Health Disparities and
Disabilities among
Hispanic Populations
Lucy Wong-Hernandez, M.S.
School of Allied Health Sciences
East Carolina University
&
Monica Carrion-Jones, MD
Physical Medicine and Rehabilitation
Brody Medical School
East Carolina University
1
Objectives

Identify the target population

Identify health disparities among this population

Causes of Health Disparities and Disabilities

How can we decrease the gap
2
Hispanic Population

This ethnic group includes any person of
Cuban, Mexican, Puerto Rican, South or
Central American, or other Spanish culture or
origin, regardless of race.

According to the population estimates of the
U.S. Census Bureau review of 2006, there
are approximately 42.6 million Hispanics in
the U.S. (14% of total population).
3
Health Disparities
As define by the National Institute of
Health (NIH)
“…health disparities indicates differences in the





incidence,
prevalence,
mortality, and
burden of diseases and other adverse health
conditions that exist among specific
population groups in the United States."
4
Where are the Hispanics?
5
Areas of Health Disparities
 Cancer
 Immunization
 Diabetes
 Infant
 Heart
Disease
 HIV/AIDS
Mortality
 Stroke
 Asthma

Work-Related Injuries
6
Cancer

In 2003, Hispanic men were 19% less likely to have
prostate cancer as non-Hispanic white men.

In 2003, Hispanic women were 39% less likely to have
breast cancer as non-Hispanic white women.

Hispanic men and women have higher incidence and
mortality rates for stomach and liver cancer.

In 2003, Hispanic women were 2.2 times as likely as
non-Hispanic white women to be diagnosed with cervical
cancer.
7
Diabetes

In 2003 Mexican American adults were 2 times
more likely than non-Hispanic white adults to
have been diagnosed with diabetes by a
physician.

In 2002, Hispanics were 1.5 times as likely to
start treatment for end-stage renal disease
related to diabetes, as compared to nonHispanic white men.

In 2003 Hispanics were 1.5 times as likely as
non-Hispanic Whites to die from diabetes.
8
Heart Disease

In 2004, Hispanics were 10% less likely to have
heart disease, as compared to non-Hispanic
whites.

In 2003 Mexican American men were 30% less
likely to die from heart disease, as compared to
non-Hispanic white men.

Mexican American women were 1.2 times more
likely than non-Hispanic white women to be
obese.
9
HIV / AIDS

Hispanics accounted for 18% of HIV/AIDS cases in
2004.
 Hispanic males had over 3 times the AIDS rate as nonHispanic white males.
 Hispanic females had over 5 times the AIDS rate as nonHispanic white females.


Hispanic men were 2.7 times as likely to die from
HIV/AIDS as non-Hispanic white men.
Hispanic women were 4.5 times as likely to die from
HIV/AIDS as non-Hispanic white women.
10
Immunization

In 2004 Hispanic adults aged 65 and older were 20%
less likely to have received the influenza (flu) shot in
the past 12 months -- as compared to non-Hispanic
whites of the same age group.

In 2004, Hispanic adults aged 65 and older were 40%
less likely to have ever received the pneumonia shot,
-- as compared to non-Hispanic white adults of the
same age group.

Although Hispanic children 19 to 35 months old had
comparable rates of immunization for hepatitis,
influenza, MMR, and polio -- they were slightly less
likely to be fully immunized, when compared to nonHispanic white children.
11
Infant Mortality

In 2003, infant mortality rates for Hispanic
subpopulations ranged from 4.6 per 1,000 live births to
8.2 per 1,000 live births, compared to the non-Hispanic
white infant mortality rate of 5.7 per 1,000 live births.

In 2003, Puerto Ricans had 1.4 times the infant mortality
rate of non-Hispanic whites.

Puerto Rican infants were 2.1 times as likely to die from
causes related to low birth weight, as compared to nonHispanic white infants.

