Ideas for Improving Hispanic Health with Dr. Elena Rios, President & CEO, National Hispanic Medical Association; Charles Barber on “Paz y Salud” Publication

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Introduction ( 00:00 ):
The following episode of Conversations on Healthcare originally aired in May of 2021.

Mark Masselli ( 00:17 ):
We're speaking today with Dr. Elena Rios, president and CEO of the National Hispanic Medical
Association, representing 50,000 Hispanic physicians in the United States. She is also president of the
National Hispanic Health Foundation, seeking to improve the health of Hispanic populations in this
country.

Margaret Flinter ( 00:36 ):
Dr. Rios is an internist. She served as advisor for Regional and Minority Women's Health at the US
Department of Health and Human Services, and she's a trustee of the New York Academy of Medicine.
Dr. Rios, we welcome you to Conversations on Healthcare today.

Dr. Elena Rios ( 00:50 ):
Thank you. Honored to be here.

Mark Masselli ( 00:52 ):
That's great. And, Dr. Rios, the Hispanic community has been hit especially hard by the pandemic,
amplifying the depth of health inequity, long experienced by people of color in this country. I'm
wondering if you could help our listeners understand the true impact that COVID - 19 has had on the
Hispanic community and put it into perspective for us.

Dr. Elena Rios ( 01:16 ):
Well, I think, overall, not every state collects data on Hispanics, that's the first problem. But, overall,
Hispanics and other vulnerable communities have really had twice as many deaths than the white
population. And a lot of that is because of the underlying conditions that Hispanics, who are mostly
lower - income, working class people, known as essential workers in our communities now, have lots of
underlying conditions, like diabetes and obesity and heart disease and cancers, and also are living in
multi - generational housing, working in small businesses, or in the service industry, or in the agriculture
business, or meat packing plants, et cetera, where they've lost jobs and are really feeling the economic
impact of COVID - 19, as well as the physical and emotional impact of this horrible pandemic.

Margaret Flinter ( 02:31 ):
Well, Dr. Rios, I think one piece of good news is that there seems to be adequate supply of vaccine out
there now, in most communities, but we still see vaccine hesitancy in many communities, and we see
some of it in the Latino community as well. I know the National Hispanic Medical Association, of which
you've been such a leader, has launched the app Vaccinate for All campaign, to address this issue. Tell us
about this effort. And what are the vaccine resistance challenges, the key areas that you're seeking to
address, educate, or help overcome?

Dr. Elena Rios ( 03:08 ):
Yeah. Well, I think some of the important issues with vaccination is education and outreach. And, many
people are afraid of government programs, just don't trust government programs. And we do know that
the NIH has worked with the pharma companies to produce us vaccinations that are very safe, very

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effective, but many people just don't understand that yet. And I think the other problem is that we do
have people that are, again, don't have the money to pay for vaccines and don't know that it's free. And
that, for people that are undocumented, maybe, or have undocumented people in their family, may be
afraid of privacy issues. And making sure that the people know that the vaccine providers are not going
to give away information to anybody, like the INS or any other authorities, and that it really is a private
issue.
( 04:17 ):
So, the National Hispanic Medical Association is proud to be able to have a national campaign, funded
by CDC, and we call it Vaccinate for All because we think everyone in the family should understand how
important vaccinations are for everyone. Right now, we can get vaccinations to those who are 16 years
old and older. And we're hoping that by the end of the summer, or thereabouts, that we will have a
vaccine for 12 - year olds to 15 - year olds.
( 04:50 ):
And so, I can tell you that the most important part of our campaign is that we are encouraging health
professionals and patients alike to sign up and be a champion for Vaccinate for All, which means that if
they come to our website, which is www.nhmamd.org and go to the Vaccinate for All page, they can sign
up and become a champion, where they can send information to their families and to their loved ones.
Simple information in English and Spanish about how to get vaccinated and the importance of these key
facts about vaccinations, that they're safe, effective, and important to be able to have a vaccination in
one or two doses, that will be very effective in decreasing the impact of the disease of COVID - 19. And
that it's much better to get a vaccination than to end up in a hospital, on a ventilator.

Margaret Flinter ( 05:56 ):
Absolutely.

Mark Masselli ( 05:56 ):
Right.

