1st Quarter & 2nd Quarter Combined Update
July - December 2009 Submitted To: The Honorable Governor Mike Beebe Senate President Pro Tem Speaker of the House Arkansas General Assembly
YO U R H E A LT H . O U R P R I O R I T Y.
1123 S. University Ave., Suite 312 Little Rock, AR 72204 Toll Free: 1-877-264-2826 Main: 501-686-2720 Fax: 501-686-2722 www.arminorityhealth.com P u t t i n g
Y o u r
T o b a c c o
D o l l a r s
t o
W o r k !
2009 YO U R H E A LT H . O U R P R I O R I T Y.
Submitted By:
I d o n i a L . Tr o t t e r, J. D . , M . P. S .
E x e c u t i ve D i r e c t o r / A r k a n s a s M i n o r i t y H e a l t h C o m m i s s i o n
GOAL The goal of the Arkansas Minority Health Commission is to be a catalyst in bridging the gap in the health status of the minority population and that of the majority population in Arkansas. To achieve this goal, the commission focuses on addressing existing disparities in minority communities, educating these communities on healthier lifestyles, promoting awareness of services and accessibility within our current health care system, and making recommendations to relevant agencies, the Governor and to the state legislature.
Letter from the Executive Director Dear Governor Mike Beebe and Members of the Arkansas General Assembly, It is with great excitement that I present to you this update of the broad yet focused work occurring at the Arkansas Minority Health Commission (AMHC) during the 1st and 2nd Quarters of FY2010, which encompasses July through December 2009. I am pleased to inform you that such reports can be anticipated on a quarterly basis to keep you well-informed on the Initiated Act I Minority Health Initiative executed by the AMHC. We are energized toward a commitment of collaborative efforts that assist in making a positive impact on state-wide community awareness and education; research aimed at making evidence-informed recommendations to decision makers; pilot projects that assist in guiding those recommendations, and public health policy advocacy. Our overall goal is to see significant reductions in minority health disparities throughout the state in the foreseeable future. Through an intensive strategic planning process, AMHC’s focus is more refined than ever before! In the past six months, the AMHC has been aggressively engaged in; • Two multi-county community health fairs providing a wide range of health related services and resources • Numerous local health fairs and educational events to promote awareness and increase understanding • Screening of hundreds of minority citizens throughout the state • Public policy advocacy • Awareness campaigns utilizing different approaches to address diseases that disproportionately impact minority Arkansans • Focused intervention strategies through piloted projects • Scholarly publications and studies spearheaded by the AMHC Medical Team that includes the Arkansas Racial & Ethnic Health Disparity Study II, a timely survey which contains the largest voice from the Hispanic community in Arkansas and, • Model collaborations and partnerships that maximizes the effectiveness of services and resources The second half of FY2010 is poised to be bright as we shine the light on living healthier lifestyles. We hope this update will inform you as well as move you to join us as we seek to better the health of minority citizens; thereby advancing the state’s overall goal of improving the health of all Arkansans.
Idonia L. Trotter, J.D., M.P.S. Executive Director Executive Director’s Quarterly Update 1
Mission Statement
The mission of the Arkansas Minority Health Commission is to ensure all minority Arkansans access to health care that is equal to the care provided to other citizens of the state and to seek ways to provide education, address issues and prevent diseases and conditions that are prevalent among minority populations. The AMHC will achieve this mission through: • Outreach • Research • Public Policy • Coordination/Collaboration • Pilot/Demonstration Projects
Vision Statement Minority Arkansans have equal access to health, health care and preventive care.
Goal The goal of the Arkansas Minority Health Commission is to be a catalyst in bridging the gap in the health status of the minority population and that of the majority population in Arkansas. To achieve this goal, the commission focuses on addressing existing disparities in minority communities, educating these communities on healthier lifestyles, promoting awareness of services and accessibility within our current health care system, and making recommendations to relevant agencies, the Governor and to the state legislature.
STRATEGIC PLAN OBJECTIVES FOR 2014 The AMHC, in collaboration with partners throughout the state of Arkansas, will, by the year 2014: • Increase the percentage of minority Arkansans that obtain recommended screening for diseases that disproportionately impact minorities; • Increase education and awareness of minority Arkansans regarding HIV/AIDS and Sickle Cell prevention and/or treatment; • Establish a system of Supported Navigation to help minority citizens identify and gain access to appropriate health and health care resources in their communities; • Establish a collaborative network of stakeholders to address workforce diversity issues by increasing the percentage of minority health professionals practicing in the state; • Establish a comprehensive system of coordination and collaboration with other agencies and organizations addressing the health of minority populations through data collection and reporting; and • Build a comprehensive constituency network of individuals, community-based organizations, and communities committed to the mission and goals of the Arkansas Minority Health Commission. 2 Executive Director’s Quarterly Update
Table of Contents AMHC Purpose ....................................................................................... 4 AMHC Key Foci FY2009-FY2014 ........................................................... 6 AMHC Presentations/Workshops............................................................. 8 1st Quarter Multi-County Health Fair - Sevier County ............................. 9 2nd Quarter Multi-County Health Fair - Dallas County ............................ 11 Local Health Fairs & Educational Events ................................................ 13 1st & 2nd Quarter Screenings ................................................................. 13 Intervention Strategies/Pilot Projects ...................................................... 14 Public Policy ............................................................................................ 17 AMHC Scholarly Publications & Studies ................................................. 20 Awareness Campaigns ........................................................................... 21 AMHC Collaborative Partnerships . ......................................................... 23 AMHC Commissioners ............................................................................ 26 AMHC Leadership & Staff ....................................................................... 27
Executive Director’s Quarterly Update 3
PURPOSE Established through the enactment of Act 912 of 1991, the Arkansas Minority Health Commission (AMHC) is charged to;
• Study issues relating to the delivery and access of health services; • Identify gaps in health delivery systems; • Make recommendations to relevant agencies and the General Assembly for improving health delivery; and
• Study and make recommendations as to whether services are adequate and available. In 2001, the Arkansas General Assembly passed Initiated Act 1, commonly known as the Tobacco Settlement Proceeds Act. The Minority Health Initiative, administered by the AMHC, is one of four Targeted State Needs programs identified. Initiated Act 1 mandates that the AMHC establish and administer the Arkansas Minority Health Initiative for screening, monitoring, and treating hypertension, strokes and other disorders disproportionately critical to minority groups in Arkansas. The program is established to:
1. Increase awareness of hypertension, strokes, and other disorders disproportionately critical to minorities by utilizing different approaches that include but are not limited to the following; advertisements, distribution of educational materials and providing medications for high-risk minority populations;
2. Provide screening or access to screening for hypertension, strokes and other disorders disproportionately critical to minorities but will also provide this service to any citizen within the state regardless of racial/ethnic group;
3. Develop intervention strategies to decrease hypertension, strokes and other disorders noted above, as well as associated complications, including: educational programs, modification of risk factors by smoking cessation programs, weight loss, promoting healthy lifestyles, and treatment of hypertension with cost-effective, well-tolerated medications, as well as case management for patients in these programs; and
4. Develop and maintain a database that will include; biographical data, screening data, costs, and outcomes.
4 Executive Director’s Quarterly Update
PURPOSE Act 574 of 2009 modified, clarified and expanded the AMHC’s duties with regards to disparities in health and health care to;
1. Gather and analyze information regarding disparities in health and health care access 2. Perform statewide educational programming regarding disparities in health/health care and health care equity
3. Make specific recommendations relating to public policy issues 4. Promote public awareness and public education encouraging Arkansans to live
healthy lifestyles
5. Develop, implement, maintain and disseminate a comprehensive survey and 6. Publish evidence-based data, define state goals and objectives and develop pilot projects for decreasing disparities
Act 358 of 2009 specifies that the AMHC;
1. Develop, implement, maintain, and disseminate a comprehensive survey on racial and ethnic minority disparities in health and health care
2. Repeat the study every five years; including disparities in geographic location and economic conditions
3. Publish evidence-based data, define state goals and objectives and develop pilot projects for decreasing disparities.
Executive Director’s Quarterly Update 5
KEY FOCI
FY2009-FY2014 Based on 2008 RAND (state external evaluator) recommendations, the Commission voted to follow RAND guidance and concentrate its key health foci for FY2009-FY2014 on two critical health disparities; HIV/AIDS and sickle cell outreach initiatives. The Commission voted to adopt two additional areas of focus: health care workforce diversity and the development of a health navigation system that will include an integrated resource center with searchable databases of health care resources generally and specifically pertaining to minority health and access to health care. During the first half of FY2010, we are pleased to report that all key foci are well under way.
