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'Hispanic Agenda' Targets Latino Concerns at NIH

By Josť Alvarado

On the Front Page...
The Department of Health and Human Services has launched a major initiative to reach the burgeoning numbers of Hispanic/Latino people in the nation, who often suffer high rates of disease and health problems due to limited access to health care. A key goal is to raise the disproportionately low Hispanic representation in the workforce of agencies such as NIH. The "Hispanic Agenda for Action: Improving Services to Hispanic Americans" complements efforts already under way here to increase Hispanic employees.

Last September, Secretary Donna Shalala announced the "Hispanic Agenda for Action," prepared by a departmental working group on Hispanic issues in response to her request for "practical recommendations about how we can better serve our Hispanic customers." (The complete text of the agenda can be accessed on the Web: The agenda involves recognizing the health problems of millions of Hispanics and widening the Hispanic workforce to meet those needs. It is expected that by the year 2009, the number of Hispanics will reach 40 million, surpassing all other minority groups in size, and that in 2030 Hispanics will be the largest minority group among the elderly.

NIH's initiatives help train young people like Dr. Gonzalo Graupera, a former participant in NINDS's summer program who is currently pursuing a specialty in internal medicine at Brigham and Women's Hospital in Boston.

The agenda also includes: providing more educational opportunities for Hispanic American youth, improving Hispanic data collection and analysis, increasing Hispanic participation in research, establishing procurement practices that allow Hispanic American-owned companies and individuals to compete for HHS contracts, and translating program materials for customers whose primary language is Spanish.

Shalala appointed a steering committee to follow up on the progress of Hispanic agenda recommendations at all HHS agencies. A Hispanic agenda task force has been set up at NIH, chaired by deputy director Dr. Ruth Kirschstein. Each component of NIH must craft its own action plan to implement agenda goals.

Gaps in Health Care

"Despite having the highest rate of labor force participation of all U.S. population groups, Hispanics/Latinos are the poorest minority group living in the United States today, and more than one-third of the population is uninsured," reads a 1993 Surgeon General's report. "Not only do they lack accessible, affordable, available, affable, and portable health care, but they also are severely underrepresented in ownership of health-related enterprises." Government statistics show that 32 percent of the nation's current population of 22 million Hispanics are uninsured, compared to 13 percent of Anglo-Americans and 20 percent of African Americans. Employed Hispanics and their families are less likely to be covered by employer insurance, with only 40 percent of Hispanics receiving insurance from their employer or a relative's employer, compared to 70 percent of Americans as a whole, according to 1990 data.

In addition, a 1995 report by the National Coalition of Hispanic Health and Human Services Organizations (COSSMHO) indicates that Hispanics are less likely to visit a doctor, and often prefer to approach family members, friends, neighbors or shopkeepers for their medical advice. The COSSMHO report says Latinos feel American health care institutions are too impersonal and cold. According to surveys, many Hispanics have a great distrust of the health care system and believe it discriminates against them. COSSMHO cites studies documenting many examples of how lack of cultural sensitivity leads to misunderstanding between patient and health care provider and frequently to misdiagnosis of the patient's illness.

Beginning in childhood, lack of adequate primary care has led to a higher incidence of vaccinepreventable illness among Hispanic preschool children, who during the 1991 measles outbreak were 5.8 times as likely as non-Hispanic white preschool children to contract the illness, according to COSSMHO. Among Hispanic adolescents, studies have shown they are least likely to use family planning services compared with their non-Hispanic Black and white peers. Mexican American and Puerto Rican adults have rates of diabetes approximately twice that of non-Hispanic whites, which is linked to poor diet and lack of exercise. High alcohol consumption among Hispanics has made liver disease the third leading cause of death for Hispanics ages 45 to 64, although it is the sixth leading cause of death for non-Hispanic whites. And Hispanics are three times as likely to live in polluted areas, as designated by the Environmental Protection Agency, says the COSSMHO report.