Dr. Elena Rios ( 05:56 ):
So, that's our main message.

Margaret Flinter ( 05:59 ):
Yeah.

Mark Masselli ( 05:59 ):
Well, that is such a great program. And you said the word earlier, that a key to having all this happening
is developing trust. And probably hasn't been a lot of trust happening with the Department of Homeland
Security, but they recently stated that ICE and the Border Patrol will not conduct enforcement
operations at or near vaccination sites. That must be so critical to the work that the National Hispanic
Medical Association is undertaking. And I'm wondering, is this fact getting out to the community? And,
also, just talk to us about the negative impact of immigration policy has had on Hispanic health.

Dr. Elena Rios ( 06:45 ):

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Well, I think we all need to tell more people of the importance of this message, about those who are
getting the vaccine will not be fearful of having any kind of government ICE or INS be part of the
vaccination sites. So, yes, it is very important that more people know about it. I think the most
important problem for undocumented is that there are very few access to healthcare. One is through
community health centers. Federal community health centers are supported, to take care of anyone
that walks in their doors. And the other is emergency rooms. And I should say doctors who are able to
provide charity care. And we do see a lot of Hispanic doctors, especially in our poor communities, taking
care of patients, when they can.
( 07:49 ):
I do think that it's important to know that some places, like California and New Jersey, have changed
state laws, to allow funding from Medicaid, from the state portion, to be able to take care of people that
are not documented. And I think that that's the major problem, is the lack of access to resources,
because... And many can get some insurance from employers, while employers are still able to provide
insurance.

Margaret Flinter ( 08:23 ):
Yeah. Dr. Rios, I want to thank you for the shout - out to community health centers, obviously where we
do most of our work. But, also, Mark, it never even occurs to me these days that people would think
there's a cost for the vaccine -

Mark Masselli ( 08:38 ):
Right. Right.

Margaret Flinter ( 08:38 ):
... because there has been no cost associated. But you're so right, Dr. Rios, that that may be something I
take for granted is absolutely known among our communities and it may not be, so thank you for that
reminder. And I wanted to ask you, also, about Dr. Marcella Nunez - Smith, who I know was a keynote
speaker at the recent annual meeting of your organization. Of course, she's the Biden Administration's
Director of Equity, through the Pandemic and beyond. Share some of her insights on how the president's
policies might have the potential to address some of these really entrenched health equity challenges,
that we've lived with for way too long and desperately need to do something about.

Dr. Elena Rios ( 09:24 ):
Yeah. Dr. Nunez - Smith was great. And I think that her big message was how important it was to be more
inclusive and to listen to people in our communities, that have suffered so long with health inequities
because of their poverty levels, lack of education, limited English, just maternal mortality. There's... You
can go on and on and on. And I mentioned, earlier, obesity and diabetes and heart disease. I would just
say it's toxic stress in poor communities that need to be addressed.
( 09:58 ):
And what Dr. Nunez - Smith did, she did a great job in discussing some of the key points, that we now
know as the American Rescue Plan of President Biden and the White House. It's been, he actually
addressed this last week, in the joint congressional session. And I think a lot of this will be taken care of.
Just basic necessities, like more funding for food programs in our communities. The schools, having
money to revamp schools, so they can open. College, student loans. Rent for people and other housing
programs. People are really desperate, right now, because they've lost so many jobs and are more

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unemployment, until the fall. And I think one of the major issues, that I think we're really proud to see,
is that this administration is taking a real look at poverty -
Margaret Flinter ( 11:00 ):
Yeah.
Dr. Elena Rios ( 11:00 ):
... and decreasing child poverty in half, by the tax credits that they put into the American Rescue Plan.
Margaret Flinter ( 11:00 ):
Yeah.
Dr. Elena Rios ( 11:07 ):
So, the tax codes would be changed, so that families would get tax credits for not only being married or
having a family, but for each child.
Margaret Flinter ( 11:17 ):
Mm - hmm.
Dr. Elena Rios ( 11:17 ):
And I think that that's going to go a long way, to help, again, working families have a little bit more hope,
with some money to pay their bills and buy food.
Mark Masselli ( 11:29 ):
We're speaking today with Dr. Elena Rios, president and CEO of the National Hispanic Medical
Association and President of the National Hispanic Health Foundation, seeking to improve the health of
the Latino population in this country. You know? I really want to pull the thread on your shout - out to
the Biden Administration and about the American Families Act and the American Rescue Plan. I'm just
wondering, as you think about policy, going forward, no plan is perfect, though this one does a really
good job. You really talked about the guarantee for really trying to cut child poverty in half, throughout
the land, which is so important to do. But what other additional reforms are you and the National
Hispanic Medical Association advocating for, things that people at state should keep their eye on, as well
as the national level?
Dr. Elena Rios ( 12:24 ):
Well, I think, again, with the stress that has been developing, even at a higher level than ever, because
of the pandemic, I think we have to look at the importance of anxiety and mental health and all of the
issues happening within families. Domestic violence -
Mark Masselli ( 12:43 ):
Mm - hmm.
Dr. Elena Rios ( 12:43 ):
... opioid abuse -

