aida l. giachello, ph

June 15, 2000 Minority Health Project, University of North Carolina, Chapel Hill

Issues and Challenges in Reducing

Health Disparities Among

Hispanics/Latinos in the U.S.

Aida L. Giachello, Ph.D.

Associate Professor and Director

Midwest Latino Health Research, training and Policy Center

University of Illinois at Chicago

1640 W. Roosevelt Rd, Suite 636

Chicago, Illinois 60608

Tel. 312 413-1953

[email protected]

Copyright © 2000, Aida Giachello

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Midwest Latino Health Reseach Center 2


Objectives of Presentation

• To share and discuss some of the social, economic and health disparities of Hispanics/Latinos in the U.S.

• To share some of the current issues and challenges in reducing health disparities

• To issues regarding cultural competency in serving this and other populations

• To provide some program, policy and research recommendations for health leaders, health care providers and institutions to reduce health disparities for the year 2000 and beyond

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WHAT ARE THE FACTS?

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Population Estimates, March,

1999

31.7 Million or 11.7% of Total U.S. Population

This population estimate does not take into account:

• 3 to 6 million undocumented workers

• 3.8 million persons in the island of Puerto Rico

• 7% to 12% estimated undercount-1990

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Spanish Speaking Countries

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Composition of the

Hispanic/Latino Population, 1999

• Mexican/Mexican American 66.2%

• Puerto Rican 9.6%

• Cubans 4.3%

• Central and South American 14.4%

• Other Hispanics 6.6%

Source: U.S. Census, “The Hispanic Population in the U.S. March,1999- February, 2000.”

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Diversity among

Hispanics/Latinos (2)

For example,

• Some are U.S. citizens, others are not

• Some are recent arrivals to the U.S. while others

have been in this country for many years and for

many generations

• Many speak only Spanish, some are bilingual in

English and Spanish, and others are

monolingual in English.

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Diversity among

Hispanics/Latinos

There is diversity by:

• National origin

• Levels of acculturation and assimilation

• Socioeconomic status

• “Push” and “pull” factors for immigration

• Health, knowledge, beliefs, and behaviors

• Health status, and

• Patterns of health services utilization.

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Dramatic Population Growth

1990-1998 Increases

1980-90 % Change

22.3 million 35%

1990-98

• Hispanics 7.7 million 34%

• Blacks 3.8 million 12%

• Asians 2.9 million 39%

• Native Americans 0.3 million 1%

• Non-Hispanics 6.9 million 4%

• Puerto Rico 3.8 million

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U.S. Hispanic Population 1990-2100

22m31m

41m51m

63m

95m

190m

0

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

120,000,000

140,000,000

160,000,000

180,000,000

200,000,000

1990 2000 2010 2020 2030 2040 2100

Series 1

Source: National Association of Hispanic Publications, United States Bureau of the Census, 1999.

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U.S. Hispanic Population 1990-2100

0%

5%

10%

15%

20%

25%

30%

35%

1990 2000 2010 2020 2030 2035 2070 2100

Source: U.S. Census Bureau Projections of the U.S. Resident Population, 1999.

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Population Projections

Of the total U.S. Population

Hispanics/Latinos will be

• 12.6% by 2005

• 18.9% by 2030

• 21.7% by 2035

• 33.0% by 2100

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POPULATION GROWTH

• Hispanics grew at six times the rate of non-Hispanic whites

• Arkansas: from 20,000 to 50, 000

• Number almost doubled in North Carolina, Georgia and Nevada

• Other geographical areas with dramatic growth:

Salt Lake City, Minneapolis, Oklahoma City and Colorado Spring

• In suburbs of big cities

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States with the Largest Number of

Latinos,1998

• California 10.1 million

• Texas 5.8 million

• New York 2.6 million

• Florida 2.2 million

• Illinois 1.2 million

• Arizona 1.0 million

• New Jersey 1.0 million

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States With The Highest

Concentration Of Latinos,1998

• New Mexico 40.3 %

• California 31.0 %

• Texas 29.7 %

• Arizona 22.1 %

• Nevada 15.9 %

• Florida 15.0 %

• Colorado 14.5 %

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Social & Economic Disparities,

