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Doctors & Diversity: Health Care for the Latino/Hispanic Population

Posted by Scott Harrah
September 24, 2013

The 2010 U.S. Census reported 50 million Latinos/Hispanics in the United States, a 43% increase from the year 2000. The Census Bureau released statistics in June 2013 saying Latinos/Hispanics are predicted to become the majority in America by 2043. Latinos/Hispanics have been some of the biggest supporters of the Affordable Care Act (ACA/Obamacare), and all U.S. and Caribbean medical students and future doctors need to understand the unique health care needs of this growing population.

In the second installment of our “Doctors and Diversity” series, the UMHS Endeavour looks at the many ways doctors and the entire medical community are already adapting to specifically serve Latino/Hispanic Americans, from knowing the difference between “Latino” and “Hispanic” to hiring bilingual physicians and learning about diseases and conditions unique to Latinos/Hispanics to a current UMHS student’s experience working with migrant workers at a Florida clinic. Finally, we look at medical schools partnering with hospitals and Latino/Hispanic community organizations to serve this important demographic.

The Terms ‘Latino’ & ‘Hispanic

Most U.S. doctors’ offices have paperwork new patients must fill out that includes demographic information regarding race/ethnicity, and it can be a sensitive topic. “Latino/Hispanic” is one of the categories, but it is important to know the difference to avoid offending patients.

In the article “Which is Politically Correct: Latino or Hispanic?” on the website About.com (http://womeninbusiness.about.com/od/businessetiquette/a/pc-hispanic.htm), Lahle Wolfe clarifies matters: “The U.S. Government often groups people of Hispanic and Latino origins together despite the words having two separate identity meanings to individuals and unique dictionary definitions. For this reason, neither term should be universally used to the exclusion of the other. Adding to the debate on which term is considered politically correct is that, depending upon who you ask, you will likely get a different definition. One of the reasons for this lack of clarity is because any word used to identify a person as part of a large group can be both subjective and a matter of choice—even when there is an actual concrete definition.”

Ms. Wolfe says one should never assume anything about origin just because someone speaks Spanish, and makes the following key points about the two terms:

  • “Polls and studies conducted on the subject of Latino vs. Hispanic conflict so substantially that it is hard to really know the personal preferences of individuals on anything other than a very broad and unreliable scale. For this reason, care should be taken to be sensitive when referring to anyone who speaks Spanish by either term.”

  • It is okay to ask a person about their origin and what country they come from, but not about their race. It is okay to ask, “Are you of Hispanic or Latin American origin?" Note that neither term describes a race. Asking about race can be illegal due to anti-discrimination laws.

Difference Between Latino & Hispanic

  • Latino refers to countries (or cultures) that were once under Roman rule. This includes Italy, France, Spain, etc. Brazilians are considered to be Latino, but are not considered to be Hispanic. In the U.S., Latino is the most commonly used term, identifying both men and women. When specifically referring to women, use Latina.

  • Hispanic describes cultures or countries that were once under Spanish rule (Mexico, Central America, Cuba, Puerto Rico, the Dominican Republic, and most South American nations in which Spanish is the primary language).

Heath Care Needs of Latinos/Hispanics

SE HABLA ESPAÑOL: Spanish-speaking doctors with understanding of Latino/Hispanic culture & religion are needed in America. Photo: Gualberto10/FreeDigitalPhotos.netIn the U.S., Latinos/Hispanics have suffered from a number of factors regarding health care. In 2007, about 20 % of Latinos/Hispanics in America were living at the federal poverty level, according to the U.S. Department Health and Human Services. For many, problems have arisen concerning the cultural and social determinants of health and a lack of health insurance; the language barrier; religion; and fears about exposing immigration status, amongst others, have hindered the community. With the ACA/Obamacare, many Latinos/Hispanics will be offered new access to health care, so it is vital to understand the illnesses and situations that affect them.

(Photo, inset right) SE HABLA ESPAÑOL: Spanish-speaking doctors with understanding of Latino/Hispanic culture & religion are needed in America. Photo: FreeDigitalPhotos.net

Most American medical associations point out the medical needs of Latinos/Hispanics. The American Medical Association says in its publication Health Disparities that “Hispanic Americans are twice as likely to die from diabetes as are non-Hispanic whites.” AMA adds that “among preschool children hospitalized for asthma, Hispanic American children are less likely than white children to be prescribed routine asthma medications.”

On the website for the Patient Centered Outcomes Research Institute, in the post “Conversations with the Latino/Hispanic Communities” from August 5, 2013, authors Romana Hasnain-Wynia, MS, PhD, and Susan Sheridan, MBA, MIM cite other health-related concerns, from higher rates of breast cancer to unhealthy environmental exposures to low health literacy.