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Margaret Flinter ( 12:44 ):
Mm - hmm.
Dr. Elena Rios ( 12:44 ):
... was always there, but it's just exacerbated. The other issue is really the healthcare workers
themselves. We really need more diversity, within the medical profession, doctors, nurses, dentists. But,
more importantly, we need more community people to step up and be part of the messenger system.
And we've seen the Biden Administration increase community health workers for accessing health
insurance, through the Affordable Care plan. I think we need more community health workers working
within public health, to be the trusted messengers for getting people to understand where they can go
get a vaccine, helping them find appointments, the navigators, if you will, within public health. And I also
think that we're going to see a lot more importance of public health -
Margaret Flinter ( 12:44 ):
Mm - hmm.
Dr. Elena Rios ( 13:41 ):
... and building back the infrastructure -
Mark Masselli ( 13:43 ):
Yes.
Dr. Elena Rios ( 13:43 ):
... of public health that was there in the 1950s, when we had polio and polio vaccines in the 1960s. And
we have so many problems in our communities. I mean, homelessness is another one that really is a
public health issue, when we think about getting prepared for the next pandemic. So, these are just
some of the things I could think of, that are really across the board, needed at the state level and the
national level.
Mark Masselli ( 14:15 ):
Yeah.
Margaret Flinter ( 14:16 ):
Well, Dr. Rios, every one of those that you mentioned is very important, but I wonder if we could just
zero in, for a moment, more on your specific thoughts about how we reach into the Hispanic and Latino
communities and excite people, engage them in thinking about careers in the health professions and
bring them in. And you've done a spectacular job with physicians, within your organization, within the
world of physicians. But I'm wondering, you spoke about nurses and community health workers, the
dentists, the therapists, the people are going to lead and run these operations. What are your thoughts
about how we do that, so that the individual who comes into any healthcare organization feels like,
"Wow. This is a place that reflects me, as well as everybody else in the community"?
Dr. Elena Rios ( 15:10 ):

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Well, it starts young. I think we need more awareness among young people in the K through 12 and our
grammar schools and high schools, about the important role for jobs. The healthcare industry is the
number one industry with jobs in this country.

Margaret Flinter ( 15:10 ):
Right.

Dr. Elena Rios ( 15:28 ):
And anywhere you go, you can get a job in the healthcare industry, you can move and find a hospital, a
nursing home, a clinic. And I think that there are jobs that don't take that much time. Not everybody can
go to medical school and has that stamina to stay there for 10 years and go to school. But I do think it
has to start young. And the other thing is we really do need more role models.
( 15:58 ):
The National Hispanic Medical Association is made up of mainly the Hispanic doctors that are alumni of
the United States Medical Schools. But, unfortunately, only 5% of all the doctors in the country are
Hispanic, so there's very few of us. And what we need is more doctors in our medical school alumni to
go out and talk to community PTAs, parents of grammar school kids, talk to the grammar school kids
about what it takes to... If you're very interested in science and math and critical thinking, there's no
reason why you can't be supported to continue along that path.

Margaret Flinter ( 16:36 ):
That's right.

Dr. Elena Rios ( 16:37 ):
Unfortunately, we don't have the good counselors in the public school system, to understand that they
can make or break a student's vision of themselves, going to be in healthcare, if they don't support them
in continuing to be good in math and science. And then, in college, I think the same thing. We run a
program called the College Health Scholars Program. And we've seen over 2,500 Hispanic students from
Texas, California, the East coast, just different places around the country. And we're matching them with
mentors who are Hispanic students that are in medical school, that are telling them, "Look. We made it.
You can make it too." And I think that's what's real important, that we have mentoring, because so
many of our families do not have fathers or mothers that are health professionals.