HIV/AIDS In 2007-2008, the AMHC, through a strategic planning process, performed an analysis of health problems that disproportionately affect minorities in the state. In that process, it was identified that while there were increased incidence, prevalence, disparity and mortality from HIV/AIDS in minority communities, there was not clear investment in primary prevention reaching grassroots minority communities in Arkansas. Therefore, AMHC chose HIV/AIDS as a key focus and developed multiple activities to address HIV/AIDS in Arkansas. As a result, in 2008, the Arkansas HIV/AIDS Prevention Coalition, including faithbased, community-based and HIV/AIDS service organizations, was formed by AMHC to foster primary prevention activities in the state of Arkansas. The group organized activities in conjunction with World AIDS Day that included a book signing with renowned author Marvelyn Brown, a youth rally, Compassion Sunday and an HIV/AIDS vigil at the Arkansas State Capitol. In 2009, this coalition offered a capacity building workshop that covered the core concepts of HIV prevention such as HIV 101, program planning, community needs assessment and evaluation. The workshop was offered to community-based organizations, AIDS service organizations, faith-based institutions, health educators, prevention program staff, health department staff and other grassroots organizations involved in HIV program planning across the state. In collaboration with the Arkansas Department of Health, the ADH/AMHC HIV “Know Your Status” testing and awareness campaign was developed in early 2009, meant to increase awareness of the continued epidemic of HIV/AIDS in minority communities and to encourage screening. In early 2009, the AMHC developed a competitive community grant pilot project to address high-risk minority communities and build capacity among community-based organizations that could better reach the targeted populations. The Commission received tremendous response with innovative proposals to reach youth, the homeless, African-American and Hispanic women and other high-risk populations. Seven organizations are currently administering HIV/AIDS education, awareness, and screenings as a part of the AMHC’s HIV/AIDS Outreach Initiative in 22 counties. The second half of FY2010 is expected to expand the commission’s HIV/AIDS focus as a part of a model collaborative education/awareness campaign with the Arkansas Department of Health HIV/STD/Hepatitis C Unit.
6 Executive Director’s Quarterly Update
KEY FOCI
FY2009-FY2014 SICKLE CELL DISEASE During this reporting period, the AMHC began its initial research phase of the development of a wide reaching sickle cell outreach initiative. While best practice research is underway, AMHC has partnered with the Sickle Cell Support Services, Inc. of Pulaski County and the Mutual Sickle Cell Support Group of Jefferson County in their efforts to enhance the wellbeing of sickle cell consumers and their families through outreach, education, increased screenings and awareness campaigns. In addition, Executive Director Trotter has been appointed to the Arkansas Legislative Taskforce on Sickle Cell Disease.
WORKFORCE DIVERSITY In September 2004, the Sullivan Commission on Diversity in the Healthcare Workforce released “Missing Persons: Minorities in the Health Professions,” (http://www.jointcenter. org/healthpolicy/docs/SullivanExecutiveSummary.pdf) funded by the Kellogg Foundation. The report outlined the commissions’ findings and recommendations regarding the diversity of the health care workforce in the United States. The report states that “Basic quality care is beyond the reach of far too many Americans. As the population has become increasingly diverse, glaring disparities in the quality of care, especially for racial and ethnic minorities, have led to thousands of premature deaths each year and incalculable hours of lost productivity, pain and suffering.” Even more compelling, the report highlights “Support for a direct link between poorer health outcomes for minorities and the shortage of minority health care providers,” came from the Institute of Medicine’s landmark study ‘Unequal Treatment.’ (http://www.nap.edu/openbook.php?isbn=030908265X) The Institute of Medicine’s study documented the lower quality of health care and higher rates of illness, disability and premature deaths among minority populations.” Based on this national data, as well as state estimates (that do not exist in a comprehensive manner at this time), the AMHC adopted health care workforce diversity as an area of focus and intervention strategy toward the long-term goal of decreasing critical disease states among minority Arkansans. During this reporting period, the AMHC engaged this strategy through the following: 1. PUBLIC POLICY: Working with legislative and state agency leaders to implement legislation that the AMHC helped research and draft during the 2009 legislative session. (See Act 1489 and Act 1490 on page 19) 2. STUDENT PIPELINE SUPPORT: Providing sponsorship support for pipeline enrichment programs. AMHC co-sponsored the Arkansas Medical Dental Pharmaceutical Association Scientific session, an annual conference which includes a student component called the Discovery Summer Science Program. 3. SCHOLARSHIP SUPPORT: Contributing to the establishment of endowed scholarships to benefit underrepresented minority students including the Miller Scholarship at UAMS ($50,000).
Executive Director’s Quarterly Update 7
KEY FOCI
FY2009-FY2014 AMHC NAVIGATION SYSTEM An integrated, online resource center with searchable databases of health care services in Arkansas, including information and services especially pertaining to minority health and health care. The Navigation System will provide the public with free and easy access to all relevant sources on minority health care in Arkansas through one convenient, user-friendly Web site. Public Access to Resources for Minority Health & Healthcare is a key component of AMHC’s Navigation System. It will contain databases of health care providers, such as physicians, hospitals, free and low-cost clinics, in counties across Arkansas, as well as links to other valuable health information. Considering the constituency of the AMHC, this information will also be reduced to a paper resource guide for greater access in rural communities. (Activities pursuant to Initiated Act I, (1)(2)(3) & (4); Act 574 of 2009, (4) (5); Act 378,(3); and the spirit and intent of Act 912 of 1991)
AMHC Presentations/Workshops The AMHC medical team, executive director and senior project managers have participated in national conferences and educational activities to promote the Minority Health Initiative’s mission, goals and key foci during the first half of FY2010. WHERE
DATE
PRESENTER
EVENT
TOPIC
Jonesboro
Aug. 7
Nash/Trotter
Lead AR Class 14
“Health Issues & Disparities in Rural Arkansas”
Los Angeles, CA
Aug. 14-16
Minor-BAI Fellow
Black AIDS Institute (BIA) Supplemental Training & Development Workshop
HIV Capacity Building
Little Rock, AR
Sept. 25
Nash
Little Rock Central High National Historic Site 52nd Anniversary Symposium
Speaking the Truth on Social Issues & Politics in the 21st Century
Little Rock, AR
Sept. 26
Trotter
Moody Chapel Women’s Conference
“Health Disparities and Women’s Health”
Orlando, FL
Sept. 30 Oct. 2
Woods
37th Annual Sickle Cell Disease Association of America Conference & Workshops
SIckle Cell Capacity Building
San Diego, CA
Oct. 29 - 31
Minor-BAI Fellow Co-Presenter
U.S. Conference on Aids
Challenges and Success in Implementing HIV/AIDS Mobilization Programs in the South: Experiences in three Southern States: Georgia, Louisiana and Arkansas
Monticello, AR
Oct. 31
Trotter
Drew County NAACP Annual Banquet
“Health Disparities; A Matter of Equality”
Hot Springs, AR
Nov. 16-18
Nash/Trotter
Arkansas EvidenceInformed Health Policy Workshop
Evidence - Informed Research in Policy Making Processes
8 Executive Director’s Quarterly Update
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SEVIER COUNTY a o in ly 2g4a5rdp e nreesou srceews nthdeorHs ispnadnimsms nCteenntteȱor in FY2010 fi eraPolk, C)phpreonxitm o a h e H h t r r t t rst t ,e ndrol a ichceLittle i (Howard, Hempstead, Little River) c t e ȱi M y De Qu m i ants Polk, u (Howard, erde v eaHempstead, e educnadt ȱt ommuRiver) n (A nesysriCad m uinnit lyic9a0b0o+ d pon een, A quarterly C t t a o o n e a s i f p i l t s a s y r i a r e l n fol a tic r reg rka om g is oep rt(e4d);ȱ are avicaciloam bthlee. p(ub romseastio(bn.hFcr areipansets, cinh a 2)oȱ& for RA the public iamataerdding livin nsas. The munity He omm ral Aw pa1nAMHC e ( t t o A t p alth F l health ) e e g N t hosted its FY2010 first quarterly Community Health Fair on July 30, 2009 from 10 e b c c r u g s s c n o Community D pfirst 99t1in h th danits ealt0h9,ȱ(1hosted vihtieeas , gluh(AMHC) The Health onfaJuly Equarterly pu tiCommission urpo air on ceFY2010 daunt th Cult Arkansas a )ȱȱ ND e nee ealHealth e Hi duMinority ier lifFair ȱpIuVrsuAwareness i s e . c n r s 0 c h w e e T n r t 2 Ju e t w s a ȱ o e H t n A d e a.m.