Diabetes Is 2 to 3 Times More Common Among Hispanics Than Whites; Cultural Understanding Could Combat It
Doctors and their Latino patients face barriers to effective diagnosis and treatment including lack of trust and understanding, personal biases and language that can undermine the care and health of millions of Americans.
Those barriers can be broken by providing cultural competence education to health care professionals, said the National Hispanic Medical Association (NHMA), which met in Washington for a congressional briefing July 22.
“If doctors knew that Hispanics tend to have a fear of insulin, blindness and tend to be more fatalistic when it comes to their health, they might be able to care for them better,” said Dr. Elena Rios, NHMA president. That cultural understanding could help combat diabetes in the Hispanic community, which is 2 to 3 times more likely to have the disease than non-Hispanic whites. Some 700,000 Hispanics have diabetes and don’t know it.
“There are 40 million Hispanic Americans today the largest ethnic group in the U.S.,” Rios said. “If we don’t understand how to serve this growing population, we can expect devastating health problems for the country at large and we’ll be doing a disservice not only to them but to the nation’s health. We want to work with federal officials to promote U.S. funded programs that can stem this tide and educate our doctors on the cultural differences of providing health care for Hispanics.”
For example, doctors must understand that Latinos tend to be more formal and less trusting when they first meet their physicians, unlike whites. Also, cultural barriers can lead to misdiagnosis, medical errors, lack of informed consent, poor compliance, patient mistrust, increased stress for the patient, malpractice claims and poor health outcomes. Those and other findings were presented at the congressional briefing.
Because many Hispanics are bilingual and Spanish is prevalent among the population, it is critical to provide training for physicians and medical students about the proper use of interpreters, Rios said. Some 32 million Americans speak a language other than English at home, with Spanish being the main other language.
“We understand that if patients are going to receive quality health care in hospitals, we have to make our patients feel comfortable with doctors, nurses and other staff,” Karen Scott Collins said. “When patients don’t feel comfortable, they are reluctant to ask a question. Recent studies have shown that in 24 percent of the cases with Spanish-speaking patients, they won’t even ask a critical question.”
“It is critical that we educate and train a more diverse workforce, particularly physicians and nurses of color, whom we need desperately to deliver culturally competent health care and to help eliminate the racial and ethnic health disparities that threaten our nation’s health and well-being,” said Robert K. Ross, MD, president and CEO of The California Endowment. “We strongly urge medical and health professional schools, as well as undergraduate institutions, to continue to actively recruit and enroll underrepresented minority students.”
Rios said NHMA and The California Endowment have entered into a two-year partnership to educate Congress and policymakers on four priority areas: access to health care, racial and ethnic health disparities, increasing diversity in the health care workforce and increasing cultural competence and language services.
“NHMA applauds Congress for making critical changes in the Medicare program and the prescription drug program,” Rios said. “But if we don’t provide that information or market the benefits of these programs in Spanish and have translators to communicate that information to patients, Hispanics will be left out.”
Rios said NHMA wants to encourage policymakers to improve Medicare policies and to include reimbursement and financial incentives so doctors can more readily work in underserved areas. NHMA also wants cultural competence extended to hospitals so they can be reimbursed for having translators available for Hispanic patients.
NHMA also would like the administration to restore Medicaid coverage to expectant mothers so they can receive prenatal care and immigrant children, so they can receive immunizations, regular checkups and preventive care.
“Cultural competence is more important than ever with new statistics showing that one in six children in the United States is Hispanic, and by 2020 the number is expected to be almost one in four,” Rios said. “Those children deserve a brighter, healthier future.”