Margaret Flinter ( 17:33 ):
That's right. Mm - hmm.

Dr. Elena Rios ( 17:35 ):
Although, they may go to a dentist or go to a doctor and see them, they don't necessarily think that they
can get to that point.

Mark Masselli ( 17:45 ):
Well, that's just a wonderful roadmap for the future of individuals, but also for the future of the
healthcare system, by providing that mentoring. I think it's fair to say that you are a futurist for
healthcare. And the National Hispanic Medical Association, as we talked about a little earlier, is involved

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in the All of Us Precision Medicine Initiative. As a federally qualified health center, we were one of the
vanguard of when Dr. Collins ran it, started this program up. It's so important to have a program that
focuses on research, that looks like all of the country, not just a limited part of the country. I'm
wondering if you could share with us your vision for this wonderful effort by NIH and how it may lead to
improved healthcare and healthcare outcomes in the Latino community?

Dr. Elena Rios ( 18:35 ):
Yeah. The All of Us program was designed to follow a million people in America, that live here, over 18,
who can be followed for 10 years, so that our researchers can learn more about how people live and
how they face different diseases, as they age, over 10 years. And I think it's so important that we have
more Latinos sign up for the program. And there is a website, where you can sign up. But I think it's
important that we have participants who can provide knowledge for the next generation, about our
communities. And we'll only learn about how Latinos face diabetes or heart disease and the struggles
they go through, but also the important tips and how they respond to medications and therapy and
exercise. And, I think it's just so important that we get involved, so that we can also learn from each
other and pass on the information to the next generation.

Margaret Flinter ( 19:45 ):
Well, that's great. And I think we can say that they're still accepting people into that program.

Mark Masselli ( 19:50 ):
Yes.

Margaret Flinter ( 19:50 ):
I think they're still recruiting -

Dr. Elena Rios ( 19:51 ):
Yes. Yes.

Margaret Flinter ( 19:51 ):
... so not too late for people to participate and get their families involved as well. We've been speaking
today with Dr. Elena Rios. She's the president and CEO of the National Hispanic Medical Association and
President of the National Hispanic Health Foundation. Learn more about her work by going to
nhmamd.org or follow her on Twitter at Elena Rios MD. Dr. Rios, we want to thank you so much for your
leadership, for all of your contributions to health equity and for joining us today on Conversations on
Healthcare.

Dr. Elena Rios ( 20:22 ):
Thank you. It was a pleasure.

Mark Masselli ( 20:24 ):
Well, it's good to see everybody. Welcome. And what a great conversation we had with Dr. Rios. And
this month we're celebrating a Hispanic Heritage month. And we have a lot of exciting things that are
happening, all across the health system. But, today we're here with Charles Barber, who is the author of

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Peace and Health. Many of you have heard us talking about it. Hopefully, you've maybe purchased the
book, or listened to the audio, or downloaded the Kindle Shameless Plug, You Know Us.
( 21:01 ):
But, we're excited today to launch Paz y Salud. And Charlie just finished taking a look at the book. We
had it translated. We had really some great contributors in terms of both the audio and the Kindle
version and, obviously, the print version, so we're very excited that it's released today. Charlie, this is
the first time one of your books, maybe, had been translated into Spanish?

Charles Barber ( 21:27 ):
Absolutely. It's wonderful just to see it. Paz y Salud has a wonderful ring to it. And, as an author, it's just
wonderful to see it translated. It is the first book that I've had translated. And, from the beginning, for
the project, Mark, we were interested in getting it out to the people, and access, and telling the story, to
as many people as we can, and this is a huge step in that process.