–4 p.m. at the Cultural Center in De Queen, Arkansas. The health fair was s e f ( n n I b s a n , t i v e R y i o A t a o 30, 2009 from 10a –4p at the Cultural Awareness Center in De Queen, Arkansas. The health fair was very successn n t e y ȱ t y s n t l g r n r -one h es, pr ed on y succ ly egula s for Shig en ensio ctȱ574 ȱtoȱInitia for successful ess s, and e d very 0 w o r e l t l v y 0 h T y a perten athe Hispanic in creating greater awareness community living ose w tedȱAToin 9lth ca regarding e creating ful community living healthier providing t teste to iding acce ess;ȱAthe Hispanic ctȱItregarding ce. Bhawareness relifestyles, ho act geaccess pert &(4)ȱin s port greater urcin i y n o e r , n ohealth ȱ e r ( a s , 1 l l a o )services H r lifestyles, uascreened. (2)(3the teeducating oresources, providing access to care and resources, the d)(3) nd healthier onpublic dtested and educating about toIVregularly get lly sign d and scree ss to , gluco and foPand are care tihealth vendoand )&(need teservices athe s t 2 s z ( t 4 g i a r ) ) n e ed in) s ȱ n 5 n n C ; r s 1 e ȱ i s s A hto a Although ȱ( urethe need grethere ctȱ57who oleregularly chosigned 24 public get tested and screened. Although 245, participants muRAND are reported for purposes (based on those , there ed. sterIom eted were ts in only lester in), e en245 tȱI,about 4only ȱofȱ2actually cparticipants l t A h ȱ we o pan lth scr te900+ 0 e iapproximately l and with a crow 09greeted d ,ȱ(1were purposes (based those who actually signed in), there 185 for RAND Gluon participants inVattendance. Twenty-one health care related vendors )(2)ȱ&the crowd a immu d with re ia are reported e c t o i s h I e ( n n 4 e );ȱand were izatio 31 emyriad oȱ I Free health screenings hypertension, HIV, H glucose, immunization approximately 900Hparticipants infor attendance. Twenty-one health cholesterol care relatedand collaborative ȱtheȱin n wer a 180 ntȱt of information. IV e tentȱo su a ravailable. fȱActȱ vendors greeted the crowd with a myriad of information. The attendees (ActivitiesȱpursuantȱtoȱInitiatedȱActȱI,ȱ(1)(2)(3)&(4)ȱ;ȱActȱ574ȱofȱ2009,ȱ(1)(2)ȱ&(4);ȱandȱtheȱintentȱofȱActȱ912ȱofȱ Imm were more likely to 9 cose 1 80 uniza 25 cholesterol, glucose Glu blood pressure, tionsFree health receive screenings than other screenings. otal S 2 5 (Activities pursuant to T l o ign-In screenings for HIV and immunization were also available. Initiated r te s e 0 l 8 o 1 h 3 1 of 2009, (1)(2)HIV &(4); andImmunizations the intent of ActTotal 912 Sign-In of 1991) Estimated Estimated Blood Act I, (1)(2)(3)&(4) Cholesterol ; Act 574 Glucose C A 245Attendance ttendance Pressure 0 18 900 185 Blood 180Cholesterol 180 31 Glucose HIV25 Immunizations Total 245Estimated 900 y l u Pressure Sign-In Attendance on J
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n uee ity 180 25 31 245 De Q s900 , r c n ng i senato luation orki t e w d va Me ive ives an uted e cluded opt The A a l rk gis an tat trib t in 30, 20 ansas Gen a Le presen HC dis rts tha d had tated d l e s n e o e M counc 09 at the C ra l Assemb lth h state r The A ting eff nded a ercent about a e ultura y’s S il mem l ub lA rke ea. ty H atte forms rea ore ee p b miinttoerei were a unty ar gh ma eople hty-thr ning m and a ers, may or waren ess comM ssiste ing wi ar coo throu f 98 p s. Eig s and oth Ceeenotner. Iance onivMein d th d le n r t o e f e d i t m e t a r l y g i t n portun local citize the Subco m t e a u H r t a n l e r e e foce A toetalthhhaelle t repo m m actttedsoffrfoicm bnldican i n c ld .w that th ty to voice s to ensSuurbcomt iettre. eInin o l ia u l a s i p f c ncae esreanadreapsetrcean Legislati r c e i o e o cebrly’s Cesnig nif off rgantihzei am d e ve Me n f 3 ate rep i c g ns rsesg n v egisla y learned m enm i d e c r 9 e g anntizcion eting Public atttherepsuou unty a Health cte Assembly’s reheld ThesArkansas on icleoMinority tion th aerdlein yuSubcommittee sentaa Legislative h mnm t e aarbeone General a b i in De w l g i g r l As orw c , e aetraim r r h y t n f a u s i o e t v o i u e . t r a Queen e e y t u n T l h s m t t atctoeCultural paal cAt tin De m thro he AM heeeheinon July h30, und and s were ic at the Awareness Center. In attendance n Forum car2009 ot Queen m v e r o e o Jul r d h G e a c a e H u s e r The Arkansas General Assembly’s Subcommittee on Minority Health held a Legislative Meeting in De Queen t u l n n n s e i g t C t t t h s h c a h r i l a e v d e e t n o a e m i y ors, ci onnJuly a i . u c fand strielected mlth oifica s arketand th ecity paer osenators, A tota mayors rsstateorepresentatives C area s, recouncil members, other n b m o c n u e a p t i y t y h i l s t e k n e h l h t a c o n 30, 2009 at the Cultural Awareness Center. In attendance were area state representatives and senators, city d g e l o e i u l n g b f e i e r Ar 9 at t rs, mofficials r a i c v 9 f p t u c f h e 8forms orts th the aluatio s aevaluation S from . eir cdistributed m peopland assisted he foarea. eoofficials yAMHC nd area. reas five oaunfive uThe at inevaluation challe The be d themayors e attdistributed 00 em members, elected AMHC ingcounty ty wcounty o p mm unnitity. from dother 2council nsu and cluded n r e h e h e n t a nded working t i l g l o g e e m m s a subcommittee in organizing the public forum through marketing efforts that included t s i 9 e l o . e i 3 r s s E a c perce marketing orkh ightefforts that nd included n thernSubcommittee r organizing the public forum through nc ndand as assisted had a wworky-thre attended uforms eiin nt reof izewith the tofensure e scitizens t h i t c t nanopoplocal significant community attendance. A total 98 people c a e p n u l o p o s o r o e ing with local citizens to ensure significant community attendance. A total of 98 people attended and had a t r e c c b h c m d learni and ent sta or ith lo voiceand ohad re aane h ealt opportunity to voice concerns regarding health care services, Eighty-three resources ted ng m portunity to voice concerns regarding healthcare services, resources and challenges. percent w m o , ore ab stated d th ng nity t rnechallenges. t c o orn Eighty-three percent stated that they learned more about the health of people in a u u a t p H that they learned more about the health of people in their county while 93percent reported learning more about t e r l im ra po they hattheir county while 93 percent reported learning more about legislation that impact the health t rba own legislation a that lationthat impact the health of their community. B hd s n. of their community. Se As legi
185
J os e ept ph B of ates He alth ,
180
Dr. Joseph Bates, AR Dept of Health
Dr. Joseph Bates, Dr. J osep AR Dept of Health AR D h ept o Bates, f Hea lth
8
8
nd ed a n e t s li nts ive side legislat ealth e r a a e r a ty h in een ipated minori De Qu u Q een ar De partic um on e for particip a residents listenpueblic ated in public d a le and forum on in gislative De Queenm areaoresidents rity he listened and participated alth on minority health in a legislative public forum
De Queen area residents listened and participated in a legislative public forum on minority health
Sen. Barbara Horn, Ashdown
Sen. Barbara Horn, orn, Ashdown . Barbara H Sen own AshdQuarterly Executive Director’s Update 9
MULTI-COUNTY COMMUNITY HEALTH FAIR & COLLABORATIVE PUBLIC FORUM SEVIER COUNTY
(Howard, Polk, Hempstead, Little River) Attendees at the De Queen Community Health Fair and Legislative Public Forum were asked to complete evaluations of the events. Attendees also provided demographic information. All evaluation forms were available in English and Spanish. Attendees were mostly married, Hispanic and female. The majority of event attendees were 25 – 44 years old and reported completing less than a high school education. Two-thirds of the attendees reported a household income of less than $20,000 annually. The attendees reported plans to make changes in their health routine based on information presented and visit a doctor to follow-up on any abnormal screenings. There were also reported increases in knowledge about the health of people, the types of services available and legislation that impacts public health in the community. The most effective methods of informing the predominantly Hispanic attendees about the events were by radio and word of mouth. The church also played a major role in disseminating information about the events as this location was the most reported to have posters displayed. (To review the Complete Sevier County Evaluation Report, go to www. arminorityhealth.com).
MARITAL STATUS
%
RACE
%
GENDER
White, Non Hispanic
16%
Male
33%
Female
67%
Single
26 %
African American
2%
Married
62%
Hispanic
80%
Divorced
5%
Native American
2%
Separated
5%
Asian/Pacific Islander
0%
Widowed
2%
HOUSEHOLD INCOME
51%
$10,000 - 19,999
26%
$20,000 - 29,999
8%
%
$30,000 - 39,999
7%
$40,000 - 49,000
4%
$50,000 - 59,999
1%
$60,000 - 69,999
2%
$70,000 – 79,999
0%
$80,000 – 89,999
0%
$90,000 – 99,000
0%
Over $100,000
1%
%
Less than high school
66%
Under 20
12%
High School/GED
12%
20 – 24
6%
Some College
6%
25 – 34
24%
2-year college degree
7%
35 – 44
31%
4-year college degree
5%
45 – 54
15%
Graduate or professional degree
4%
55 and over
12%
AGE
%
Less than $10,000
EDUCATION LEVEL
10 Executive Director’s Quarterly Update
%
MULTI-COUNTY COMMUNITY HEALTH FAIR & COLLABORATIVE PUBLIC FORUM DALLAS COUNTY
(Ouachita, Calhoun, Cleveland, Clark) AMHC hosted its FY2010 second quarterly Community Health Fair on October 24, 2009 from 10 a.m. – 3 p.m. at the Fordyce Civic Center in Fordyce, Arkansas. Heightened awareness regarding living healthier lifestyles, access to health care services and resources, and educating the public about the need to get tested and screened awaited the predominantly African American attendees. Approximately 200 adults attended. There were 19 health related collaborative vendors present. The attendees were more likely to receive blood pressure, cholesterol and glucose screenings, although screening for HIV/AIDS and sickle cell were also available. (Activities pursuant to Initiated Act I, (1)(2)(3)&(4); Act 574 of 2009, (1)(2) &(4); and the intent of Act 912 of 1991) Blood Pressure Cholesterol Glucose 52
57
57
HIV
Sickle Cell
Total Sign-In
13
32
167
Estimated Attendance 200
The Arkansas General Assembly’s Subcommittee on Minority Health held a Legislative Public Forum in Fordyce on the evening of October 23 at the Fordyce Civic Center. In attendance were area state representatives and senators, county judges, mayors and other elected officials from a five county area. The AMHC distributed evaluation forms and assisted the subcommittee in organizing the public forum through marketing efforts. A total of 59 people attended and had an opportunity to voice concerns regarding health care services, resources and challenges in Dallas County and surrounding counties. Eighty-four percent of attendees reported understanding all, while 15 percent reported understanding some of the information presented at the legislative meeting. Ninety-five percent of respondents reported that they were able to discuss important health concerns. Sen. Jack Crumbly (left), Subcommittee on Minority Health Chair, and Sen. Percy Malone (right), Chair of the Senate Public Health, Welfare and Labor Committee, answer questions from the public in Dallas County.
