Introduction
The Hispanic/Latino population is the largest minority group in the United States, accounting for 18.1% of the total population as of July 1, 2017 (U.S. Census Bureau, 2018). A person of Hispanic/Latino origin is described as any person originating from a Spanish or Latin American country, including Mexico, Cuba, Puerto Rico, and countries in South America or Central America. Within these countries, there are myriad of cultures, languages, and ideals that are unique to each country. The subgroup with the largest population in the United States are Mexicans, who account for more than half of the Hispanic/Latino population at 62.3% ('Office of Minority Health, 2019). The majority of the group’s population is concentrated in the south and southwest regions of the United States, which California and Texas having the highest populations. A large part of this is due to the proximity of the south and southwest to Mexico and Central America. While a majority of these state populations are Mexican, Florida has a high concentration of Cubans because of its proximity to Cuba. Between 2011 and 2015, roughly 78% of the Cuban population lived in Florida (Batalova & Zong, 2017). When it comes to gender, the population is almost fifty-fifty; 50.5% of the population is male and 49.5% female. There is a variance in age groups, but a majority of the population are between the ages of 5 and 17 (see graph 1 below). The main religious affiliation of the Hispanic/Latino group is Catholicism, with more than half of the population, 55%, practicing the religion ('Chapter 1: Religious Affiliation of Hispanics', 2018).
Barriers
The number one barrier for this population is the language barrier. Less than half of Hispanic/Latinos of any race living in the US are fluent in English. Almost 75% of the population speaks a language other than English and a mere 30% speak a small amount of English, but not very well (Data Access and Dissemination Systems (DADS), 2010). With such discrepancies in the language, many people in this population group often do not seek medical treatment or seek it only when necessary. Also, with a lack of Spanish-speaking health professionals, it can be difficult to communicate with the population without the aid of interpreters. Coupled with a scarce amount of Spanish-speaking health professionals, many healthcare facilities often do not have the proper tools to promote health literacy among the population. There often aren’t any brochures or informational packets printed in Spanish, which means this group is unable to receive accurate information that they can understand. Another reason many people of this group do not seek medical treatment is because of cultural practices. Many Latinos rely on family more than a healthcare professional as their main source of obtaining medical information (Bastable, Sopczyk, Gramet, Jacobs, & Braungart, 2020, p. 375). Lack of medical insurance also plays an important role in access to health services. According to the United States Census Bureau, in 2017, Hispanics had the highest uninsured rate among all races and ethnic groups at 16.1% (Berchick, Hood, AND Barnett 2017). Without proper health insurance coverage, access to decent healthcare, or any healthcare at all, is severely limited. This group is often left to rely on public healthcare facilities such as local health departments or emergency rooms. Hispanic/Latinos also have some of the highest percentages of poverty and are two times more likely to live in poverty than other minority groups. In 2015, 21.4% of this population lived below the poverty line. These factors combined constantly put this minority group at a disadvantage. Prospects across the board are limited because of the language barrier, this lowers job prospects, which prevents access to enough income and the chance to gain private health insurance. These barriers can be difficult to overcome which leads to an overall poor lifestyle and a plethora of social and health issues.
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Major Health Disparities
A few of the top health disparities of the Hispanic/Latino community are obesity, alcoholism, diabetes, hypertension, HIV/AIDS, and cancer (Bastable, Sopczyk, Gramet, Jacobs, & Braungart, 2020, p. 373). A disproportionate amount of this population suffers from one or more of these chronic diseases. Women are more likely to suffer from obesity and hypertension than men, with 48.4% and 25.2% of women over age 20 who have these conditions, respectively ('FastStats - Health of Hispanic or Latino Population', 2017). Hispanic/Latinos also have the second highest percentage of diagnosed and undiagnosed cases of diabetes. Between 2011-2014, 16.8% of this population were afflicted by diabetes. Within the Hispanic/Latino subgroups, Mexicans had the highest percentage of adults with diabetes at 18.0%, which is tied with Black/African Americans ('FastStats - Diabetes', 2017, p. Table 40). The leading causes of mortality are cancer, cardiovascular diseases, homicide, and accidents from unintentional injuries. The number one cause of death among males and females of this population is heart disease, with 24.2% and 21.8%, respectively ('Deaths: Leading Causes for 2017', p. 9, Figure 1). Cancer was the second cause of death, also affecting males and females proportionally with 21.9% and 20.7%, respectively ('Deaths: Leading Causes for 2017', p. 9, Figure 1). While heart disease and cancer were equal causes of mortality between both sexes, men were more likely to die by accidental, unintentional injuries than women were. Many of these health disparities are caused by socioeconomic factors, environment, and chronic stressors like poverty. As mentioned earlier, this group has some of the highest rates of poverty and uninsured people. They often live in low-class neighborhoods with no access to healthy food choices, no parks or other green spaces to play and exercise, and with no quality healthcare facilities. All these factors combined contribute to overall unhealthy individuals, which cause these chronic health disparities. Many Hispanic/Latino adults end up developing these diseases by no fault of their own. They are stuck in a cycle of unhealthy eating, not enough physical exercise, and a language barrier which can make everyday tasks difficult. They are slow to receive medical treatment if available, and by the time they do decide to seek treatment, it’s often at the very last minute and can be too little too late.
