Arizona Fights against its Future

When Arizona Governor Jan Brewer signed the "Support Our Law Enforcement and Safe Neighborhoods Act" on Friday, it brought back memories of the bruising battle that occurred in neighboring California in 1994 over Proposition 187, called at the time the "Save the State Initiative." Although the methods used to combat illegal immigration are different (The California measure relied on the denial of services in health care, public education, and social services, whereas Arizona empowers the police to arrest immigrants for violations of immigration law), the volatile environment contributing to the enactment of these two measures was quite similar, and their likely fate, i.e. being struck down on constitutional grounds, is the same.

Just as California was on the brink of becoming an "all minority" state back in 1994, so too, Arizona today is on a similar threshold.  Both states straddle the border with Mexico. At the time of Proposition 187's passage in California, that state received the bulk of illegal border crossings. That distinction has now passed to Arizona.

With far fewer blacks, fewer Asians, and more whites than the national average, Arizona possesses a growing Latino population (The state is now 4th in the nation in the percentage of Latinos to total population).  By combining its above-average Native-American population (4.9%) with its Mestizo and Latino populations (30.1%), you arrive at a total of 35% of the state's population. Add in Asians and blacks, and you're at 41.7%.

An interesting picture emerges: many among the non-Hispanic white majority (58.4% of the population) probably worried about their future in the coming "all-minority state" - a minority that will be largely Latino. Some of these people, moreover, are older transplants from other states, who chose to live out their retirement in sunny Arizona, perhaps never expecting to find so many new neighbors different from themselves.

Of course, most of the people supporting the new law would vehemently deny that there is a racial element behind its passage. In their minds, the new law is simply an attempt to combat immigration lawlessness, especially lawlessness that disproportionately impacts their state. However, human psychology suggests that the mind operates on various levels, some conscious and others less so. Information is often filtered and distorted to suit the predilections of the unconscious mind. Facts that don't accord with the bias of the believer are ignored.
 
How many anti-immigrant Arizonans, for example, have puzzled over the historical mismatch between abundant job openings in the U.S. service sector and the limited supply of legal visas to fill those openings? Or how the new  law, described as a "law enforcement tool," will help to apprehend gang and crime syndicate members when residents in affected communities fear communicating and coooperating with the police?

Are there any lessons to be drawn from the Arizona situation?  First, demographic change is a challenge to the political leadership of any state or political jurisdiction. Second, public policy can be driven in constructive or harmful ways, depending on the decisions of political leaders, many of whom in this case seem to be pandering to extreme elements, rather than following their better instincts.  

Arizona will have to live for many years to come with the consequences of this law. A Boycott Arizona movement is gaining momentum. Criminal elements will find it easier to conceal their operations, as immigrant communities circle the wagons to protect the undocumented. And business will suffer as workers flee the state. Although the wave of demographic change may be resisted for a few years, in the end, Arizona will have to deal constructively with the challenges of diversity, or face a future of economic stagnation and social strife.
                                                                                                     Nick Montalto

Proposed New Jersey budget harsh on low-income immigrants

The austerity budget announced by New Jersey Governor Chris Christie, if adopted by the legislature, will have dire consequences for many of the State's immigrants.

The entire budget of $3.7 million for the Center for Hispanic Policy, Research and Development is slated to be eliminated, jeopardizing the survival of many Latino and immigrant-serving organizations in New Jersey. Such organizations function as trusted hubs of information and services within immigrant communities and perform an important bridging function between government agencies and members of culturally and linguistically isolated communities,

Adult education has also taken a major blow. The appropriation of $10 million for support of New Jersey's network of adult high schools has also been eliminated, undoing a century-old partnership between the State and local schools districts to encourage local public schools to become centers of community learning, and closing doors of opportunity for the poorest and most disadvantaged members of the community, many of whom are first or second generation immigrants.

Finally, 12,000 legal immigrants have been dropped from New Jersey's FamilyCare program, apparently for the reason that they've been permanent residents for less than five years and - despite the downturn in the economy and severe job losses within the immigrant community -- the administration feels that they are not entitled to publicly-financed benefits, even though they meet all other criteria for participation.  The proposed budget also ends all funding for FamilyCare outreach, a program that has been instrumental in reaching socially isolated communities, including immigrants.