The Patient Centered Outcomes Research Institute held two separate roundtables, one for Latina women and Latino men, in April and July 2013, respectively. Women and men talked about their concerns. The following issues were addressed:

  • Cultural sensitivity in health communications and of working cooperatively with community health workers to improve health systems.
  • Hesitation to take advantage of medical services, in part because of fears about immigration status or lack of insurance or other sources of payment.
  • The health care available for Latinos in many areas is substandard.
  • Problems of health literacy in Latino communities and the need for mental health assessments as a routine element of physician office visits.
  • Strong family ties are one of the strengths of Latinos. Couples and families tend to stay together and care for each other into old age.
  • Latinas expressed concern “about the shortage of care for elderly people, especially the frail and chronically ill, and the lack of supportive services for caregivers.”
  • They stressed “the importance of the healthcare community directly addressing Latinas because they tend to make healthcare decisions for the family.
  • Latino men raised issues about asthma related to environmental agents. Support networks are needed, including family and survivors of the disease being treated.
  • Men who came to the U.S. without their families are amongst the most vulnerable segments of Latinos in America. The group suffers from “from loneliness, depression, and often the stress of working more than one job.” Support services are needed for this group.
  • Young-adult Latinas and parents of adolescent Latinas need help making decisions about the HPV vaccine, thought to help protect young women from cervical cancer.

The U.S. Centers for Disease Control and Prevention (CDC) Office of Minority Health and Health Disparities (OMHD), as part of its Hispanic Health Program, outlines the following health concerns of Latino/Hispanic communities on its website.

  • Challenges remain in understanding acute and chronic health concerns associated with disparities involving their occupations, environment, economics, education, culture, language, and migration patterns/immigration status.”
  • Hispanic/Latino children are more likely than non-Hispanic white children to live in poverty and experience a disproportionate burden of infant mortality, low-birth weight, asthma, endocrine, neurological, and behavioral disorders which may be associated with exposure to hazardous substances.”
  • Hispanics/Latinos face high rates of exposure to toxic substances, including the top four threats to human health: ambient air pollution, worker exposure to chemicals, indoor air pollution and drinking water.”

A UMHS Student’s Experience with Latino/Hispanic Migrant Workers

STRONG BONDS: Research shows Latinos/Hispanics have strong family ties, from childbirth to old age. Photo: David Castillo Dominici/FreeDigitalPhotos.netUMHS medical student Jasmine Rivas speaks about personal experience with Latino/Hispanic migrant workers, an important segment of the Spanish-speaking community in the U.S. with specific medical issues.

(Photo, inset right) STRONG BONDS: Research shows Latinos/Hispanics have strong family ties, from childbirth to old age. Photo: David Castillo Dominici/FreeDigitalPhotos.net

“Having worked in a pediatric clinic in Homestead, Florida, I am aware of the needs of the migrant population from Mexico and Guatemala, among others,” Ms. Rivas says. “In order to serve this sector of the population, we need to be educated in the trials they face, as well as their cultural beliefs—and it all starts with communication. The ability to communicate with our patients is vital to our ability to serve their medical needs. Even when using a translator to overcome a language barrier, they need to feel our empathy and understanding. These are all topics covered in Dr. Garmon's Medical Ethics course, here at UMHS, St. Kitts."

The CDC’s OMHD lists three problems associated with health care for Latino/Hispanic migrant workers:

  • Agriculture is recognized as being one of the most hazardous industries in the United States ranking second only to the mining industry in yearly fatality rates.
  • Eighty-five percent of hired agricultural crop workers in the United States are foreign-born, and of that population, 90% are from Latin America.
  • Of the estimated three to five million migrant and seasonal farm workers who work in the United States each year, approximately 7% are adolescents.

The CDC has a national program in agricultural safety and health, with “each component” of the program addressing workers from immigrant/Hispanic populations, including two extramural partners in two states using promotores de salud (lay health care workers, commonplace in the Latino world, who have been specially trained, speak Spanish, and usually share the ethnicity, socioeconomic status, and life experiences of the community); and an intervention program to reduce eye injuries and illness in Latino farm workers.

Benefits of Being Bilingual & Understanding the Culture

Many Spanish-speaking patients are simply uncomfortable discussing their health with anyone but a doctor. Victor Dominguez, M.D., a family physician at the Ventura County Family Centers for Health in Santa Paula, California, tells the website California Health Report that even Latino patients who fluently speak English as a second language may prefer to discuss their health in Spanish to fully express themselves.

“I find that a lot of patients don’t feel comfortable communicating with a provider that doesn’t speak Spanish, because they don’t like to bring an interpreter into the room, and there are privacy issues associated with that,” Dr. Dominguez says. “Also it’s very important in terms of having good-quality care, so I can really get the whole history of a patient.”

