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Latino Health Disparities:

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Title: Albemarle County Author: Owner Last modified by: Owner Created Date: 10/10/2009 8:15:25 PM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: Latino Health Disparities:


1
  • Latino Health Disparities
  • An Overview

2
Why this presentation is important
  • 45.5 million Hispanics (and Latinos) or 15 of
    the U.S. population
  • Only Mexico and Colombia have larger Latino
    populations
  • Largest minority in 23 states (50 live in CA
    TX)

3
Why this presentation is important
  • Latino specific socioeconomic, cultural, and
    language barriers
  • result in
  • their limited knowledge about health conditions,
    prevention treatments, and their limited access
    to available services

4
Why this presentation is important
  • Studies have shown that Latinos are more likely
    to suffer
  • misdiagnosis, inappropriate medication, and low
    screening participation rates
  • and among other disparities, Latinos have
    disproportionately high rates of preventable
    diseases (HIV/AIDS, diabetes, heart disease) and
    to be hospitalized for complications caused by
    chronic health conditions

5
Why this presentation is important
  • Many disparities in the health system exist
  • because of
  • Lack of understanding about the importance of
    culture values, assumptions and perceptions
    that are instilled early on in life and are
    expressed in the way we behave and act
  • Inadequate cultural competence ability to work
    effectively with individuals from different
    socioeconomic, cultural and ethnic backgrounds
  • Complications of language barriers

6
Latino Demographics - Nationwide
  • Latinos come from Mexico, Central America, South
    America the Caribbean
  • Most are Mexicans (64), Puerto Ricans (10),
    Cubans (3.5), Salvadorans (3), Dominicans
    (2.7)

The Americas
7
Beware of Generalizations!
  • Not all Latinos are recent immigrants some have
    been in the U.S. for centuries
  • Differences among Latinos from color,
    ethnicity, historic, geographic, language,
    socioeconomic class, and educational level to
    cuisine, reason for coming to the U.S.
    acculturation differences

Salvadoran Gangs
Salvadoran Police Officer , Albemarle Co.
8
Beware of Generalizations!
  • English Proficiency
  • Most South Americans Puerto Ricans
  • Least Mexicans Central Americans

9
Beware of Generalizations!
  • Puerto Ricans higher rates of asthma 1 in 5
    Puerto Rican children suffer from asthma vs 1 in
    10 Hispanic children overall
  • Diabetes and obesity are significantly highest
    among Mexicans, Salvadorans other Central
    Americans.
  • Puerto Ricican men more likely than other
    Hispanics to contract HIV from injection drug
    use sexual contact with other men is the primary
    cause among Mexican men.
  • New immigrants healthier than U.S.-born
    Hispanics a diet high in fruits vegetables
    active lifestyle before coming to the U.S. vs a
    diet high in sugar and processed foods and
    sedentary lifestyle

10
Hispanic Demographics Emphasizing
Diversity Virginia Charlottesville/Albemarle
11
Immigrant Demographics - Virginia
  • One in 10 Virginians is foreign born
  • Top five countries of origin El Salvador,
    Mexico, Korea, Philippines India
  • Most densely populated areas Arlington
    Alexandria (20), Harrisonburg (9), and
    Charlottesville, Richmond, Virginia Beach
    Winchester (6)

12
Latino Demographics - Virginia
  • Almost 500,000 Latinos
  • Over half are Mexican the rest are largely
    Salvadorans, Guatemalans Hondurans
  • Half are U.S. born citizens and another 13 are
    naturalized citizens. The rest have or do not
    have legal authorization to live here. 85 of
    Virginias Latino children under 18 are U.S.
    born.
  • Adult Hispanic citizens surpass Virginians
    overall in levels of educational attainment and
    household income

13
Latino Demographics Cville Predominant
Countries of Origin
Mexico
El Salvador
Honduras
14
Latino Demographics - Cville
  • 5 6,000 Latinos reside in the Cville-Albemarle
    area
  • Many newcomers (young, single Salvadoran men
    young, single Honduran women with children
    single indigenous Mexicans in Cville )

Guatemalan Jaime Reyes at his Mexican store on
Carlton
15
Latino Demographics Cville Our Latino adults
are mostly
  • undocumented
  • 20-40 years of age
  • rural poor
  • have low literacy levels in Spanish and speak
    little or no English
  • have low acculturation

Typical Salvadoran town
16
Latino Demographics - Cville
  • With few exceptions, our Latino children are U.S.
    born and bicultural school age children speak
    Spanish at home and English elsewhere.

Southwood Trailer Park (Albemarle County)
Resident
17
Latino Demographics Cville Our Latino
adults have limited or no experience with
  • Government offices, documents (birth
    certificates, licenses, etc), regulations
    procedures
  • Bank accounts, being paid by check
  • Doctors, hospitals health insurance

18
Our Latino Residents are unaccustomed to
  • modern conveniences, from credit/debit cards
    to gas or electric ovens, home heating air
    conditioning, indoor plumbing, and washing
    machines
  • concepts of punctuality or planning ahead

Washing Clothes in El Salvador
19
Health Care Disparities Common Sources
  • Poverty
  • Unhealthy and crowded housing internally (lead
    piping and paint, mold, mildew, dust, and pest
    infestation) and externally (outdoor pollution,
    unsafe neighborhoods, limited access to green
    spaces and recreational facilities)
  • Poor transportation
  • Low educational levels and literacy rates
  • These conditions are worse for Latinos because of
    language, immigration status and cultural
    idiosyncrasies

20
Health Care Disparities Latinos
  • Employment
  • Overwhelmingly represented in the construction,
    agriculture and hospitality industries where job
    hazards are high
  • Latino workplaces less likely to comply with
    health and safety laws and to provide workmans
    compensation
  • Unaware of rights and afraid to complain less
    likely to receive treatment for job related
    injuries and illnesses.

