The Hispanic/Latino Community in Cincinnati: Culture and HealthFebrero,2011

Ligia Gómez,MA

Why is Cultural Competency Important? Illness and disease perception vary by culture Diverse belief systems exist on health, healing and

wellness Cultural attitudes affect physician-patient

relationships Patients may seek complementary and alternative

health therapies which are unfamiliar to the physician or health care professional

Health disparities exist…

Immigrants and their descendants constitute the majority of the population of the U.S.

They arrive with suitcases full of dreams…

The U.S. and Immigrants

Immigrants to the U.S. Hopes of…

-New economic opportunities-Good schools for their children-More money-Greater peace of mind

They also bring…-Their own lifestyles-Habits-Dietary Customs-Genes

Demographics

~46MM Hispanic/Latinos in the US: 16% of total

Largest U.S. Minority Fastest growing

minority: By 2020, 1 in 5 people in

U.S. will be Hispanic or Hispanic descendant

By 2050, 25% of U.S. will be Hispanic

Distribution of Hispanics in USA

Hispanics in the Cincinnati Area

>50,000 Hispanic/Latinos in Cincinnati region (8 counties)

Almost half of Cincinnati area Hispanics (20,000) are under age of 18

Source: Center for Family and Demographic Research, BGSU

Hispanics in the Cincinnati Area

Most are from Mexico and Guatemala

Areas of concentration: Springdale, Hamilton, Sharonville, Norwood, Fairfield, Lower Price Hill, Covington, Florence.

Why Hispanics are coming

Seeking economic opportunities

War, oppression Political instability

in their countries

Where They Come From

Hispanic immigrants have diverse origins: cosmopolitan cities and rural areas

Mexicans Since 1948 migration

to and from the U.S. has continued largely uninterrupted

Mexicans make up over 66% of the U.S. Hispanic population

2 million seasonal workers

Primarily work in agriculture, restaurants, construction

Puerto Ricans

2nd Largest group U.S. citizens at birth 4% of the Hispanic

Population in U.S. Come to U.S. seeking

employment, higher education, better quality of life

Cuban-Americans

4% of Hispanic Population

First wave had high level of education and income

Cuba 90 miles from Key West

Main reason for immigration: Desire for personal

freedom Political exiles

seeking refuge Promise of economic

opportunities

Central Americans

Economy tends to be unstable: depends on few

agricultural exports owned by small segment of society

Immigrate to: Find refuge from

violence: El Salvador, Nicaragua

Seek economic stability

South Americans Colombia, Venezuela,

Ecuador, Peru, Chile, etc. Longer journey than from

Mexico and Central America: Arrive via plane: tend to

have higher socioeconomic level

Migrate because of: economic opportunities political instability Pursuit of higher

education

Photographs: Ronald de Hommel

Hispanic Culture Culture is the sum of beliefs, practices, habits,

customs, rituals and so forth that are passed to us by our families and society

Core Values of Hispanic/Latino Cultures

La Familia (Family)

Respeto (Respect)

Personalismo (Personal relationships)

Confianza (Trust)

La familia (family):the most important social unit Include parents,

grandparents, siblings, aunts, cousins, compadres (close friends), godparents (padrinos)

Emphasize interdependence over independence, cooperation over competition

Respeto

Dictates appropriate behavior towards others base on age, sex, social position, economic status and authority.

Health providers are given a high level of respect.

Elders are highly respected

Personalismo Personal rather than

institutional relationships Hispanics expect health

providers to be warm, friendly and to take an active interest in the patients life

Closer physical space Attuned to non verbal

messages When the provider shows

respect for the culture and shows personal interest wins their confianza (trust)

Integrated Health Hispanics tend to view

health from a synergistic point of view The body, mind and spirit

represent a continuum: all play important roles in health

Illness and death seen as normal part of life Strong belief in fate: Lo que

Dios quiera Curanderismo (folk healers)

and home remedies are highly respected

Acculturation The process of adopting aspects of the

mainstream culture. External acculturation: Changing food habits,

clothing, learning/adapting to the majority language.

Internal acculturation: Values and more complex patterns of behavior.

The Impact of Acculturation level: Diet

Low Acculturation

Related to healthier diets: Higher fiber, low fat diet

Higher consumption of fruits, vegetables, rice, meat, beans, whole milk

More likely to breastfeed

High Acculturation

Higher consumption of sweetened drinks

High levels of refined sugar

Higher consumption of fats

Lack of breastfeeding

Low intake of fruits and vegetables

Highly processed convenience foods

The Impact of Acculturation level on health indicators and outcomes Low

acculturation: Lower rates of

high blood pressure

Favorable cholesterol profiles

Low type 2 diabetes

Low mortality rate

Bicultural: Avoidance of high

energy food, saturated fats, cholesterol

Higher level of physical activity

High acculturation: Higher risk of

being overweight or obese.

Higher mortality.

Type 2 diabetes

Hispanic Paradox

-Higher poverty rates

-Less access to health care

-Worse health and nutrition outcomes: obesity and type 2 diabetes

-But: high life expectancy! Latinas:83.7; Latinos:77.2

Specific cultural factors may buffer the negative influence of poverty

Feeding in a cultural context

Mexican women place high value on child nutrition: important part of being a good mother

Chubby or overweight children are consider healthy

Skinny infants are unhealthy or sick

Eating Habits Meals are the central social activity of the family,

with family/community news and discussion:

Desayuno (breakfast): light meal that includes tortillas, coffee, chocolate, eggs, bread, etc

Almuerzo (lunch): main meal of the day; full menu followed by a siesta

Merienda (snack): coffee, tea, rolls

Cena: A light supper; may be as late as 9 pm

Teaching feeding practices While Hispanics share the

same language, their cultures frequently vary

Things to consider when planning educational programs:

Educational levels Language skills Income levels Cultural values

Barriers to Health Care and Health Services Cultural differences: concept of time Language Lack of health insurance Education Poor understanding of U.S. care system Poverty Transportation Immigration status Limited knowledge of resources Work schedule

Barriers: Insurance

44 million Americans are uninsured 14% of all Americans 12% of all children 40% of Hispanic adults 31% of Hispanic children

Barriers to health insurance: Employers don’t offer insurance Unaffordable Inability to complete paperwork (language, education) Immigration status

“We have to get beyond the cultural stereotypes

of the media and recognize that all our

patients are human beings. We all come

from the same place and have the same

dreams for our families and our future, and

we have to base our actions as health care

professionals on trying to provide the best

possible vision of healing in the very sacred

places where we do our work.”

-Pete Duarte, CEO Thomason Hospital, El Paso, TX