Mexican American mothers were twice as likely as nonHispanic white mothers to begin prenatal care in the 3rd
trimester, or not receive prenatal care at all.
12
Asthma
 During
1993-1995 in the northeast U.S.,
Hispanics/Latinos had an asthma death
rate of 34 per million -- more than twice
the rate for white Americans (15.1 per
million).
13
Work-Related Injuries

Mexican foreign born workers accounted for
more than two thirds (69 percent) of the 2,440
fatally injured, foreign born workers between
1995 and 2000.
 Lower percentages of fatally injured workers
came from Cuba (146 or 6 percent), El Salvador
(131 or 5 percent), Guatemala (90 or 4 percent),
and Dominican Republic (87 or 4 percent).
14
Stroke
 In
2003, Hispanic men were 20% less
likely to die from a stroke than nonHispanic white men.
 In
2003 Hispanic women were 30% less
likely to die from a stroke than nonHispanic white women.
15
Causes of Health Disparities

Socioeconomic factors

Lifestyle behaviors

Social and built environment

Access to preventive health-care services

Access to affordable health insurance
16
Socioeconomic factors
 Education
attainment
 Employment
 Poverty
 Insurance coverage
17
NO Usual Place of Care
(Preventive care in a clinic or health center VS. doctor’s office)
Race/Ethnicity
Hispanic/Latino
Women
Non-Hispanic
White Women
Non-Hispanic
Black Women
Percentage
56.4%
41.4%
40.9%
18
NO Health Insurance Coverage
Hispanic/Latino
U.S. Born
Percentage
18.3%
Foreign-born U.S.
Citizen
Not U.S. Citizen
22.0%
51.9%
19
Lifestyle behavior
 Lack
of physical activity
 Alcohol
intake
 Smoking
 Food
intake (diet)
20
Social Environment
 Educational
and economic opportunities
 Racial/ethnic discrimination
 Neighborhood and work conditions
 Lack fluency in English
 Lack of familiarity with the U.S.
health-care system
21
Access to preventive
health-care services
 Cancer
screening
 HIV screening
 Vaccination
 Pre-natal care
22
What is happening in NC?
23
Social and economical well-being
24
Maternal care
25
Adult Health
26
Communicable diseases
27
Adult Health
28
Violence and Injuries
29
Health Promotion
30
How do we eliminate the GAP?
Increment National Standards on
Culturally and Linguistically Appropriate
Services.
 Community education that involves all
members of the community
 Knowing the problem and the causes
(Research).
 Promoting preventive health care that is
also culturally sensitive.

31
DISABILITY
AMONG HISPANICS
****
32
Disability
Overview:
 Disability Definition
 Access & Challenges
 Health & Disability Disparities Issues
 Cultural Sensitivity & Competency
 Recommendations for Research
33
DISABILITY

Disability definition:


The condition of having a disability or limitation.
The period or length of such a condition

A disadvantage or deficiency, especially a physical or
mental impairment that interferes with or prevents
normal achievement in a particular area or major life
activities of the individual.

Law: A legal incapacity or disqualification.
34

In 2005, an estimated 20.6% civilians not living in an
institution (or 53.9 million people) met the criteria for
disability.

Women and girls with disabilities are estimated to
number 28.6 million, which is 21.3% of the female
population.

An estimated 25.3 million men and boys with
disabilities make up 19.8% of the male population.

One in five Americans has a diagnosed disability;
more than half of those with disabilities are female.
35
Americans with and without disability by gender
36
Females report more limitations in old age,
while males report more limitations in youth.
37
Disabilities in NC
 Approximately:
1,139,375 adults 18 and
over experience a disability.
 Representing
 Women:
 Men:
18.3% of the population
19.4% or 648,215
17.0% or 491,160
38
Disabilities in NC
Rate by Age:
Rate by Race & Ethnicity:
 Age 5 to 20 = 7.4 %
 Age 21 to 64 = 14.4%
 Age 65 and over = 43%  Hispanics 13.8%
 Whites non-Hispanics 18.5%
 Blacks 19.1%
Causes:
 Native Americans 23.5%
1. Genetic
2.
3.
4.
Work related injuries
Automobile and
industrial accidents
Environmental
contamination
39
Demographic Trends

It is projected that by the year 2020, --- 30% of the new workers
entering into the labor force will be people from diverse cultural
and ethnic backgrounds --- also classified as people from minority
backgrounds.