1999

Total ME P.R. Cuban C&S Total

Latinos Non-L

Median Age 26.5 24.3 27.0 40.8 28.7 38.1

% with HS+ 54.7 48.6 61.1 65.2 63.3 87.7

Median Family

Income $26,178 25,347 23,646 35,616 29,960 44,321

(1997)

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Social & Economic Disparities,

1999 (2)


Latinos Non-H/W

% Unemployment 6.7 7.0 7.3 4.9 5.9 3.6

% Male in LF 78.4 80.0 66.0 73.0 81.0 74.3

% Female in LF 55.8 55.2 52.6 49.2 61.8 60.3

% of Families

Headed by

women 23.7 21.3 37.2 17.0 23.7 13.0

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Social and Economic Disparities (3)


Latinos Non-H/W

% of families below

poverty levels

headed by a women

(1998 data) 43.7 46.9 48.0 25.3 31.6 20.7

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% of persons below poverty, 1998 Social and Health Disparities (4)

Hispanics

Total 25.6%

< 18 34.4%

18-64 20.8%

65+ 21.0%

Non-Hispanic

White

8.2%

10.6%

7.3%

8.2%

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Social and Health Disparities (5)

• 3/4 were living in or near poverty

• Hispanic household report over 2 times the rate of food insufficiency and hunger

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Factors affecting poverty rates

• Low education

• Low median

earnings

• High poverty

among married

couple families

• Low participation

in the labor force

• High

unemployment

• Large family size

• High teen

pregnancy

and parenthood

• high no. of families

headed by women

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Other key facts

• % who speak Spanish: 64%-86%

• % who are Immigrants:36%-52%

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Growth of the Latino Elderly

Population

Latino elderly population has grown

61% since 1970 Latino Elderly Total Minority Elderly

1995 4% 14%

2025 18% 35%

Source: U.S. Census, CPS, 1995. Abstracted from the Henry S. Kaiser Foundation.

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Facts about Latino immigrants

• Diversity

• Low education

• Older

• Limited English

• Levels of education

and income vary by

country of origin

• Have higher fertility

• Tend to live in larger households

• Work harder and earn less income

• Least likely to have health insurance

• Low prevalence of certain illnesses but poor outcomes

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HEALTH DISPARITIES

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HISPANIC/LATINO’S

HEALTH VARY BY

• National origin

• Age

• Socio-economic status

• Gender

• Acculturation

• Place of birth

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Latinos are most Likely to die of:

• Heart diseases

• Cancer

• Injuries

• Homicide

• Cerebral Vascular Diseases

• Diabetes

• Liver diseases

• HIV/AIDS

• Pulmonary diseases

• Suicide

• Viral hepatitis

• Tuberculosis

• Drug-related deaths

• Infant mortality

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Leading Causes of Death

U.S. Latinos: 1997 Rates

0

5

10

15

20

25

30

35

40

Heart/Stroke

Cancer

Injury

Hom

icide

Diabetes

MALES

FEMALES

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Diabetes Mellitus

• Overall, 6% (1.2 million) of U.S. Hispanics have

Diabetes

• Prevalence & Mortality is twice the rate for non-

Latino whites

• Mexican Americans and Puerto Ricans

experience 110% to 120% higher rates

• Rates for Cubans are 50% to 60% higher

• 40% to 60% do not know that they have diabetes

until complications develop

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Age–adjusted prevalence of diabetes among persons

aged 18 by ethnicity and location, United States

1994–1997

0 2 4 6 8 10 12

non-Hisp whites

Puerto Rico

S/SEast

NEast/MWest

West/SWest

Percent

Source: CDC:United States, Behavioral Risk Factor Surveillance System, 1998

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Prevalence of diabetes among persons aged 18 by

age and ethnicity,

United States 1994–1997

0

5

10

15

20

25

18-44 45-64 65+ 18+ adjusted

Pe

rce

nt

Hispanics non-Hisp whites

Source: CDC:United States, Behavioral Risk Factor Surveillance System, 1998

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AIDS

N=688,200 Accumulated Cases, 1998

• Women 19.1%

• Blacks/African Americans 39.2%

• Hispanics/Latinos 18.1%

• Persons currently living with AIDS:

