Latino Health Disparities: An Overview

1. Latino Health Disparities: An Overview

2. 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)

3. Latino specific socioeconomic, cultural, and language barriers result in their limited knowledge about health conditions, prevention & treatments, and their limited access to available services Why this presentation is important

4. Why this presentation is important 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) andto be hospitalized for complications caused by chronic health conditions

5. Why this presentation is important 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

6. 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

7. 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 Gangs Salvadoran Police Officer , Albemarle Co.

8. Beware of Generalizations! English Proficiency Most: South Americans & Puerto Ricans Least: Mexicans & Central Americans

9. 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

10. Hispanic Demographics: Emphasizing DiversityVirginiaCharlottesville/Albemarle

11. 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%)

12. 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

13. Latino Demographics – CvillePredominant Countries of Origin Mexico El Salvador Honduras

14. 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

15. 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

16. 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

17. Latino Demographics – CvilleOur 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

18. 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 Clothes in El Salvador

19. 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

20. Health Care Disparities: Latinos Employment • 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.

21. Health Care Disparities: LatinosLimited health insurance coverage

22. Health Care Disparities: Latinos Trauma • 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

23. 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)

24. 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

25. 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

26. Cultural attitudesTraditional 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

27. Health Care Disparities: Latinos Institutional 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

28. 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)

29. What our Latino patients need from us 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

30. What our Latino patients need from us • 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.

31. 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.

32. 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/

33. 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/

34. 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