Dr. Creshelle Nash, AMHC Medical Director
Executive Director’s Quarterly Update 11
MULTI-COUNTY COMMUNITY HEALTH FAIR & COLLABORATIVE PUBLIC FORUM DALLAS COUNTY
(Ouachita, Calhoun, Cleveland, Clark) Attendees at the Community Health Fair and Legislative Public Forum were asked to complete evaluations of the events, which included demographic information. The Health Fair evaluation was completed by 65 attendees, while 165 attendees provided demographic information. The Legislative Public Forum evaluation was completed by 50 attendees. The event attendees were mostly married (51%), African American (64%) and female (75%). The majority were 55 years old and over (44%) and reported earning a high school diploma or equivalent (49%). More than half of the attendees reported a household income of less than $19,999 annually (56%). The attendees that reported not having access to medical care when needed indicated that this was due to the cost of medical services. The groups that reported the least access to health insurance and prescription coverage were male and Hispanic. They also were likely to report $10,000 – $19,999 in household income. (To review the complete Dallas County Evaluation Report, go to www.arminorityhealth.com).
Access to Medical Care by Demographics GENDER
Yes, Yes, No Always Sometimes
Male
62%
15%
23%
Female
65%
25%
10%
AGE
Yes, Yes, No Always Sometimes
Under 20
50%
50%
0%
20 – 24
75%
25%
0%
25 – 34
55%
18%
27%
35 – 44
65%
17.5%
17.5%
45 – 54
57%
21.5%
21.5%
55 and over
73%
23%
4%
HOUSEHOLD INCOME
Yes, Yes, No Always Sometimes
Less than $10,000
75%
14%
11%
$10,000 - 19,999
58%
29%
13%
$20,000 - 29,999
56%
24%
20%
$30,000 - 39,999
66%
17%
17%
$40,000 - 49,000
100%
0%
0%
$50,000 - 59,999
50%
50%
0%
$60,000 - 69,999
100%
0%
0%
$70,000 – 79,999 67%
33%
0%
$80,000 – 89,999 100%
0%
0%
RACE
Yes, Yes, No Always Sometimes
White, Non Hispanic
66%
28%
6%
African American
65%
21%
14%
Hispanic
50%
0%
50%
Native American
100%
0%
0%
Other
100%
0%
0%
Access to Health Insurance ?
12 Executive Director’s Quarterly Update
Yes
68%
No
32%
LOCAL HEALTH FAIRS & EDUCATIONAL EVENTS JULY—DECEMBER 2009
From July to December 2009, members of the AMHC leadership, board and staff participated in more than 48 educational awareness events and local organizational health fairs. Through these grassroots community events, an estimated 8,399* predominantly minority Arkansans have been exposed to the message of healthier lifestyles promotion, minority health disparities, health equity and have obtained an increased awareness of hypertension, stroke and other disorders disproportionately critical to minorities. As of December 18, 2009, of the 48 educational awareness events and local organizational health fairs, the following represents the percentage of event outreach to different minority populations in Arkansas during the first half of FY2010. African American 79.6% Hispanic
18.5%
Asian
1.85%
Marshallese
.05%
*number derived from sign-in sheets, attendee estimations by event coordinators and AMHC, and/or media reports
1st & 2nd QUARTER SCREENINGS Early screenings can save lives. AMHC is dedicated to creating greater awareness of personal health knowledge to help minority populations throughout the state live healthier and longer lives through early detection and preventive screenings. Through its outreach initiatives, health fairs and collaborative partnerships, the following screenings are reported for the 1st and 2nd Quarter of FY2010. Blood Cholesterol Glucose Pressure 564
345
369
HIV
Sickle Cell
Prostate
Total Screenings
679
104
86
2180
(Activities pursuant to Initiated Act I, (1)(2)&(4) ; Act 574 of 2009, (1) &(4); and the intent and spirit of Act 912 of 1991)
Executive Director’s Quarterly Update 13
INTERVENTION STRATEGIES/PILOT PROJECTS Alliance on Community Health The Southern Arkansas AIDS Project provides gender relevant and culturally sensitive social skills training to reduce highrisk behavior by heterosexual women and a community mobilization program to reduce unintended pregnancy and HIV. (Union, Miller, Bradley, Columbia & Ouachita)
Arkansas Human Development Corporation educates the Hispanic population in four targeted counties to increase HIV/AIDS awareness and screening. (Benton, Garland, Pulaski, Sevier)
Arkansas Medical, Dental and Pharmaceutical Association assists minority students with medical school expenses and mentors students to assist in successful matriculation. Academic progress reports of the scholarship recipients provided to AMHC. (Statewide)
Arkansas Minority Health Commission Navigation System The system will be an integrated, online resource center with searchable databases of health care services in Arkansas, including information and services especially pertaining to minority health and health care. The Navigation System will provide the public and health care professionals with free and easy access to all relevant sources on minority healthcare in Arkansas through one convenient, user-friendly Web site. It will contain databases of health care providers, such as physicians, hospitals, free and low-cost clinics in counties across Arkansas, as well as links to other valuable health information, such as the Arkansas Department of Health’s Web site healthyarkansas.com and the Department of Human Service’s Web site in Spanish/ Espanol. An interactive map of Arkansas will be used to locate services according to region, county, and city. (Statewide) 14 Executive Director’s Quarterly Update
Arkansas Racial and Ethnic Health Disparity Study II A statewide racial
attitude survey focusing on health and health care disparities. This project continues AMHC’s efforts to study gaps in services and increase awareness about health disparities and diseases that affect minority Arkansans. The study is a continuation of the 2004 Arkansas Racial and Ethnic Health Disparity Study and work with the UALR Survey Center on the Pulaski County Racial attitudes survey focusing on Health and Health Care in Pulaski County. The survey is a statewide survey that examines multiple health and health care issues in the community and provides an oversampling of African-Americans and Hispanics in the state. Some areas examined include health beliefs, health literacy, access to health care, quality health care, cultural competency, trust and perceptions of treatment by race and medical mistakes. It is a 50-question survey that was completed in July 2009. Results of the study were released on January 19, 2010. (Statewide)
Black Community Developers Play Safe The program conveys HIV prevention
education through visual and performing arts, written word, group presentations and work shops for youth and link to job readiness and life skills. (Pulaski)
Brothas and Sistas, Inc. The program provides prevention education and testing to LGBT population in the community club setting. The program utilizes internet networks as a communication portal for online training, counseling and to gather much needed demographics and health information. (Pulaski, Jefferson, Garland, Crittenden & Saline) Future Builders, Inc. It’s Your Choice Program is designed to reduce risky behaviors in the homeless population by providing education and
INTERVENTION STRATEGIES/PILOT PROJECTS intervention sessions along with screenings in church and community day centers for the homeless. (Pulaski)
Marianna Examination Survey on Hypertension (MESH) MESH is a
population-based representative household examination survey of blood pressure and Jefferson Comprehensive Care cardiovascular disease risk factors in adults in Marianna, AR. It originated as an effort Systems, Inc. The SISTA (Sisters to assess the rate of hypertension of those Informing Sisters About Topics on AIDS) at risk for cardiovascular disease, diabetes Project provides social skills training for and stroke focusing on diagnosed, as well Sickle Support African-American to Cell decrease high Services n to decrease high risk sex- women Sickle Cell Support Services women to decrease high risk sex- on as,education undiagnosed cases. Study results from risk sexual behavior the campuses Sickle Cell Support Services Provide sickle cell through Arto decrease highdisease risk sexmpuses ofAfrican-American historically or pre-women Provide sickle cell disease education through Arthis pilot project are anticipated March e campuses of of historically or prehistorically or predominantly black community education Provide sickle cell disease2010. education through Arkansas of through workon the campuses historically or prersities andual in behavior 10 counties. (Lee) kansas through community education workand in 10 counties: UAPB, universities anduniversities in 10 counties. through community education workshops.and Provide educationkansas to hospitalized dominantly black universities in Baptist 10patient counties. College, Arkansas Baptist Philander Smith College, Arkansas shops. Provide patient education to hospitalized mith College, Arkansas Baptist shops. ProvideServices patient education to hospitalized patients which include 150 kits for patients. (UAPB, Philander SmithAshley, College, Arkansas Baptist hley, Chicot, Desha, Drew, College. (Arkansas, Chicot, Desha, Sickle Support patients which include 150Cell kits for patients. s, Ashley, Chicot, Desha, Drew, patients which 150 kits for patients. HostLonoke, a sickleLincoln cell camp for 30 kids andcell five campinclude Drew, Pulaski, Jefferson, Provides sickle disease education College). (Arkansas, Ashley, Chicot, Desha, Drew, oke, Lincoln & Prairie) Host a sickle cell camp for 30 kids and five camp Lonoke, Lincoln & Prairie) & Prairie) education workshops. Host a sickle cell camp for 30 kids and five camp counselors. (Pulaski) Pulaski, Jefferson, Lonoke, Lincoln & Prairie) through community counselors. (Pulaski)Provides patient education to hospitalized es, Inc., The counselors. (Pulaski) The namilies, tool forInc., patients which include 150 kits for patients. CenterCenter for Families, Inc., The JonesJones forSouthern Families, Inc., Ain’t Fried Sundays ation tool for Host a sickle cell camp for 30 kids and five anders) Sundays Southern To design Design an acculturation“Southern tool for an Ain’tAin’t FriedFried Sundays” (SAFS) is a Ain’t pro- Fried Sundays Southern ic Islanders) camp counselors. (Pulaski) oming acculturation tool “Southern Ain’t Fried Sundays” (SAFS) is a proMarshallese (Pacific Islanders) ject uniquely designed to educate“Southern African- Ain’t Fried Sundays” (SAFS) is a probe coming for Marshallese stly NW living in or that will be coming ject uniquely designed to educateabout AfricanAmerican churches and