Latino Health Disparities: An Overview

Latino Health Disparities: An Overview

Why this presentation is important

45.5 million Hispanics (and Latinos) or 15% of the U.S. population

Only Mexico and Colombia have larger Latino populations

Largest minority in 23 states (50% live in CA & TX)


Latino specific socioeconomic, cultural, and language

barriers

result in

their limited knowledge about health conditions,

prevention & treatments, and their limited access to

available services


Studies have shown that Latinos are more likely to suffer

• misdiagnosis, inappropriate medication, and low screening participation rates

• and among other disparities, Latinos have disproportionately high rates of preventable diseases (HIV/AIDS, diabetes, heart disease) and to be hospitalized for complications caused by chronic health conditions


Many disparities in the health system exist because of

Lack of understanding about the importance of culture: values, assumptions and perceptions that are instilled early on in life and are expressed in the way we behave and act

Inadequate cultural competence: ability to work effectively with individuals from different socioeconomic, cultural and ethnic backgrounds

Complications of language barriers

Latino Demographics - Nationwide

• Latinos come from Mexico, Central America, South America & the Caribbean

• Most are Mexicans (64%), Puerto Ricans (10%), Cubans (3.5%), Salvadorans (3%), Dominicans (2.7%) …

The Americas

Beware of Generalizations!

Not all Latinos are recent immigrants: some have been in the U.S. for centuries

Differences among Latinos: from color, ethnicity, historic, geographic, language, socioeconomic class, and educational level to cuisine, reason for coming to the U.S. & acculturation differences

Salvadoran Police Officer , Albemarle Co.

Salvadoran Gangs

Beware of Generalizations!

English Proficiency

Most: South Americans & Puerto Ricans

Least: Mexicans & Central Americans

Beware of Generalizations!• Puerto Ricans: higher rates of asthma;

1 in 5 Puerto Rican children suffer from asthma vs 1 in 10 Hispanic children overall

• Diabetes and obesity are significantly highest among Mexicans, Salvadorans & other Central Americans.

• Puerto Ricican men more likely than other Hispanics to contract HIV from injection drug use; sexual contact with other men is the primary cause among Mexican men.

• New immigrants healthier than U.S.-born Hispanics: a diet high in fruits & vegetables & active lifestyle before coming to the U.S. vs a diet high in sugar and processed foods and sedentary lifestyle

Hispanic Demographics: Emphasizing Diversity

Virginia

Charlottesville/Albemarle

Immigrant Demographics - Virginia

One in 10 Virginians is foreign born

Top five countries of origin: El Salvador, Mexico, Korea, Philippines & India

Most densely populated areas: Arlington & Alexandria (20%), Harrisonburg (9%), and

Charlottesville, Richmond, Virginia Beach & Winchester (6%)

Latino Demographics - Virginia

Almost 500,000 Latinos

Over half are Mexican; the rest are largely Salvadorans, Guatemalans & Hondurans

Half are U.S. born citizens and another 13% are naturalized citizens. The rest have or do not have legal authorization to live here. 85% of Virginia’s Latino children under 18 are U.S. born.

Adult Hispanic citizens surpass Virginians overall in levels of educational attainment and household income

Latino Demographics – CvillePredominant Countries of Origin

Mexico El Salvador Honduras

Latino Demographics - Cville

5 – 6,000+ Latinos reside in the Cville-Albemarle area

Many newcomers (young, single Salvadoran men; young, single Honduran women with children; single indigenous Mexicans in Cville …)

Guatemalan Jaime Reyes at his Mexican store on Carlton

Latino Demographics – Cville Our Latino adults are mostly

* undocumented

* 20-40 years of age

* rural poor

* have low literacy levels in Spanish and speak little or no English

* have low acculturation

Typical Salvadoran town

Latino Demographics - Cville

With few exceptions, our Latino children are U.S. born and bicultural; school age children speak

Spanish at home and English elsewhere.

Southwood Trailer Park (Albemarle County) Resident

Latino Demographics – Cville

Our Latino adults have limited or no experience

with

Government offices, documents (birth certificates, licenses, etc), regulations & procedures

Bank accounts, being paid by check …

Doctors, hospitals & health insurance

Our Latino Residentsare unaccustomed to

modern conveniences, from credit/debit cards to gas or electric

ovens, home heating & air conditioning, indoor plumbing, and washing machines …

concepts of punctuality or planning ahead …

Washing Clothesin El Salvador

Health Care Disparities: Common Sources

Poverty

• Unhealthy and crowded housing: internally (lead piping and paint, mold, mildew, dust, and pest infestation) and externally (outdoor pollution, unsafe neighborhoods, limited access to green spaces and recreational facilities)

• Poor transportation

• Low educational levels and literacy rates

These conditions are worse for Latinos because of language, immigration status and cultural idiosyncrasies

Health Care Disparities: LatinosEmployment

• Overwhelmingly represented in the construction, agriculture and hospitality industries where job hazards are high

• Latino workplaces less likely to comply with health and safety laws and to provide workman’s compensation

• Unaware of rights and afraid to complain: less likely to receive treatment for job related injuries and illnesses.