Example of Research
An interesting published study that I discovered dealt with intervention strategies to promote living a healthier lifestyle and teaching healthier lifestyle choices to overweight Hispanic women to prevent cardiovascular disease. Cardiovascular disease is the number one cause of death in this population group. The article is titled A community health worker-led lifestyle behavior intervention for Latina (Hispanic) women: Feasibility and outcomes of a randomized controlled trial (Koniak-Griffin, et al., 2015) and aims to see if behavioral interventions led by promotoras, community health workers who are specially trained to work with the Hispanic/Latino community, were successful in reducing the risks of developing heart disease in overweight, immigrant women. The target group consisted of 223 women between the ages of 35-64 with low levels of income and very low levels of education, particularly less than an eighth-grade education. The women were excluded if they had a self-reported history of stroke, type 1 diabetes, limited or impaired mobility, uncontrolled hypertension, or heart attack. The women were randomized with the use of a web-based program to either the Lifestyle Intervention group or the control group. The intervention group received group and individual teaching and training, consisting of eight weekly classes based on Your Heart, Your Life (Su Corazón, Su Vida), which is an educational program that was developed by the National Heart, Lung, and Blood institute specifically for the Hispanic/Latino population. This curriculum aimed to promote healthy lifestyle behaviors, including the promotion of eating a healthy diet and engaging in physical activity. After completion of the eight weekly classes, the subjects also received eight individual teaching and education visits to reinforce what was learned in class, and to continue the promotion of healthy lifestyle changes by helping the subjects achieve personal goals and providing guidance to overcome barriers to change. The program emphasized four major goals: making healthy food choices, practicing portion control, managing emotional eating, increasing physical activity, and trying to walk 10,000 steps a day. Other topics that were emphasized were heart-healthy eating, preparing heart-healthy meals, the importance of not smoking, and education on diabetes, hypertension, and cholesterol. The control group received eight group educational classes as well, but on topics such as emergency preparedness, keeping children and the elderly safe at home, and preventing the spread of the flu. These were also followed up with the eight individual sessions that went over content learned in class in a more in-depth manner. After the group and individual sessions, the participants were offered two classes on the key information presented in Su Corazón, Su Vida. In conclusion, the study showed that through promotora-led health interventions, the lifestyle choices of overweight Latina women can be greatly improved through in-depth teaching, including learning how to prepare healthier meals and encouraging ways to promote increased physical activity. By using a community approach and culturally relevant information, the program was able to reduce the risks of these women developing cardiovascular disease and other related issues.
Programming Considerations
When developing health programs for this population, it is important to remember the cultural beliefs and practices, the specific issues that plague this population, as well as the language barrier. Culturally, this population is very family oriented, so it is important to include all present and interested family members during the teaching process. If working with a Hispanic/Latino woman, be mindful that she may not be as willing to make decisions without her husband present. This is a very male-dominated culture and they are often the final decision maker, so do not get offended or rush the process if she isn’t comfortable making decisions on the spot if she is alone. Within the Hispanic/Latino group are many subgroups, such as Mexican, Puerto Rican, and Cuban. Although there are many similarities of all Hispanic/Latinos, there are also many minute differences between each subgroup, so before developing a blanket teaching method, make sure to identify the specific needs, language dialects, and beliefs of your targeted population to make sure they are appropriate. Identifying the specific health issues of the group is very important so that the most relevant topics are discussed so that the proper lifestyle changes can be implemented. The top health disparities of this population are cardiovascular disease, cancer, and diabetes, so emphasizing healthy eating choices and promoting staying physically active should be a top education priority. The biggest consideration when working with this population is the language barrier. When implementing teaching strategies, it is vital to utilize use of an interpreter or translator to ensure information is being exchanged accurately. Also, keep learning materials simple; avoid using big words or too much medical terminology which can be misunderstood. An important method I learned from chapter 8 of Health professional as an educator: principles of teaching and learning 2nd edition is that nodding or agreeing from someone of this population does not always equate to an understanding. They use these nonverbal cues as a sign of showing respect, not because they agree and understand, so it is important to use the teach-back method to have the patient repeat the information in their own words so that an understanding can be made (Bastable, Sopczyk, Gramet, Jacobs, & Braungart, p. 377). Practicing these methods when educating this population will lead to a more effective approach in conveying the information and make the person feel more comfortable and willing to accept the information you are providing to them.
