Latinx

To understand the complexity of the language used to describe Latinx, it is important to note the diversity within Latin American communities. Individuals of Latin American descent have various skin tones, dialects, indigenous ancestry, and different geographical upbringings that are rich with cultural traditions and norms. When describing and referring to Latinx populations, various forms of the term latin have been developed over time. Resistance to settler-colonial influences has increased and activists and scholars have encouraged changes to language to be inclusive to all — especially those who do not identify with the male/female binaries.

Over time, the term Latinx has grown widely as an “impetus for ungendering Spanish and the relationship among language, subjectivity, and inclusion.”  However, Latinx can be exclusionary toward certain Latin American communities that do not have the letter “x” in their dialects and cause resistance for the potential grammatical nuances that this term can bring. Recently, it has been suggested that the term Latin* be used as an umbrella term encompassing Latinx, Latiné, Latinu, Latino, Latina, Latina/o, Latin@, Latin, or Latin American, or any other terms that are yet to be included in the mainstream vocabulary.  To ensure inclusion in health care, it is important to ask each patient how they choose to describe their ethnicity.

The term “Hispanic” refers to people whose native language is Spanish or whose cultural heritage is linked to Spanish-speaking communities, including Spain, Central and South America, and parts of Equatorial Guinea and Western Sahara in Africa. This broad geographic distribution is largely a remnant of a shared history of colonization by the Spanish Empire. While most Hispanic people in the United States can trace their history to Central and South America, Brazilians (who speak Portuguese) and others whose first language may be Dutch, English, or French are typically not considered Hispanic.

“Latinx/ Latiné /Latinu” are inclusive terms to describe diverse peoples who have origins in Central or South America, regardless of native language. While “Latinx” was developed by Latinx scholars in the U.S. to reclaim history of racial and ethnic resistance, it is not a perfect term and continues to be reconstructed to empower communities.

Learn more:

• Who is Hispanic? (Pew Research)
• Measuring the racial identity of Latinos (Pew Research)

The terms “race” and “ethnicity” may appear together in demographic questions and are often used interchangeably, but they refer to very different concepts. Race refers to the physical characteristics of a person (e.g., skin color or hair texture) and has historically been used to create social hierarchies that benefit specific groups of people. Many people are surprised to learn that our understanding of race — largely based on skin color — has very little basis in biology, and there is often more genetic variation within a racial group than between different racial groups.

Ethnicity, on the other hand, denotes the social or cultural group with which someone may identify (e.g., language, customs, or religion). Because some of the defining characteristics of Hispanic and Latino individuals are their shared language, national origin, and/or cultural background (regardless of their race), “ethnicity” is a more accurate term.

A person can identify as Hispanic or Latinx and another race (or multiple races), highlighting the racial diversity within these ethnic groups. However, many report that racism still impacts their daily lives. According to a 2021 survey, 62% of Hispanic or Latino respondents believed that Hispanic and Latinx individuals with darker skin face more disadvantages compared to those with lighter skin.

Spanish has numerous dialects and variations, but speakers have little difficulty understanding the differences. Census data indicate that 3.9% of Minnesotans speak Spanish at home. Of those, 62.8% report speaking English very well. A common assumption can be that all Latinx people speak Spanish. Census data above shows this is not the case and in fact, lack of Spanish skills does not make them less Latinx. Furthermore, it is critical to have options available for those who do not speak English.

Learn more:

• Interpreter Roster: Spoken Language, Health Care, Minnesota Department of Health

Latinx people in Minnesota face several disparities in health outcomes and care delivery compared to the overall population. While some health issues may be genetic, many are tied to social inequities, including poverty.