"Improved access to culturally sensitive care would go a long way toward addressing Hispanics' unusually high cause-specific mortality rates for conditions such as diabetes, liver disease, pneumonia/influenza, hypertension and certain cancers," writes Dr. Lauro F. Cavazos, a former secretary of education, in a newsletter for the Association of American Medical Colleges.

NIH Diagnosis

Since 1981, the Hispanic Employee Organization -- an advocacy group not affiliated with the Office of Equal Opportunity -- has pressed HHS and NIH administrations to hear out Hispanic concerns, and to implement policies such as the Hispanic agenda to address those problems. "I think the time is ripe for things to happen," said Dr. Ernest Marquez of NIGMS, who is president of NIH-HEO, founded in 1995. "We have the best chance that we have ever had at the NIH to actually make a difference and improve the number of Hispanics being employed, in spite of the fact that we are downsizing everywhere."

HEO officials say that years of studies and recommendations from government-appointed bodies to improve workplace conditions and consumer services for Latino citizens have been either ignored or halfheartedly implemented. This has resulted in a workforce that is a long way from reflecting even the present demographic realities of the Hispanic population of the country, let alone one prepared to handle its future expansion, claims HEO.

Officials from the Office of Equal Opportunity say Hispanic Americans, along with Native Americans, are "severely" underrepresented at NIH. While Hispanics currently represent 10 percent of the U.S. workforce and 5.7 percent of federal employees, the fiscal year 1996 workforce for HHS includes 1,451 Hispanics, or 2.7 percent, of its 53,579 career employees, according to Hispanic agenda data. In Senior Executive Service policymaking posts in the department, there were 536 slots for FY 1995, but only 2.61 percent were filled by Hispanics. Eight of these were career appointments; the remaining six were political appointees.

Currently at NIH, out of a permanent workforce of 13,256 employees, 281, or 2.1 percent, are Latino, according to statistics from the Division of Human Resource Systems. This compares with 22.3 percent for African Americans, 5.8 percent for Asian/Pacific Islanders, and 0.5 percent for Native Americans. The proportion of Hispanic employees at NIH has risen since 1992, however, when it was just 1.8 percent.

Dr. Carlos Caban

Dr. Carlos Caban of the Office of Extramural Research, who is president of the HHS-wide HEO, says NIH efforts to recruit more Latinos do not go far enough, and that new approaches are needed. "Actual hiring of Hispanics has not improved over time as it has for other minority groups."

In 1995, NIH started its own initiative through OEO to correct minority workforce underrepre-sentation. Dr. Harold Varmus, NIH director, mandated a new affirmative action planning process to address general frustration with lack of progress by traditional affirmative action programs. For the first time, goals were set to recruit minorities in occupations at each ICD that were most underrepresented, taking into consideration 1990 U.S. Census data that show percentages of minorities in each occupation. This information is used to compute an underrepresentation index, which indicates "severe underrepresentation" when it is below 50 percent. At the beginning of the program, Hispanics were below this range for all occupations at NIH, except for medical officers, general health scientists, nurses and management analysts.

In the short time since the program's implementation, OEO statistics show partial fulfillment of first-time AAPP goals for hiring Hispanics. OEO officials admit these numbers can improve, but consider it better than the absence of goals before.

Invisible Applicants and Opportunities

Hispanic NIH'ers point out several obstacles to achieving Latino equality in the workplace. They say the way ICDs recruit is not helping efforts to increase representation of Hispanics in the workforce. Vacancies are advertised every week in job series where consideration is limited to NIH employees or HHS employees, among which Hispanics are already underrepresented.

The 'status only' requirement, as it is called, excludes persons who are not career employees. Latino employees and HEO officials see a need to lift the 'status only' requirement where it is not essential and in jobs in which there is under-representation of Hispanics. They say the hiring process has to be modified to attract a larger pool of minorities.

