Hispanics and Latinos make up the fastest-growing demographic of the U.S. population. They also are experiencing the fastest increase in the rates of both Type 1 and Type 2 diabetes, and that alarms many public health officials.
According to a recent American Diabetes Association analysis of diabetes health data, 52.5% of Hispanic women and 45.4% of Hispanic men will have Type 1 or Type 2 diabetes in their lifetimes. In contrast, only 31.2% of non-Hispanic women and 26.7% of non-Hispanic men will experience diabetes, according to a WebMD report. In a recent survey conducted by the Robert Wood Johnson Foundation and the Harvard School of Public Health, health care costs and diabetes rank as the top health concerns among Latino and Hispanic Americans, according to an article in Kaiser Health News.
Such demographic trends mean that if we’re to have any hope of containing diabetes costs, it will require effective outreach to Hispanic and Latino communities. Unfortunately, public health experts warn, there are multiple barriers to providing these communities with the tools needed for effective diabetes care, and failure to meet the diabetes needs of Hispanics and Latinos is draining the U.S. health care system. A 2009 study by the Urban Institute estimated that inferior access to health care among racial minorities will cost the nation $337 billion over a 10-year period.
“Our health care system is barely prepared to face the challenge of managing diabetes in this high-risk group,” writes Dr. A. Enrique Caballero, director of the Latino Diabetes Initiative at the Joslin Diabetes Center, in a position paper on Hispanics and diabetes.
To provide proper diabetes care for Latinos and Hispanics, it’s necessary to understand why these communities experience higher rates of diabetes. Many public health officials agree that genetics play a role, at least when it comes to Type 2 diabetes. In 2013, the Slim Initiative in Genomic Medicine for the Americas released findings that show Latin Americans are much more likely to have a variation in genetic sequencing that predisposes them to Type 2 diabetes than people of European or African ancestry. The study, which was published in the journal Nature, examined the genetics of 8,214 Mexicans and other Latin Americans with and without Type 2 diabetes. They found that the participants studied were more prone to carry genes with 4 amino acids which leaves a person more prone to Type 2 diabetes. The same genetic variation is also common among Native Americans.
Economics also present a high barrier to well-controlled diabetes among Hispanics and Latinos. Latino and Hispanic individuals are statistically more likely to live in neighborhoods that lack safe places to exercise and good access to healthy food, says Manny Hernandez, president of the Diabetes Hands Foundation, the nonprofit that runs social networks TuDiabetes.org and EsTuDiabetes.org. A recent study by the National Council on La Raza found that predominantly Hispanic neighborhoods are ⅓ less likely than other neighborhoods to have a chain supermarket with a large produce section, and traditionally corner bodegas usually don’t sell produce or sell produce of inferior quality. (Several public health initiatives have been working with bodega owners across the nation to offer more healthy food.)
Cultural factors also present a sizable barrier to good diabetes control among Latinos and Hispanics. While news reports have discussed a “cultural of obesity” ad nauseum, less discussed is the way different communities view chronic health conditions. Diabetes carries a significant stigma in Hispanic and Latino communities, says Dr. Elizabeth Ortiz de Valdez, founder and CEO of Concilio Latino de Salud Inc. While conducting research of Latinos and Hispanics in Phoenix, Arizona, Dr. Ortiz de Valdez was surprised to hear how prevalent that stigma was.
“People are embarrassed that they have diabetes because they think they’re going to be a burden on their family,” she reports.
And access to health care is made more complicated for undocumented individuals. Many undocumented Latinos or Hispanics are barred from programs that offer subsidized or free insurance because of their immigration status. Others are afraid to seek care for fear of being deported.
So what would effective outreach to Hispanic Americans and Latino Americans look like? It’s difficult to say. Certainly, health officials have put resources towards the effort. The CDC offers dozens of links and resources in both English and Spanish, as does the American Diabetes Association, which launched its Latino Diabetes Toolkit in 2008.
But effective outreach may be more about quality than quantity, as culturally nuanced outreach efforts could make all the difference. First and foremost, effective outreach must be truly bilingual, says Hernandez.
“We observe a true hunger for easy-to-understand, easy-to-digest Spanish diabetes education,” he says.
But, he says, the need goes deeper than just something that can be solved by translation. Information also must be delivered in a culturally appropriate way, and that requires understanding the complexities of the Hispanic and Latino communities.
“It’s not one-size-fits-all,” Hernandez says. “A Mexican-American has a much different background than a Cuban-American. Their diets are very different, especially [among the] first generation. It requires an intimacy with the different cultural realities and with the different people who are clustered together.”
This is where the importance of community outreach comes into play, says Dr. Ortiz de Valdez. Effective outreach requires intimate knowledge of individual communities, even at the neighborhood level.
“In order to reach people, you have to be known in the community, and you have to build the trust of the community, and you have to respect the language and the culture,” she says.
Her organization uses a technique called “asset mapping” to see what resources are available in the community and then partnering with community health centers, areas of aging, schools, and even barbershops to boost the signal of outreach. Another invaluable item in her organization’s toolkit is maintaining excellent relationships with Spanish-speaking radio stations and local papers.
“It’s a community outreach, but it’s really an in-reach,” she explains. “We go out of where we are to really reach in.”
In some ways, the rules of the road on effective outreach may still be waiting to be written. That’s because the Affordable Healthcare Act (aka Obamacare) most likely will change who has health insurance and who will seek health care, says Hernandez. It presents a golden opportunity for health care workers to connect with Latino and Hispanic people with diabetes. And it’s an opportunity we can’t afford to miss, as the economic and human costs would be too great if our health care system fails to help the fastest-growing segment of the U.S. population effectively treat diabetes.
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