• In 2021, 68.9% of adults who identify as Hispanic in Minnesota were obese or overweight compared to 66.6% of whites.
• The risk of developing type 2 diabetes is higher for Latinx adults (50% chance) compared to the overall average for U.S. adults (40%).
• Cervical cancer is more commonly diagnosed in Latinx women than in White women (7 versus 7.2 per 100,000, respectively). In 2020, 72.9% of Latinx people were current with cervical cancer screenings compared to 78.8% of non-Hispanic White women.
• Latins people are about one and one-half times as likely to have Alzheimer’s or other dementias as older White people.
• Latinx patients had poorer health care outcomes than non-Hispanic/Latino patients for multiple Minnesota quality measures including optimal diabetes care, optimal asthma control (for adults and children), adolescent mental health screening, colorectal cancer screening, and depression measures.
• In 2021, 15.3% of Minnesota’s Hispanic population lacked public or private health insurance, while only 3.4% of non-Hispanic whites had no health insurance.
• Latinx older adults were less likely to feel confident that they could access providers who met their cultural needs.

Learn more:

Disparities by Race, Hispanic Ethnicity, Language, and Country of Origin

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

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

Social determinants of health, sometimes also referred to as social drivers of health (SDOH), are economic and social conditions that influence the health of people and communities. While poverty and immigration are key underlying issues for Latinx communities in Minnesota, their resiliency and faith mitigate some of the disparate outcomes. Nevertheless, recent immigrants and their children often have high rates of poverty and may lack insurance due to immigration status, which can result in missed preventive health care and limited health choices. The threat of deportation imposes a pervasive fear and anxiety. Children exposed to and experiencing this increases the risk they will experience and develop internalizing symptoms, including depression and anxiety.

According to the American Psychiatric Association (APA), Latinx adolescents experience higher internalizing symptoms than others in their age group. Internalizing symptoms and similar responses to life stressors renders children particularly vulnerable given difficulty in detection. The risk is compounded by the cultural stigma associated with mental health, lower mental health literacy, and underutilization of mental health services due to fears surrounding the documentation status of caretakers and parents. These symptoms often correlate with substance use, risky behaviors, and psychological disorders. Other examples of SDOH factors and their impact are below.

• In 2022, the four-year high school graduation rate for Latinx people in Minnesota was 69.3%, compared to 83.6% of white students.
• In 2021, the median income for Latinx people in Minnesota was $64,102, compared to $80,293 for non-Hispanic whites.
• 22% of Latinx children live in poverty, compared to 10% of non-Hispanic/Latino Whites.

Learn more:

• Social Determinants of Latino Health Disparities (begins at 8:45 in the video)

Many aspects of the “Minnesotano” culture reflect the culture of the general U.S. population and generational differences impact social practices. The following aspects of traditional Latinx cultures may influence how patients approach their health:

• Familismo is loyalty to family that often outweighs the needs of the individual. Grandparents, aunts, cousins, and even people who are not biologically related may be considered part of the immediate family. Consulting or bringing many family members to medical appointments and making medical decisions is common. Often, children of immigrants will translate and advocate for family members.
• Machismo is a strong sense of masculine pride. From a positive perspective, machismo can be a health motivator through family-centeredness. On the contrary, it can be associated with violence and abuse, homophobia, alcoholism, and risk-taking behaviors. It can be toxic for children as boys are taught not to cry or show weakness and are mocked for feminine expression. Men who show machismo will likely only seek medical attention when their work ability is affected.
• Marianismo refers to the high value Latina women place on being dedicated, loving, 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.
• Religious Beliefs: Faith can help mitigate fears and provide strength for Latinx people. While many views certain illnesses or chronic pain as part of God’s will, they do seek support from others to navigate health issues.
• Respecto is the 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. Medical professionals can help guide patients when creating a care plan and by using knowledge of the concepts above, patients are empowered and heard.

Learn more:

• Understanding the Hispanic/Latino Patient – Health Concerns of Latinos

Latinx diets vary greatly. For example, 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 pork and poultry). Chorizo, a spicy pork sausage, is commonly served for breakfast with eggs. Popular fruits and vegetables are tomatoes, squash, sweet potatoes, avocado, mango, pineapple, papaya, and aguas naturales (fresh fruit blended with sugar and water). Additionally, Latinx families have a variety of celebrations that include sweet and sugared beverages and alcohol.

