and California. So if you’re thinking about ways to have a significant impact on this population — a solution that may not require efforts across all 50 states — focusing on those key states where there are large proportions of the population can have an impact.
When you think about health reform, we need to think about where those three states are in the process. Where are these states on their expansions of Medicaid? What are the struggles they’re facing? Because if the states have difficulty with that expansion, and they’re not messaging the Hispanic population in a culturally appropriate languages and in a culturally appropriate manner, we probably will not see these populations enrolled in programs that can help benefit them and provide them improved access to care.
Will health care reform improve the situation?
Cara James: This is to be seen. Health reform has not been fully implemented and won’t be until 2014. But we do know that in the law as it is written, a lot of help is expected to come through the expansion of Medicaid — the program for low-income individuals. That will have a significant impact on the Hispanic population. Part of that is because such a high proportion of this population has an income that is below 138 percent of the federal poverty level — which is the level that would qualify you for Medicaid. Additionally, for those who are working, many of them would be eligible for some of the insurance subsidies for purchasing coverage through the health exchanges that are going to be set up through health reform.
Has the telenovela approach to health awareness been used before? Do you think it’s effective?
Cara James: I think it probably is. When “ER” or “Chicago Hope” was on, there would be messaging inserted into those programs, and polls would be conducted to see what people remembered. And you do see a bump with some of these messages. But the bigger question is, What is the longer-term retention of that information, and what can be done to encourage people to do more. And I think part of the reasons we see those messages in a lot of these programs is because they are an effective way of getting that information out there, to get people to at least start to ask those questions when they go to their provider or to encourage people to go to their provider and find out more information.
Regarding Alicia’s fate, we’re sorry to report the character died from her colon cancer — something that could have been prevented had she sought medical help earlier.
Also, check out The Power of the Telenovela
- For the record, “Crossroads” is funded by Colorado Health Foundation, which is also an underwriter of the NewsHour.