The pain, however, doesn't stop there. Other programs, with broader mandates but with a high profile within lower-income communities, are also being eliminated.  New Jersey After 3, for example, which provides supervised after-school activities, involving tutoring, physical exercise, and the arts, largely in low-income African-American and Latino communities, is also on the chopping block.

Surely, there must be a better way of putting New Jersey's fiscal house in order, without placing such a disproportionate burden on the most vulnerable members of society.

NJ Governor Jon Corzine Creates Commission on New Americans

Seven days before leaving office, New Jersey Governor Jon Corzine issued an executive order creating a 23-member Commission on New Americans, to be housed in the Department of the Public Advocate.  The appointment of the Commission, consisting of 17 public and 6 ex-officio members, was a key recommendation of Corzine's Blue Ribbon Panel on Immigrant Policy, which issued its final report in March of 2009. 

As described in the executive order, the primary goal of the Commission is to develop a "holistic statewide policy of immigrant integration" in order to "ensure that all state agencies provide services in an efficient and culturally and linguistically competent manner." It will also review progress in implementing the recommendations contained in the Blue Ribbon report.

The charge to the Commission is quite broad and ambitious. The Commission is viewed as "the central coordination and oversight entity for the inter-departmental collaboration regarding immigrant integration," with authority "to call upon any department, office, division, or agency of this State to supply it with any information, personnel, or other assistance available to such agency as the Commission deems necessary to discharge its duties..."

In addition, the Commission is empowered to "evaluate the structure and organization" of state, county, and local government, including independent authorities and local school districts, in an effort to determine the best method for achieving immigrant integration.

The executive order also charges the Commission to produce a "resource guide" to "targeted services" available to immigrants through a "maze of state and local resources," and to become "a repository of best practice models for effective immigrant integration at the local government level," as well as a source of "technical assistance to any municipal or government entity that requests such assistance." The order also calls on the Commission to produce an annual report to the governor.

New Jersey's budget dilemma, however, places severe constraints on the operation of the Commission and raises doubts as to the ability of the Commission to achieve its important mission. According to the executive order, staffing will be assigned to the Commission at no cost to the state, but rather through a "redirection of existing resources," either from the Office of the Governor or from the Department of the Public Advocate.

Whether those resources will materialize, however, is an open question. With 51 attorneys and a comparatively miniscule budget of roughly $17 million, the Department of the Public Advocate is not particularly well-resourced to provide staff support to the Commission.  Moreover, the Department has statutory responsibility for a wide array of concerns, including protection of  NJ homeowners from unwarranted evictions and abuses of eminent domain, investigation of  utility rate increases, mental health advocacy, advocacy for the developmentally disabled, child advocacy, and general citizen relations with state government Yet there is a logic behind housing the Commission within the Public Advocate's office, described in its enabling legislation as the "principal executive department of the state dedicated to making government more accountable and more responsive to the needs of average New Jerseyans."  

The Commission may also suffer by association with the administration of a departing Democratic governor.  In a less than auspicious note, New Jersey Republican State Chairman Jay Webber faulted Corzine's move as an attempt "to make policy into the Christie Administration" and to "expand the size of government yet again." However, the new Governor Chris Christie could reshape the Commission over time by replacing current commissioners with members more to his liking. The 17 public members have staggered terms ranging from one to three years, with the first batch of 6 ending their initial terms of service in 2011.

The decision to house the Commission within the Department of the Public Advocate's office also exposes it to cost-cutting moves targeting the Department itself.  Originally created by Democratic Governor Brendan Byrne in 1974, the Department was abolished when Christine Todd Whitman became governor in 1994, and then reinstated in 2005. Christie's opponent in the Republican primary Steve Lonegan called for the abolition of the Public Advocate's office, but Christie himself has not taken a position on the question.

New Jersey stands at an important crossroads in its effort to implement a comprehensive immigrant integration policy. The establishment of the Commission is an important first step. That effort can either be embraced by the new governor, signaling bipartisan commitment to immigrant integration and reflecting a consensus as to its connection to good governance and quality service delivery, or rejected.  Rejection could take two forms, either an outright attempt to abolish the Commission, or what is equally lethal: starving the Commission of the staff resources necessary to its proper operation.  In that scenario, New Jersey is left with the trappings of reform, but not true reform.

