Post on 12-Jan-2016
description
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)
Why this presentation is important
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
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
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
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)
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
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.
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