According to data from the Department of Labor:
There is a higher incidence of work disabilities among minorities:

13.7% --- of African Americans
8.2% --- of Hispanic Americans
AS COMPARED TO:
ONLY 7.9% --- of White Americans
who acquired a work related disability.
40
What is Culture?
•
•
Culture is a collective reality of a group of people --- and
it is from this collective reality --- that attitudes,
behaviors, and values are formed and become
reinforced among a group of people.
Culture is commonly held
characteristics such as beliefs,
values, customs and patterns
of behaviors held by a group,
which has been learned and
reinforced through a socialization
process.
41
Hispanic / Latino

The Hispanic American population: is the fastest
growing and most diverse ethnic group in the U.S.

According to the latest US Census report of 2000 --- and
its latest revision (2005) – the U.S Hispanic or Latino
population is projected to grow from 31.7 million (12% of
the population) in 1999 -- to 98.2 million (24% of the U.S.
population) by 2050.

This indicates the Hispanic American population has
grown over 7 times ---- and as fast as the rest of the
nation --- between 1980 to 1990 and 1990 to 2005.
42
Hispanic

Hispanic is not a racial group – it is an ethnic group
(including White Europeans, Blacks, Asians of various
ethnic groups including indigenous and “mestizos”).

Hispanics are united by a common language – but not all
Hispanics are fluent in the Spanish language.

15.3 % --- have some type of disability (US).

They are mostly affected by what is labeled as
“preventable causes of disability.”
43
Access to Health Care among
Hispanic Women: U.S., 2000-2002*
Among the nation’s 33.4 million Hispanic women:
•
31% do not have health insurance coverage;
• 20% do not have a usual clinic to go for medical
care; and
• 22% experienced unmet health
care needs during the past year
due to cost.
*Centers for Disease Control and
Prevention (CDC, 2005)
44
Lack of access to health care
creates health disparities.
45
What is “Health Disparity?”
A health disparity is a difference in health
status that is persistent across subgroups of
a population.
Source: http://www.health.state.mn.us/
46
Consequences of Health Disparities

Absence of and poor health care contributes to chronic
illnesses.

Chronic illnesses become permanent disabilities.

Disabilities may become complicated by secondary
disabling conditions.

There is close correlation between disability and poverty.

25% of the population diagnosed as disabled is living at
poverty level or lower.
47
Barriers Affecting Hispanics with
Disabilities
Attitudes
Services
Provided
Resources
Employed
Outcomes
48
Health Disparities among
Persons with Disabilities





Less health insurance coverage and use of the
health care systems.
Higher rates of chronic illnesses and secondary
conditions.
Lower rates of social participation.
Lower rates of recommended health behaviors
(e.g. smoking cessation, diet, etc).
Less participation in health screening (women
with disabilities).
49
Health & Disability Disparities

Over 53 million Americans have either a severe
or a non severe disability

Disparities in rates of disability are pronounced
for culturally diverse groups

Hispanic Americans with disabilities are second
to African Americans with disabilities with a
20.0%
 Self-reported health status is one of the lowest
at: 30.4% for Good and 47.7% for Poor health.
50
Health & Disability Disparities:
Social and Economic Burden
 Persons
with disabilities are less likely to
be meaningfully employed.
 Severity
of disability impacts employment
status -- as well as quality of employment.
 Women
with disabilities are at higher risk
for unemployment and low socioeconomic
status.
51
Cultural Sensitivity
A good starting point to implement good
practices of health care services and improve
health equity -- begins with Cultural Sensitivity:

Being aware of your own cultural feelings and
that of others.
 Respect to cultural implications.
 Reasonable accommodations and flexibility.
 Culturally based services and outreach.
52
Cultural & Disability Sensitivity

Persons with disabilities
are people first -equally deserving
respect and quality
health care.

Having a disability is
only one aspect of a
person's life
53
Cultural Competence

Individual -The ability to communicate effectively
with individuals representing diverse racial and
ethnic heritages.

Organization -The ability to be responsive to
diverse cultural, ethnic, or linguistic clientele.

