Using Civil Rights Law to Address Racial and Ethnic Health Disparities
Carlos Casillas, Michael A Rodriguez, MD, Robert Garcia, JD, Daphne P. Hsu, JD
(1) Department of Family Medicine, David Geffen School of Medicine at UCLA, (2) The City Project
Background
Disparities based on race, color, or national origin are well
documented by extensive research. These disparities in health,
prevention, and health care prompt the need for researchers and
advocates to use a wide array of strategies to promote public health.
One strategy that has been underutilized is equal protection laws,
specifically, Title VI of the Civil Rights Act of 1964 and its regulations,
which prohibits discrimination on the basis of race, color, and national
origin in programs and activities of entities receiving federal financial
assistance.
Title VI has been previously used to address disparities in education;
however, such legal approaches are seldom used to address health
disparities.
Results
AFFECTED POPULATION
SUPPLEMENTAL NUTRITION
ASSISTANCE PROGRAM
•
Latinos
• Low income, students of color
PHYSICAL EDUCATION
BARRIERS TO PROGRAMS OR ACTIVITIES
•
•
•
Awareness of eligibility
Conflict of working hours with business hours
Limited LEP services
•
Inconsistencies in school offered curriculums for
PE due to lack of enforcement
Notion that PE is less important to academic
outcomes compared to classroom time
Failure to provide translations or interpreters
Lack of awareness for both health care
professionals and LEP patients regarding available
language services
Lack of a unified national standard for interpreter
training
•
• Non-US born groups
LIMITED ENGLISH PROFICIENCY
•
•
•
Objectives
I.
To make the case that disparities exist affecting disadvantaged
populations using three examples of programs or activities where
access should be equally available:
1. Access to the Supplemental Nutrition Assistance Program
(SNAP), commonly known as the Food Stamp Program
2. Compliance with Physical Education (PE) requirements in
California (CA) public schools
3. Access to health care for limited English proficiency (LEP)
populations
II. To demonstrate how Title VI and its regulations can be used to
create more equitable access
Methods
To make the case for addressing these disparities:
1. A literature review was conducted in PubMed for papers
published within the last 10 years
• The terms used to search in PubMed were:
1.Foods stamps with Supplemental Nutrition Assistance
Program (SNAP), health outcomes, and food insecurity
2.Physical education, activity with children and disparities
3.Limited English Proficiency with health barriers, health
care, disparities, and language services
• 141 papers were chosen based on specific inclusion,
exclusion criteria and examined to determine the disparities
and health barriers within the three respective areas
2. Interviews were conducted with legal experts on these disparities
and the application of Title VI and its regulations to address them
The Case for Disparities
Problem: Food insecurity, which results in
negative health consequences, is an issue
for many Americans, especially Latino
households
Programs: SNAP provides assistance to
low-income households to help them
obtain a more nutritious diet by increasing
their purchasing power
Disparity: Eligible Latinos have a lower
participation rate in SNAP than the
national average
Problem: Obesity is a major issue for
today’s youth, especially in students of
color
Programs: PE that emphasizes more
moderate-to-vigorous physical activity has
been shown to demonstrate positive
health and academic outcomes
Disparity: Many CA schools, with
disproportionately low income, students
of color, have a curriculum that does not
meet state minimum requirements
Problem: Patients with LEP, disproportionately non-US born, have worse
access to and worse quality healthcare
resulting in poor health outcomes
Programs: When patients are given
language assistance, they receive greater
access to and better quality health care
which results in greater health outcomes
Disparity: Despite the mandate for
language services, LEP patients are not
being provided the necessary services to
improve their access and quality of care
Implications
Conclusions
Strong evidence of disparities based on race, color, or national
origin in access to SNAP, PE and resources for LEP populations
exists. To eliminate these inequities, voluntary compliance of Title
VI and its regulations should be addressed within responsible
agencies through:
SNAP
•Easier application accessibility (online) and telephone interviews to
reduce office visits
•Evaluation of counties to ensure they are in compliance with civil right
obligations regarding LEP
Disparities in access to publicly funded resources based on
race, color, or national origin is unjust. Compliance with Title VI
and its regulations can help alleviate such disparities. Failure to
do so can lead to administrative complaints, loss of federal
funding, or litigation.
PE
Health impact assessments can be a means of analyzing and
alleviating health disparities through the process of applying for,
reviewing, and complying with Title VI and its regulations as a
condition of receiving federal financial assistance
•Greater enforcement of PE requirements in public schools
•A means of monitoring and evaluation to ensure that schools maintain
compliance with requirements
This provides an opportunity for health professionals to work
with civil rights advocates to use legal tools to help reduce
health disparities
LEP
•Translations and interpreters for LEP populations, and a grater
awareness of available language services
•More education
regarding language services and
greater
incorporation into healthcare settings at all levels to ensure greater
utilization
•A unified, national standard for interpreter training to ensure
consistent quality services
Acknowledgments
Supported by UCLA Hispanic Center of Excellence
Contact information:
Carlos Casillas
UCR/UCLA PRIME
E-mail: carloscasillas@mednet.ucla.edu