The failure of the New Jersey In-State Tuition Bill in the State Senate -- withdrawn yesterday by its sponsors for lack of sufficient votes to ensure passage -- calls for a review of the strategy pursued by supporters in their long campaign to permit undocumented high school graduates to attend local colleges at in-state rates. New Jersey is not alone in running into strong headwinds with such measures. Other states, such as Maryland, Colorado, and even liberal-leaning Massachusetts, have failed to enact similar legislation. In some of the ten states that have passed such legislation, efforts to repeal are a constant threat.

What went wrong?  It seems as if allies were missing in key places. Republicans, for example, appeared to be united in opposition. Although no votes were actually held on the floor of either house, there was not a single Republican who had announced support for the measure in either house, and to complicate matters, incoming Governor Christie announced his intention to veto any bill that came to his desk during his term as governor.  In the other ten states where in-state tuition bills have been passed, Republican support was often critical to passage.  Republican Senator Orrin Hatch of Utah, for example, was a strong champion of in-state tuition legislation in that conservative state, and is a co-sponsor of the Dream Act in Congress.

In Hatch's case, and with other Republican lawmakers in Utah, their support was solidified through direct contact with the young people seeking to realize their dream of higher education. An illuminating history of the passage of in-state tuition in Utah is found in a recent report issued by "Voices for Utah's Children." Although nativist voices are trying to enforce their version of ideological purity on the Republican Party, backers of in-state tuition should not abandon the effort to convince immigrant-friendly Republicans to back the measure, and they should do it "up close and personal," as was done in Utah.

Business groups in New Jersey were also missing in action. Indeed, some may have been lobbying behind the scenes against the measure, arguing the futility of providing higher education to young people ineligible to work legally in the United States. The underlying assumption behind this position is that Congress will fail to provide a future path to legalization for these young people, either through the Dream Act or the Comprehensive Immigration Reform. Whether this is wishful, wrong-headed, or hard-nosed thinking is a matter of debate.

The business case for in-state tuition is strong, however. According to the National Conference of State Legislatures, "Immigrant families tend to fall in the lower income bracket, which means that the cost of college factors heavily in their children's ability to attend. Provision of tuition at instate rates to those who meet residency and tax criteria could go a long way to allowing these students to contribute to their maximum potential." A report by Anastasia Mann for New Jersey Policy Perspective on the in-state tuition issue in New Jersey also stresses the economic argument.  Local school districts have already made a considerable investment in the education of these children through high school. Why should a wall be erected to prevent them from capitalizing on this investment? In Utah, the business community, including the Salt Lake Chamber of Commerce, has been an important ally in beating back repeated attempts over the years to repeal the Utah law. My guess is that the business community in New Jersey would find such arguments equally compelling.

Guest Blogger: Tom Sticht, International Consultant in Adult Education

At the turn of the new century, in February 2000, I wrote a report in which I expressed my optimistic thoughts that the Adult Education and Literacy System (AELS) was positioned to become a "high growth" educational system for the 21st century with the power to reach not only adults, but, through the intergenerational transfer of attitudes and knowledge, to reach children, too. I noted that many adults look for the non-formal, "functional" education that helps them achieve short-term goals of a specific nature. I argued that the extraordinary diversity of the adult population requires education that is much different from that of the K-12 or higher education systems.

Later, in September of 2000, the National Institute for Literacy (NIFL) published and distributed a report entitled From the Margins to the Mainstream: An Action Agenda for Literacy. The report called for a system of QUALITY services for adult students, ease of ACCESS to these services, and sufficient RESOURCES to support this quality and access. The report called for action to get the federal budget for the AELS up to $1 billion by 2010.

What Happened During the Decade?

Regarding QUALITY: Presumably, the more full-time professional personnel in an educational system, the better the quality of the system. Using this indicator of quality, in program year 2001-02 there were a total of 153,390 personnel in the AELS, and 21 percent were full-time. The number of students per full-time personnel was 87 to 1. By program year 2004-05, there were

144,169 personnel, but only 15 percent were full-time, and the student to full-time personnel ratio was 116 to 1.

