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For U.S. Latinos, Shared Heritage Has an Impact on Health

Washington, DC, June 9, 2004 (PAHO)—Latinos living in the United States have poorer access to health care services yet enjoy longer life expectancy than other U.S. population groups. This “epidemiological paradox” —and the reasons behind it— are the focus of “Health for One and All: Latinos in the USA,” an article in the latest issue of Perspectives in Health, the magazine of the Pan American Health Organization (PAHO).

According to the most recent population projections, as of 2002 there were 38.8 million Hispanics living in the United States, representing a 58 percent increase since 1990 and making them today the nation’s largest minority.

Census data also show that Latina women have a life expectancy of 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. Yet health surveys show they have less access to health care services (63 percent of working Latinos have no health insurance) and to state-of-the-art treatment.

The reasons for this apparent paradox are complex, but René Rodríguez, chief of orthopedics at the Veterans’ Hospital in Miami and president of the Interamerican College of Physicians and Surgeons, says the explanation is partly 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. “In 1989, Hispanics became part of health surveys,” notes Jane Delgado, president of the National Alliance for Hispanic Health. “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. Latinos 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).

Latinos 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.

Juan 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. In 2003, his 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.

“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,” he says.

An indication 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.

These and other cultural differences pose a number of challenges for improving Latino health. Joxel García, deputy director of the Pan American Health Organization (PAHO), says that “even medication should be prescribed differently.” Moreover, “many Latinos, not just undocumented ones, do not go to doctors because they’re afraid of the questions they’ll be 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.”

Jane Delgado notes that the health of Latinos in the United States is shaped by many interrelated and changing influences that need to be well understood if one wants to protect the positive and reduce the negative aspects of their shared profile.

“Maybe because of the survival instinct, first-generation immigrants who arrive here are stronger in terms of health than their children born here,” Delgado says. “But the fundamental values of the immigrant, the sense of community, of family, these cannot be lost by the newer generations because these are values that also help guarantee health.”

Other articles in this issue include: “Aging in the Americas,” “Casting the AIDS Lifeline” (expanding antiretroviral treatment in the Americas), and “A Question of Human Rights” (about violations of the rights of the mentally ill).

The Pan American Health Organization, founded in 1902, works with all the countries of the Americas to improve the health and quality of life of their peoples. It also serves as the regional office of the World Health Organization.

For more information, please contact: Donna Eberwine, Public Information, (202) 974-3122, e-mail: eberwind@paho.orgwww.paho.org