Remarks to the National Advisory Council on Migrant Health

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by HRSA Administrator Mary K. Wakefield

February 8, 2011
Washington, D.C.

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I want to thank everyone for joining us today.

This Council has been advising HRSA and the HHS Secretary for more than three decades.  We count on you to be our eyes and ears for the migrant health center program.

Secretary Sebelius and the Department recognize that migrant and seasonal farmworkers and their families face various challenges when accessing health care. The challenges range from the relatively simple to highly complex in nature – from economic needs, to language barriers to geographic challenges.  

I should make it clear that the Secretary hears you.  She charges HRSA when appropriate, or other entities to look into matters that you identify as issues of concern.

Put another way, this Department, with HRSA in the lead, is committed to providing high-quality services to migrant and seasonal farmworkers.  To do that – to reach that goal – we rely on dedicated Advisory Council members like all of you.

Your input, and of course your annual recommendations, are crucial to the process of establishing health center sites in medically underserved areas.  Without your work, we wouldn’t be nearly as effective or successful in expanding preventive and primary health care services where they are needed most.  So your contributions are valued and important to us and to our efforts.

I strongly encourage the Council to continue to share information, give us your best advice about where services are needed, and recommend the best ways for reaching the people you serve.  We recognize, as I know you do, that some recommendations are easily doable and others, of course, take longer due to the complexities of the government and the health care system.  Nonetheless, we share a commitment to these populations and the Advisory Council is a key player in the broader process we direct here at HRSA of efficiently delivering health services to people in need.

Our work now and going forward is carried out in a new environment that has changed markedly over the past couple of years, offering both breathtaking challenges and opportunities.  For example, against the backdrop of incredibly serious fiscal constraints from local to federal levels, we’ve seen two crucial pieces of legislation that reflect an unshakable commitment from this President: the 2009 Recovery Act and last year’s historic health care reform, the Affordable Care Act.

HRSA is the lead agency in implementing 50 provisions of the ACA and is co-lead on over a dozen more.

Most importantly for those of you who run health center programs, the Affordable Care Act appropriated $11 billion over five years to improve and expand the system.  And those funds followed the investment of $2 billion in Recovery Act funds to expand health centers sites and services.

The Affordable Care Act appropriations are intended to nearly double the current patient base of 19 million by 2015.

Right now, HRSA supports 8,100 health center sites across the United States.  The number of those sites will grow as we add new grantees through the ACA.  And the physical size of those sites and the range of services they provide will grow.

The $11 billion for health centers is split in two:

• $9.5 billion will be used to expand sites and services.  Of that amount, 8.6 percent – or more than $800 million – is dedicated to expand the migrant health center network.

The remaining $1.5 billion is dedicated to new construction grants, and migrant health center grantees are eligible to compete for those funds, too.  Obviously, this bodes well for the future of HRSA’s migrant health programs.  According to 2009 UDS data, HRSA supports 155 migrant health centers that serve 865,000 patients.  Once fully implemented, the Affordable Care Act will raise both of those numbers significantly.

Our support for migrant health fits tightly into HRSA’s vision and strategic plan.

HRSA’s vision as an agency is focused on Healthy Communities and Healthy People.  Our mission is:  to improve health and achieve health equity through access to quality services, a skilled health workforce and innovative programs.  It’s a tall order, but one we’re committed to through our strategic plan and associated work.

Our strategic plan has four goals.

• The first is to improve access to quality health care and services.

We’re doing this, in part, by assuring a medical home for the populations our grantees serve; by expanding oral health and behavioral health services and integrating them into primary care settings; and by strengthening the linkages between primary care and public health.

• Our second goal is to strengthen the health workforce.

We’re using our programs to train the health workforce to provide high-quality, culturally and linguistically appropriate care; to increase the number of providers to address shortages; and to develop strategies to monitor, forecast and meet long-term health workforce needs.

• Goal number three is to build healthy communities.

Here, we collaborate with others to help communities strengthen resources that improve health for populations.  Part of our efforts focus on linking people to services and supports from other sectors that contribute to good health and wellbeing, and we’re focused on strengthening illness prevention and health promotion efforts across populations and communities.   More broadly, that’s an important focus of the Affordable Care Act that’s often lost in the rhetoric around the legislation.

• Our fourth goal is to improve health equity: we want to eliminate disparities in access to quality health care across populations and communities.