The National Reporting System reported that an average of some 60 to 65 percent do not complete an arbitrarily defined learning level in either ABE/ASE or ESL in a given year. What this means about quality is not clear since the various states use different methods (various standardized tests, portfolio assessments) to determine learning outcomes for a given year.

During the decade the only federally funded national research center aimed at improving the quality of adult literacy education was discontinued.

Regarding ACCESS: Unfortunately, access to the AELS plunged in the first decade following the National Literacy Summit report. A large drop occurred in enrollments in the AELS from some 4 million in 1999 to fewer than 2.5 million at the end of the decade.

Regarding RESOURCES: At the end of the decade, in 2009, the funding for state grants for the AELS from the federal government was still over $400 million below the $1 billion target called for in the Action Agenda of 2000. The web page for ProLiteracy Worldwide advertises that $800 dollars educates an adult for one year.

An additional blow to resources came when funds for the federal Even Start family program was cut drastically from some $250 million in fiscal year 2002 to just over $66 million in 2008. Fortunately, the AELS field was able to ward off a move to totally drop funding for the AELS at the federal level.

The Fall From the Margins of Education

At the end of the first decade of the 21st century my optimism in 2000 has been replaced by pessimism. Instead of the unique education system that I envisioned in 2000, which would not be like the K-12 system, the field has moved more toward the provision of a "mini-K-12-college prep" education system for adults.

Perversely, as the ProLiteracy Worldwide web page indicates, federal and state funds combined provide on average only some $800 per enrollee, about one tenth of average expenditures for a K-12 child in a year, while the AELS is expected to educate adults from as low as the 2nd grade reading level up to where they can meet college entrance standards!

Ironically, at the end of the decade, it was announced that the National Institute for Literacy (NIFL), which published the Action Agenda in 2000, was to be disestablished in 2010.

Overall, it appears that instead of moving from the margins to the mainstream of education in the first decade of the 21st century, the AELS is no longer even on the margins of education. Perhaps the decade from 2010 to 2019 will be better. But who knows. Clearly, we don't always get the change we hope for!

Parsing the Massachusetts New Americans Agenda

Massachusetts has become the fifth state this decade to attempt to develop and implement a comprehensive approach to immigrant integration.

After a year of work, involving six public hearings, consultations with policy experts and state officials, and a review of available research, the Governor's Advisory Council for Refugees and Immigrants released its New Americans Agenda at a public gathering at the State House on November 17. In his remarks at the event, Governor Deval Patrick embraced the agenda as a useful framework for state action and charged his department heads to produce implementation plans and timelines within 90 days.

The New Americans Agenda contains a staggering 131 recommendations in 12 topical areas: civil rights, adult English language proficiency, economic development, education, public safety, employment and workforce development, access to state services, citizenship assistance, health, refugees, youth, and housing and community development. Some recommendations, such as the passage of an in-state tuition bill, are mirrored in other state-level reports. Others, such as the need to develop creative sources of funding for the expansion of ESOL classes or improving public transit in underserved areas to improve access to job opportunities, are unique to the Massachusetts report and may be deserving of consideration elsewhere in the country.

Although hard to summarize a report of this nature, there are a number of themes that are struck repeatedly throughout the report.

One is the need for improved and ongoing training in cultural and linguistic competence, whether for teachers, police officers, or public servants. Another is the need to recruit immigrants into the ranks of the state bureaucracy, state and local advisory bodies, and civilian employees of local police departments, so as to create strong connections with newcomer communities.

The need for language accommodations is another recurring theme. One recommendation calls for the creation of a "multilingual guide" for parents to enable them to navigate the educational system. Another for the creation of a "web-based clearinghouse of multilingual school-related documents." Another for the translation of drivers' manuals. And still another for "a multilingual resource line...to access information about state services." In a more sweeping recommendation, all state agencies are urged to provide information about basic services in multiple languages, using print, internet, or multilingual staff resources. Finally, the Agenda calls for the establishment of "a centralized state office...for interpreter and translation services" within the Massachusetts Office for Refugees and Immigrants. The office "should develop contracts with community-based organizations as well as with language service agencies to assure availability of a range of language access resources (and) encourage the use of innovative technologies for interpretation."

