Health Disparities in the Latinx Community

By Arianna Brinkley, Soumya Gudipudi, Edly Hyppolite, and Sophia Sheldon

Playlist

In this playlist, the narrators provide insight into the health disparities that impact the Latinx community in North Carolina. Dr. George Cosmos, a retired physician in Warren County, NC, reflects on his family’s past inability to receive proper health care, and how their medical expenses were paid by dedicating a jar for extra money that his mother would put aside from time to time. Mirna Allende, a Puerto Rican native, resides in Newton Grove, NC working as a health administrator for CommWell Health. Being a devoted worker at CommWell Health since 1998, Allende touches upon how the number of clinics that catered to Latinx migrants has increased over the years to support the also increasing Latinx migrant population in NC. Ana Maria Deaver, a Latina woman born in Panama, devotes her time as a Certified Nursing Assistant and interpreter at CommWell Health in Clinton, NC. Deaver shares her experiences in working in healthcare as a bilingual provider and the rewarding aspects of helping those in need. Jane “Sabra” Hammond resides in Asheville, NC, where she works as a physician assistant for CommWell Health. In her interview, Hammond touches upon the hindered relationships that she has with her migrant patients, as they avoid discussion documentation and immigration status. This relationship between Hammond and her patients is further strained as she found it difficult to effectively communicate the severity of illness and potential treatment options, and sheds light on the health consequences of these difficulties.

Essay

Introduction

Stories to Save Lives (SSL) is a research initiative by the Southern Oral History Program at UNC, dedicated to collecting oral histories from Southerners about their health and the health of their communities. SSL has conducted many interviews from people of varying ages, races and ethnicities to get their perspectives on how receiving, and in some cases providing, healthcare has been throughout their lives. Using these interviews and other external research, we have examined racial and ethnic health disparities in North Carolina with respect to the Latinx Community. Issues such as immigration, health affordability and access, language barriers and an increased likelihood for certain medical conditions are among the long list of blockades faced by this community.

Immigration and Documentation

One of the causes of healthcare disparities in the Latinx community is due to their immigration status. As of 2003, about two-thirds of the Latinx population in North Carolina were foreign-born (NC Latino Health). While some of them are citizens, others are permanent residents, visa-holders, or undocumented immigrants. This means that as a group, Latinx residents of North Carolina face challenges unique from other groups in trying to obtain health insurance or access basic healthcare.

Firstly, immigrants must prove that they are eligible for specific forms of health insurance. Due to recent paranoia over undocumented immigrants due to “fake news” and political divisions, even legal immigrants have been restricted in their ability to get health insurance. “Qualified” immigrants are eligible for most publicly funded programs, but are barred from certain programs like Medicaid. This means that for long stretches, immigrant families do not have access to health insurance that is available to citizens. The situation is worse for “unqualified” immigrants who are solely eligible for emergency Medicaid (NC Latino Health).

In order to qualify for health insurance in most states, some form of identification or documentation is needed, but people who immigrated recently do not have access to all the documentation they require. Legal permanent residents are recent immigrants who technically qualify for insurance may not get it because of their lack of credit history. For example, a 2015 article tells the story of the Ramos family, a family who recently legally immigrated to North Carolina. The Ramos family did not yet have a credit history, and thus could not prove their identities in the health care insurance application (Namkoong).

As a result of these difficulties, Latinx immigrants have access to very few healthcare providers, especially in the past. In her interview, Mirna Allende comments on how the situation has evolved for Latinx migrant workers over the years. She says that there was initially only one clinic, CommWell, that would address their needs, but overtime, more clinics were set up around the state to accommodate them (Allende 10:45-12:00). Despite this increase in options, the problem of healthcare disparities continues. Few to no clinics offer low cost services to immigrants due to their lack of healthcare, and consequently, immigrant families are more likely to only seek help in times of emergency. As a result, worse health outcomes occur for this group compared to non-Hispanics. Also, a lack of insurance means that there is little to no preventative care, such as vaccines, available to the Latinx community in North Carolina (Coffman).

The problem persists even in the case where Latinx immigrants find a physician. Sabra Jane Hammond, a physician’s assistant who worked with Latinx patients, points out that patients are also afraid to disclose their immigration status to their physician. She says that her Latinx patients do not say that they are undocumented or migrants for fear of what would happen and if they will actually receive care for their problem (Hammond 10:28-11:08). This shows that even if Latinx immigrants are able to find a provider, they must continue to tip-toe around their immigration status for fear of being turned away.

Healthcare Affordability and Access

For the Latinx community, the biggest factor affecting cost-effective and accessible healthcare is health insurance coverage. Questions like “will there be an expansion of programs in NC that can stand in place of Medicaid?”, plague many North Carolinians in the Latinx community who do not have health insurance. Another big factor is documentation, with questions like, “how does a person’s status in the United States affect their access to healthcare, what are public policy makers doing to respond, and what do healthcare providers do to accommodate their local populations?”