organizations ject uniquely designed to educate African(mostly NW (Pacific Islanders) Ain’t Fried uration American churches Southern and organizations aboutSundays to live in Arkansas (mostly NW healthier alternatives American churches and organizations about cculturation living in or thatalternatives will Southern Ain’t Hawaii. Arkansas) using acculturation healthier to preparing and cookhealthier alternatives ed in Hawaii. be coming to live inand cookFried Sundays Marto preparing handbook developed ining Hawaii. southern-style to preparing and(SAFS) cook- is a de MarArkansas (mostly and ac- The goal is to provide MaringItsouthern-style foods. directly ading southern-style e of and acNW Arkansas) using adproject uniquely are re- shallese knowledge of and foods. directly acdresses the It issue of foods. It directlydesigned adlth care rean acculturation to rovide cess to quality health care dresses the issue of rethe high percentage of dresses the issue of Africanes. Provide handbook based on educate ce as the high percentage of sources and services. Provide African-Americans the high percentage of Hawaii model. The who American dstance to the asany additional assistance African-Americans who as are overweight and African-Americans who and goal is to provide churches oject. add“Living to the in Arkansas: areItoverweight needed by AMHCknowledge to addobese. toofthe is alsotoa and are overweight and Marshallese and access organizations ot project. “Living in Arkansas: w as a Marshallese” was pilot un- project. obese. ItinisArkansas: also a success of this “Living creative mechanism quality healthwas careunresources and services. obese. It is alsoabout a healthier as ainMarshallese” dKnow the Gaps to Marcreative mechanism WhatServices You Need to Know as a Marshallese” was unfor partnering with “Living in Arkansas: What You Need to alternatives creative mechanism C and the 20, Gaps in Services to Mar- for partnering with November 2009 at the veiled by the AMHC andthese the Gaps in Services to Mar- for partnering with Know as a Marshallese” was unveiled to preparing groups in an efon November 20, 2009 at the groups inatanthe efshallese Taskforce onthe November 20, 2009 by the AMHC and Gaps in Services cooking fort tothese educate their these groups in and an effort to educate their JonestoCenter. Marshallese Taskforce on November southern-style foods. It directly addresses members about the signs and symptoms of fort to educate their members thethe signs and symptoms of 20, 2009 at the Jonesstroke, Center. (Bentonabout &and heart issue of the high about percentage of Africandiabetes attacks. members the signs and symptoms of stroke, diabetes and heart attacks. Washington) Americans who are overweight and obese. It SAFS is now being revamped andstroke, offered yeardiabetes and heart attacks. SAFS is now being revamped and offered yearis also a creative mechanism for partnering round. The “New and Expanded SAFS” SAFS isalso nowin-being revamped and offered yearround. The “New and Expanded SAFS” also with churches in an effort to ineducate their cludes individual memberships and a Hispanic round. The “New and Expanded SAFS” also includes individual memberships and a Hispanic members about the signs and symptoms of outreach component to start in FY2011. There memberships cludes individual and a Hispanic stroke, diabetes and have heart attacks. SAFS component to start in FY2011. There are aoutreach total of 43 church organizations that outreach component to start in FY2011. There is now being revamped to be offered year are a total of 43 church organizations that have participated in the SAFS program anda 29 have are total of 43 church organizations that have round. The “New and Expanded participated in the SAFSon program and 29 have SAFS” requested more information the American participated in the SAFS program and 29 have also includes individual memberships and moreSearch information on the American Heartrequested Association’s Your Heart (SYH) prorequested more information on the American aSearch Hispanic outreach component Heart Association’s Your Heart (SYH) pro-to start Survey on Hypertension gram. The Search Your Heart program is offered Heart Association’s Search Your Heart (SYH) proin FY2011. There are is a total of 43 church tion Survey on Hypertension gram. The Search Your Heart program offered
ERVENTION STRATEGIES/PILOT PROJECTS INTERVENTION STRATEGIES/PILOT PROJECTS PROJECTS INTERVENTION STRATEGIES/PILOT
Marianna Examination Survey on Hypertension as an optional component to the gram. AMHCThe SAFS pro- Your Heart program is offered Search as The an optional component to the AMHCproSAFS proon-based (MESH) representative gram. Search Your Heart collaborative as an optional component to the AMHC SAFS proulation-based representative The Search Your Heart collaborative survey ofThe blood pressure and gramgram. MESH is a population-based representative offers a 9-week curriculum that focuses on pro-Your Heart collaborative program. The Search ation surveyinofadults blood in pressure and gram offers a 9-week curriculum that focuses on Director’s Quarterly Update 15 Executive risk factors household examinationphysical survey ofactivity, blood pressure nutrition,and and health grameducation. offers a 9-week curriculum that focuses on ease risk factors in adults in physical activity, nutrition, and health education. ted as ancardiovascular effort to assessdisease the An riskevaluation factors in was adults in completed by the “Southern physical activity, nutrition, and health education. iginated as an to assess the An evaluation was completed by the “Southern those at risk foreffort cardiovascuMarianna, AR. It originated as an effort to assess the AnBased Ain’t Fried Sundays” participants. on the evaluation was completed by the “Southern n of those at risk for cardiovascu-
INTERVENTION STRATEGIES/PILOT PROJECTS organizations that have participated in the SAFS program and 29 have requested more information on the American Heart Association’s Search Your Heart (SYH) program. The Search Your Heart program is offered as an optional component to the AMHC SAFS program. The Search Your Heart collaborative program offers a 9-week curriculum that focuses on physical activity, nutrition, and health education. An evaluation was completed by the “Southern Ain’t Fried Sundays” participants. Based on the evaluation, 69 percent of the participants agree that the program has influenced the way they cook. (statewide)
STARHealth - Arkansas Department of Health The primary
purpose of STARHealth is to pilot a community health workers’ initiative in three Arkansas Delta counties in an effort to improve community health outcomes in these counties with large African-American populations. This innovative project engenders collaboration from AMHC, ADH and several other health support agencies and organizations and the full engagement of residents of the targeted counties. (Desha, Chicot & Lincoln)
Tri-County Rural Health Network This program provides education and referral services for the citizens of Lee, Monroe, Phillips, and St. Francis Counties in which will increase awareness around living with HIV/AIDS, providing linkage to available treatment, and prevention programs. Each county will play host to a community summit for further education and awareness.
UAMS Center for Diversity Affairs Provide academic enrichment for students ages 6 to 12. Help increase the pool of minority students entering the professions that promote health quality. Promote careers in health sciences to elementary-age children in Arkansas. 16 Executive Director’s Quarterly Update
UAMS Delta AHEC Develop plan for a mobile “1-stop-shop” for resources that can move to different community locations. Examine and address health disparities and utilization of services in a seven county service area of the Delta AHEC. (Chicot, Crittenden, Desha, Lee, Monroe, Phillips & St. Francis) UAMS Arkansas Aging Institute The Arkansas Aging Institute Delta Center on Aging will enroll 40 Delta Center on Aging patients in the “Healthy Lifestyles Challenge” 12- week program. The program focuses on the elderly population under physician supervision. The program is individualized for each participant and allows monitoring of health benefits and focusing on developing a healthy lifestyle. (Chicot, Crittenden, Desha, Lee, Monroe, Phillips & St. Francis)
UAMS Regional Programs Medical Interpreter Training Program UAMS Regional Program provides their Medical Interpreter Training Program (MITP) in health care facilities that are serving the fast growing Spanish speaking populations in Calhoun, Union, Bradley, Ouachita, Hot Springs, Lafayette, Hempstead, and Desha counties in Arkansas.
Womens’ Council on AfricanAmerican AffairsThis program provides
educational sessions for youth focused on health and wellness. Sessions include Health Education, Violence Prevention and Conflict Resolution, Substance Abuse Prevention, HIV/AIDS Education Awareness and Career Opportunities. (Pulaski)
PUBLIC POLICY ADVOCACY HEALTH CARE REFORM
The Facts In Arkansas*:
While the national debate about health care reform was in full swing during this reporting period, the AMHC developed and released two policy statements and met with members of our congressional delegation in August and December to ensure that Minority Health Initiative interests were known and considered. AMHC’s December health policy statement included guiding principles for health reform and facts in Arkansas;
Many Arkansans lack health insurance: • 26 Percent of Black Arkansans • 33 Percent of Hispanic Arkansans • 13 Percent of White Arkansans
AMHC Guiding Healthcare Principles
Many adults 19 - 44 in Arkansas lack health insurance: • 62 percent of Black Arkansans • 80 percent of Hispanic Arkansans • 61 percent of White Arkansans *Arkansas Center for Health Improvement Multi-State Integrated Database, Current Population Survey 2007
Principle 1: Health care legislation should increase access to health care coverage for communities of color. Principle 2: Health care legislation should include provisions to focus on racial and ethnic health disparities. Principle 3: Health care should invest in prevention and wellness. Principle 4: Health care coverage should not be denied based on a pre-existing medical condition. Principle 5: Health care legislation should include provisions to increase public health workforce diversity. Principle 6: Health care legislation should reduce cost for poor people. Principle 7: Health policy decisions should be assessed with respect to their effect on minorities in underserved populations.