Health Care Disparities: Latinos

Limited health insurance coverage

Health Care Disparities: LatinosTrauma

• separation from family in country of origin

• with war or natural disasters

• being in a country with different and often conflicting customs

• from linguistic isolation

• from anti-immigrant sentiments

= fear or embarrassment of asking or disagreeing

How Latinos frame a condition and different notions of what causes illnesses

• cultural [mis]perceptions (hot/cold)

• superstitions (mal de ojo)

• religious beliefs (deliberate act of God, fatalism)

Traditional health providers: folk healers or spiritualists

• “curanderos” who use plants & herbs, massages and spiritual rituals

• corner store or pharmacy: self-medicating

• cultural attitudes about the use of traditional vs conventional medicine

Cultural attitudes: Fear and mistrust of doctors and medical staff

• unaccustomed to interacting with them

• socioeconomic, cultural & language differences

• unease and distrust of impersonal interactions

• perceived & real anti-immigrant sentiments

• undocumented immigrant status

Cultural attitudes Traditional ideas

• importance of family

• gender roles

• taboo to think or talk about breasts, “private parts”, and sex (feeling uncomfortable about exposing the body, ignoring and denying problems because of shame)

Rosa Galvez, her mother, and husband at their Central American store off Rt 29

Health Care Disparities: LatinosInstitutional Disparities

• Underrepresentation of bilingual (Spanish speaking) and bicultural (Latino) doctors and other medical staff (5% of physicians, 3% dentists & 2% nurses)

• Few, inadequate or no language access resources (bilingual staff, trained interpreter services)

• Healthcare provider biases (racial, language differences, immigrants, undocumented immigrants)

• Lack of cultural awareness

What our Latino patients need from us

• Be respectful: establishing a relationship before the consultation; tone (not treating adult patient like a child); asking if the patient wants family members present

• Be warm and friendly: maintaining smiling and direct eye contact; minimizing physical distance and other appropriate caring gestures (touching)


Acknowledge family members: Be receptive to their suggestions and consider including them in consultations, keeping in mind potential gender role dynamics and whether they may influence the consultation.

Use trained, gender appropriate medical interpreters, ideally bicultural, while maintaining eye contact with your patient


• Ask patients what they believe caused their illness and then explain the medical reason for the illness. Recognize they may not agree with you about the cause or treatment.

• Avoid technical jargon and explain conditions, treatments and prescriptions in ways that can be understood.

• Don’t take yes as an answer. Ask open-ended questions, such as, “please describe what you are feeling,” rather than “do you have pain?” Ask patients to repeat back health information to ensure understanding.

What our Latino patients need from us• Provide written materials with

pictures and minimal verbiage

• Educate patients about diet and exercise and the importance of immunizations, screenings, and other preventative strategies

• Explain how to navigate your health care facility and why being on time for visits is important

• Advise clients of language access resources (Spanish phone message line, bilingual staff, interpreter services) to schedule appointments, find out about test results, or to leave messages.

Appendix 1: Suggested follow up

National Library of Medicine

Search terms: latino health, hispanic health

http://www.nlm.nih.gov

Pew Hispanic Center

http://pewhispanic.org/reports/report.php?ReportID=113

National Council of La Raza

http://www.nclr.org/content/policy/detail/51846/

Cultural Competence Resources for Health Care Providers/ USDHHS

http://www.hrsa.gov/culturalcompetence/

Appendix 1: Suggested follow up

CLAS - Culturally and Linguistically Appropriate Health

Care Services for Virginians. A web site designed to assist healtcare

providers in delivering culturally competent care for their limited English

proficient patients. It contains many commonly used phrases in the

clinical setting, their Spanish translations, and audio files where

listeners can practice correctly pronouncing these phrases.

http://www.vdh.virginia.gov/ohpp/clasact.asp

CDC (in Spanish)

http://www.cdc.gov/spanish/

Medline Plus (in Spanish)

http://medlineplus.gov/spanish/

Appendix 2: Linda Hemby• Political Sociologist, BA (University of Michigan), MA and two

years of doctoral coursework (University of California, Santa Cruz)

• Dual Citizenship: U.S. and Salvadoran • Bilingual (English/Spanish) – bicultural (U.S./Salvadoran)• Single parent of a Salvadoran boy• Activist in the local Latino community • Contributor to Nuevas Raíces newspaper• Albemarle Social Services Employee• Member, Executive Committee of Creciendo Juntos,

coordinator of its web site and weekly email bulletin, and its Southwood expert – www.cj-network.org

• In Latin America: directed regional anti-corruption and free press projects; author; researcher; lobbyist; university professor; and human rights/social justice activist

• In US: D.C. Office of Human Rights (Title VII agency) and social justice activist

Documents

Latino Health Disparities: An Overview