The COVID-19 pandemic exacerbated food insecurity for Latinx households. Compared to Whites, the rate of food insecurity was 60% higher for Hispanic households with children. In 2021, Latinx people were 2.5 times more likely to experience food insecurity than White people, and 18.5% of Latinx children experienced food insecurity. Latinx older adults in Minnesota were more likely than other older adults to skip a meal sometimes or often due to financial worries.

• Caring for Latino Patients highlights special medical concerns of Latinx populations and includes information on traditional illnesses and traditional Mexican medicinal herbs.
• Working with Latino/a and Hispanic Patients includes best practices and culture-bound syndromes.
• Immigrant Child Health Toolkit​​​ identifies effective clinical practices, strategies and community resources to address matters related to immigrant child health.

Approximately one in five of all adults in the U.S. experiences mental illness each 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 treatment access to and in the quality of treatment they receive 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. Undocumented immigration and flight from areas of conflict increase the likelihood of trauma.

• Hispanic & Latino Substance Abuse Prevention. Fact sheet provides data on substance use and related factors to help guide decisions about prevention efforts.
• Substance Use and the Hispanic/Latino Population: What to Do? This article discusses the factors that impact substance use in the Hispanic/Latiné community and how to provide culturally appropriate care.
• The Impact of Discrimination. An illustration of how discrimination exacerbates stress.
• Latino Mental Health. Discusses common challenges many Latinos face in seeking mental health care so they can find help.

“As a 24/7 family caregiver, the level of stress increases while taking care of my parents and taking care of myself. However, having them with me and the opportunity to take care of them is gratifying and valuable, which I do with great honor.”

In Latinx communities, it is common for women to begin having children at younger ages. Career is often second to motherhood and in Latin American countries, it is common for a man to bring his girlfriend to his parents’ home to live with them. The familism values of Latinx communities creates multigenerational homes that impact the the roles of caregivers and how families age together. The differences between U.S.-born and immigrant Latinx caregivers highlight implications of the dynamic between caregivers and receivers.

Many caregivers within the Latinx community don’t realize they are caregivers or don’t identify with the term. Some think they are just doing what they should for their families or loved ones. However, this is a full-time job requiring adequate conditions to fulfill tasks as caregivers or in other life roles. The toll is heighted for those whose family members lack legal status and can create additional financial and mental stress. This increased burden often means that Latinx caregivers neglect their own health. As older generations age, family members often provide palliative and hospice care, but it can also be provided by others in the community. Nursing homes in Latin America do not exist and while there is a toll on caregivers, having older generations in the home has many benefits for children and can support the continuation of traditions and sense of community.

Learn more:

Why We Must Support Latinx Caregivers (asaging.org)

Overall, people in U.S. Latinx communities live longer than Whites, Blacks, and Asians. However, the COVID-19 pandemic took a devastating toll, dropping the average life expectancy by over three years. Latinés in the United States have higher rates of diabetes, putting them at greater risk for developing Alzheimer’s. The leading causes of death are heart disease, cancer, stroke, diabetes, unintentional injuries, and Alzheimer’s disease, although the leading cause of death in 2020 was COVID-19.

When discussing end-of-life issues with any patient, health care professionals 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. Latinx people are underrepresented in hospice care, but this may be due in part to a lack of culturally responsive communication. They may be more likely to prefer family-centered decision making for advanced care planning than other racial or ethnic groups.

• Alzheimer’s Culturally Responsive Resources for Patients and Families. Minnesota resources for Latinx and other populations. ACT on Alzheimer’s.
• Hospice Latino Outreach Guide. Community outreach tips to engage Latinx in end-of-life discussions before they are faced with a crisis. National Hospice and Palliative Care Organization, 2009. This resource includes PowerPoint templates for community education.
• Hispanic Americans and Alzheimer’s | Alzheimer’s Association Facts about Hispanic Americans with Alzheimer’s and resources.

• Hispanic/Latino Cultural Profile. Information on history, culture and community with emphasis on health-related issues.
• History and Evolution of the term Latinx.