The question of the costs associated with implementation of the plan is mentioned at a number of points. In taking note of the "constraints of the current financial climate," the authors of report suggest that "the main energy of the recommendations is about utilizing existing funds and programs in more effective and creative ways." Yet, the authors acknowledge that new funding is needed to implement some of the key recommendation in the report, including "full funding" for the Office for Refugees and Immigrants (the meaning of full funding is not fully explained), funding for legal services for immigrants, universal pre-K programs, dual language immersion programs, individual development accounts, and funding for a number of research projects, e.g. an analysis of non-state funded ESOL programs, and a study of the scale and impact of trafficking in Massachusetts,  It would be interesting to test how much savings could be realized through a coordinated and comprehensive approach to multicultural service delivery.

As one ponders the scope and depth of these recommendations, one begins to think that this kind of sustained attention to immigrant integration, while helpful in understanding the unique circumstances and needs of newcomers to our society, also begs a larger issue, the willingness of government at all levels to move away from assembly line approaches to human services. If cultural diversity is normative in global societies, and not necessarily a transitory phenomenon linked to high levels of immigration, then public policy and the human services system in general must deal with diversity as a key element in quality assurance, an approach that will benefit not only immigrants, but other disadvantaged and underserved populations.

Obama signs long-delayed hate crime legislation

Yesterday, President Obama signed into law the Matthew Shepard and James Byrd Jr. Hate Crimes Prevention Act.  Bottled up in Congress for the last eight years and stalled under the threat of veto by President Bush, the new law extends protected status to three new bias categories:  gender identity, sexual orientation, and disability. In addition, the law grants federal officials greater authority to investigate and prosecute hate crimes on the local level and provides greater funding for state and local agencies to investigate hate crimes.

Since the inception of hate crime statutes in the sixties, there has been a tendency to increase the number of protected groups, with the addition of women, individuals with disabilities, and sexual preference as expansion options. However, as the battle in New York over the addition of sexual preference shows, these gains have not been uniform and have sparked opposition on the local level.  Indifference has also locked out people with disabilities. Despite more than 25 years of lawmaking in this area, for example, only about half the states include disabilities as a protected category, even though individuals with disabilities constitute one of nation's largest vulnerable populations.

New Jersey, however, was a pioneer in this area. As Human Rights First reported in a 2005 report, "a severely mentally retarded man was kidnapped, choked, beaten, burned with cigarettes, taped to a chair, and then abandoned in a forest in New Jersey. Eight people were subsequently tried and convicted in 2001 for the crime in one of the first prosecutions of a disability-based hate crime in the United States. Physical and mental disabilities had been added as protected classes to New Jersey's hate crime law just months before the attack."

Immigrants, it should be pointed out, are not protected as a class under most hate crime statutes, even though many benefit through their racial or ethnic minority status. The recent spike in the number of hate crimes in the United States has been fueled by anti-immigrant rhetoric in the media and the propaganda of local groups. According to a report by the Southern Poverty Law Center, which tracks the activities of extremist groups in the United States, "Virtually all the old line hate groups have turned their attention almost entirely to illegal immigration."  The lack of legal status becomes the pretext for attacking people of certain nationalities

Hate crime laws are no panacea, however, for the problem of intergroup hatred and violence. One of the most important unanswered questions is the extent to which such laws actually deter the commission of such acts.  Doubts have been raised on both the right and the left.  Writing several years ago in the neoconservative journal The Public Interest, James B. Jacobs questioned the efficacy of such legislation in addressing deep-seated social problems:

"The possibility that criminals can be threatened into not discriminating in their choice of crime victims seems slight. Whether the criminal law can be employed successfully in eradicating or reforming deep-rooted prejudices is doubtful."

Critics on the left think that the efficacy of hate crime legislation may be analogous to that of the death penalty.  If researchers can find no association between the imposition of the death penalty and reductions in violent crime in a particular jurisdiction, how can one assume that sentence enhancement for hate crimes will lead to a lower incidence of such acts and better human relations?

One of the best studies of hate crime law and practice in the United States was done by Michael Shively in a commissioned 2005 report to the National Institute of Justice. Shively noted the absence of research documenting the impact of such legislation and found evidence of significant underreporting of hate crimes, caused by conflicting definitions of what constitutes such a crime and lax enforcement on the local level.