Kirschstein explained that the shrinking federal workforce makes it difficult to do away with 'status only.' She said the limits on how many employees NIH can have -- its "ceiling" -- rules out hiring from the outside because priority must be given to employees already inside NIH. "It's a very difficult problem, but one that we have to think about creatively in order to solve. We are not sure we have all the answers, but we are working on it."

Luis Arvelo

Luis Arvelo, an NINDS personnel management specialist, tackles the hiring problem head on, making sure his office follows up on EEO efforts to hire minorities in his institute. He says the ICDs are not doing enough to support EEO programs that assist in hiring more Latinos. "There must be more leadership from the directors, who must be more proactive in seeking out Hispanics."

Arvelo says the problem is twofold: besides the lack of effort to recruit Latinos, there is often too little persistence on the part of Hispanic applicants, who are quickly discouraged from applying to NIH. He says it is extremely important for applicants to get help preparing a competitive resume for a world-class institution like NIH and persevere in a long, rigorous process. He says there are always openings for administrative and technical areas, and clerks at entry levels.

Nevertheless, Arvelo understands the frustration of many Latinos who apply to NIH and are never called back. "They perceive NIH as a place that is not giving them opportunities because after applying, they don't get interviewed. Then they figure it is a waste of effort, and word gets around and they say 'Why bother?' So we need to have better communications programs in place and continue visiting Hispanic institutions, and continue sending announcements. But it can't be one person doing it. It must be a concerted effort."

The key to addressing the problem of underrepresentation, according to John Medina, Diversity Program manager at NIH, is to get more Hispanics to compete for NIH weekly vacancy announcements. When he first arrived in 1994, the lack of coordination between personnel staff, EEO, and ICDs made hiring qualified Latinos extremely difficult. "Now, much more coordination is taking place," he said. "ICD, personnel and EEO officers are advising me of vacancy announcements targeted toward Hispanics. We get the word out nationally to qualified Hispanics. It is a slow, tedious process, but we are having some success in getting Hispanic candidates to compete on equal terms with others."

A Youth Pipeline

Many at NIH say the best bet to get more Hispanic employees, especially as scientists, is to build a pipeline for the future. They are referring to the different minority youth initiatives and internship programs that expose high school and college students to NIH career and academic opportunities and encourage pursuit of careers in health and medicine. This summer, the National Hispanic Youth Initiative and the Native American Youth Initiative gave dozens of students from around the country a chance to explore the inner workings of different research and policymaking agencies and talk with leaders in medicine. Many Hispanic students from past initiatives are now working as interns.

Levon Parker

Levon Parker, minority and special concerns program officer and director of the summer program at NINDS, says the Hispanic agenda should focus on increasing the participation of Hispanics in NIH's biomedical research program. The best opportunity for many Latinos, according to Parker, can be participating in programs such as the tenure track of the Intramural Research Program, and the Undergraduate Scholarship Program for individuals from disadvantaged backgrounds. He says the permanent jobs at NIH and in industry are going to those with a solid background in biomedicine.

"If the pool stays the same, you are never going to change the numbers," says Parker. "So unless you build a pipeline to enlarge the pool so that new candidates can come out, you will never change the picture. Where do you begin to change the pool? With the youngsters. That's going to become your feeder going into the next century. You have to let Latino and other minority students know about the opportunities. They have to know that they are welcome and that people are going to bend over backwards to work with them."

Lynn Ramirez from California, a biology major at Harvard, is doing her fourth internship at NINDS laboratories. She says her participation in the 1993 National Hispanic Youth Initiative helped her get into college and decide on a career in medicine. Her high school science teacher gave her the application to NHYI, which rescued her from the indifference of other school officials. "My counselor didn't do anything for me, he didn't care. His attitude was like, 'You are Hispanic and you are not going to get anywhere anyway.'"

Ramirez, who has worked on mad cow disease, believes NIH youth initiatives benefit minorities who would otherwise have research opportunities pass them by. She says it is crucial to have more Latinos represented in research. "Latinos doing research will have a better idea of what the needs of their communities are. Not that others won't, but they will have a different, close-up perspective of our health problems."

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