Health for One and All:
Latinos in the USA
by Paula Andaló
They arrive with suitcases full of dreams: of new economic opportunities, good schools for their children, more money, greater peace of mind. But the Latinos who come and put down roots in the United States bring more than their hopes; they bring their own lifestyles, habits, dietary customs, and genes. They bring their health and maladies. They are distinct, not only in their cultural and physical characteristics, but also in having higher rates of certain diseases, less predisposition toward others, and different attitudes about what it means to be healthy or sick.
According to the most recent population projections, as of 2002 there were 38.8 million Hispanics living in the United States, an increase of 58 percent since 1990. At 13.4 percent of the population, Hispanics are now the nation's largest minority. To put the numbers in perspective, there are now more Hispanics in the United States than there are Argentines in Argentina (38.7 million), and they outnumber the Chilean population by more than 2 to 1.
Their presence, by now firmly established, is felt across the U.S. map. But 70 percent of the Hispanic population is concentrated in (in descending order) California, Texas, New York, Florida and Illinois. Mexicans, Puerto Ricans, Cubans and Salvadorans currently top the list of first-generation immigrants.
In terms of health, how are Hispanics different from other U.S. population groups? The last census found that Latinos enjoy higher life expectancy than other groups. Latina women can expect to live 83.7 years and Latino men, 77.2 years—compared with 75.1 and 68.4 for African Americans and 80.1 and 74.7 for non-Hispanic whites.
Paradoxically, Latinos in general have less access to health care services and up-to-date treatments and medication (63 percent of working Latinos have no health insurance and 22 percent live below the poverty line).
Latinos: Remaking America, a recent book from Harvard University's David Rockefeller Center for Latin American Studies, notes that "there is a consistent bias toward assuming that because Latinos are of low socioeconomic status, their health must show adverse indicators." On the contrary, the book says, Latinos in fact "do not exhibit these adverse indicators. ... The 'unpredictability' of Latino health norms is seen most comprehensively in birth outcomes." Although Latina women have less education, lower incomes, and less health care during their first trimester than mothers from other groups, they have fewer low birth-weight babies than other groups and lower infant mortality than African Americans. This "epidemiological paradox" is reflected in other indicators as well.
La Clínica del Pueblo ("The People's Clinic") is situated in the heart of Adams Morgan, Washington, D.C.'s most heavily Latino neighborhood. Right across the street is the local parish church, whose habitually open doors lead to a large meeting room... [Read more]For René Rodríguez, chief of orthopedics at the Veterans' Hospital in Miami and president of the Interamerican College of Physicians and Surgeons, one explanation for this relatively upbeat profile is cultural.
"The sense of family is what saves Latinos," says Rodríguez. "Solid family ties are essential for preserving health. When someone of Hispanic origin gets sick, the whole family shows up worried at the clinic or hospital. This support, this solidarity, is an essential part of Latino life."
Although Latinos have been settling in the United States for more than half a century, not much was known about their specific epidemiological characteristics until the 1980s. Jane Delgado, president of the National Alliance for Hispanic Health, says that "in 1989, Hispanics became part of health surveys. Until then, we didn't know how many of us were dying or what was making us sick."
Today, indicators paint a clearer picture. Due to factors as diverse as lifestyle, behavior, nutrition, faith, family, genetics and community, U.S. Hispanics have higher rates of asthma, HIV and other sexually transmitted diseases, obesity, and obstructive lung disease than non-Hispanic whites, according to the Centers for Disease Control and Prevention (CDC). They share the two leading causes of death—heart disease and cancer—with the general population, but they differ on those immediately following. The third-leading cause of death for Latinos is accidental injury, followed by stroke, diabetes, cirrhosis of the liver and homicide. For Hispanic men under 35, traffic accidents are the leading cause of death.