Comparison with another Ethnic Group
As a member of the Black/African American ethnic group, there are quite a few similarities between my ethnic group and the Hispanic/Latino group. Both groups share common health disparities, the main ones being cardiovascular disease, cancer, and diabetes. While the Hispanic/Latino group has the highest mortality rate from cardiovascular disease and cancer, the Black/African American group has the highest mortality rate from diabetes and hypertension. All these chronic diseases have similar causes and are due to issues that stem from SES and high poverty rates, although there are important differences to remember as well. Although both groups share similar socioeconomic conditions, the health of the Hispanic/Latino community is closer to that of White Americans than of Black/African Americans, which suggests the health of the Black/African American community may be worse than the health of the Hispanic/Latino community, even with the similar health disparities. Many members of the Hispanic/Latino community often do not seek healthcare services due to lack of insurance, cultural beliefs, and the difficulty the language barrier creates, while the Black/African American population do not seek healthcare services due to mistrust stemming from years of discrimination and unethical practices, such as the Tuskegee syphilis study. Both ethnic groups rely heavily on family support and religion or spirituality, which both are contributing factors in seeking healthcare services. The health outcomes between groups seem to be slightly better for the Hispanic/Latino community than for the Black/African American community. The average life expectancy of the Hispanic/Latino community is longer than of the Black/African American community. According to the US Census Bureau, in 2015 the average life expectancy of the Black/African American community was only 76.1 years while it was 81.9 years for the Hispanic/Latino community ('Office of Minority Health, 2015). These statistics, combined with the fact that the Hispanic/Latino group has overtaken the Black/African American group as the largest minority group, lead me to believe that the overall quality of life and access to healthcare services will become increasingly better over the years for the Hispanic/Latino group as the healthcare system will have to make adjustments to meet the specific needs of this rapidly growing population.
Summary and Conclusion
In conclusion, the Hispanic/Latino ethnic group is a large and diverse group of people consisting of many subgroups with varying language dialects and cultural practices. I chose to examine the main ethnic group instead of focusing on individual subgroups because I wanted to give a detailed overview of the most important and relevant issues and demographics of this group while highlighting the variety amongst the subgroups. This report has opened my eyes to the challenges and struggles faced by a minority group other than my own. As a future health education specialist, I will take the knowledge I’ve gained from this report to help better recognize the specific needs and challenges of this group. This information will be helpful in creating relevant programs and developing appropriate teaching methods for the promotion of healthier lifestyle choices. It has also made me more sensitive to their cultural and religious practices to avoid specific topics as to not offend them, while also making these practices make more sense to me as I have encountered them while dealing with this population at work. I look forward to working more closely with this population in my future career.
References
- US Census Bureau. (2018, January 23). About Race. Retrieved from https://www.census.gov/topics/population/race/about.html
- (2019, August 22). Office of Minority Health. Retrieved from https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64
- Batalova, J., & Zong, J. (2019, May 3). Cuban Immigrants in the United States. Retrieved from https://www.migrationpolicy.org/article/cuban-immigrants-united-states
- (2018, August 6). Chapter 1: Religious Affiliation of Hispanics. Retrieved from https://www.pewforum.org/2014/05/07/chapter-1-religious-affiliation-of-hispanics/
- [bookmark: _Hlk18849631]Bastable, S. B., Sopczyk, D., Gramet, P., Jacobs, K., & Braungart, M. M. (2020). Health professional as an educator: principles of teaching and learning (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
- Data Access and Dissemination Systems (DADS). (2010, October 5). American FactFinder - Results. Retrieved from https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk
- (2017, May). FastStats - Health of Hispanic or Latino Population. Retrieved from https://www.cdc.gov/nchs/fastats/hispanic-health.htm
- FastStats - Diabetes. Retrieved from https://www.cdc.gov/nchs/fastats/diabetes.htm
- Deaths: Leading Causes for 2017. Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_06-508
- Koniak-Griffin, D., Brecht, M.-L., Takayanagi, S., Villegas, J., Melendrez, M., & Balcázar, H. (2015). A community health worker-led lifestyle behavior intervention for Latina (Hispanic) women: Feasibility and outcomes of a randomized controlled trial. International Journal of Nursing Studies, 52(1), 75–87. DOI: 10.1016/j.ijnurstu.2014.09.005
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