Disparities in Health Access Through the Lens of the Latino Community
By Jasmin Gutierrez
In 2021, Latinos accounted for over fifty percent of the United States’ demographic growth. Currently, Latinos comprise nearly nineteen percent of the United States population, making them the second-largest minority group [2]. The Latino population is comprised of vibrant cultures and resilient communities whose historical roots have forever shaped America. They are the backbone of America as many of them fill critical workforce gaps in labor short industries. Despite their prominent contributions to American culture, barriers to medical care have generated notable disparities in the quality of health provided. In some instances, access itself is unattainable [3]. The aforementioned barriers include language, cultural beliefs, lack of insurance, and citizenship status. These barriers coupled with the medical racism present in hospitals and medical clinics heighten the lack of cultural competence that contributes to the devaluation of Latino-identifying individuals. America’s Healthcare System must recognize the factors that disproportionately affect minority groups so that future individuals, Latino or non-Latino identifying, are not victims of the same injustices.
An overwhelming majority of Latinos in the United States are not bilingual, with Spanish being their primary language. In fact, the United States holds the title of having the second largest population of Spanish speakers with numerous senior citizens and older generations, who are more likely to be limited in English proficiency [5]. Many also rely on their children to be translators. However, in a medical setting, where terminology is complicated and emotions are heightened, a lapse in translation is inevitable. A language barrier weakens the connection between patient and physician, leading to an added layer of difficulties and a secondary level of care.
Latinos overall also share a lower level of health literacy in comparison to their White acculturated counterparts [7]. Access to resources becomes limited and support dwindles, especially for low-income Latino communities. Latina women, for instance, are less likely to attend postpartum clinical visitations compared to their White counterparts [6]. One may assume it is because of ignorance. That is not the case, however. These women lack the reproductive knowledge acculturated individuals have to seek appropriate care. The Latino physician shortage further contributes to a lack of understanding. As demographics in the United States shift, Latinos continue to be one of the most dominant ethnicities. This representation is not seen in the medical field, however, as only five percent of physicians identify as coming from Latin descent. Of that five percent, not everyone speaks Spanish.
Intimidated by the lack of knowledge, Latinos become more likely to leave a medical facility with unanswered questions and feel like they have been treated unfairly. If an individual cannot relate to the person they are entrusting their care to, or even fully understand their diagnosis, how can we expect them to participate in their own care?
Latino views towards health and wellness are deeply rooted in traditional beliefs. For instance, Latino cultures pride themselves on having a strong belief in traditional healing methods. The heavy reliance on holistic medicine and medicinal herbs is part of Curanderismo. Folk medicine is heavily used especially during the preconception, pregnancy, and postpartum periods. Common healing methods include reliance on herbal teas and curanderos (similar to spiritual healers). Latina women are also less likely to seek modern postpartum care because they rely on faith as opposed to medicine.
Ana Lopez, a 17-year-old immigrant farm laborer from Oaxaca Mexico, was admitted to the emergency room in East Valley Hospital for an emergency c-section. Her baby was diagnosed with neonatal encephalopathy, a brain disease. Ana only speaks Mixteco while her husband is only haltingly conversant in Spanish. It is until they meet with a Spanish-speaking social worker that they learn their child’s diagnosis, but do not fully understand the extent. Hugo, Ana’s husband, suggests una limpia de huevo, (for the baby to be cleaned with an egg). This request is met with dismissal from the nurses and staff, who lack the background to provide culturally competent care. Given the reactions of the nurses and doctors, it was clear neither had indigenous Mexican knowledge [1]. Western practitioners often assume favoritism towards folk medicine stems from a lack of knowledge or will. However, even basic training or exposure would have contributed to a better hospital visit and would also have physicians question their assumptions and gain a new approach to healing.
