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Increasing the cultural competence of health care providers serving Minnesota's diverse populations
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Common health equity issues for Latino populations
Cultural competence is the ability to recognize and understand the role culture plays in health care and to adapt care strategies to meet patient needs.
Get to know patients on an individual level. Each person’s preferences, practices, and health outcomes are shaped by many factors. Generalizations in this material may not apply to your patients.
Hispanic/Latinos in Minnesota
72% of Latinos in Minnesota are of Mexican origin
More than 275,000 Latinos live in Minnesota. In 2014, 72 percent were of Mexican origin and 61 percent are U.S.-born. Latinos are the state’s third fastest-growing racial group. Latinos have been part of the cultural, social, and economic fabric of Minnesota since the 1800s. Immigration increased in the 1920s with growing employment opportunities, especially in food processing, construction, and manufacturing. The Twin Cities and southern Minnesota had the highest proportion of Hispanics in the state.
Hispanic, Latino, Latinx?
Hispanic refers to people whose native language is Spanish, which excludes Brazilians and others whose first language may be Dutch, English, or French. Latino refers to diverse peoples who have origins in Central or South America. Latinx is a newer word sometimes used as a gender-neutral term for both Latino (male) and Latina (female).
Spanish has numerous dialects and variations, but speakers have little difficulty understanding those differences. Census data indicates that 3.8 percent of Minnesotans speak Spanish at home. Of those, 56.2 percent report speaking English very well. Hispanic/Latinx older adults in Minnesota were less likely than others to be English speakers.
Hispanics and Latinxs in Minnesota face several disparities in health outcomes and care delivery compared to the overall population. Some health issues could be biologically tied to race; many are tied to social inequities, including poverty.
More data on disparities in health and healthcare for Latinos in Minnesota:
Social determinant disparities
Social determinants of health are economic and social conditions that influence the health of people and communities. Poverty and immigration are key underlying issues for Latinos in Minnesota. Recent immigrants often have high rates of poverty, which can result in lack of preventive health care and limited health choices.
More on social determinants impacting Latinos:
The Latinx community in Minnesota is diverse. Many aspects of Latinx-Minnesotan culture reflect the culture of the general U.S. population and generational differences impact social practices. The following aspects of traditional Latino culture may influence your patient’s behaviors:
Many acculturated Latinos have replaced traditional meals with fast food, contributing to an increase in obesity, diabetes, and hypertension. Latinx immigrants in the U.S. usually do not get as much exercise as they did in their native countries. Overconsumption of alcohol also is a health risk.
Latinx diets vary greatly. A traditional Mexican diet is rich in complex carbohydrates, which are provided mainly by corn and corn products (usually tortillas, present at almost every meal), beans, rice, and breads. This diet also contains an adequate amount of protein in the form of beans, eggs, fish and shellfish, and a variety of meats mostly including pork and poultry. Chorizo, a spicy pork sausage is served for breakfast with eggs. Popular fruits and vegetables are tomatoes, squash, sweet potato, avocado, mango, pineapple, papaya, and aguas naturales (fresh fruit blended with sugar and water). The nutrients most likely to be inadequately represented are calcium, iron, vitamins A and C, and folacin.
Rates of food insecurity were much higher among U.S. Latino households than the national average: more than 26 percent of Latinx households versus nearly 15 percent of all households. Nearly one-third of Latinx children, 32 percent, are living in food insecure households. Hispanic/Latinx older adults in Minnesota were more likely than other older adults to skip a meal sometimes or often due to financial worries.
Approximately one in five of all adults in the U.S. experiences mental illness in a given year. While Latinx communities show similar susceptibility to mental illness as the general population, they are less likely to seek mental health treatment. Disparities in access to treatment and in the quality of treatment received puts them at a higher risk for more severe and persistent forms of mental health conditions. Stress and trauma caused by immigration and by immigration policies like “zero-tolerance” impact Latinx health and their willingness to access care and supportive resources. Illegal immigration and flight from areas of conflict increase likelihood of trauma.
End of life
Latinx life expectancy will increase to age 87 by 2050, surpassing all other ethnic groups in the United States. Latinxs in the United States have higher rates of diabetes, putting them at greater risk for developing Alzheimer's. The leading causes of death for Latinxs are heart disease, cancer, stroke, diabetes, and chronic liver disease, followed by chronic lower respiratory disease, influenza, pneumonia, perinatal conditions, unintentional injuries, and homicide, according to the Centers for Disease Control and Prevention.
When discussing end of life issues with any patient, health care providers need to understand preferences based on personal and family views. Hospice and nursing home care might seem to go against the Latinx cultural tradition of the family providing care for the sick and elderly at home. Only 2.1 percent of hospice patients are Hispanic.
Hispanics may be more likely to prefer family-centered decision making for advanced care planning than other racial or ethnic groups.
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