leading causes of death and illness among Hispanic Americans
Introduction
While the two terms are often used interchangeably, Latino and Hispanic are not synonymus. The term Hispanic refers to spoken language and Latino refers to geography of origin. Since the majority of Latinos are also Hispanic the terms have blended and in the US the federal government uses Hispanic on all documents and forms. Because differentiation is difficult we will continue to use Hispanic/Latino in thi module of study.
About one in six people living in the US are Hispanic/Latino,which is approximately 57 million making Latino/Hispanics the largest minority in the US. Three fourths of the total Hispanic/Latino American population is: Puerto Ricans, Cubans, and Mexicans with Mexican Americans the largest group. Puerto Ricans are the second largest group of Hispanics/Latinos, and Cubans are the third largest group making up about 4% of the population of the U.S.
Puerto Rico is a US territory and it’s people are American citizens, which makes them neither natives nor immigrants. However due to high unemployment rates, poverty and the recent devestation by Hurricane Maria, Puerto Ricans come to the U. S. in hopes of finding jobs and a better life and also to join other family members who have already migrated to the U.S. The majority of those who come to the mainland live on the East Coast, mainly in New York City and New Jersey.
Mexico with its close proximity to the U. S has led to both legal and illegal immigration to the U. S. Many Mexicans come to the U. S. because of promises of employment but many of these jobs are low paying labor positions. This population is less likely to have access to healthcare and health insurance.
Cuban Americans make up about 4% of the population of the U.S. during the Cuban Revolution, many Cubans fled to the United States to escape the Fidel Castro regime. These immigrants were of lower socioeconomic class, some with criminal records, not educated, and more likely to live in poverty.
Learning objectives for the module:
At the end of this module, the student will be able to:
Identify traditional health beliefs of Hispanic
Describe disparities in the Hispanic population
Understand culturally appropriate care for Hispanic population
Readings:
Andrews.& Boyle, J. Chapters 5, 6, & 10
Topic 1: Defining Health and Illness
The Hispanic culture views health through the continuum of the mind, body, and spirit. All symptoms manifest from the mind, body, and spirit connection. Being very family oriented they usually rely on family members when ill and it is expected that the family will show them lovee and support by pampering them during illness. They will usually reject assistance from social workers or social services. As a present-oriented society, preventive health care is rarely instituted. And since most Hispanics are Catholics, birth control methods are not acceptable, with the exception of the rhythm method,. When examining patient the healthcare provider need to understand that plumpness is ideal in this society and thinness is viewed as a problem so weight reduction discussion may be met with resistance.
For social, physical, and psychological problems, a holistic healer referred to as a curandero is often used. The curandero has a religious orientation and because of this includes elements of the Catholic and Pentecostal rituals and artifacts such as penance, confession, lighting candles, wooden or metal offering in thee shape of the afflicted body part, laying on of hands, and offerings of money. Curanderismo is defined as a medical system that combines Aztec, Spanish, spiritualistic, homeopathic, and scientific elements.
Again, this society is family oriented and values privacy. Personal matters are considered private matters and are handled only within the family. Privacy and modesty are valued and extend to both sexes. Women prefer their mothers with them during labor and culture dictates that the husband cannot see his wife or child until the delivery is over and both have been cleaned and dressed. A midwife is also accepted to care for a woman during delivery.
People with mental illness are looked down on by this culture and therefore do not seek professional help and they do not like to share this information with relatives. Psychological problems may carry a stigma and may be viewed as a sign of weakness particularly in the male population. The symptoms such as pain, shortness of breath, abdominal pain, sweats, and/or chronic illness are labeled as “de nervios” or stress. Within this culture each of these symptoms have a specific cause that requires nonmedical treatment.
Among the Hispanic/Latino community in the US, there is a respect for mainstream medicine, tradition, and traditional healing along with a strong religious influence. Their broad definition of health and illness offers many challenges to the healthcare provider. This population does not seek medical care unless they are ill and find it strange and a luxury to seek preventative care and the APN needs to keep the mind-body-spirit focus when providing and providing education.
Topic 2: Current Health Problems
Health disparities exist among Hispanic subpopulations and vary according to age, gender, and socioeconomic status (Kosoko-Laski, Cook, & O’Brien, 2009). Hispanic Americans have a high incidence of conditions such as asthma, chronic pulmonary obstructive disease, HIV/AIDS,diabetes and obesity. They suffer higher death rates from these diseases and work-related injurie than white Americans. Heart disease and cancer are the twoleading causes of death in Hispanics accounting for 2 out of 5 deaths which is close to that of whites. However, Hispanics have more deaths from diabetes and chronic liver disease than whites. The health risks also vary by Hispanic subgroups. For example, 66% more Puerto Ricans smoke than Mexicans leading to more cancers and COPD deaths than Mexican Americans.
Hispanic-Americans are disproportionally affected by HIV/AIDS. It is the third leading cause of death for Hispanic men and fourth for Hispanic women. Infection rates in the Hispanic-American community have increased to such a rate that Hispanics are three times more likely to be infected as Non-Hispanics.
Approximately 85% of health problems common to Mexican Americans are communicable diseases; respiratory tract infections, diarrhea, and skin disorders. And the risk of TB in the US Hispanic population is 4 times that of non-Hispanic whites.
Topic 3: Health Care Disparities
The Institute of Medicine reports four areas that specifically contribute to Hispanic health-care disparities. They include inadequate health insurance, language and communication barriers, few minority doctors, and biases among health-care providers. Of these, lack of health insurance is the main barrier to healthcare. Lack of health insurance is a major problem. In 2006, 30.7% of Hispanic/Latino population lacked health insurance. There are several reasons for this including lack of understand of the system and the need for health insurance along with communication difficulties. A lack of access to care and no transportation also contributes to this problem
For effective physician communication medical translators are often necessary. Research shows that medical interpreters are often not called, insufficiently trained, or not available. Often family members are relied upon to be translators which can lead to misinterpretation and misunderstanding.
Lack of health insurance, less access to regular medical care, and fewer immunizations of children and elders impact these health disparities. Improving access to medical care and alleviating poverty may perhaps have a positive effect on death and disability of this population.
When working with Hispanic/Latinos the advanced practice nurse must be aware of the many sub-cultures’ beliefs, cultures and traditions,and spirituality within each group and their effects on their acceptance and trust of health care in the US. Each nationality has their own views on how they have been treated and how they view themselves. The way that they entered the country, such as illegally, legally, or as a refugee, will also impact them. One must take into account the degree of acculturation and the level of socioeconomic status, education, and country of origin in order to provide culturally competent care.
References:
Andrews, M. & Boyle, J. (2016). Transcultural concepts in nursing care. Philadelphia: Walters Kluwer
Centers for Disease Control and Prevention: Vital signs(2015) – Hispanic Health retrieved from: https://www.cdc.gov/vitalsigns/hispanic-health/index.html
Dayer-Berenson, L. (2014). Cultural competencies for nurses: Impact on health and illness. Sudbury, MA: Jones and Bartlett Publishers.
Kosoko-Lasaki, S., Cook, C., & O’Brien, R. (2009). Cultural proficiency in addressing health disparities. Sudbury; MA. Jones and Bartlett
Rose, P.R. (2018). Health disparities, diversity,and inclusion. Miami: Jones and Bartlett Learning