21
Health Care Disparities Latinos Limited health
insurance coverage
22
Health Care Disparities Latinos
  • Trauma
  • separation from family in country of origin
  • with war or natural disasters
  • being in a country with different and often
    conflicting customs
  • from linguistic isolation
  • from anti-immigrant sentiments
  • fear or embarrassment of asking or disagreeing

23
How Latinos frame a condition and different
notions of what causes illnesses
  • cultural misperceptions (hot/cold)
  • superstitions (mal de ojo)
  • religious beliefs (deliberate act of God,
    fatalism)

24
Traditional health providers folk healers or
spiritualists
  • curanderos who use plants herbs, massages and
    spiritual rituals
  • corner store or pharmacy self-medicating
  • cultural attitudes about the use of traditional
    vs conventional medicine

25
Cultural attitudes Fear and mistrust of doctors
and medical staff
  • unaccustomed to interacting with them
  • socioeconomic, cultural language differences
  • unease and distrust of impersonal interactions
  • perceived real anti-immigrant sentiments
  • undocumented immigrant status

26
Cultural attitudes Traditional ideas
  • importance of family
  • gender roles
  • taboo to think or talk about breasts, private
    parts, and sex (feeling uncomfortable about
    exposing the body, ignoring and denying problems
    because of shame)

Rosa Galvez, her mother, and husband at their
Central American store off Rt 29
27
Health Care Disparities Latinos
  • Institutional Disparities
  • Underrepresentation of bilingual (Spanish
    speaking) and bicultural (Latino) doctors and
    other medical staff (5 of physicians, 3
    dentists 2 nurses)
  • Few, inadequate or no language access resources
    (bilingual staff, trained interpreter services)
  • Healthcare provider biases (racial, language
    differences, immigrants, undocumented immigrants)
  • Lack of cultural awareness

28
What our Latino patients need from us
  • Be respectful establishing a relationship
    before the consultation tone (not treating adult
    patient like a child) asking if the patient
    wants family members present
  • Be warm and friendly maintaining smiling and
    direct eye contact minimizing physical distance
    and other appropriate caring gestures (touching)

29
What our Latino patients need from us
  • Acknowledge family members Be receptive to
    their suggestions and consider including them in
    consultations, keeping in mind potential gender
    role dynamics and whether they may influence the
    consultation.
  • Use trained, gender appropriate medical
    interpreters, ideally bicultural, while
    maintaining eye contact with your patient

30
What our Latino patients need from us
  • Ask patients what they believe caused their
    illness and then explain the medical reason for
    the illness. Recognize they may not agree with
    you about the cause or treatment.
  • Avoid technical jargon and explain conditions,
    treatments and prescriptions in ways that can be
    understood.
  • Dont take yes as an answer. Ask open-ended
    questions, such as, please describe what you are
    feeling, rather than do you have pain? Ask
    patients to repeat back health information to
    ensure understanding.

31
What our Latino patients need from us
  • Provide written materials with pictures and
    minimal verbiage
  • Educate patients about diet and exercise and the
    importance of immunizations, screenings, and
    other preventative strategies
  • Explain how to navigate your health care facility
    and why being on time for visits is important
  • Advise clients of language access resources
    (Spanish phone message line, bilingual staff,
    interpreter services) to schedule appointments,
    find out about test results, or to leave
    messages.

32
Appendix 1 Suggested follow up
  • National Library of Medicine
  • Search terms latino health, hispanic health
  • http//www.nlm.nih.gov
  • Pew Hispanic Center
  • http//pewhispanic.org/reports/report.php?ReportID
    113
  • National Council of La Raza
  • http//www.nclr.org/content/policy/detail/51846/
  • Cultural Competence Resources for Health Care
    Providers/ USDHHS
  • http//www.hrsa.gov/culturalcompetence/

33
Appendix 1 Suggested follow up
  • CLAS - Culturally and Linguistically Appropriate
    Health
  • Care Services for Virginians. A web site
    designed to assist healtcare
  • providers in delivering culturally competent care
    for their limited English
  • proficient patients. It contains many commonly
    used phrases in the
  • clinical setting, their Spanish translations, and
    audio files where
  • listeners can practice correctly pronouncing
    these phrases.
  • http//www.vdh.virginia.gov/ohpp/clasact.asp
  • CDC (in Spanish)
  • http//www.cdc.gov/spanish/
  • Medline Plus (in Spanish)
  • http//medlineplus.gov/spanish/

34
Appendix 2 Linda Hemby
  • Political Sociologist, BA (University of
    Michigan), MA and two years of doctoral
    coursework (University of California, Santa Cruz)
  • Dual Citizenship U.S. and Salvadoran
  • Bilingual (English/Spanish) bicultural
    (U.S./Salvadoran)
  • Single parent of a Salvadoran boy
  • Activist in the local Latino community
  • Contributor to Nuevas Raíces newspaper
  • Albemarle Social Services Employee
  • Member, Executive Committee of Creciendo Juntos,
    coordinator of its web site and weekly email
    bulletin, and its Southwood expert
    www.cj-network.org
  • In Latin America directed regional
    anti-corruption and free press projects author
    researcher lobbyist university professor and
    human rights/social justice activist
  • In US D.C. Office of Human Rights (Title VII
    agency) and social justice activist
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