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New Mexico Health Equity Partnership’s Health Impact Assessment Training
The staff at the New Mexico Health Equity Partnership (HEP), an initiative at the Santa Fe Community Foundation, thinks that every New Mexican should have the opportunity to lead a healthy life, live in neighborhoods where children and families can thrive, and have a say in decisions that impact their lives and communities. HEP’s staff sees too many New Mexicans living in historically impoverished neighborhoods where the air is dangerous to breathe, the water is dangerous to drink, healthy food is not readily available, the quality of education is poor, and people are not fairly compensated for their work.
To address these challenges, HEP connects people, community groups and decision makers, and provides training, coaching and tools such as the Health Impact Assessment (HIA), which builds leadership and makes it possible for residents to hold policymakers accountable. Through the HIA, people learn how to collect and utilize data to inform policy change, learn about decision-making processes, learn how to navigate the political system, and they become more comfortable speaking with decision-makers. The HIA also fosters communication and collaboration among disparate groups.
HIAs make the adoption of community recommendations more likely. A forthcoming report to the Robert Wood Johnson Foundation highlights the HIA as a best practice and notes that a common vocabulary for learning and action is being instituted in New Mexico because of the number of communities using HIAs.
The HIA is supported by a grant from the HEP, Santa Fe Community Foundation and the W.K. Kellogg Foundation. For more information, visit www.nmhep.org or contact Jessica Jensen: 505.490.1202, firstname.lastname@example.org
Santa Fe Indian Health Service Hospital
The Underfunded Healthcare Provider of Choice for Urban Natives
The Indian Health Service (IHS) provides healthcare for approximately 2.2 million American Indians and Alaska Natives (AIANs) in 36 states. In the U.S., nearly 80 percent of AIANs live away from their reservations. Collectively, this population is often classified as Urban AIANs, although they do retain their unique tribal identities even while living away from their tribal lands. For those who do not live near or on their reservation, access to IHS facilities comes with significant limitations, most importantly, restrictions on eligibility for payment for specialty care through the Purchased/Referred Care payment program. Santa Fe, New Mexico, is home to the Santa Fe Service Unit IHS Hospital, healthcare provider of choice for the majority of AIANs in Santa Fe County. From 1998-2010, the IHS was forced to operate on an outdated budget during a time when healthcare spending per capita nearly doubled. This underfunding forced the IHS to make serious cuts to facilities across the country, including to the Santa Fe Service Unit IHS Hospital.
In 2016, the Santa Fe Indian Center and I collaborated to complete a Health Impact Assessment (HIA) to document the impact budgeting policies have on the Urban AIAN community in the county. Through this collaboration, the research team collected 165 surveys that asked questions on health priorities, health conditions, social determinants of health and cultural factors important to Santa Fe’s Urban AIANs. The team also conducted targeted interviews with key stakeholders and an additional 17 qualitative interviews with 17 Urban AIANs within the community.
AIANs in Santa Fe County experience substantial health disparities, with higher rates of mental distress, higher rates of poverty, unemployment, alcohol-related disease and death and higher rates of accidental death. AIANs die at younger ages than their non-AIAN counterparts. AIAN children in New Mexico are more likely to live in poverty, have no parent in the workforce and have no health insurance.
The team found that Santa Fe’s Urban AIAN community was most concerned about diabetes, body size, mental health, heart disease and addiction, both personally and in the larger AIAN community. They found that food insecurity was a serious issue, with 53 percent of respondents reporting the need to ration food or eat less in the last 30 days because they didn’t have enough money for food. Mental health and addiction services were frequently cited as a need for care. As one individual stated, “If you’re mentally healthy, then you know how to be physically healthy, spiritually healthy, working with your mind to make your mind healthy, your child’s relationship, your relationship with your spouse, your mother.”
Based on the results of this HIA, the team made the following recommendations:
1. Fund the Indian Health Service at 100 percent of need.
2. Address food insecurity through the creation of a food bank and expansion of nutrition services to meet the needs of the Santa Fe Service Unit IHS Hospital community.
3. Increase IHS funding to improve mental and behavioral health programs.
4. Eliminate Purchased/Referred Care eligibility by area service unit and replace it with funding that follows the patient.
Through this research, the HIA team demonstrated the need for increased funding to address significant health disparities in Santa Fe County in the AIAN population. The research team found that the Urban AIAN community has strong ties to the Santa Fe Area Unit IHS Hospital, with trust in the health care providers and a feeling of ownership for the facility. Even in an environment with multiple options due to the expanded services offered through the ACA, the Santa Fe Area Unit IHS Hospital is the community’s preferred provider.
Emily A. Haozous, Ph.D., RN, FAAN, is an associate professor and Ph.D. program director at the UNM College of Nursing. Dr. Haozous’ research is focused on cancer prevention and symptom management, and promoting health equity for American Indians and Alaska Natives. Her work integrates traditional American Indian values with contemporary research methods. Dr. Haozous is a member of the Chiricahua Warm Springs Fort Sill Apache Tribe. She is from Santa Fe, New Mexico.
Wage Theft Impacts Workers’ Health
Latino Immigrants and Native American Workers in Gallup
From the McKinley Worker Justice Coalition
Most of us spend a large portion of our days working to put food on the table, pay rent or a mortgage and establish financial security for loved ones and ourselves. When we don’t get paid, our families and communities suffer.