According to Xóchitl Castañeda and Valdemar Díaz Hinojosa, authors of Access to Healthcare for Latinos in the United States, the Latinx community has the highest uninsured rate of any racial or ethnic group in the United States. In the United States, “in 2016, 18.9% of the adult Latino population under age 65 were not covered by health insurance, as compared to 7.4% of the adult non-Latino White population” (Castañeda). For many healthcare providers the frustration associated with the complexity of the health insurance system deteriorates the level of care a patient receives.

Hammond emphasizes the frustration that she as a healthcare provider feels when having to balance being a provider while dealing with the administrative red tape of health insurance. Hammond in her interview explains:

It is deeply distressing to be practicing medicine in this country where, no matter where I am, whether it’s here where people are very poor but get sliding-scale medicine and treatment, or I am in an affluent suburban community somewhere outside the city of Asheville or outside of anywhere, I rarely have an appointment with a patient where cost does not become part of the discussion. (Hammond 34:32)

With this frustration, Hammond offers a possible solution to the lackluster healthcare system that is disproportionately affecting the Latinx community. Hammond expresses the need for a complete overhaul of the current healthcare system, and starting from scratch by instituting universal healthcare “like every other industrialized nation on Earth” (Hammond [34:32]).

Although it may not be universal healthcare, the Obama administration instituted the Affordable Care Act, decreasing the uninsured rate from 43.2% in 2010 to 24.8% in 2016 in adult Latinos. According to Michelle Doty and Sara Collins, bloggers for the Commonwealth Fund and authors of the article Millions More Latino Adults Are Insured Under the Affordable Care Act, uninsured rate among adult Latinos will continue to drop as “restrictions on the eligibility of undocumented immigrants” is loosened. Without effective policies and the revision of the current healthcare system, those in minority communities, specifically in the Latinx community, will never be able to afford comprehensive healthcare. The Affordable Care Act is just the start in creating a future where the uninsured among those in the Latinx community is 0%.

Language Barrier

One of the largest, most difficult barriers faced by the Latinx community is the language barrier. Many members of the community speak Spanish as their first language, with English as their second language. Oftentimes their English language skills are either only conversational or completely non-existent. This presents a problem in the healthcare community when there is a clear lack of communication between patient and physician. Translators are employed at some facilities, but even then, they are not as effective as having a bilingual doctor. Hammond explains that translators do not always relay the severity of the situation to the patient:

…if I feel like this is someone who only will respond to the most primal kind of motivations, then I am more likely to say things like, ‘This will kill you.’ And the translators don’t want to say that, and so I think my success rate is probably considerably lower when I’m working in translation. (Hammond 15:15-15:42)

Hammond’s thoughts here show that simply having a translator is not sufficient to effectively communicate everything that the physician needs to say. The miscommunication between both patient and physician results in a cloud of confusion, all of which could be avoided with steady employment of bilingual physicians and staff.

Ana Maria Deaver, a bilingual CNA working at CommWell Health, recounts her experience being a bilingual healthcare provider in her SSL interview. Deaver is very grateful for her abilities to provide understanding to patients as she notes:

My experience as an interpreter I think is a blessing because it’s a blessing to help people that can’t speak the language, and a lot of time we see people that really cannot understand and cannot speak, and I think that for us to have the bilingual language is a good experience, because even yourself, if you was in Mexico and you couldn’t speak Spanish, there would be somebody to speak English for you. (Deaver 25:25-25:57)

Deaver lists personal benefits to being a bilingual employee in healthcare, but they do not stop at the employees. When a patient doesn’t have to speak to their physician through another person, the physician-patient bond is renewed. The patient experience is more positive than that of a patient who speaks limited English and never talks directly to whom they have trusted their health.

While healthcare providers have adopted practices to help combat this issue, some of the initiatives have proved unhelpful. Whether it be that translators are not provided as frequently as necessary, or that the staff isn’t as bicultural as needed to relate to patients, the language barrier still remains as the primary obstacle among Latinx healthcare seekers. In a 2012 Piedmont Triad region study of self-identifying Latinx as having Limited English Proficiency, 65% reported difficulty with registering at healthcare facilities due to lack of Spanish Language services. An overwhelming 95% reported needing help reading written materials, such as physician instructions and pamphlets (Calo, William A, et al). Members of the Latinx community feel alienated and underserved when seeking healthcare services due to a seemingly insurmountable language barrier. These increasing numbers of patient dissatisfaction speak volumes to the work that needs to be done in the healthcare system of North Carolina.