It is also important to note that favoritism towards traditional medicine also has underlying motivations. Speaking from experience, Latinos have to rely on medicinal herbs and nontraditional medicine because a doctor’s consultation is not feasible given their earnings. Hugo missed his child’s delivery because he feared he would be fired from his work. Ana worked in the fields up until her delivery date and lacked the financial means or documentation to have insurance [1]. A substantial amount of Latinos in the United States can not afford private medical insurance; over thirty-two percent of Hispanics are uninsured. Those that are insured usually have government-subsidized insurance like Medi-Cal or Covered California. Even then, a study conducted by UCLA reported that the majority of Latinos do not have a stable health care source or a recurring doctor [9]. Health insurance is not an option for everyone. Holistic medicine is the more affordable option, and therefore, the most used. This further emphasizes quality healthcare is only available to those that can afford it. This dehumanizing practice takes the lives of Latinos daily. Human lives are invaluable, and corporate interests should not be prioritized over providing care to individuals that need it most.
A significant amount of the Latino population is also undocumented. Many came to the United States chasing the American Dream in hopes of a better life. Unfortunately, their feelings are not reciprocated. The constant fear of deportation and stigma hinders an immigrant’s eligibility for health insurance. Migrant farmworkers are some of the most affected and their working conditions also place them at a higher risk. In the agricultural environment, they are exposed to toxins and pesticides that lead to greater mortality rates. Despite this, less than half receive medical care because of socioeconomic and political limitations [8].
“Lack of legal status not only renders migrants ineligible for federal Medicaid, but also makes them reluctant to approach any official-looking institution for fear of detention and deportation. As a consequence, they commonly end up at the emergency room or, when lucky, at a free clinic when seriously ill. At that point, handling their condition becomes both more difficult and more expensive because it often requires inpatient and specialty care. Firm owners who profit mightily from this source of labor assume no responsibility for these costs.” [4]
Medical professionals should learn to recognize these factors and gain a much deeper understanding of the community to produce quality improvement in healthcare. Having uncomfortable conversations and acknowledging the disparities in healthcare is a step in the right direction. Health professionals must recognize their internal bias and standardize care across all patients, regardless of ethnicity. Education is also vital to ensuring that Latinos have the knowledge to take care of themselves and their families when a doctor’s visit is not feasible. Community outreach to Latino communities and free clinics would also improve health access.
It is important to recognize the disparities in health access in the Latino community continue. State and nationwide policies including an indigenous language translator in hospitals and integration of language into the medical school curriculum (justified by the varying demographic of the United States) are just a few that can be implemented. Latinos are getting inadequate medical care at a disproportionate rate and their families are suffering the consequences. An individual, like my mother, should never be denied access to a hospital because of their ethnic background again.
References
[1] A Difficult Birth: Navigating Language & Cultural Differences (Karen Peterson-Iyer, Markkula Center For Applied Ethics, Santa Clara University)
[2] United States Census Bureau: Quick Facts (Census.gov)
[3] Health Care Access Among Hispanic Immigrants:¿Alguien Está Escuchando [Is Anybody Listening?] ( Rafael Pérez-Escamilla, NAPA Bulletin)
[4] The U.S. Health System and Immigration: An Institutional Interpretation ( Alejandro Portes, Sociological Forum
[5] The U.S. Has The Second-Largest Population Of Spanish Speakers — How To Equip Your Brand To Serve Them ( Sonia Thompson, Forbes)
[6] Familias Sanas: An Intervention Designed to Increase rates of Postpartum Visits among Latinas ( Flavio F Marsiglia, Journal of Health Care for the Poor and Underserved )
[7] Culturally Competent Care for Latino Patients (Karen Peterson-Iyer, Markkula Center For Applied Ethics, Santa Clara University)
[8] Impact of Individual-, Environmental-, and Policy-Level Factors on Health Care Utilization Among US Farmworkers (Katherine D Hoerster, American Journal of Public Health vol. 101,4)
[9] Important Health Care Issues for California Latinos: Health Insurance and Health Status (Jennifer Aguayo, UCLA Center for Health Policy Research)
Jasmin Gutierrez is a first-generation second-year student. She is a Biology major minoring in Chicana/o and Central American studies at UCLA and is a THINQ 2021–2022 clinical fellow.
Visit our website at thinq.med.ucla.edu and follow us on Facebook and Instagram @uclathinq!