270,841

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Pediatric AIDS Cases, 1998

N=1,875

• Whites 23.3%

• Blacks 63%

• Hispanics 11.5%

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HIV Infection

Men Women

White 43.6% 24.0%

Black 46.9% 67.4%

Hispanics 0.7% 6.6%

Source: CDC:HIV/AIDS Surveillance Report, 1999

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Other STDs

• Primary & secondary syphilis: 5 times as likely to contract it as whites

• Gonorrhea: 3 times most likely to contract it

• Chlamydia and trichomoniasis: most prevalent among Latino youth

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Environmental Risk Factors

• Children have

elevated lead blood

levels

• Families live in

neighborhoods near

toxic waste dumps

• Workers are more

likely to be exposed to

hazardous chemicals

and conditions in their

workplace

• Violence in the street

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Latino Women’s Health

• Live longer with a life expectancy of 77.1,

compared to Latino men (69.6), but less compared

to white women (79.2)

• Despite living longer, Latino women experience

more symptoms of illnesses, chronic conditions,

disabilities, depression and their quality of life

and medical care is poorer.

• Latino women experience higher levels of physical

sexual and emotional abuse.

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Selected Maternal Characteristics,

1998


Latinos White

% Birth rate 24.3 26.4 19.0 10.0 23.2 12.1

% Fertility rate 101.1 112.1 75.5 50.1 90.2 56.7

% Mothers born in U.S. 39.9 39.7 63.8 39.7 10.1 94.9

Source: National Vital Statistics March, 2000

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Hispanic Birth Rates, 1998

12.1%

24.3%

26.4%

19.0%

10.0%

23.2%

0%

5%

10%

15%

20%

25%

30%

Non-

Hispanic

White

Total

Latino

Mexican Puerto

Rican

Cuban Central &

South

American

Birth Rates by Ethnicity

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Births to Unmarried Latino

Mothers by Place of Birth, 1998

22.5%

40.7%

48.0%

37.2%

46.3%

35.1%

61.8%

55.2%

45.8%

24.4%

47.5%

41.6%

Non-

Hispanic

White

Total

Latino

Mexican Puerto

Rican

Cuban Central &

South

American

Births to Unmarried Mothers

US Born

Foreign

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Latino Teen Births by Place of

Birth & Nationality, 1998

9.7

3.5

25.4

11.2

26.4

11.6

23.7

18.7

12.1

3.5

21.8

9.0

24.0

9.8

0

5

10

15

20

25

30

Non-Hisp.

White

Total

Latinos

Mexican Puerto

Rican

Cuban C & S

American

Other and

Unknown

Hisp.

Mothers Under 20 Years of Age (by Percent)

Mothers Born In US

Mothers Born Outside US

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Latino Mothers’ Levels of

Education by Place of Birth, 1998

87.0%

90.2%64.5%

41.4%

62.7%32.7%

64.3%63.6%

86.1%87.6%

78.4%59.5%

Non-Hispanic White

Total Latino

Mexican

Puerto Rican

Cuban

Central & South American

Mothers' Level of Education

12 years of School or More

Mothers Born Outside US

Mothers Born In US

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1st Trimester Prenatal Care

0.0%

50.0%

100.0%

1998 1989

1998 82.8% 87.9% 74.3% 72.8% 76.9% 91.8% 78.0% 73.3%

1989 75.5% 82.7% 59.5% 56.7% 62.7% 83.2% 60.8% 59.9%

All

Races

Non-

hispanic

Total

LatinoMexican

Puerto

RicanCuban

C&S

Amer.

