Building a Workforce for Health Equity
By 2030, California is projected to face a shortage of over 4,000 primary care physicians and 600,000 home health care workers, while sustaining just two-thirds of the needed psychiatric workforce. According to the California Future Health Workforce Commission's Final Report, seven million Californians, of which a majority are Latino, African-American, and Native American, live in counties that face a dearth of primary care, dental care, and/or mental health practitioners. These shortages are compounded by the fact that though people of color will make up a majority of Californians by 2030, they are vastly underrepresented in the health workforce. For example, although Latinos make up 40% of California’s population, they compose only 7% of the state’s physician workforce.
Recognizing the immediacy of restructuring the state’s health workforce to ensure the highest attainable level of health for all Californians, Cal-IHEA has made “Building a Workforce for Health Equity” one of its priority areas. With student training programs such as our Undergraduate Health Equity Scholars, Masters Fellowship Program, and Sutter Health Doctoral Fellowships, Cal-IHEA remains as committed as ever to providing opportunities for underrepresented students to produce meaningful health equity-focused work and research. In addition, our Evidence to Action Awards and Quickstrike Consultations support UC and CSU faculty evidence consultations to develop and evaluate policies and programs aimed at improving the capacity and diversity of the state’s health workforce.
Improving Health Access for All Immigrants
An estimated 2.1 to 2.5 million Californians are undocumented and they make up 58% of the state’s currently uninsured. Undocumented Californians are an integral part of the state’s social fabric, vibrant diversity, and workforce, making up almost 10% of the labor force. Yet, undocumented Californians are not allowed to apply to Medi-Cal or receive Federal subsidies to acquire health care insurance coverage through Covered California, the state’s health insurance exchange created as part of the Affordable Care Act. Moreover, there are a number of additional barriers to care for the undocumented in CA, including financial, political, and cultural barriers. Due to the current federal actions, immigrant households, including mixed-status families with US-citizen children, face uncertainty and anxiety in their day‐to‐day lives. The recent increase in anti-immigrant policies and rhetoric has adversely affected the health of immigrant families, with several reports documenting the impacts of increased fear and toxic stress on physical and mental health. This anxiety leads to distrust of government agencies and significant confusion regarding the use of services that keep families healthy. Cal-IHEA collaborates with UC and CSU faculty and community partners with expertise in addressing the physical and mental health needs of immigrant families to provide technical assistance to policymakers and identify policy changes to improve health access for all immigrants.
California has led the nation in embracing the Affordable Care Act (ACA), with the rate of uninsured Californians dropping from 17% in 2013 to just under 7% in 2017, but recent federal challenges to the ACA have challenged enrollment. About 3 million Californians have no health insurance coverage at all, however. Of these, about 1.8 million are ineligible for coverage due to immigration status; about 725,000 are eligible are subsidized or free coverage through Covered California, the state’s health insurance marketplace or Medi-Cal, the state’s Medicaid program; and 550,000 are citizens or lawfully present immigrants who are not eligible for subsidies. Despite the high rates of health insurance coverage in the state, there are significant issues related to access and cost that have motivated discussions about how to expand coverage to all Californians while using resources more efficiently. Cal-IHEA partners with UC and CSU faculty to bring their substantial expertise to assist in advancing solutions to achieve universal coverage for the state.
Despite overall health improvements across the state, life expectancy of African Americans is 7 years less than for other Californians, stroke-related deaths remain 50% higher among African Americans, and the chronic disease burden among African Americans and Latinos is disproportionately high. Poor health and poverty are strongly linked, and in CA nearly 30% of African American and Latino children live in poverty while the household median income for African Americans and Latinos is nearly 50% lower than Whites. Insufficient and unsafe housing, limited transit, inadequate services, discrimination, displacement, and environmental degradation compound basic food, housing, and social support needs. More than health care is needed to address poor health—education, employment, housing, active and public transportation, community safety, and social support are necessary to sustain California and its diverse communities. Cross-sector research, along with effective research translation and dissemination, is essential to identify the programs and policies that advance health equity. Cal-IHEA and its affiliates support cross-sector collaborations—between government, health care, education, business, and community-based partners—that improve health for all Californians by prioritizing the needs of those most vulnerable to the conditions of poor health.