2/4/2013
Objectives
Disparities in Services to
Hispanic/Latino Populations
Luis R. Torres, PhD
University of Houston
Graduate College of Social Work
National Hispanic and Latino
Addiction Technology Transfer Center
Work Group Meeting
January 29-30, 2013
San Antonio, TX
University of Houston
Graduate College of Social Work
1. Review recent demographic shifts in the Hispanic population
and their implications for service delivery.
2. Articulate important issues impacting disparities in service
delivery (e.g., cross-cultural factors, personal biases,
structural issues, etc.) and other risk factors for adverse
health and mental health outcomes in Hispanics.
3. Identify strategies for targeting and decreasing Hispanic
Health Disparities (e.g., increasing culturally-competent
practice with Hispanics in healthcare settings).
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Movie Clip (Selena)
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Does the clip resonate for yourself or the clients you work
with? If so, how? If not, how is it different from your
experience or that of your clients?
Is this true of all Mexican-Americans/Chicanos? How about
other Hispanic groups?
What issues are identified in the clip that can potentially
impact health disparities?
HISPANICS AT A GLANCE
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National
Who is Hispanic/Latino
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A person of Mexican, Puerto Rican, Cuban, South
or Central American, or other Spanish culture or
origin, regardless of race. The term, “Spanish
origin,” can be used in addition to “Hispanic or
Latino” (OMB Definition)
A person of Mexican, Puerto Rican, Cuban, South
or Central American, or other Spanish culture or
origin, regardless of race (Census Definition)
Numbers
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52 million Hispanics in U.S.
16.7 % of U.S. population
43.3 % increase between 2000 and 2010
132.8 million by 2050 (30% of U.S. population)
63% of Hispanics are Mexican/Mexican American
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Puerto Ricans 9.2%, Cubans 3.5%, Salvadorans 3.3%,
Dominicans 3.2%, All Others 18.2%
Source: U.S. Census Bureau, 2010, 2011
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2/4/2013
New Destination States
U.S. Hispanic Population
1. North
Carolina
2. Georgia
3. Arkansas
4. Tennessee
5. Nevada
6. South
Carolina
7. Kentucky
8. Nebraska
9. Alabama
10.Utah
Source: Ennis, Sharon R., Merarys Ríos-Vargas, and Nora G. Albert. “The Hispanic Population: 2010”. U.S. Census Bureau. May 2011
“<http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf.>
National
National
Numbers
• Median Age 27 (vs. 35)
• 51% Male, 49% Female (Total US 49% Male, 51%
Income, Poverty, and Health Insurance
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Female)
• 60% U.S.-Born, 40% Foreign-Born
• 75% are immigrants or children of immigrants
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$38,039 Median income of Hispanic households (2009) vs.
$50, 221 for total U.S. population
25.3% Poverty rate in 2009 (23.2% in 2008) vs. 14.3% for
total U.S. population
32.4% Percentage lack health insurance (30.7% in 2008)
vs. 16.7% for total U.S. population (1 in 3 vs. 1 in 6)
Source: U.S. Census Bureau, 2005-2007 American Community Survey; 2010 Census
Source: U.S. Census Bureau, 2010
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National
National
Families and Children
Education
10.4 million Hispanic households in the U.S. in 2010
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63% married couples (2-parent homes)
39% consist of a married couple younger than 18
75% Speak language other than English at home
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63% of Hispanics 25 and older had at least a high school
education in 2010 vs. 84.6% for total U.S. population
14% of Hispanics 25 and older had a bachelors degree or
higher in 2010 vs. 27.5% for total U.S. population
20% of elementary and high school students are Hispanic
25% of Children enrolled in Head Start and Early Head Start
are Hispanic
Source: U.S. Census Bureau, 2010
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Why do the stats matter???
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More than 60% of Latino youth live in low-income families,
compared to 26% of non-Hispanic White children
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Low socioeconomic standing makes it difficult for Latino
children to receive the mental health care they need
Hispanic children are the least likely of any minority
demographic to receive mental health care services
Hispanic Health Disparities: Risk Factors
for Mental Health, Substance Abuse,
Family Violence, And Other Health Issues
National Center for Children and Poverty, 2012
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What are “health disparities”?
