Healthcare or healthcareless?

(My longest blog…so far; stick with me)

As promised, I want to do a deep dive into the healthcare issues facing the Hispanic populations in the United States. I have typically relied on newspaper articles or policy reports found online to provide information and research on the topics in which I am interested. However, I decided for this topic to look at Google Scholar.

I’m sorry to report that the top posts are from 2007, 2006, 2010, 2012, and 2016. The most recent article in the top 10 was from the Journal of Family and Economic Issues in October 2020, entitled Timing of Immigration Effects Asset Change Among Hispanic Caregivers of Older Family Members. Although an interesting report about how older Hispanic immigrants are more dependent on family members as caregivers, it did not help me with the task at hand.

It is interesting to me that Google Scholar did not have more recent research on the topic. It seems that it would be of primary importance to many, especially during the pandemic. Fortunately, I did find a few articles that were only a few years old; and reverted to my tried-and-true source of information via news articles.

I reverted to an article on Google Scholar entitled Reducing Health Disparities Among Low Socioeconomic Status Hispanics in the United States. It was written in October 2019 by Johnathan Tran, a graduate student at the Massachusetts College of Pharmacy and Health Science. Although his paper was fairly recent, much of the research he used was over 15 years old. The lack of research on this population may need to be another blog topic.

In his paper, Tran tackles the irony that although Latinos/Hispanics make up a large proportion of the US population and the majority of its workforce, most of these jobs are low-wage and lack healthcare benefits. Tran states: “As a result of an adverse manual labor-centered life, the health of many underserved Hispanic communities is not only poor, but they suffer inequities in their access and quality of medical care as well. These disparities exist on many different planes, from the individual level to the area of government policies.” (1)

His paper looks at the different barriers and risk factors of health disparities that affect large portions of the US Latino/Hispanic population. These include education, personal beliefs, interpersonal barriers such as language and work conditions, environmental and living circumstances, and nearly inescapable poverty. In my opinion, all of these contribute to poor health outcomes and increasing disparities in our healthcare system.

From all I have read, it is important to understand that healthcare disparities are multifaceted. A solution to one or more of the issues is not going to solve the underlying problems. Here are some key areas that need to be addressed to produce better healthcare outcomes for the Hispanic population:

·      Individual beliefs/culture: Hispanic populations often have cultural beliefs and a fear of Western Medicine. In their native countries, they often are accustomed to folk healing techniques, like Shamans and herbs. (2) In addition, this past summer I learned that in many Latino cultures men are considered weak if they are sick or need medical attention.

·      Educational barriers: Hispanics are the least educated segment of the U.S. population. (3) Education provides the information and skills needed to solve problems. Lack of education equates to less understanding of preventative healthcare and treatment of medical conditions. It also equates to a lower ability to navigate the U.S. healthcare system.

·      Interpersonal barriers: Only 5% of the physicians in the U.S. are of Hispanic origins. (4) As a result, a language barrier often exists between Hispanic patients and their health care providers. Hispanic patients would likely find it easier to relate and be comfortable with a provider of the same ethnicity. In addition, most Hispanics don’t have a primary care doctor or have the flexibility in their job to take off time to go to a scheduled doctor’s appointment. Instead of having healthcare providers that are sincerely interested in their health and working with them to prevent medical issues in the future, they are seen at urgent care centers or hospital emergency rooms that have long wait times and impersonalized care.

·      Community risks: People in low-income communities typically have poor health because of the living conditions and environmental circumstances. Although unhealthy behaviors are sometimes a product of personal decisions, a research paper from 2011 illustrates that health conditions are greatly influenced by the areas in which people live and work. “Choosing a healthy diet is quite difficult for low-income households because healthy foods and supermarkets are often too far away. In contrast, fast food is both locally available and cheap.” (5) As a result, Hispanics face some of the highest rates of obesity. (6)

·      Income Risks: Income is an indicator of a household’s ability to afford health care and other important health services. Despite having the highest rates of labor workforce participation, Hispanic families have the highest rates of poverty in the U.S. Earnings for Hispanic immigrants are heavily stratified by race and ethnicity and are also the lowest of all immigrants with this disparity in income. (7) As a result, Hispanics, in general, have the lowest rates of insurance in the U.S. and are working low-wage jobs that don’t offer health insurance or employee benefits). The U.S. Agency for Healthcare Research and Quality estimated that a third of Hispanic Americans lack health insurance coverage. (8)

Admittedly, I am a fan of Obama’s Affordable Care Act (ACA), which was enacted in 2010. Although it took a few years to impact healthcare in the U.S., in my opinion, ACA should be considered as the appropriate benchmark to begin tackling some of the issues that can be solved by public policy. The implementation of the ACA decreased the number of uninsured Hispanics to 41.8% from 30.3 %, providing nearly 4 million additional people with health insurance. (9)

Other initiatives that I think would lend to an increase in the number of Hispanics enrolled and therefore covered by healthcare insurance include the following:

1.     Create a national task force of members of the Hispanic community from various states to propose a budget-neutral strategic plan focused on reviewing and analyzing all current healthcare problems with the programs available to the Latino population. The plan would restructure, redirect, and reallocate federal and state funds where health disparities are most prominent.

2.     Develop and provide multi-lingual educational materials for Spanish-speaking individuals so they can better understand their options.

3.     Create undergraduate and graduate grants that specifically fund the medical education of Hispanic/Latinos to increase the number of physicians, nurses, and physician assistants in that segment of the U.S. workforce.

 4.     Provide health insurance coverage for new and undocumented immigrants. Currently, New York and California have already waived the State mandated five-year waiting period for immigrants and provide them with health insurance using State resources.

5.     Offer tax credits or health savings accounts (HSA) for small employers in order to offer health insurance coverage to all of their employees.

6.     Provide tax credits to individuals who are independent contractors who are not technically employees and therefore not sponsored by their employers.

Sources

1.     Reducing Health Disparities Among Low Socioeconomic Status Hispanics in the United States By Johnathan Tran MCPHS University

2.     Caring for Latino Patients. Juckett, G. https://www.aafp.org/afp/2013/0101/ p48.html (January 1, 2021)

3.     Strategies for improving Latino healthcare in America. Valdez, J., & R. Posada. (June 2006)

4.     Provider Perspectives about Latino Patients: Determinants of Care and Implications for Treatment. Valdez, C. R., M. J. Dvorscek, S. L. Budge & S. Esmond. The Counseling Psychologist, 39(4), 497-526. (2011)

5.     Where Health Disparities Begin: The Role of Social and Economic Determinants—And Why Current Policies May Make Matters Worse. Woolf, S., & P. Braveman. (October 2011).

6 & 8.    To Address Health Disparities for Latino Youth, and to Promote Their Engagement in Health Care. Raymond, M. https://www.jahonline. org/article/S1054-139X(17)30095-2/fulltext (2017).

7.     The Integration of Immigrants into American Society. Waters, M. (2015).

9.     To Address Health Disparities for Latino Youth, and to Promote Their Engagement in Health Care. Raymond, M. https://www.jahonline. org/article/S1054-139X(17)30095-2/fulltext (2007).