Positions: Director, Center for the Advancement of Underserved Children Professor of Pediatrics and Population Health
Director, Pediatric Primary Care Research Fellowship, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin
Clinical Scholar: 1993–1995, Yale University School of Medicine
Research Project: Racial/Ethnic Disparities in the Health and Health Care of Children
Clinical Specialty: Pediatrics
No one suggests that racial/ethnic disparities do not exist in the health care system. "What causes the disparities? That's what everyone is asking," says Glenn Flores, MD.
A Robert Wood Johnson Foundation Clinical Scholar from 1993 to 1995, Flores, and researchers at Boston University School of Medicine, set out to explore ethnic disparities in a dataset of some 100,000 children drawn from the 1989–1991 National Health Interview Surveys. Instead of looking at ethnicity broadly, they sought to examine the differences among the subgroups—Puerto Rican, Cuban and Mexican—that make up the Latino community.
The results were dramatic: Mexican-American children were the poorest, the least healthy and had the least well-educated parents. And even more surprising, the differences in health status among the Latino ethnic subgroups were at least as pronounced as those between the major racial/ethnic groups.
For Flores, the lesson was clear. "Not only do we need to look at all groups," he says, "but within each group there may be interesting and important differences that we overlook because we just cluster everything into a homogeneous group."
Since his days as a Clinical Scholar, Flores has continued to tackle the disparities issue—more recently with an eye toward what can be done to eliminate them.
"Racial and ethnic disparities in health care are a combination of reduced access to care, greater risk of lacking health insurance and systems that aren't designed for diverse populations," says Flores. "Everyone is growing weary of hearing about them, so my research is on community-based interventions that work."
Toward that end, Flores developed an intervention in Boston, funded in part by the Robert Wood Johnson Foundation (RWJF), that sought to insure Latino children—21 percent of whom are uninsured compared with 7 percent of White kids.
"Our case managers, Latina women from the communities, were at supermarkets, laundromats and corner markets," Flores recalls. "We found uninsured families there, and our case managers talked about various programs, filled out applications, brought together all of the documents, submitted them with the family and provided follow-up with the agencies."
Of the 275 uninsured Latino children recruited in Boston, Flores and his team were able to reduce the percentage of uninsured children to 4 percent. "The intervention was more effective than Medicaid or SCHIP [State Children's Health Insurance Program]," says Flores. "We were able to insure 96 percent of the uninsured children compared to 57 percent with traditional methods."
The study prompted a Congressional Research Briefing, the introduction of legislation by Congresswoman Hilda Solis, and Flores receiving the 2006 Outstanding Achievement Award from the American Academy of Pediatrics (for the application of epidemiological research in child health advocacy).
In recent research, published in the February 2005 Pediatrics as a follow-up to his work during the Robert Wood Johnson Foundation Clinical Scholars program, Flores studied 2,608 children, 4 to 35 months of age, from the 2000 National Survey of Early Childhood Health.
He found that "Hispanic and African-American children were significantly less likely than whites to be in excellent or very good health, and were more likely to be uninsured (31, 18 and 9%, respectively)." Minority parents reported significantly fewer phone calls to doctor's offices and were referred less often to specialists than White parents.
In further studies supported through RWJF, Flores has documented language barriers experienced by minority groups when they seek health care.
Flores doubts that he would have been able to make a career out of addressing the needs of underserved populations—an important but under-funded issue—without RWJF's support through the Clinical Scholars program and other grants.
"The Clinical Scholars program provided me with a rigorous background in research methodology that was crucial," says Flores. "That really helped me to structure my thinking so that I could follow through in a rigorous fashion on my research ideas."