Non-

Hispanic

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Selected Maternal Characteristics,

1998

Total ME P.R. Cuban C&S Total Latinos White

% Teen birth (U.S. born) 25.4 26.4 23.7 12.1 21.8 9.7

% Teen birth (Non US born) 11.2 11.6 18.7 3.5 9.0 3.5

% With 4+ birth (U.S. born) 11.2 11.8 11.1 4.9 5.0 8.4

% With 4+ birth (Non US born) 15.2 16.6 14.5 6.2 11.8 9.7

% Birth to unmarried mothers (US) 48.0 46.3 61.8 25.5 45.8 22.5

% Birth to unmarried mothers (N.US)37.2 35.1 55.2 24.4 41.6 10.7

% Mothers with HS+ (US) 64.5 62.7 64.3 86.1 78.4 87.0

% Mothers with HS+ (Non US) 41.4 32.7 63.6 87.6 59.5 90.2

Source: NCHS: Ventura et al, National Vital Statistics March, 2000

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High Acculturation danger to

Latino Health

• Infant mortality

• Low birth weight

babies

• Cancer rates

• High blood pressure

• Obesity

• Teen pregnancy

• Smoking

• Alcohol use

• Illicit drug use

• Less breast-

feeding

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STRATEGIES &

RECOMMENDATIONS

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1. Need for long term

institutional/structural changes

This calls for an improvement in the levels of

education and income, and better distribution of

resources and services

Hispanic health must be viewed within a

broader societal context

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For Example: Structural

conditions impacting health

• Type and location of employment within

the economic structure (i.e., services

industry)

• Environmental and occupational hazards

By not addressing the origins of the

problems we are treating the most costly

symptoms.

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2. Stronger Government & Private Sector

Commitment at all Levels

For Example:

To eliminate health disparities, in addition to the U.S. DHHS, you need to involve the Depts. of Education, housing, Commerce, Environmental Protection Agencies, etc.

• You need Strong commitment from industries, foundations, and many other key players

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3. More Funding to Public

Health Activities

It calls for greater commitment to prevention

Example:

• 70% of premature mortalities are due

primarily to environmental and behavioral

factors

• However over 90% of our resources go to

medical care

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No Leisure Physical Activity

% Adults 1988-94 NHANES III

0

5

10

15

20

25

30

35

40

45

NHWhite Hispanic NHBlack

Men

Women

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Fruit\Vegetable Consumption BRFSS 1997

0

2

4

6

8

10

12

Nwhite NHBlack Hispanic

US < 1/day

IL <1/day

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Overweight Persons, 20-74 NHANES III, 1988-94

0

10

20

30

40

50

60

NHWhite NHBlack Mex-Amer

Male

Female

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PREVALENCE OF SMOKING % Persons 18, NHIS 1997

0

5

10

15

20

25

30

35

40

45

NHWhite

s

Nblacks

Hispanics*

Asian

AmIndian

MEN

WOMEN

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Overweight Persons, 20-74 NHANES III, 1988-94

0

10

20

30

40

50

60

NHWhite NHBlack Mex-Amer

Male

Female

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4. Reduce Institutional

Racism &Sexism

“The established, customary, and respected

ways in which society operates to keep the

minority in a subordinate position”

(Bacca Zinn, 1989).

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Racism

“Any policy, practice, belief or attitude that

attributes characteristics of status to

individuals based on their race, and sexism

when it is done so according to sex.”

(Rosenberg, 1995)

It can be:

• Conscious or unconscious

• Intentional or unintentional

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Institutionalization of Racism and

Sexism:

When all institutions in society act to

maintain the subordination of people

of color by white people, or the

subordination of women by men, and

they call upon the force of history to

reinforce the system of subordination

and inequality (Rosenberg, 1995)

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Latino Experience with Being Treated Unfairly when

Seeking care due to Race or Ethnicity

• Have you? 13%

• A Family Member? 21%

• A Friend or Someone

You know? 25%

Source: Kaiser Family Foundation Survey of Race, Ethnicity & Medical Care:

Public Perceptions & Experiences, Oct.1999

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5. Increase Access to Health Care

Hispanics/Latinos are:

• Least likely to be linked to a regular source of health care

• Least Likely to have health insurance

• Experience a host of inconveniences in accessing the health care system

• Have poor health status

• Under utilize the health care system

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People Without Health

Insurance, 1998

All People Poor People

White 15.0 % 33.8 %

Non-Hispanic White 11.9 % 28.5 %

Black 22.2 % 28.8 %

Asian And Pacific 21.1 % 32.3 %

Hispanic Origin 35.3 % 44.0 %

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People Without Health Insurance,

1998(cont.)