While more than 30 countries now have some form of hate crime legislation, the passage of legislation doesn't ensure that perpetrators will be reported and prosecuted. According to Human Rights First, which tracks hate crime prevention around the world and publishes an annual report on the subject:

Even when hate crimes legislation is on the books, most countries fall short on its implementation for any but the most serious and publicly notorious crimes. In the majority of cases, criminal justice systems neither track nor effectively prosecute bias crimes, while timely, accurate, and public information on these crimes is the exception, not the rule. Public policy responses to racist, antisemitic, and other bias crimes too often reflect indifference, political expedience, or the same prejudices that generate these crimes.

A good summary of the arguments for and against hate crime legislation was given by Fred Persily, Executive Director of the California Association of Human Relations Organizations, who came down on the side of such laws, while according some legitimacy to the arguments of opponents.

Perhaps, the best case for hate crime laws was made by former Supreme Court Justice William Rehnquist, writing in 1993 ruling on the constitutionality of hate crime legislation,  "this conduct is thought to inflict greater individual and societal harm.... bias-motivated crimes are more likely to provoke retaliatory crimes, inflict distinct emotional harms on their victims, and incite community unrest."

Report calls for creation of Federal Health Equity Commission


The Advisory Committee on Minority Health, an eleven-member body created in 1999 to advise the U.S. Department of Health and Human Services (HHS) on ways to improve the health of racial and ethnic minorities in the United States, has issued a report and set of principles and recommendations to ensure that health disparities are addressed in health care reform. One of the major recommendations in the report is the creation of a "Federal Health Equity Commission," having the same "status and scope of responsibilities and authorities," in the health care field as the Federal Civil Rights Commission, established during the sixties, which focused national attention on historical and persistent inequities in American society and served as a catalyst for positive change in American life. Despite many high level reports and studies calling attention to problem of health disparities in the United States, the report notes that "the gaps in health status remain the same or are worsening with shocking consequences." Simply, expanding health coverage to the uninsured will not solve the problem. Equally important is an effective community health care planning process, involving members of local communities in the problem-solving process, and focused attention on the "social determinants" of health, including the elimination of "unhealthy behaviors and unsafe living environments." The report also recommends that state level minority health commissions, such as the Office of Minority and Multicultural Health in New Jersey, would be "answerable and accountable" to the Health Equity Commission. Finally, the report is noteworthy for the attention it pays to the special needs and circumstances of immigrants, in particular the importance of "language concordance" in the delivery of health care.

The National Conference of State Legislatures has released its half-year analysis of immigration related legislation in all 50 states.  During the first six months of 2009, more than 1400 bills have been considered around the country, surpassing the total for all of 2008. Some bills employ an “integrative approach,” whereas others are enforcement-oriented, i.e. designed to deny state-funded services to undocumented immigrants. Although New Jersey was rated as “somewhat integrative” in its approach to immigration in 2008 by the Progressive States Association, a research and advocacy organization, largely on the basis of the work of Governor Corzine’s Blue Ribbon Panel on Immigrant Policy, the State may move into the “inactive” category in 2009.

 

Out of 259 laws and resolutions enacted nationally during the six-month period, only four were passed in New Jersey, and they had slight connection to contemporary immigration issues. State resolution 85 --the most significant state action -- seeks to raise public awareness of Ellis Island’s role in American history and to promote rehabilitation and reuse of its buildings, perhaps as a conference center devoted to contemporary immigration issues.

 

NCSL noted the following examples of integrative actions taken by state legislatures during the six-month period:

 

• The State of Iowa appropriated $200,000 for a “Cultural Community Grant Program,” to create a cultural and educational center to showcase immigrant communities from Southeast Asia.

• The State of Missouri appropriated $200,000 to establish a special program to provide naturalization assistance to elderly and other immigrants unable to benefit from or attend classroom instruction in English or citizenship.

• A new law in Tennessee required the Department of Labor and Workforce Development and the Department of Education to establish and administer a grant program, called the “We Want To Learn English Initiative,” to provide resources for immigrants and refugees in Tennessee to learn English. Classes will be held where immigrants “live, work, pray, and socialize, and where their children go to school.”  The law appears designed to “lay the foundation for receiving federal funds targeted towards immigrant integration.”   