Speaking Spanish is not the only thing that helps when treating Latinos. Petra Luna, comprehensive perinatal services program manger for the Ventura County Family Centers, says, “Knowing the culture, the customs, the religions and trying to be sensitive to that is so important. It makes the patients feel like people.”

Medical Schools & Community Organizations Helping the Latino/Hispanic Community

IMMIGRATION ISSUES: Some Latinos/Hispanics hesitate to take advantage of medical services because of fears about immigration status. Photo: Brandon Sigma/FreeDigitalPhotos.netOn the Association of American Medical Colleges (AAMC) website, Sarah Mann writes in a September 2011 article for the AAMC Reporter, “Medical Schools Focus on Meeting Health Care Needs of Growing Hispanic Population”, about two faculty members at the University of California, Los Angeles (UCLA), David Geffen School of Medicine, finding ways to care for Southern California’s growing Hispanic population in 2006.

(Photo, inset right above) IMMIGRATION ISSUES: Some Latinos/Hispanics hesitate to take advantage of medical services because of fears about immigration status. Photo: Brandon Sigma/FreeDigitalPhotos.net

“A sizable number of international medical graduates (IMGs) from Latin or South America were living in California, but were unable to practice medicine because they had not met U.S. licensing requirements,” Ms. Mann writes. “Instead, these doctors were working as health educators, X-ray technicians, or pharmacy staff while they settled in the United States.”

UCLA members created the IMG Program, helping foreign-trained physicians prepare for and take the  United States Medical Licensing Examination (USMLE). The goal was for these doctors to provide care to California’s Hispanic and Latino communities. The IMG Program helps medical students prepare for the USMLE by providing English courses to those who need help with proficiency. Students who pass USMLE take a clinical observership in family medicine before applying for residency.

UCLA is not the only medical school working to meet the health care needs of Latino/Hispanic patients.

Many schools focus on training to treat this population with respect and dignity. Some, like the Albert Einstein College of Medicine at Yeshiva University in Bronx, NY, also have programs to provide training. The Hispanic Center of Excellence (HCOE) was founded in 2001 at Einstein. The school has elective classes in medical Spanish, teaching students “how to communicate treatment recommendations and have other common medicine- and health-specific conversations in Spanish.” Students can practice language skills at the school’s Einstein Community Health Outreach Free Clinic.

At the University of Illinois at Chicago College of Medicine (UIC), medical students learn through the Urban Medicine (UM) program “to develop a better understanding of the issues low-income, urban communities face” Students gain “a personal perspective on the culture and experiences of underserved populations,” including Latinos/Hispanics.

The UM program works with such community organizations as Community Health, a Chicago clinic with a large percentage of Latino/Hispanic patients. Urban Medicine program students work with Community Health on health promotions and education abut type 2 diabetes, asthma, and high blood pressure, illnesses that affect the Latino/Hispanic community.

Maria Soto-Greene, M.D. is the former president of Hispanic-Serving Health Professions Schools, an association supporting efforts to improve Latino/Hispanic health at medical and public health schools. Dr. Soto-Greene tells the AAMC Reporter that it has been beneficial for medical schools to work with Latino/Hispanic organizations.

“Medical schools and public health schools that have stated within their framework that they are committed to a particular population have [had success] in galvanizing initial critical mass and attracting students who want to participate in programs that are committed to the Hispanic community,” Dr. Soto-Greene says.

Jorge Girotti, Ph.D, director of the UM program in Illinois, says focusing on language skills and clinical training within this community helps enrich all students’ interest in minority health issues.

“There are a lot of individuals who come to our medical school who are not members of minority groups, but who have a very genuine commitment to serving underserved communities,” Dr. Girotti says. “We need to nurture that interest through their years in medical school. If we rely only on members of minority groups to take care of the medical needs of minority communities, we are always going to fall short.”

Web Resources for Medical Students to Help Latinos/Hispanics

National Hispanic Medical Association

National Forum for Latino Healthcare Executives

Hispanic-Serving Health Professions Schools

 

(Top photo) AMERICA’S FASTEST GROWING POPULATION: Future doctors must learn to meet Latino/Hispanic medical needs. Photo: David Castillo Dominici/FreeDigitalPhotos.net


About UMHS:

Built in the tradition of the best US universities, the University of Medicine and Health Sciencesfocuses on individual student attention, maintaining small class sizes and recruiting high-quality faculty. We call this unique approach, “personalized medical education,” and it’s what has led to our unprecedented 96% student retention rate, and outstanding residency placements across the US and Canada.

Posted by Scott Harrah

Scott is Director of Digital Content & Alumni Communications Liaison at UMHS and editor of the UMHS Endeavour blog. When he's not writing about UMHS students, faculty, events, public health, alumni and UMHS research, he writes and edits Broadway theater reviews for a website he publishes in New York City, StageZine.com.

Topics: Medicine and Health Health Equity

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