All People Poor People

Native 14.4 % 29.0 %

Foreign Born 34.1 % 53.3 %

Naturalized Citizen 19.2 % 35.2 %

Not a citizen 49.9 % 58.6 %

Source: U.S. Bureau of the Census, 1999 (online)

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Universal Health Care

• Health care is a right and not a privilege

• Sooner or later we must have a national

solution

• Without health we cannot work, we cannot take

care of our families, and we cannot be

productive citizens

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6. Reduce the Inconveniences in

Obtaining Care

• Long waiting time when calling for a doctor’s appointment and the actual visit

• Low time in getting to the source of care

• many private physician and clinics do not have hours of services during evening or weekends

• Cultural and linguistic barriers

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7. Close monitoring & regulations

on Managed-care Networks

Concerns exist with

• Access to specialists and/or

hospitalization

• Marketing strategies

• Limited support services and follow-up

• Possible violations to patients’ rights

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8. Need for Quality of Care

Improvement

Some health care providers serving minorities are not familiarized with clinical guidelines on the management and control of chronic conditions

Example:

• Treatment of Asthma & Diabetes

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Total

Latinos

African

Americans

P Value

Education

Percent

% Observed inhaler use 77.4 77.8 77.1 NS

% Peak flow meter use 23.9 9.1 33.7 0.001

% Literature given 56.5 41.8 66.3 0.005

% Home control 63.4 46.2 74.1 0.002

% Crisis written plan 36.2 21.8 45.8 0.004

Medications

% Oral steroids 64.7 46.3 77.1 <0.0001

% Inhaled steroids 64.7 49.1 74.7 0.002

% Steroids bursts 41.0 18.0 56.0 0.002

Asthma Treatment Variations, 1996

Source: McDermott, Silva, Giachello, Al. Journal of Medical Systems. Plenum Press, New York, 1996

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9. Need for Creative Solutions and

models

Example:

• REACH 2010 Initiative

• Use of trained community lay persons or health promoters

• Community Participatory Research Models

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The Department of Health and Human

Services identified six priority areas

• Infant Mortality

• Deficits in Breast and Cervical

Cancer Screening and Management

• Cardiovascular Diseases

• Diabetes

• HIV Infections/AIDS

• Child and/or Adult Immunizations Source: CDC:Racial and Ethnic Approaches to Community Health (REACH 2010) Demonstration Projects

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REACH 2010

Demonstration Projects are

• Two-phase projects

• Communities to mobilize and organize

their resources

• Effective and sustainable programs

• To eliminate the health disparities of

racial and ethnic minorities

Source: CDC:Racial and Ethnic Approaches to Community Health (REACH 2010) Demonstration Projects

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10. Participatory Research Model

DIABETES REACH 2010 MODEL

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CHICAGO SOUTHEAST DIABETES ACTION PLANNING GROUP PARTICIPATORY RESEARCH & COMMUNITY ORGANIZING MODEL

(REACH 2010)

Process

A c t i v i t i e s

1.

Coalition

Formation

2.

Capacity Building

(Training)

3.

Data

Collection

4. Community

Organizing

5.

Action Plan

6. Implemen-

tation

Action Plan

Orientation

Expansion

Strengthening

Diabetes

Today

Research

Methods

Secondary data

analysess , ex.

- vital Statostocs

- hospital data-

Focus Groups

Telephone

Survey

Hlth providers

FGs &

Survey

Community

Assets/Inv

Community

Forums

Working

Groups

Policy

Training

Comm. Educ.