Most people who are uninsured are working: • 79 percent of employed Black Arkansans • 96 percent of employed Hispanic Arkansans • 86 percent of employed White Arkansans
ARKANSAS RACIAL & ETHNIC HEALTH DISPARITIES STUDY II This project continues AMHC’s effort to study issues relating to the delivery and access of health services and to identify gaps in services. Release of the study to the Governor and Arkansas General Assembly, which makes recommendations for improving the health of minority Arkansans and health care delivery in Arkansas, occurred January 19, 2010. To access the report, go to www.arminorityhealth.com.
ARKANSAS MINORITY HEALTH SUMMIT 2010 The AMHC, in collaboration with the UAMS Fay W. Boozman College of Public Health, is on tap to convene the “Arkansas Minority Health Summit 2010” April 15 - 17, 2010. Specifically, the summit will address the health status of minority Arkansans through presentations, discussions and workshops dealing with subject matters ranging from the social determinants of health to the
Executive Director’s Quarterly Update 17
PUBLIC POLICY ADVOCACY healthcare workforce pipeline. A significant goal of the summit is to develop common solutions, strategies, and best practices that can inform, shape, and operationalize public health policies in Arkansas. Confirmed speakers include three former U.S. Surgeon Generals; Dr. David Satcher, Dr. Joycelyn Elders and Dr. Richard Carmona.
ARKANSAS COALITION for OBESITY PREVENTION (ArCOP) Arkansas BMI data has shown that minority children, specifically Hispanic and AfricanAmerican children, are most at risk for overweight and obesity that can ultimately affect adult health status. The AMHC is a part of the Arkansas Coalition for Obesity Prevention to represent needs specific to minority children and to address racial and ethnic health disparities as it relates to obesity in Arkansas. ArCOP is the recipient of a grant from National Initiative for Children’s Healthcare Quality (NICHQ) titled “Mobilizing Healthcare Professionals as Community Leaders in the Fight Against Childhood Obesity.” The project team includes representatives from the state school nurses, rural hospital program, telemedicine, NAPHE, Arkansas Dietetics Association, Arkansas Chapter of the American Academy of Pediatrics, Arkansas Department of Education and the AMHC. The AMHC, specifically Dr. Nash, is a part of the project team to facilitate the inclusion of minority health care providers and to train health care providers in advocacy related to childhood obesity.
ARKANSAS HIV/AIDS MINORITY TASKFORCE AMHC has hosted four HIV/AIDS Minority Taskforce meetings in this reporting period. Executive Director Trotter represents the AMHC at taskforce meetings. Currently, in anticipation of the release of its second annual report to the Governor and Arkansas General Assembly, the taskforce has
18 Executive Director’s Quarterly Update
partnered with Harvard Law School’s Wilmer-Hale Legal Services Center in assessing the current state of HIV/AIDS in Arkansas through the Harvard SHARP (State Healthcare Access Research Project) program. SHARP is conducted in conjunction with in-state community partners that examines states’ capacity to meet the healthcare needs of people living with HIV/AIDS. The HIV/AIDS Minority Taskforce second annual report is anticipated for release in early 2010.
ACUTE STROKE CARE TASKFORCE The Acute Stroke Care Taskforce is charged with coordinating statewide efforts to combat the debilitating effects of strokes on Arkansans and to improve health care for stroke victims. This reporting period, the taskforce has completed a survey of hospitals with respect to stroke care in Arkansas and is developing a strategic plan of activities for 2010. AMHC’s Medical Director, Dr. Creshelle Nash, was elected to Chair the Policy & Standards Subcommittee of the Taskforce.
SOUTHERN REACH & GULF COAST HIV/AIDS RELIEF FUND / NATIONAL AIDS FUND AMHC applied to the National AIDS Fund during this reporting period in the amount of $75,000 and anticipate a decision on the award late January 2010. With an eye towards increasing HIV/AIDS advocacy in Arkansas (and to seek external funding beyond tobacco settlement dollars), this application, if approved, will allow AMHC to build the advocacy capacity of current grantees and other health service organizations.
PUBLIC POLICY ADVOCACY ARKANSAS MINORITY HEALTH CONSORTIUM The Arkansas Minority Health Consortium is a collaboration of approximately 30 entities united to increase awareness of minority health issues and to advocate for resources. The primary goal of the consortium is to make an impact on health policy by researching and developing legislative initiatives to address health policy concerns that will benefit all Arkansans. During this reporting period, the AMHC continued to work collaboratively with appropriate entities to ensure continuation and/or implementation of legislative policy support initiatives of 2009.
Consortium Legislative Policy Support Initiatives 2009: Act 180 -- Expansion of ARKids (SCHP) – reduces the number of uninsured children Act 308 – Primary Seat Belt Law Act - improves the safety of motorists on highways and roads in Arkansas making the mandatory seat belt law a primary law Act 352 – Substance Abuse and Prevention Treatment Legislation – concerning the offense of knowingly giving, procuring or furnishing alcohol to a minor Act 358 – AMHC Delta Survey – mandates a survey of health issues in the Delta every five years Act 393 – Trauma System Legislation – establishes a comprehensive trauma system for the state Act 574—AMHC Structure —modifies, clarifies and expands the AMHC’s structure, duties Act 709 – Health Care Student Summer Program -- creates the Health Care Student Summer Enrichment Program for underrepresented student Act 722 – Legislative Taskforce on Reducing Poverty SB 957 – Violence Prevention and Awareness – creates a taskforce to study the long-term impact of black-on-black crime Act 976 – Substance Abuse and Prevention Treatment – establishes criminal liability for social host who knowingly serves visibly intoxicated persons and allows minors to consume alcohol on his/her property Act 1191 – Sickle Cell Taskforce – creates the Legislative Taskforce on Sickle Cell Disease Act 1374 -- Colorectal Cancer Legislation – takes the colon cancer pilot project statewide HB 1389 – Eye Exams for Children Entering School – provides for comprehensive eye exams for children entering schools for the first time Act 1489 – Minority Recruitment and Retention – requires state agencies, boards and commissions that license health professionals to procure and report demographic data to AMHC, ADH & ACHI Act 1490 - Minority Participation on Health Commissions and Boards - ensures that each state health related board and commission reflects the diversity of the state
Executive Director’s Quarterly Update 19
AMHC SCHOLARLY PUBLICATIONS & STUDIES JULY - DECEMBER 2009
AMHC Medical Director, Dr. Creshelle Nash was published in the Journal of the American Academy of Pediatrics and Arkansas Foundation for Medical Care Journal during this reporting period. In addition, Dr. Nash completed the five year update to the Arkansas Racial & Ethnic Health Disparity Study II in collaboration with Arkansas Children’s Hospital, and the UALR Survey Research Center. This 2009 study focuses on trends and behaviors in the Hispanic community of Arkansas. To obtain a copy of these articles, go to www. arminorityhealth.com
Arkansas Racial and Ethnic Health Disparity Study II:
a minority health update
INJUSTICE in healthcare is the most shocking and the most inhumane. - R e v. D r. M a r t i n L u t h e r K i n g , J r.
National Convention of the Medical Committee for Human Rights, Chicago, March 25, 1966
CRESHELLE R. NASH MD, MPH
&
2009 E D D I E O C H OA , M D , FA A P
A
LOOK AT QUALITY C L O S EA CLOSER R L O O K A T Q U A L I T Y EDITORIAL PANEL: MICHAEL MOODY, MD; NICK J. PASLIDIS, MD, PHD, MHCM; STEVEN STRODE, MD, MED, MPH; J. GARY WHEELER, MD, MPS
Health Care Quality and Disparities and the Health Care Provider:
What We Can Do
Community Engagement and its Impact on Child Health Disparities: Building Blocks, Examples, and Resources Eduardo R. Ochoa, Jr and Creshelle Nash Pediatrics 2009;124;S237-S245 DOI: 10.1542/peds.2009-1100L
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://www.pediatrics.org/cgi/content/full/124/Supplement_3/S237
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2009 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Downloaded from www.pediatrics.org by on December 11, 2009
BY CRESHELLE R. NASH, MD, MPH
T
he current debate about health care reform has centered primarily on controlling the cost of health care and health insurance access. The third essential component of health policy — health care quality — must be addressed as well. Despite a lack of media attention, health care quality initiatives are significant components of health care reform. However, racial and ethnic health care disparities receive much less attention in discussions of health care reform and quality. This debate represents an opportunity for health care providers to address health care quality for all Arkansans. HEALTH CARE QUALITY AND HEALTH CARE DISPARITIES Quality health care in the United States should be safe, effective, patient-centered, timely, efficient and equitable. Equitable health care is care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. While the U.S. spends 16.2% of its GDP on health care, our health care delivery system does not provide consistent, high-quality medical care to all people.