Research - evaluate changing demographics,
culturally-based consumer-centered services,
and validation of best practices as key for
increasing cultural competence.
54
Why is Cultural Competence
important to avoid health
disparities?
 Patient
diversity
 Concepts of illness and healthcare
 Changing expectations in
the medical and other
health care fields.
55
Unequal Treatment: Confronting Racial and
Ethnic Barriers in Health Care, (CDC. 03.2002)
56
Important cultural factors for providing
services to Hispanic Americans





Perception of health and disabilities varies.
Cultural perception of mental illness may cause
difficulties in identifying and gaining support from the
family.
Long-term rehabilitation and lack of coping skills may be
treated as being “weak” or “irresponsible”.
If disability may be perceived as something that cannot
change (fate) and efforts are placed on adjusting vs.
treatment and rehabilitation.
Endurance is a cultural value.
57
Hispanic Family
 Traditionally, members of the nuclear
family are the most important source of
support and guidance in many different
situations.
 The extended family and friends safety-net
is an additional support system.
 Outside help is avoided if possible with the
exception of Clergy or Doctors.
58
 The
idea of needing
"professional counseling,
therapy or social services" has certain
negative connotations --- not very
appealing to a traditional Hispanic family.
 The
perception of service systems is
directly affected by their cultural values
and beliefs.
59
Common Emotional Reactions of
Family Members
 Take
into consideration the impact of
disability on the family and the family role
of the person with the disability.
60
Common Emotional Reactions of
Family Members
 Depression:
Depression is a common and long-term
consequence of disability. Depression
may be expressed as anger.
61
 Anxiety:
Anxiety is a common reaction
to the chaotic change and
uncertainties that follows the onset of a
disability.
Challenges with emotional liability and
coping with the situation can create an
atmosphere of sustained anxiety.
62
 Anger:
Anger has been reported as a common
consequence of injury related disability
and to frustration.
63
 Prolonged
Emotional Distress:
The effects of adjusting to a disability may
persist for a long time. Physical
and mental exhaustion can reduce
coping ability, diminish hope,
and exacerbate emotional distress.
64
Working with Culturally, Ethnically and
Linguistically Diverse Groups

Identify the cultural and linguistic background of
the individual with the disability and his/her
immediate family members.

Learn about their culture, beliefs, and values
and how these affect their attitudes toward
disabilities.

Understand the cultural implications and how
individuals manage mental and physical
illnesses.
65
Language Barriers
 Use
qualified interpreters and translators
with appropriate training.
 Preferably a person that is not related to
the individual.
 Adopt the Standards on
Culturally and Linguistically
Appropriate Services (CLASS)
66
Research Needs to Eliminate
Health & Disability Disparities
 Cultural
Competence
 Culturally based health care practices
 Community Participation
 Capacity
to respond to the increasing
needs of the Hispanic population in
reference to prevention, health care and
eliminating health and disabilities
disparities.
67
Recommendations for Future
Research -- Cultural Competence

Evaluate the needs
for Cultural
Competence training.

Evaluate the
outcomes of Cultural
Competence in
service delivery.

Examine the
awareness and
application of cultural
factors.
68
Recommendations for Future
Research -- Community Participation

Evaluate accessibility
in private and public
health care sectors.

Evaluate Health and
Wellness educational
services for youth and
adults with
disabilities.

Evaluate the effects
of lack of education
and training on
service provision.

Research the impact
of collaboration of
community
participation.
69
Recommendations for Future
Research -- Resources

Research the effectiveness of skills development
models for research related to health and
disabilities.

Examine how community-based research
methods provide insight to eliminate health and
disability disparities.

Identify partnership models that can be
developed to facilitate knowledge transfer.
70
Final Thoughts

A “one size fits all” health care system cannot meet the
needs of an increasingly diverse American population.

Rather than making assumptions, take the time to
uncover the information you need while fostering a
working rapport with culturally diverse clients/patients.

It is within our power to make a change and narrow the
gap of health and disabilities disparities.
****
71
References


E-mail: jonesmo@ecu.edu
E-mail: wongl@ecu.edu

https://cccm.thinkculturalhealth.org
A Physician’s Practical Guide To Culturally
Competent Care
www.ncminorityhealth.org

N. C Office of Minority Health and Disparities

www.omhrc.gov
National Office of Minority Health
 www.cdc.gov
CDC, 2006
 www.census.gov US Census Bureau review 2005 (a)
72

MULTUMESC
73