Prov. Training

Values

Goals/

Objectives

Strategies

Strengths &

Limitationes

Resources

Needed

Workplan

Evaluation

Resource

development

Community

Leaders

Ex. Focus

Groups

Others

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11. Use of Train Community Lay

Workers

Role of the Health Promoter

• Diabetes Educator

• Person that takes time to listen to participant’s concerns

• Provides individualized attention

• Provides the human care that many of the participants

seem to need

• Creates social-capital (social connectedness, rapport,

trust) among participants

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Role of Health Promoter (cont.)

• Delivers an educational program

that takes into consideration the

sociocultural, linguistic, religious,

and other environmental realities

of minorities

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Changes Hb A1c Wave I

16.5

14.7

12.4

11.8

10

11

12

13

14

15

16

17

Class #1 Class #12 6 Months after class #12 12 Months after class #12

Time of Intervention

Hb

A1

c3

Ra

ng

e

Hb A1c

Effectiveness of Health Promoter

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Relatives Perceived Change

of Participant’s Behavior

Examples:

Participant’s General Health Status,

compared with three months ago.

Percent

Better 71.1

Much Better 17.8

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% of Changes in Selected Behaviors

Reported by Relatives

Diabetes-Related Health Services Utilization

In the past three months ...

% Who had Emergency Room Visit 4.4

% Who had Hospitalization 4.4

% Who had Unscheduled Doctor's Visit 17.8

% Who had a Nutritionist/Dietician Appt 24.4

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% of Changes Reported by

Relatives (2)

% Who had a Podiatrist Appt. 24.4

% Who had a Ophthalmologist Appt. 42.2

% Who had Changed Doctors/Clinics 6.7

% Who had Blood Test (at Clinic) 55.6

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of Participant’s Behavior (2)

In the Last Three Months, How often (the Patient)

engaged in the following behavior? Was it more,

the same, less or quit?

% More % The same

Took Medication regularly 24.4 62.2

Injected prescribed Insulin 6.7 20.0

Checked and Cleans his/her

Feet Daily 57.8 15.6

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In the Last Three Months, How often Patient engaged in the following behavior? Was it more, the same, less or quit?

% More % The same % Quit Smoke Cigarettes 2.2 4.4 22.2

Obtained inf.bout

Diabetes 42.2 33.3

Engaged in regular

Alcohol drinking 0 80.0 20.0

Used Home

Remedies 31.1 28.9

Kept Appts/MD 44.4 48.9

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3 Months Post-data

In the Last Three Months, How often patient… More The same

Checked his/her Blood sugar 60.0 17.8

Discussed Diabetes Concerns 64.4 17.8

Is Involved in Grocery shopping 77.8 15.6

Reads Food Labels 77.8 8.9

Cooked with Less Oil 86.7 8.9

Used Less Salt 84.4 8.9

Eats more Vegetables and Fruits 88.9 6.7

Eats smaller Portions 82.2 8.9

Drinks Diet refreshments 71.1 15.6

Exercises 53.3 33.3

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11. Improvement of Data

Issues

• Health data systems are poorly equipped to provide information

on the health status of Hispanics groups (GAO Report, 1992)

• Insufficient Identifiers for subgroups

• Incompleteness

• Puerto Rico is excluded from data systems.

• Ethics (informed consent, community participation, etc)

• Ex: Improve section to data state holders

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11. Increase amount and quality of

Research on Latinos and other minorities

• The research on minority health

traditionally has had limited or no utility

in understanding or solving important

health and social issues.

• Most research on Latinos and on other

people of color has not been culture,

gender, age or education-appropriate

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Research (1)

• Most research on Latino health have

been done by researchers who belong to

either the middle class and/or have a

middle class mentality

• Stress a cultural deficit model that

reinforces, as a result of the findings, the

victim blaming ideology

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Research (2)

• The research process has included methods

of observation, criteria for validating facts

and theories that intentionally or

unintentionally have been designed to

justify pre-conceived ideas and stereotypes

of people of color

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Research (3)

It consequently, …has reinforced in

our society the traditional patterns

of power, status and privilege

(Hixson, 1993)

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Research (4)