Common Medical Conditions Within the Latinx Community

The Latinx population is the fastest growing ethnic group in the United States, with 60 million individuals from Latin backgrounds residing within its borders (CNN). By the headline numbers, this is the healthiest ethno-racial group in the United States. As measured by the CDC, this community experiences a 27% lower age-adjusted death rate when compared to non-Hispanic whites (CDC). Despite this positive indicator, certain medical conditions and diseases seem to affect this community at a higher rate than non-Hispanic whites. The most common of these conditions include obesity, hypertension, and diabetes which can ultimately lead to fatal diseases and untimely deaths (CDC).

Obesity is a major epidemic in the United States, as nearly 100 million people fall under the category of ‘obese’ (Trust for America’s Health). In the Latinx community, individuals are 23% more likely to suffer from obesity (CDC), and thus more predisposed to encounter the medical consequences associated with being obese. From a public health perspective, the initial focus should be combating obesity as it is a causative factor in the most significant conditions affecting the Latinx community, namely hypertension and diabetes.

Hypertension, when untreated, is another forerunner to a range of serious medical conditions, such as renal failures, heart attacks, and strokes (Mayo Clinic). As a whole, 44% of individuals within the Latinx community suffer from hypertension (American Heart Association). Interestingly, research has found that Latinos born outside of the United States have somewhat lower rates of hypertension and cancer than those born within the United States (CDC). “People do not change their genes when they move,” said CDC Director Dr. Tom Frieden, “The longer they stay [here in the United States], the greater those factors in the environment play in their health (CDC).” These findings point to cultural, behavioral, and environmental factors including diet, exercise, and exposure to pathogens which are distinct relative to a Latinx individual’s country of origin. Public health officials should identify and focus on these factors in order to address the emerging health needs of the Latinx community.

Given the disproportionately high incidence of obesity and hypertension in this community, it naturally follows that diabetes would be a concern. Research has found Latinx individuals are 50% more likely to succumb to diabetes-related causes of death than non-Hispanic whites (CDC), while also being 2.6 times more likely to be hospitalized for a diabetes-related illness (Office of Minority Health). Hammond’s experience working with predominantly Latino patients, she witnessed the toll that chronic diabetes takes on the Latinx community. She explains the severe health risks of poorly managed diabetes:

If that sugar stays outside of the cell and floats around in the bloodstream, it does harm…It does harm to the inside of your blood vessels, and that causes heart disease and the possibility of stroke and a decrease in circulation that ultimately winds up costing people sometimes their feet or their legs. It causes damage to the back of their eyes and causes blindness, and it causes kidney disease. It makes people old before their time and it leads to their untimely deaths. (Hammond 11:57-13:57)

Much like obesity is a precursor to a range of conditions including diabetes, diabetes in turn increases the risk of multiple other serious conditions. As a whole, the Latinx community is healthier, and younger, than the general population, possibly stemming from beneficial cultural dynamics. The cautionary observation, as Hammond vividly portrays, is that elevated levels of diabetes over time will rapidly erode this health advantage, particularly once these positive cultural dynamics dissipate.

According to a 2018 study, Latin adults are 70% more likely to go more than a year without seeing a physician as opposed to their non-Hispanic white counterparts (CDC). Without proper awareness and diagnosis of their current medical conditions, Latinx individuals are less able to identify and effectively treat the potential development of diseases, all the while losing precious years of their lives.

Conclusion

The Latinx community in North Carolina is significantly impacted by healthcare disparities. They are disproportionately affected by proclivity to certain health problems, language barriers, health insurance, and immigration documentation. These problems leave the Latinx community extremely vulnerable in terms of health compared to their counterparts in other racial and ethnic groups. Despite decades of these problems, very little has been done to alleviate the healthcare disparity. This disparity must not be allowed to continue and get worse. Thus, it is essential to take steps now to change current policies and healthcare systems to help the Latinx community.

References

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Calo, William A, et al. “Experiences of Latinos with Limited English Proficiency with Patient Registration Systems and Their Interactions with Clinic Front Office Staff: an Exploratory Study to Inform Community-Based Translational Research in North Carolina.” BMC Health Services Research, BioMed Central, 23 Dec. 2015,www.ncbi.nlm.nih.gov/pmc/articles/PMC4690234/

Castañeda, X., Díaz, V. (2017). “Access to Healthcare for Latinos in the United States”. (Fact Sheet) UC-Mexico Initiative, Health Working Group. https://hiaucb.files.wordpress.com/2017/04/access-to-healthcare-for-latinos-english.pdf

Coffman, Maren J et al. “Health Care Access and Utilization Among Latino Immigrants.” Hispanic Health Care International 5.2 (2007): 73–80. Web. 15 Apr. 2020.

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Namkoong, Hyun. “Latinos Face Significant Barriers to Signing Up for Health Insurance.” North Carolina Health News. N.p., 28 Jan. 2015. Web. 16 Apr. 2020.

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