Wage theft comes in many forms. It includes underpayment of hours or overtime worked, misclassification of employee status, an hourly wage less than the mandated minimum, or unlawful paycheck deductions. Workers in low-wage industries, women, people of color and immigrants are especially vulnerable and report violations at different rates because they encounter barriers in the claim process. Most do not report violations or try to recoup their stolen wages out of fear of retaliation from employers. One out of three workers who have complained say they experienced retaliation.
The McKinley Worker Justice Coalition was formed in September 2015 to bring organizations and community members together to strengthen workers’ rights and improve workplace conditions. Coalition members identified wage theft and other employment violations such as discrimination and inadequate health and safety standards as starting points to advocate for equitable policies.
Coalition members decided to conduct a Health Impact Assessment (HIA) to better understand the impact of these problems on Latino immigrant and Native American communities. Their priorities included more community education, stronger wage-theft enforcement and expansion of workplace protections for all low-wage workers in McKinley County. They focused on health determinants of economic security, discrimination, and health and safety in the workplace. Through questionnaires and focus groups, they evaluated workers’ experiences. Here are a few testimonies:
“In the hotels, there is a lot of danger for housekeepers. When we do our cleaning, you find blood. They don’t give you gloves to protect you from all the chemicals that you have to use to clean. They give you 15 minutes to clean a room. When you have to pull off the covers quickly and move everything, workers have found needles that stuck them. They don’t have medical insurance.”
“When my husband and I moved to Farmington for that job, we left our home. We had to pay rent in Farmington. We were working 120 hours a week. Our 12-year-old son washed dishes in the restaurant to help us. Our dream was to have some money to be able to buy a food truck. During the time we were there working and never received any wages, we used all our savings. We came back without any money and had to start from the bottom.”
“In my job, they discriminate against me a lot. They tell you to go back to your country. They are always joking about the fact that you don’t speak English and make fun of you.”
The HIA survey of the focus group, along with experiences reported by members of the McKinley Worker Justice Coalition, showed that 75 percent of Latino immigrants reported a violation in their employment history, compared to 68 percent of Native American workers. Nearly half of workers reported experiencing discrimination, Native Americans at a higher rate than Latinos. The findings also showed that one out of four workers had been injured on the job. Nearly half indicated that their work is dangerous. Forty percent of workers who were victims of wage theft said that the violation adversely affected their health, and another 40 percent said they had to take out a loan to make ends meet.
Low-wage workers, community leaders and elected officials across the state are joining forces to combat wage theft. To learn about your rights or get involved, contact Somos Un Pueblo Unido at 505.424.7832. To read the entire report, visit www.somosunpueblounido.org
Tularosa Basin Downwinders Consortium
No major health study has ever been conducted on the people living downwind and downstream of the world’s first atmospheric nuclear test. Residents of south-central New Mexico exposed to radiation from the July 16, 1945 atomic bomb test at the Trinity Site have been the unknowing, unwilling and uncompensated “collateral damage” of the test that ushered in the Nuclear Age.
On Feb. 10, 2017, the Tularosa Basin Downwinders Consortium (TBDC) will release a Health Impact Assessment (HIA) that attempts to cull information relevant to the health and status of these communities that have been historically ignored. The report addresses what the coalition identifies as the short- and long-term health impacts—physical, mental, generational and economic—in Otero, Lincoln, Socorro and Sierra counties. The report also considers ways that the passage of amendments to the federal Radiation Exposure Compensation Act (RECA) could affect the health of individuals and communities in the Tularosa Basin.
There is a growing awareness of Downwinder communities. For years these communities have appealed to New Mexico’s congressional delegation for amendments to RECA that would include them. Amendments have been introduced, but no congressional hearings have been held. These proposed amendments would include the Trinity Downwinders, the Post ’71 uranium miners and, in general, New Mexico residents (former and current) as Downwinders in the U.S. history of atmospheric testing.
The HIA provides evidence and analysis to support the passage of the proposed RECA amendments. The three primary health determinants examined are lack of access to healthcare, economic impact(s) to patients and families and generational trauma. The TBDC compiled the data from approximately 800 health surveys collected over the years from individuals and families living downwind and downstream of the test, literature reviews and focus groups. The New Mexico Health Equity Partnership of the Santa Fe Community Foundation funded the HIA, which included training and technical assistance throughout the process.
Myrriah Gómez, Ph.D., author of the HIA, said, “The most powerful part of the HIA process was meeting with Trinity Downwinders to hear about their experiences and their families’ stories about how the bomb has tragically impacted New Mexican families and communities.”
The TBDC has requested that the U.S. government issue an apology and award reparations to individual and families who have suffered as a result of radiation exposure from the Trinity test.
The public is invited to attend the HIA release events. A light meal will be served.
Friday, Feb. 10, 6 p.m. at Tularosa Town Hall
Saturday, Feb. 11, noon in Socorro (location TBA)
Wednesday, Feb. 15, 6 p.m. at the ABQ Peace and Justice Center, 202 Harvard SE, Albuquerque
To learn more, get involved, or to download the HIA, visit http://www.trinitydownwinders.com/
Tina Cordova grew up in Tularosa and now lives in Albuquerque, N.M. She organized the Tularosa Basin Downwinders Consortium with the late Fred Tyler in 2005. She is a cancer survivor who has worked tirelessly to bring attention to this issue. She says, “We were the unknowing, unwilling, uncompensated victims of the first atomic bomb, without any recognition or help from the U.S. government.”
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