Because research is done within a socio-

political and historical context,

The research agenda is one of

confronting issues of power, politics,

sexism and racism

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12. Examine the impact of recent

social and health Policies

• Welfare Reform on health status and on access to health care

• Immigration Reform

• Children’s Health Insurance Program (CHIP)

• Affirmative Action

• Child Care Legislation

• Medicaid and Medicare Managed-Care

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13. To increase Latino representation in

health professions

• Between 60% to 75% of Latinos never go to

college

• Those that do go, less than 10 will graduate

• 90% of our students are in urban public

schools which suffer from a limited tax base

• School segregation has increased for

Hispanics/Latinos

• Only 3% of all teachers in US are Hispanics

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Health Professions (2)

• To increase Latino health professionals in

proportion to their representation in the US

we will need an additional 200,000 Latino

workers

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14.

Achieve Cultural Diversity &

Competency in the health care

system

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Additional thoughts about Cultural

Competency

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cultural competence

• The capacity to work effectively with people,

using the elements of their culture such as

values and beliefs in a constructive manner.

• Involves working with 3 aspects: cognitive

(vocabulary, symbols, knowledge), affective

(values, attitudes), and process (relationships,

skills, learning styles)

• Policy/Organizational changes

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Cultural Competence Skills

• Distinguish between cultural and

environmental/contextual and social (class)

issues

• Sensitivity to diversity within and across

cultural groups (race vs. ethnicity)

• Use cultural values and beliefs in

communication and behavioral change

(affective appeals, collaboration)

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Cultural Diagnosis

• Immigration motives &

experience

• Acculturation is

multidimensional

• Language skills

• Literacy/education

• Urban/rural/suburban

• Religion/spirituality

• Family networks

• Family leadership

• Community

participation

• Experience with health

providers and systems

• Use of indigenous &

alternative healers

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A Cultural Approach 1

• Maintain respect for cultural differences.

• Obtain information on sociocultural factors in a nonjudgmental way.

• Reach a negotiated understanding of the illness and mutual agreement regarding management

• Work with cultural systems as much as possible. Recommendation should be consistent with values and norms.

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• Be sensitive to culturally-based interaction

styles, rules, and preferences.

• Involve relevant family members in

discussions on illness management.

• Use appropriate language and culturally

relevant materials.

• Use an interdisciplinary team approach to

diabetes care and education.

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Cultural Learning

• Listen and observe! Take the time.

• Learn to ask questions (open-ended).

• Visit homes and workplaces. Participate in

their lives.

• Spanish media: Watch\listen\know it.

• Immerse yourself. Visit their homelands.

• Have a mentor/consultant.

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Cultural Diversity at the Organizational

level

Steps

• Commitment from the top

administrators (board of directors,

President/CEO)

• Recruitment of Latinos in

decision-making positions

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Steps to achieve Competency in the

health care system (cont)

• Establish a Community Advisory

Committee to the Director/CEO

• Conduct a community assets and

needs assessment

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Develop & implement Comprehensive

Institutional Policies Impacting areas such as

• Board of Directors

• Personnel

• Research and Data

• Marketing

• Community outreach, Education & Partnership

• Cultural, gender and educational-appropriate Diversity Training

• Contract with Minority businesses

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Steps: Policies (cont)

• Services delivery (example, examining appointment

vs. walk-ins system, cost, accessibility of care,

interpreter Services)

• Policy on investment in Latinos and other minority

communities by providing

– Jobs, training opportunities

– scholarships to youth

– Supporting community-based organizations

– providing uncompensated emergency care to those in needs

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Conclusion

• To eliminate health disparities among Latinos will require

a comprehensive and coordinated approach working with

health and human services organizations, commitment

from different levels of government, and the private sector

• Hispanic ethnicity may be a marker for access to health

care, and for social/cultural factors that may explain

differences in risk and prevalence of illnesses.

• There is a sense of urgency to intervene now in developing

and implementing strategies that works

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Multiculturalism

• The 1990s started with an increased

interest in reducing health disparities and

and addressing issues of Multiculturalism s

in health care, These issues are about ones

of addressing issues of social

justice!

aida l. giachello, ph

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