“Indeed, between the health care that we now have and the health care that we could have lies not just a gap, but a chasm.”1 Racial and ethnic minorities fall into this chasm. Eliminating racial and ethnic health disparities is a key component of improving health care quality in the United States. Racial and ethnic health disparities are defined as differences in the incidence and prevalence of disease, access to health care, quality of care or health outcomes by racial/ethnic subgroups. There has been extensive documentation of racial and ethnic health disparities over time and across many disease states. The cause of these disparities is a complex interaction of social, economic, community, behavioral and health care system factors. The Agency for Healthcare Research and Quality’s 2008 National Health Care Disparities Report found that for blacks, Asians, American Indians/ Alaska natives, Hispanics, and people with low incomes, at least 60% of measures of quality of care either stayed the same or worsened.2 A report from the Institute of Medicine found that minority patients are less likely than whites to receive the same quality of health care, even when they have similar insurance or ability to pay for care.3 It also identi-
fied three potential sources of health care disparities: � Health care systems, hospitals, and clinics may adopt policies or practices that are based on good intentions but may harm minority patients’ ability to access care. � Some minority patients do not trust health care professionals, and so may put off seeing a doctor until their illness is too far along to treat effectively. � Health care providers’ biases, prejudices, and uncertainty when treating minorities can contribute to health care disparities. DISPARITIES IN ARKANSAS Health care disparities are seen in most diseases.4 With respect to quality of care measures and hospital admissions that are potentially preventable by quality health care, AfricanAmericans in Arkansas are: � More than twice as likely to be admitted for hypertension and congestive heart failure � 3.3 times more likely to be admitted for uncontrolled diabetes � Almost twice as like to die in infancy While data is more limited on the Hispanic population, they are
The Arkansas Foundation for Medical Care Inc. (AFMC) is the Quality Improvement Organization for Medicare and Medicaid in Arkansas. AFMC works collaboratively with providers, community groups and other stakeholders to promote the quality of care in Arkansas through evaluation and education. For more information about AFMC quality improvement projects, call 1-877-375-5700.
(Activities pursuant to Initiated Act I, (1); Act 574, (1)(5) & (6); Act 358 and the spirit and intent of Act 912 of 1991) 20 Executive Director’s Quarterly Update
AIDS Day “Speak Up! Take Charge! HIV Prevention is Your Choice” Essay & Poster Winners. RIGHT: Balloon Release at AWARENESS CAMPAIGNS Philander Smith College in Little Rock on Four major awareness campaigns occurred during the reporting period; Sickle Cell December 1, World Awareness Month, Fight the Flu/H1N1, Get Outside, AIDSHave Day. Fun and Get Healthy! campaign
AWARENESS CAMPAIGNS
WORLD AIDS DAY 2009 and World AIDS Day 2009.
LEFT: World September 20092009 provided an opportunity for the AMHC to highlight Sickle Cell Awareness AIDS Day “Speak Up! Month in collaboration with the Pulaski County-based Sickle Cell Support Services Group and Arkansas Sickle Cell Consortium. Radio advertisements educating predominantly African Take Charge! HIV American audiences for two weeks during the second and third weeks of September with Prevention isran Your the help of Corliss Williamson, former Razorback and NBA player. Choice” Essay & Poster Winners. In September andRIGHT: December, the AMHC (in collaboration with the Arkansas Department Balloon Release at of Health) ensured that predominantly Hispanic and African-American communities across the state were educated about the need to “Fight the Flu/H1N1.” Executive Director, Idonia Philander Smith College Trotter and Dr. Creshelle Nash provided listeners with the three ’C’s (cover, clean hands, in Little Rock on contain) and helped minorities understand the signs that indicate the need to see a doctor. December 1, World Awareness spots ran on Hispanic and African American radio stations two weeks in AIDS Day. both months.
The Arkansas Minority Health Commission and Thethe Arkansas Minority Health Commission and the Arkansas Game & Fish Commission Arkansas Game & Fishwith Commission (AG&FC) partnered Arkansas(AG&FC) Baptist partnered Colwith Arkansas Baptist College and Power 92 during lege and Power 92 during the Delta Classic 4 the Delta Classic 4 LiteracyGrambling game between Grambling Literacy game between University University and UAPB on November 7. The “Get Outside, and UAPB on November 7. The “Get Outside, Have Fun and Get Healthy” Campaign included a seven Have Fun and Get Healthy” Campaign included minute video that encouraged the attendees to get a seven minute video that encouraged the atten-off the couch, get out to one of the state parks and have fun dees to get off the couch, get out to one of the with their children, while at the same time, getting healthy! state parks and have fun with their children, Recipes from AMHC’s “Southern Ain’t Fried Sundays” while at the same time, getting healthy! cookbook was shared at the joint AMHC/AG&FC booth Recipes from AMHC’s “Southern Fried Vivian Flowers, AMHC Chair, poses at the event along with educational andAin’t awareness Sundays”regarding cookbook was sharedstroke, at the diabetes, joint with Gov. Mike Beebe at Power 92 information hypertension, and after an interview with Broadway Joe AMHC/AG&FC booth at the event along with good nutrition. and AG&FC reps. The focus was educational and awareness information regardabout encouraging listeners to take ing hypertension, stroke, diabetes, and good control of their health by Getting out, nutrition. having fun….and Getting Healthy!
The Arkansas Minority Health Commission and theActivitiesȱȱpursuantȱtoȱInitiatedȱActȱI,ȱ(1)(2)(3)&(4);ȱActȱ574ȱofȱ2009,ȱ(4);ȱandȱtheȱspiritȱandȱintentȱofȱActȱ912ȱofȱ1991)ȱȱ Arkansas Game & Fish Commission (AG&FC) partnered with Arkansas Baptist Col- 21 lege and Power 92 during the Delta Classic 4 Vivian Flowers, AMHC Chair, poses Literacy game between Grambling with Gov. Mike University Beebe at Power 92 after an interview with Broadway Joe and AG&FC reps.Outside, The focus was and UAPB on November 7.about The “Get encouraging listeners to take control of their health by Getting Out, Have Fun and Get Healthy” Campaign included Having Fun….and Getting Healthy! a seven(Activities minute video that encouraged the attenpursuant to Initiated Act I, (1): Increase Awareness ; Act 574 of 2009, (4) dees toPromote get offpublic the couch, getand out to one of theand the spirit and intent of Act 912 awareness public education; 1991)and have fun with their children, state of parks while at the same time, getting healthy! Executive Director’s Quarterly Update 21 Recipes from AMHC’s “Southern Ain’t Fried Vivian Flowers, AMHC Chair, poses Sundays” cookbook was shared at the joint with Gov. Mike Beebe at Power 92 after an interview with Broadway Joe AMHC/AG&FC booth at the event along with
AWARENESS CAMPAIGNS Balloon WORLD AIDS Release at DAY 2009 Philander Celebrated Statewide
Smith College in Little Rock
2009 World AIDS Day “Speak Up! Take Charge! HIV Prevention is Your Choice” Essay & Poster Winners The AMHC’s Arkansas HIV/AIDS Prevention Coalition has continued to expand its activities as well as increase collaboration to engage other organizations across the state around World AIDS Day. The HIV/AIDS Prevention Coalition and the Arkansas Department of Health partnered on a myriad of events across the state. As a result of this expansion, World AIDS Day 2009 (December 1) offered increased participation including 25 churches that collaborated with Compassion Sunday activities on November 29, six non-profit organizations that held balloon releases representing those Arkansans who have lost their lives to AIDS and three educational symposiums (ASUJonesboro, Philander Smith College-LR, L.V. Floyd Community Outreach Center-Blytheville) to explore the issue and encourage increased awareness/ screening among college students and the general public. Youth were engaged with a “Speak Up! Take Charge! HIV Prevention is Your Choice” essay/poster contest.
Dr. Paul Halverson, Director of the Arkansas Department of Health, HIV/ AIDS Prevention Advocate & Actress Sheryl Lee Ralph and Dr. Idonia L. Trotter, Executive Director of the Arkansas Minority Health Commission after the One Woman Show entitled “Sometimes I Cry” performed by Ralph at the Wildwood Park for the Performing Arts in Little Rock (Activities pursuant to Initiated Act I, (1), (2) & (3); Act 574 of 2009, (2) &(4); and the spirit & intent of Act 912 of 1991)
22 Executive Director’s Quarterly Update
COLLABORATIVE PARTNERSHIPS July—December 2009
Colleges & Universities Arkansas State University, Jonesboro Philander Smith College, Little Rock Arkansas Baptist College, Little Rock UA Div. of Agriculture Cooperative Extension Services • Pulaski County • Dallas County • UAMS Center for Diversity Affairs • UAMS College of Nursing • UAMS College of Public Health • AR Center for Health Disparities ‘Healthy Ways Weight Control Project (Pulaski, Jefferson Counties) • UAMS Delta AHEC • UAMS Living Well with Sickle Cell • UAMS “Spit for the Cure” • UAMS Texarkana Regional Center on Aging • UAMS Winthrop P. Rockefeller Cancer Institute • University of Arkansas at Pine Bluff • University of Arkansas at Little Rock • University of Arkansas for Medical Sciences
Arkansas Forestry Commission Arkansas Game & Fish Commission Arkansas Lt. Governor Bill Halter (free clinic project) Arkansas State Revenue Office—De Queen City of De Queen Mayor’s Office City of Fordyce Mayor’s Office U.S. Department of Commerce— US Census Bureau
Minority Health Representation on Monthly Taskforces, Coalitions and Committees American Heart Association Minority Action Committee Arkansas Cancer Coalition Arkansas Heart Disease & Stroke Prevention Task Force Arkansas HIV/AIDS Prevention Coalition Arkansas HIV/AIDS Minority Taskforce Arkansas Coalition for Obesity Prevention Diabetes Advisory Council Legislative Taskforce on Sickle Cell Disease Tobacco Prevention & Cessation Advisory Committee
Government Agencies/ Commissions
AMHC Pilot with Partners Community Projects
Arkansas Center for Health Improvement Arkansas Department of Health • ADH HIV/STD/Hepatitis C Unit • ADH Tobacco Prevention & Cessation Program • ADH Center for Health Statistics—BRFSS • ADH “Fight the Flu in Arkansas” Campaign • ADH Heart Disease and Stroke Work Group • ADH Sevier County Health Unit • ADH Dallas County Health Unit Arkansas Department of Human Services • Dallas County • Sevier County
• The Jones Center for Families Gaps in
Services to Marshallese Project
Center on Aging, “Healthy Lifestyles Challenge Project” Arkansas Department of Health, STAR Health Community Health Workers Project
• UAMS Delta AHEC Navigation Project • UAMS Arkansas Aging Initiative Delta •
Executive Director’s Quarterly Update 23
COLLABORATIVE PARTNERSHIPS July—December 2009
HIV Outreach Initiatives AMHC/ADH Joint HIV Prevention Project representing 12 grantees serving 41 Arkansas counties
Model Joint HIV/AIDS prevention efforts are underway throughout the state under the new leadership at the AMHC and the ADH HIV/ STD/Hepatitis C Unit. Pictured are Trotter and Kevin Dedner, ADH HIV/ STD/Hepatitis C Unit Director at a workshop for potential HIV/AIDS prevention grantees in September 2009.