To do that, we’re working to identify and advance evidence-based and promising practices to achieve health equity.  And we are partnering with diverse communities and diverse organizations to develop and disseminate innovative community-based health equity solutions, with a particular focus on populations with the greatest health disparities, such as migrant and seasonal farmworkers and their families.  This is also a very high priority for Secretary Sebelius – there’s an HHS-wide initiative to eliminate disparities, so there’s more to come on that shortly.

Specific to the populations you care about, HRSA uses various mechanisms to support the organizations that serve migrants and seasonal farmworkers.  Most visible are the migrant health technical assistance providers who have the expertise and ability to help grantees improve access and maximize quality: HRSA has continued to support these types of efforts.

HRSA has also awarded additional funds to special populations through National Cooperative Agreements.  These include agreements that provide training and technical assistance to migrant health centers, which in turn provide additional services to community-based organizations.

In addition, we continue to support inter-agency agreements that address our commitment to serve special populations.  

• For example, one IAA supported HRSA’s collaboration with the Environmental Protection Agency.  Its focus was to identify common health and environmental problems and to address respiratory and cardiovascular illness related to air pollution in patients attending our health centers.  While the agreement has concluded, a number of activities it supported remain ongoing at the community level.
• We also collaborated with the National Health, Lung and Blood Institute at NIH to establish a center to train health centers on several integral components of diabetes and cardiovascular diseases.  Again, the training and expertise provided through the agreement continues to be used and shared in the community.
• Another important inter-agency agreement is the support we receive from the Centers for Disease Control and Prevention in sponsoring the three “Stream Forums” conducted each year.
• We also partner with Federal agencies such as the Department of Labor, Department of Housing and Urban Development, and the Internal Revenue Service to promote ongoing communications when planning and serving individuals along the U.S.-Mexico border and migrant workers throughout the United States. 
• HRSA and the Department of Labor also collaborate to support the National Agricultural Workers Survey, which is the only survey presently funded by the Federal Government that has been conducted continuously and that is available to the public. 
• Currently we are working with the Administration for Children and Families to identify ways to link Migrant Heath and Migrant Head Start program activities.  HRSA also maintains an ongoing dialogue with the Substance Abuse and Mental Health Services Administration about opportunities to provide expanded mental health services through our health centers.

The activities I’ve just mentioned, and certain of our funding decisions, have been informed in part by recommendations from this group.  Among the most notable were awards made for Expanded Medical Capacity for Migrant and Homeless programs, and also the Service Expansion funds for special populations (Migrant, Homeless and Public Housing).  

These competitive funding opportunities produced terrific results.  In 2009, there were 16 awards for oral health services; 10 for behavioral health services; 8 for pharmacy-related activities and 55 for enabling services.  Approximately 100 Migrant Programs received special populations funding.

Before I close, let me mention two other valuable initiatives for migrant populations and individuals with limited English proficiency.

The Su Familia Spanish Language Telephone Helpline, a collaborative effort between HRSA and The Alliance for Hispanic Health, provides health information and referral services to Latino communities throughout the country.  The hotline is staffed by trained bilingual and bicultural health promotion specialists who provide callers with health information as well as referrals tailored to their specific needs.  Drawing from a database of over 21,000 local health providers, including our health center program, helpline specialists connect callers to health care and social services where they live.  If there’s more we can do with you to push out this service more broadly, please let us know.

And HRSA’s Text 4 Baby initiative is a free mobile information service that provides health-related text messages to pregnant women and new moms to help them care for their own health and give their babies the best possible start in life.  Subscribers receive free text messages each week, timed to their due date or baby’s date of birth. The messages are available in English and Spanish; text BABY to 511411 for messages in English or text BEBE to 511411 for messages in Spanish.  

Text 4 Baby represents the most recent illustration of HRSA’s efforts to tailor health messages to reach migrant populations.  There are others.  Last year, for instance, during the H1N1 influenza efforts, we teamed with CDC and other Federal agencies to ensure that migrant and seasonal farmworkers were accurately informed about the pandemic and had ready access to immunization.   

The projects I’ve described are one reason why I’m optimistic about what the future has in store for migrant populations and others in the new health care environment.   

Moreover, our ability to maintain and in some cases extend our reach to migrant populations through these programs underscores the value of this Council’s work and the influence of your advocacy.  These programs are the fruits of your recommendations.  They illustrate – in real and human terms – the importance of our continuing dialogue.  You are making a difference in people's lives.

Thank you again for your service, and for everything that you do to support migrant programs and populations.