A few other noteworthy actions include the following:

 

• Louisiana created an advisory council to propose ways to eliminate obstacles to the effective delivery of governmental services to Latinos

• Minnesota extended the life of the Working Group on Ethnic Heritage and New Americans, originally created in 2007, until June of 2011.

• Texas created an advisory committee to establish and recommend qualifications for certain health care translators and interpreters.

The Progressive States Association has given its highest rating of “integrative” to seven states: California, Illinois, Maryland, Massachusetts, New Mexico, New York, and Washington.

The New Jersey Health Initiatives (NJHI) Program of  The Robert Wood Johnson Foundation has awarded over $2.5 million in grants to promote health literacy in immigrant communities in New Jersey, to be  implemented by 11 lead agencies over a three-year period beginning on July 1, 2009. Health Literacy has been defined by the foundation as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”  Low health literacy has been called the "silent and invisible threat" to the health of millions of Americans, especially prevalent among immigrants, whose lack of English skills puts them at greater risk of illness and disease.

 

In April of this year, Literacy Volunteers of New Jersey convened the first New Jersey Summit on Health Literacy, in part with financial support from New Jersey Health Initiatives and the Walmart Foundation. The summit provided an opportunity for health care professionals and literacy educators to communicate with each other and to form local collaborations.

 

Some of the projects funded by NJHI reflect the development of these local collaborations. A grant to the Bergen Community Action Partnership in Hackensack, for example, will permit the introduction of a 15-hour health literacy curriculum component into the Partnership’s current ESL program. At the same time, a nurse practitioner from Bergen Volunteer Medical Initiative will provide health counseling to program participants, while other practitioners will receive in-service training focusing on cultural differences and the impact of language on health outcomes.
 

In Elizabeth, the International Rescue Committee, a refugee resettlement organization, has partnered with the Elizabeth Port Community Health Center to provide a health orientation program for newly-arrived refugees. In Newark, the Ironbound Community Corporation is partnering with the School of Nursing at UMDNJ to conduct a series of community health fairs and literacy seminars focusing on the needs of the low literate immigrant Latino population. In Trenton, working with Capital Health System and other partners, Catholic Charities of the Diocese of Trenton will work to embed health literacy objectives and learning activities into ESL and GED classes held at its South Ward Centro de Recursos para Familia.

Other lead organizations funded by NJHI include:  Jefferson Park Ministries, the Rutgers-Camden Center for Strategic Urban Community Leadership, the North Hudson Community Action Corporation, The Zufali Health Center, AtlantiCare, Inc., the Northern NJ Maternal/Child Health Consortium, and the Gateway NW Maternal and Child Health Network.

An influential report issued issued by the California Health Literacy Initiative in 2003 made the following ten policy recommendations, some of which seem to be embodied in this year's series of NJHI grants:

1. Funding for adult education should be increased. Increased funding will help alleviate the numbers of individuals struggling with low literacy skills, and will provide more opportunities to reach low literate adults with health literacy training.

2. Plain language materials should be available to patients at every stage in the health care process, and patients who require assistance with filling out paperwork should be able to easily obtain it.

3. Innovative multimedia methods for delivering health information should be explored and developed.

4. Positions such as Peer Educators and Patient Advocates should be funded and provided for in medical reimbursement. Peer Educators and Patient Advocates can accompany patients to office visits and answer questions and explain terminology, paperwork, and procedures.

5. Doctors should use plain language and should use the "teach-back" method to ensure comprehension.

6. More research is needed on effective techniques for clear communication with all patients.

7. Medical professionals and adult literacy providers should seek collaborative relationships to address issues raised by low health literacy.

8. Research into effective training techniques for medical providers is needed. Health literacy training should be part of ongoing professional education, beginning with schools of medicine and nursing.

9. Health care systems need to be designed with the awareness that a significant percentage of patients struggle with low literacy skills. Materials such as informed consent forms and discharge instructions need to be written at a plain language level, and should be accompanied by audiotapes or videotape instructions.

10. Advocates for improved language access and advocates for greater health literacy should partner to determine how the two issues overlap and interact.