Providing a Voice for the Under-Represented Through Survey Research
The Robert Wood Johnson Foundation (RWJF) Center for Health Policy at the University of New Mexico (RWJF-CHP) is a unique collaborative project between the Robert Wood Johnson Foundation and the University of New Mexico. The goal of the RWJF-CHP is to increase the number of social scientists from Latino, American Indian and other racial and ethnic communities under-represented in these fields who engage in health policy research. Our efforts are grounded in the theory that increasing the number of scholars from under-represented communities will improve our nation’s capacity to eradicate the vast racial and ethnic health disparities that continue to plague our society. We often challenge the Doctoral Fellows in our program to use their research to provide a voice for the communities that they represent. It is this challenge that motivated our Center’s efforts to engage in a collaborative survey with impreMedia and Latino Decisions (IM-LD) focused on Latinos’ perceptions of the Patient Protection and Affordable Care Act (ACA), better known as the health reform law, and the well-being of the Latino community during these rough economic times.
One of the primary findings of the survey was that the economic recession has resulted in many Latino families losing access to health insurance. We found, for example, that 28% of Latinos have lost access to health insurance over the past two years, including 38% of Latinos making less than $40,000 annually (see Figure 1).
With the Latino unemployment rate hovering at close to 12% over the past year, it is not surprising that 38% of those who have lost access to health coverage did so as a result of job loss to themselves or their family. In addition to high unemployment, the median wealth of Hispanic households fell by 66% from 2005 to 2009; the median wealth of whites is now 18 times that of Hispanic households in the United States! Our survey indicates that rising health care costs appear to be contributing to these economic disparities. The survey shows that the majority (52%) of Latino families report that the costs of health care, including insurance, have “gone up” over the past year. This is dramatically greater than the 4% who report that their costs have “gone down.” Among those who indicated that their costs have increased, 68% stated that this rise in costs had been a “financial burden.”
The survey appears to suggest that this economic stress is driving Latinos’ attitudes toward health policy. For example, Latinos from the lowest income category (<$40,000), as well as those who currently lack health insurance, are more opposed to the individual mandate: only 25% of the uninsured in the full sample support “keeping” the individual mandate. More profoundly, a robust 52% of respondents who reported that their health care costs have increased over the past year are opposed to the individual mandate. I believe that this is a result of the perceived high costs associated with purchasing health insurance during a period of high economic stress and the lack of awareness about future financial support for mandatory purchase.
The October survey builds on a 2009 poll, also conducted in collaboration with impreMedia and Latino Decisions. Both surveys asked respondents to provide their assessment of how much policy-makers have included the “health care needs” of the Latino community when considering health care reform. In 2009, 44% of respondents responded “not too much” or “not at all” to this question. Interestingly, Latinos feel even more alienated from the process now, as 58% of Latinos chose the “not too much” or “not at all” responses in this survey. This strongly suggests that the Latino community does not perceive that they are being listened to by government officials. In line with the vision of the RWJF Center, we look at this survey as an opportunity to provide a voice to those who feel that they are not being represented. In short, we are using the findings from this survey to provide a voice for the Latino community.
The opportunity to engage in this work is incredibly rewarding but also comes with a lot of responsibility. It is vital that the surveys we conduct are well designed and appropriately analyzed so that we do not misrepresent the attitudes of the community we are researching. For example, it is critical to ensure that surveys focused on the Latino population are conducted with fully bilingual interviewers. More than 60% of Latino adults in the U.S. are foreign-born—40% of the Latino citizen population. The vast majority of Latino immigrants are Spanish-dominant, even if they have achieved English fluency as a precursor to naturalization. Therefore, many prefer to conduct political surveys in Spanish, as the technical language used to tap health care and other political attitudes can be challenging in English for native Spanish speakers. Unlike many survey firms, the methodology of Latinos Decisions offers all respondents an opportunity to conduct the survey in Spanish immediately, not at a later time when a Spanish speaking interviewer is available. When a “call-back” approach is used, or worse when surveys are only available in English, we see under-representation of Spanish speaking Latinos. This ensures that the results generated from the survey are not representative of the entire Latino population, and can often lead to misleading results. As reflected in the table below, Spanish speaking respondents in this poll were much more optimistic about the ability of the Affordable Care Act to increase access to health insurance, and improve the cost and quality of health care. Given that 47% of the full sample conducted the survey in Spanish, the ability to capture the Spanish speaking Latino population was vital to providing an accurate depiction of how the Latino community views this historic legislation.
Providing policy-makers with accurate and timely information about how Latinos view health care policy will hopefully allow them to produce policies that improve substantive representation for this large and influential constituency group. Furthermore, by engaging our Fellows in this research, we are providing the next generation of health policy scholars with the skills needed to continue to provide under-represented groups a voice in the political process.
Click here for more information about the survey’s results and methodology.