In the last year, the Centers for Disease Control and Prevention (CDC) has been conducting research and analyzing statistics to shed light on the health issues that face the Hispanic community in the United States. This growing segment of the population faces some issues in particular that make providing equitable, comprehensive healthcare challenging. According to the 2012 census, Hispanics will replace whites as the majority race in the U.S. by the year 2043, if not sooner. The health of our nation is literally at issue, and there are important discoveries found in the CDC report that need to be addressed.
Leading causes of death
The two leading causes of death among Hispanics were heart disease and cancer, similar to whites. What is different is that Hispanics are much less likely to die of the top ten leading causes of death than they are of other diseases such as cirrhosis, chronic liver disease, and diabetes.
Differences in health and disease based on country of origin
“Hispanic” is the category often used as a way to make generalizations over a large group, a practice that is helpful for comparison to other large groups, but there are distinct differences in health issues among the Hispanic population based on country of origin. The CDC report found the following major differences:
- Overall, Hispanics smoke less than whites (14% as compared to 24%), but Puerto Ricans and Cubans smoke much more than other Hispanic groups (26% and 22%, respectively) and are more likely to die of cancer.
- Puerto Ricans are more likely to get screened for colorectal cancer than any other group (58% will be screened).
- Mexicans and Puerto Ricans are twice as likely to have diabetes as whites, and more likely than other Hispanic groups.
Mexicans are almost twice as likely to die from chronic liver disease and cirrhosis. Chronic liver disease and cirrhosis are most often caused by alcoholism or overconsumption of alcohol, but Hispanics have lower rates of consumption than whites. The difference here is that there exist disparities in treatment options that make Hispanics less likely to successfully complete and stick with an alcohol rehabilitation program.
According to “Ethnicity and Health Disparities in Alcohol Research” co-authored by Karen Chartier, M.S.W., Ph.D. and Raul Caetano, M.D., M.P.H., Ph.D:
“[E]xplanations for these differences are complex, likely affected by risky drinking behaviors, immigration experiences, racial/ethnic discrimination, economic and neighborhood disadvantage, and variations in alcohol-metabolizing genes.”
Additionally, even with the Affordable Care Act (ACA) in place to ensure access to healthcare for everyone, Hispanics may not have access to trauma care when they need it. The ACA allows parents to keep their children on their insurance policies until the children are age 26. Additionally, 29 states have decided to expand Medicaid coverage. These two factors combined have lowered the rates of uninsured Hispanics dramatically in the Northeast and the Midwest, but the news is not all good. In the South and the West, racial disparities in insurance coverage are pronounced, possibly due to the decision against expansion of Medicaid in 16 states and the “wait-and-see” status of the other six. Trauma is the leading cause of death for ages 15-34, but in the regions without expanded Medicaid coverage, racial disparities in trauma care are stark.
Many doctors have noted the inequality and are wading into the controversy to make their voices heard. John W. Scott, MD, MPH, a general surgery resident at Brigham and Women’s Hospital in Boston and a research fellow at the hospital’s Center for Surgery and Public Health was the lead on the report mentioned above and believes that this disparity is important to address. He notes:
“As surgeons, we like to believe that we don’t think about insurance cards, and we don’t care what the patient looks like. But there are plenty of data that suggest that insurance really matters for trauma patients. And as trauma surgeons, we should be concerned that this group — young ethnic minority trauma patients — may not benefit from efforts to improve access to care.”
Differences in quality of life
Although life expectancy is nearly the same for Hispanics and whites, some Hispanic groups have high rates of disability towards the end of their lives. This indicates that although chronic disease care has improved in general, chronic prevention care for some groups has not.
Jacqueline L. Angel, PhD at the University of Texas at Austin, and her colleagues found that Mexican Americans who reached age 65 will spend nearly one-half of their remaining years on disability or with a significant health impairment. Says Angel:
“The fact that Mexican Americans have an average life expectancy of 81.4 years indicates significant progress against the chronic diseases of aging, although longer life is not an unmixed blessing. Unfortunately we have not compressed morbidity as much as we would have liked and many older Mexican Americans need extensive care, either from their families or others. Such a burden has serious implications for Mexican-American families and for long-term care policy.”
Barriers to care
The CDC also found that some barriers to basic healthcare access exist, specifically:
- Language: Although bilingual healthcare is on the rise, Spanish-speaking people may find it difficult to locate physicians or clinics that can communicate fluently. Approximately 33% of Hispanics living in the U.S. have limited English proficiency and need a bilingual healthcare provider.
- Trust: Immigration status is a hot-button issue, and one of the unintended results is mistrust of governmental systems, of which healthcare is one part. If a family has a complicated immigration status, they may be less likely to seek preventative care, winding up in emergency rooms when a minor illness becomes a major one.
- Finances: Between 2012 and 2013, the only group to see a statistically significant decline in the number of people living in poverty in the U. S. were Hispanics, but 23.5% of this group still lives on or below the poverty line, the second highest rate in the U.S. Although the Affordable Care Act has provisions for people who are living in poverty, the previous two barriers may combine with this third barrier to restrict access to basic healthcare.
Hispanic healthcare initiatives
These challenges for quality healthcare for Hispanics are significant, and there are some groups and initiatives rising to meet them.
- The LatinaStrong Foundation: This foundation’s mission is to increase education and awareness of holistic healthcare that incorporates both the body and the mind. The LatinaStrong Foundation is part of the Pain Doctor group.
- National Alliance for Hispanic Health: This non-profit focuses on incorporating research and education into strong, tailored community medical practice.
- Healthcare for Hispanic Children: This organization’s mission is to make sure every Hispanic child receives the healthcare they deserve.
There are many more local initiatives springing up. For more information and research on Hispanics and the Affordable Care Act, visit their webpage for resources.
Image by Boris Furlan via Flickr