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Latinos in Minnesota

 

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.

  • Demographic trends. Minnesota Compass offers insights on how the Latino population is changing in the state, 2014.

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).

Language

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.

Health Check:
How do Hispanics and Latinos compare to your overall patient population across process and health outcome measures?

Health disparities

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.

  • 66.6 percent of Hispanics in Minnesota are obese or overweight compared to 63.5 percent of whites. 63.9 percent of Mexican-American men and 65.9 percent of Mexican-American women are considered overweight or obese, compared to 61 percent of European-American men and 49.2 percent of European-American women.
  • Diabetes is twice as common in the Latinx population compared to whites.
  • Cervical cancer occurs twice as frequently for Latinas than white women.
  • Hispanics are about one and one-half times as likely to have Alzheimer's or
    other dementias as older whites.
  • Minnesota Clinical Quality Measures 2017

     

    Optimal diabetes care

    Optional vascular care

    Adolescent mental health screening

    Pediatric oversight counseling

    Optional asthma control-A

    Optional asthma control-B

    Colorectal cancer screening

    Hispanic

    Non-Hispanic

     

     

     

    ↑ = Above average, ↓= Below average, Blank = Similar to average

  • Hispanic patients had poorer health care outcomes than non-Hispanics for six of the seven Minnesota quality measures: optimal diabetes care, optional vascular care, adolescent mental health screening, pediatric oversight counseling, optional asthma control-A, optional asthma control-C, and colorectal cancer screening.
  • In 2017, 21.8 percent of Latinxs lacked health insurance, while 4.6 percent of non-Hispanic whites had no health insurance.
  • Hispanic/Latinx older adults were less likely to say their services meet all their needs and goals than White older adults.

More data on disparities in health and healthcare for Latinos in Minnesota:

  • 2017 Health Equity Report. This annual report stratifies health care performance results in Minnesota by race, Hispanic ethnicity, preferred language & country of origin. MN Community Measurement, January 2018.
  • 2017 Minnesota Statewide Health Assessment. Examines Minnesota’s inequities by race and ethnicity, gender, age, sexual orientation, geography, and disability. Minnesota Department of Health, 2017.

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.

  • In 2016, the four-year high school graduation rate for Latinos in Minnesota was 65.3 percent, compared to 87 percent of white students
  • Average annual personal income of Latinxs in Minnesota is $20,000, compared to $36,000 non-Latino whites.
  • 27.5 percent of Latino children live in poverty, compared to 8.3 percent of non-Latino whites.

More on social determinants impacting Latinos:

  • Social Determinants of Latino Health Disparities. Data on health care disparities in the Latino community. Presented by Evelinn Borrayo, PhD. Colorado School of Public Health, Latino Research and Policy Center, 2018. (20-minute video, starts at 8:45)

Social structure

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:

  • Familismo is loyalty to the extended family that is more important than the needs of the individual. Grandparents, aunts, cousins, and even people who are not biologically related may be considered part of the immediate family. A large number of family members might be consulted on medical questions.
  • Machismo is a strong sense of masculine pride. In the positive, machismo can be a health motivator through family-centeredness. In the negative, it can be associated with violence and abuse, alcoholism, and risk-taking behaviors.
  • Marianismo is refers to the high value Latino women place on being dedicated, loving and supportive wives and mothers. Latinas can be reluctant to reach out for help because they believe they need to self-sacrifice for the greater good of their family.
  • Fatalismo is the belief that individuals cannot alter their disease process because it is part of their destiny.
  • Respecto is tradition of placing a high value on demonstrating respect in interactions with others, especially with people in authority and older people. This reflected in the Spanish language with formal and informal pronouns.
  • Understanding the Hispanic/Latino Patient - health concerns of Latinos. Insights into cultural differences to improve understanding of the Hispanic/Latino patient. Juan del Rincon Jarero, MD, Department of Endocrinology at MetroHealth Systems, Cleveland, OH, 2014. (11-minute video)

Diet

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.

Medical care

  • Caring for Latino Patients. Article highlights special medical concerns of Latino populations and includes information on traditional Latino illnesses and traditional Mexican medicinal herbs. American Family Physician, 2013.
  • Immigrant Child Health Toolkit. Identifies effective clinical practices, strategies and community resources to address matters related to immigrant child health. American Academy of Pediatrics
  • Interpreters: Do I need an interpreter? Video in Spanish to inform limited English speaking patients of their right to an interpreter at no cost. Minnesota Multilingual Resource Exchange, 2013. (3-minute video)

Mental health

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.

Additional resources

  • Culture Matters DVD Training - Hispanic/Latino. DVD series offers insights into the beliefs and norms of three of Minnesota’s prevalent cultures: Hispanic/Latino, Hmong, and Somali. DVDs available for purchase; facilitator discussion guides available at no cost. CEU credit available. Stratis Health.
  • Hispanic/Latino Cultural Profile. Information on history, culture and community with emphasis on health related issue. Ethnomed, University of Washington
  • Latinos or Hispanics and Health Disparities - Minorities Healthcare. Highlights how cultural characteristics effect Latino patients. It includes the history of Latinos in the U.S., how Latinos look at birth, death, pain, family, genders, machismo, spiritual healers or Curandismo, and the use of interpreters, 2013. (8-minute video)