Transcript Albemarle County - Creciendo Juntos

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 Gangs
Salvadoran Police
Officer , Albemarle Co.
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 – Cville
Predominant 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
* have low literacy levels
in Spanish and speak
little or no English
* rural poor
* 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 Residents
are 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
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: 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.
Health Care Disparities: Latinos
Limited health insurance coverage
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
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: 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
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