Disproportionate Higher Rates:
Health Conditions
Health disparities are differences in the incidence,
prevalence, mortality, and burden of diseases and other
adverse health conditions that exist among specific
population groups in the United States (NIH, 1999)
A population is a health disparity population if there is a
significant disparity in the overall rate of disease incidence,
prevalence, morbidity, mortality or survival rates in the
population as compared to the health status of the general
population (Minority Health and Health Disparities Research and
Education Act, United States Public Law 106-525 (2000), p. 2498)
• Diabetes
• Hypertension
• High Cholesterol
• Metabolic syndrome
• HIV
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Disproportionate Higher Rates:
Mental Health Conditions
And don’t forget…
• Higher rates of work-related injuries, diabetes, and
kidney disease relative to whites
• Substance Abuse,
Depression, Anxiety,
Adolescent Suicide (Latinas)
• On the rise: Impulse Control
Disorders, Dysthymia, PTSD,
Eating Disorders
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• More likely to report violence perpetrated by
strangers
• Latin@ young adults have high rates of homicide
and early alcohol use
• Higher rates of inactivity and obesity
• Adolescent pregnancies
• Child Welfare Representation
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Top 5 Leading Causes of Death for Hispanics
• Cancer
• Heart Disease
• Unintentional Injuries
• Stroke
• Diabetes
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Challenges in Assessing
and Diagnosing
Hispanics
Risk Factors
• Cultural values, beliefs, attitudes and
traditions
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Acculturation
Lack of insurance coverage
Misdiagnosis
Lower socioeconomic status
Stigma and Discrimination
Poverty
Legal Status
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Barriers to Service Delivery
• Large Diversity in Hispanic Population (sub-populations)
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Insufficient epidemiological data for mental illness and other biopsychosocial
issues with Hispanics
• Lack of Continuity among Operationalized Constructs, Data
Collection, and Data Assessment
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Inadequate representation of Hispanics in treatment research (especially in
randomized clinical trials)
• Organizational and Institutional systems
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Incomplete assessments that fail to take into consideration culture and context
• Under representation of Hispanics among Service Providers
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Biases, assumptions, and stereotypes held by the provider make their way into
clinical and other service formulations
• Differential Endorsement of Symptoms
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Misdiagnosis (leads to suboptimal treatment, lack of progress, frustration and
premature termination, and loss of credibility in the community)
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Barriers to Service Delivery
• Lack of diversity in health care’s leadership and workforce
• Systems of care poorly designed to meet the needs of
diverse patient populations
• Poor communication between providers and patients of
different racial, ethnic, or cultural backgrounds
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Strengths of the Latino Population
• Deep religious faith and strong family orientation
• High value placed on children
• Extended family network
• High overall literacy rate
• Incomes among the Hispanic population have and
tend to improve over the years
• Institutional Racism
• Most Hispanics immigrants come to the United States
because they are highly motivated to work and
improve their lives
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Video and Discussion:
Alicia Mercado’s Story
CROSS-CULTURAL ISSUES IN CULTURALLY
COMPETENT SERVICE DELIVERY
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Core Cross-Cultural Issues in
Health Care
When worlds collide …
• Mistrust & Prejudice
• Autonomy, Authority and Family Dynamics
• Role of Health Care Provider, Medicine, and
Cultures of
the patient
Cultures of
the health
care provider
Utilization
Compliance
Outcomes
Allied Disciplines
• Beliefs, Traditions, and Customs
• Styles of Communication
(Adapted from Carrillo ’04)
Cultures of
Health Care
Disciplines
ACOG Committee on Health Care for Underserved Women, 1998
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Cultural Collisions
When the cultural traditions, world
views or values of two or more
individuals or groups conflict in a
way that may challenge their
efforts to understand one another
and cooperate as needed
Cultural Competence
in Health Care
The Cognitive Components
• Awareness & acceptance of differences
• Awareness of one’s own cultural values and
those of the health care discplines
• Understanding the core cross-cultural issues
in health care
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Cultural Competence
in Health Care
Actions & Practices
• Focus on the individual, not the category
• Explore the patient’s understanding of the
illness
• Explore the patient’s social context
• Treat the illness, not just the disease
• Empower patients to be active partners
STRATEGIES FOR INCREASING
CULTURALLY-COMPETENT PRACTICE
AND TARGETING HEALTH DISPARITIES
(Carrillo ’04)
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Becoming Culturally Competent
Culturally Competent Providers…
•Understand culture and its function in human behavior and
• Readings
society
• Continuing education
•Recognize the strengths that exist in all cultures
• Supervision
•Possess a knowledge base of their clients' cultures
• Consultation
•Demonstrate expertise in providing culturally competent
• Immersion in cultural events
services (grounded in the clients values, beliefs, and
practices)
•Seek to understand the nature of social diversity and
oppression with respect to race, ethnicity, national origin,
color, sex, sexual orientation, age, marital status, political
beliefs, religion, and mental or physical disability
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• Group discussions
• Interacting with individuals of
diverse backgrounds within and
outside of service provision settings
(NASW, 1996)
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Domains of Culturally Competent Practice
Domains of Culturally Competent Practice
Genuine curiosity about oneself
•What makes me (the provider) unique?
•What do I share with others (including my client)?
•What are my cultural (“group”) affiliations?
•How do these shape my views of the world, of social problems, of my clients?
Genuine curiosity about others
•What makes my clients unique? What do we have in common?
•What are my clients’ cultural (“group”) affiliations?
•How do these shape their views of the world, of social problems, of me, of their
presenting problem, of treatment/services, etc.?
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Understanding heterogeneity
Navigating language barriers
Knowledge, comfort and skill discussing identity
Attention to issues of education and social class
Knowledge of Latino cultural values
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2/4/2013
Thank You!
Luis R. Torres, PhD
[email protected]
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