Changing demographicsJuan Romagoza has been director of La Clínica del Pueblo ("The People's Clinic") in Washington, D.C.'s Adams Morgan neighborhood since its founding in 1983. He has seen important changes in the Latino community in his city. Before the 1980s, he observed a high percentage of diplomatic personnel and employees of international organizations, "with their good legal situation and good English." Afterward "the wars in Central America displaced thousands of people, uprooting them from their homes and dispersing them across this country, especially the capital. Many of them saw their first doctor in this country," says Romagoza.
Juan Romagoza, director of La Clínica del Pueblo in Washington, D.C., explains the dangers of lead in water to participants in a community health fair. (Photos ©Armando Waak/PAHO)
In 2003, Romagoza's clinic saw 8,000 Hispanic patients, 86 percent of them of Salvadoran origin. "Immigrants who arrived in the '80s didn't view health as a value—their main objective was to survive," he says. "And at the same time, they were not accepted by the health system. But little by little, the community began to organize, they began to value word of mouth—an essential tool for communicating in the Hispanic community—and today we have health fairs that draw more than 500 people."
Romagoza says that, in his experience, emotional disorders and gang violence are among the leading problems that affect the Latino community today. He says the main challenge is to get the community to think of prevention and periodic medical visits as integral parts of good health.
What does it mean to be a Latino in the United States? The answer may bevery different for a black Dominican, a white Cuban, or a Panamanian, Colombian, Argentine, Honduran or Brazilian of any color. For statistical purposes, it makes sense to group these sometimes very different populations... [Read more]"Latinos have the fatalistic view that sometimes it's better not to know. So many of them arrive at the health center after trying ineffective alternative therapies or when their illness is so advanced it is incurable," Romagoza says.
An example that is suggestive of this can be found in a 2001 report of the American Cancer Society, which shows that 54 percent of Hispanic women get regular mammograms, as opposed to nearly 60 percent of non-Hispanic whites and African Americans. Sixty percent get clinical breast exams, versus 68 percent of non-Hispanic whites and 67 percent of African Americans. Similar differences can be found in the use of early detection tests for cervical cancer and, for men, tests for colon, rectal and prostate cancer.
Another cultural element in the Latino health picture is what anthropologists term "magical thinking." This can lead to such ideas as "in our community, there is no risk"—a particularly dangerous notion in the context of sexually transmitted diseases.
Beyond translationImproving health care for Latinos is in part a matter of bridging cultures, so providers can interpret the needs of their patients in context. "We need to expand services for Hispanics taking into account language and cultural issues," says California congresswoman Hilda Solís. "We also need more research on older Hispanics in this country."
The most recent report of the National Alliance for Hispanic Health, Genes, Culture and Medicines: Bridging Gaps in Treatment for Hispanic Americans, points out major disparities in Hispanics' access to treatment. For example, 55 percent of Hispanic patients who arrive in emergency rooms with broken bones (most of them elderly) receive no pain medication, versus 26 percent of non-Hispanic whites. Similar differences are seen in access to postoperative treatment, heart disease medication, and treatment for HIV/AIDS.
The same report notes that 43 percent of Hispanics say they have had at least some problems communicating with doctors, compared with 33 percent of African Americans and 16 percent of non-Hispanic whites. This can have serious implications for diagnosis and treatment. Part of the problem was highlighted by the Sullivan Commission on Diversity in the Healthcare Workforce, assembled by the Duke University School of Medicine and the W. K. Kellogg Foundation to examine minority participation in the U.S. health care professions. According to the commission, only 6 percent of practicing physicians are of Latin origin, although Hispanics represent 13 percent of the U.S. population.
Jóxel García, deputy director of the Pan American Health Organization (PAHO), points to other cultural problems. "Many Latinos, not just undocumented ones, don't go to doctors because they're afraid of the questions asked as part of their clinical history. So they use the emergency room when they get seriously ill, instead of having regular health care providers. For this reason, doctors need to have cultural sensitivity that will help them deal with all this diversity, because we come in all colors, from many countries. We are first, second and third generation immigrants, and all these things define our health."
Paula Andaló is a journalist in the Public Information Area of the Pan American Health Organization in Washington,D.C.