Mark Masselli ( 21:52 ):
Good. And, we want to give a shout - out to Jerry Soto, who did the voiceover here. He's a WWE
broadcaster, so many of you have probably heard. He brings great passion and energy to the book. And,
I think the question, really, for us, as an organization, is, why was this important? And it really goes back,
really, in our history of how we've been infused, by the staff and our communities with Hispanic origin.
( 22:29 ):
And, I think about one of the things that we've done, Charlie, over the years, here, is to recognize our
limitations in language. Certainly, I'll speak for myself. Even though, I should note that on my wife's side,
part of her family, her nieces and her brothers, are born and raised in Puerto Rico, so we have families in
Orocovis and San Juan. But, on my side, very limited ability to speak more than, and barely be able to
speak English. But it was really important, just thinking about my own grandparents, who came here and
really lived here for a long time, but really never got comfortable with the language.
( 23:13 ):
And we know this is true within our own patient community. And so, we've really made a commitment
to make sure that, as much as we can, that we're able to speak fluently in both languages, not only the
people who answer the phones, but also our clinicians and the like.It's a growing and vibrant population
for us. We care for about 150,000 patients, across the State of Connecticut. About 30% of them would
prefer us to speak in their native language. And while it's a native language, there are lots of cultures,
lots of communities, within that. And so, we do our best to make sure that we're celebrating all those
communities. But, Charlie, you've probably had experience, as well, with maybe the limitation. Though, I
think I just heard you speak a little Spanish, maybe a little more than I can.

Charles Barber ( 24:15 ):
[foreign language 00:24:15]. [foreign language 00:24:15]. And I'll stop there. I ran a healthcare facility for
folks with psychiatric [foreign language 00:24:24], in Washington Heights, in New York.

Mark Masselli ( 24:27 ):
Mm - hmm.

Charles Barber ( 24:27 ):

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And this was in the 90s. And half of the staff were from the neighborhood and they spoke Spanish. They
were from Dominican Republic. And same essential reason as why it was so important to us to have this
translated, I wanted to connect with my staff, so I learned Spanish and was able, probably in a fairly
butchered way, but after 3, 4, 6 months, I was able to run staff meetings in Spanish. And it was so
powerful, honestly, to the staff. And so, to me, this is sort of coming full - circle, to get the message out
and get the story out, to as many people as we can, and to respect as many cultures as we can.

Mark Masselli ( 25:17 ):
That's right. That's so important. And we hear it so often with our staff who want to share the
experience of the health center, which they all help build over the 51, almost 52 years that we've been
around. And being able to share Paz y Salud with a family member, or the audio file, or the Kindle, and
really capture that experience and hopefully help write that next chapter. And it's so important that we
focus in on the Hispanic community, as we do other communities.
( 25:54 ):
But, the health disparities that exist within the community are things that we are working hard to
address, ameliorate. And our hope is that this continues to engage, within the community. We have so
much to learn. Part of the work that we do is now framed up in what's called the Moses Weitzman
Health System. And it's an umbrella for four organizations. One, the Community Health Center, which
many of you are familiar with.
( 26:26 ):
But we also are caring for about 5 million lives, all across the country, on an e - consult program. And so
many of those are in Texas, in Southern California, where the predominant language... We're at 30%,
where the predominant language is Spanish speaking. And so the programs that we have, and I would
also say, our medical assistant training program, in our Denver office, where we're really taking on that
first generation of folks who are entering the healthcare field, where they say to us, "I'm the first person
to get a certificate or degree in my family." And I would say probably the majority of the graduates have
been Hispanic women, for the most case, all across the country. We're in 23 states doing that.
( 27:16 ):
And, also, Margaret Flinter, who co - pilots the health center with me, has formed the Nurse Practitioner
Residency Training program. And they're an infusion of people, from all walks of life, are there. So, we're
excited that we can tell the story in multiple languages. And, Charlie, just, I want to thank you for the
energy, the effort, the brilliance that you've put into this writing.

Charles Barber ( 27:41 ):
Thank you so much, Mark. It's been wonderful to work with you too.

Mark Masselli ( 27:44 ):
Yeah. That's great. [foreign language 00:27:48].

Charles Barber ( 27:51 ):
Paz y Salud.

Mark Masselli ( 27:51 ):
Paz y Salud.

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Closing Statement ( 27:56 ):
This copyrighted program is produced by Conversations on Healthcare and cannot be reproduced or
remitted, in whole or in part, without the expressed written consent from Community Health Center,
Inc. The views expressed by guests are their own, and they do not necessarily reflect the opinion of
Conversations on Healthcare or its affiliated entities.

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