Community Organizations (not mentioned elsewhere) Alliance on Community Health (Union, Columbia, Ouachita, Miller, Bradley) Arkansas Human Development Corporation (Faulkner, Garland, Pulaski) Black AIDS Institute (Pulaski, Crittenden, Jefferson, Mississippi) Black Community Developers (Pulaski) Brothas & Sistas, Inc. (Pulaski) Centers for Youth & Families (Chicot, Desha, Jefferson, Lincoln, Searcy, Van Buren) Chicot Memorial Hospital (Arkansas, Ashley, Chicot, Desha, Lincoln, Union, Cleveland, Drew, Bradley) Future Builders, Inc. (Pulaski) Jubilee Christian Center (Jefferson) Planned Parenthood of Arkansas and East Oklahoma (Pulaski) St. Francis House NWA, DBA Community Clinics (Benton, Washington) White River Rural Health (Baxter, Clay, Cleburne, Craighead, Cross, Fulton, Greene, Independence, Izard, Jackson, Lawrence, Lonoke, Marion, Mississippi, Monroe, Prairie, Poinsett, Randolph, Searcy, Sharp, Stone, Van Buren, White)
24 Executive Director’s Quarterly Update
American Cancer Society American Heart Association/American Stroke Assoc. American Indian Center of Arkansas Arkansas AIDS Foundation Arkansas Community Planning Group Arkansas Legal Services Partnership Arkansas Lupus Foundation Arkansas Prostate Cancer Foundation Arkansas Public Health Association Arkansas Regional Organ Recovery Agency Asian American Resource and Cultural Center Baptist Health—Pharmacy Black AIDS Institute, Los Angeles, CA Center for Healing Hearts and Spirits Coalition for a Tobacco Free Arkansas Community Health Centers of Arkansas, Inc. Dallas County Central Arkansas Council Dallas Prevention Training Center De Queen Medical Unit Disability Rights Center East Wind Community Development Corporation Elder House Adult Day Service El Pueblo/The Town (Sevier County Coalition) Fordyce Court Appointed Special Advocate Fordyce Head Start J Kelley Referral & Information Services LULAC Mexican Consulate Office, Little Rock
COLLABORATIVE PARTNERSHIPS July—December 2009
Marshallese Consulate Office, Springdale NAACP (Health Equity Presentations) National Association of Free Clinics (in conjunction with the Arkansas Free Medical Clinic) Odyssey Health, Inc. PARK, Inc. Part of the Solution, Inc. SW Arkansas Counseling and Mental Health Center South Arkansas Substance Abuse Center St. Mark Baptist Church Tobacco Awareness Program of Union, Ouachita, Columbia and Dallas County Village Project Tobacco Free Education/ Awareness Women’s Health Project, African Women’s Council on African American Affairs, Inc.
Sickle Cell Outreach Initiatives Mutual Sickle Cell Support Group, Jefferson Arkansas Sickle Cell Consortium, Statewide Sickle Cell Support Services, Pulaski
Media Awareness/Education to Minority Communities STAND News—African American, Central AR KIPR—Power 92—African-American, Statewide KOKY - African-American, Little Rock KCLT/KAKJ - African-American, Helena/ West Helena Asian American Reporter—Asian Print KAKJ—African-American, Forrest City, Marianna, West Helena KMLK - African-American, El Dorado KZRB - African-American, Texarkana KDQN-Hispanic, De Queen KITA—Hispanic, Little Rock Enlace Latino—Hispanic Print Hola! Arkansas—Hispanic Print
Churches Forty-three African American Churches in Delta communities and Central Arkansas had member groups assigned to the “Southern Ain’t Fried Sundays” program Fourteen predominantly Hispanic Churches participated with dissemination of flyers/ information for Sevier and surrounding counties health fair and public forum held July 30, 2009 Twenty African-American/Hispanic churches participated in dissemination of flyers/ information for Dallas County health fair and public forum held October 23, 2009 African American and Hispanic churches throughout the state were provided flyers/information regarding the Arkansas Free Medical Clinic Project held on November 21, 2009 Twenty-five Churches in Delta communities and Central Arkansas collaborated with AMHC on World AIDS Day “Compassion Sunday” events on November 29, 2009
AMHC appreciates the many volunteers across the state who have given countless hours in partnering with us on health fairs, public forums, screenings, piloted projects, awareness events and public policy advocacy during the first half of FY2010!
Executive Director’s Quarterly Update 25
AMHC COMMISSIONERS The Commissioners consists of 12 members; six appointed by the Governor, with each of the four Congressional Districts represented; three appointed by the Speaker of the House of Representatives; and three appointed by the President Pro Tempore of the Senate. (Pursuant to Act 574 of 2009) Seated: Willa Black-Sanders, Christine Patterson, Vivian Flowers Standing: Dr. Carolyn Mosley, Raul Blasini, Dr. O.T. Gordon, Vanessa Davis, Dr. Linda McGhee Commissioners Not Pictured: Marta Davis, Sandra Mitchell, Luis Calderon, Larnell Davis
Vivian Flowers, MPS, AMHC Chair Director, UAMS Office of Diversity & Recruitment Christine Patterson, MSW, LCSW, AMHC Vice-Chair Director, Office of Minority Health & Health Disparities, Arkansas Department of Health Willa Black-Sanders, MPH, AMHC Secretary Assistant Dean, UAMS College of Public Health Dr. Carolyn Mosley, Ph.D., RN, CS, FAAN Dean, College of Health Sciences University of Arkansas—Fort Smith Larnell Davis Executive Director, Jefferson Comprehensive Care Systems, Inc.
26 Executive Director’s Quarterly Update
Dr. O.T. Gordon, MD Partner, Gastroenterology Associates Raul Blasini, Retired Army Arkansas Prostate Cancer Foundation, Board Member Vanessa Davis, Assistant Director of Cultural Diversity and Minority Affairs, Division of Behavioral Health Dr. Linda McGhee, MD Associate Professor, Department of Family & Preventive Medicine, AHEC NW UAMS Marta Davis Luis Calderon Sandra Mitchell
AMHC STAFF
Dr. Idonia L. Trotter JD, MPS Executive Director
Dr. Creshelle Nash MD, MPH Medical Director
Seated: Patricia Minor (RN, Outreach Initiatives Manager), Dr. Trotter and Dr. Nash Standing: Siobhan Traylor (Receptionist), Cory Adams (Financial Analyst), Rachael Hopes (Asst. to the Director), Cassandra Woods (Senior Project Analyst), Hanan Givens (IT, Webmaster, Pilot with Partners Project Manager). Also pictured, Jonathan Dunkley (UA Clinton School of Public Service Capstone Fellow) Not Pictured: Clarissa Coleman, Silvia Fernandez, and Regina Wilkerson (UA Clinton School of Public Service Capstone Fellow).
Executive Director’s Quarterly Update 27
NOTES
28 Executive Director’s Quarterly Update
GOAL The goal of the Arkansas Minority Health Commission is to be a catalyst in bridging the gap in the health status of the minority population and that of the majority population in Arkansas. To achieve this goal, the commission focuses on addressing existing disparities in minority communities, educating these communities on healthier lifestyles, promoting awareness of services and accessibility within our current health care system, and making recommendations to relevant agencies, the Governor and to the state legislature.
1st Quarter & 2nd Quarter Combined Update
July - December 2009 Submitted To: The Honorable Governor Mike Beebe Senate President Pro Tem Speaker of the House Arkansas General Assembly
YO U R H E A LT H . O U R P R I O R I T Y.
1123 S. University Ave., Suite 312 Little Rock, AR 72204 Toll Free: 1-877-264-2826 Main: 501-686-2720 Fax: 501-686-2722 www.arminorityhealth.com P u t t i n g
Y o u r
T o b a c c o
D o l l a r s
t o
W o r k !
2009 YO U R H E A LT H . O U R P R I O R I T Y.
Submitted By:
I d o n i a L . Tr o t t e r, J. D . , M . P. S .
E x e c u t i ve D i r e c t o r / A r k a n s a s M i n o r i t y H e a l t h C o m m i s s i o n