Hispanic Health Care Realities and Opportunities for the Future

The dreary news first. Hispanic health realities are dismal for many in this country. The reasons stated include far too many Hispanics living in poverty, their inability to access assistance and inferior health care systems. It's getting better but progress is slow and the scars are deep.

Latino Health Disparities

In 2014, Families USA published "Latino Health Disparities Compared to Non-Hispanic Whites." It lists health disparities which undermine the stability of Hispanic families and communities.

Latinos are more likely to suffer from a greater variety of health conditions and they are more likely to get sicker, develop serious complications and not infrequently die from them.

Here are the most common problems:

* Hispanics are twice as likely to contract asthma.

* Hispanics are six times more likely to have tuberculosis.

* Hispanics are 15 times more likely to suffer from liver disease. This is particularly noted among those recent immigrants who may be heavy drinkers and smokers. Many agricultural workers perhaps due to environmental realities, insecticides and other chemicals, suffer from liver and kidney problems.

* Hispanics are 55 percent more likely to have deadly renal end diseases.

* Hispanics are 2.5 times more likely to die from HIV. Cultural machismo and embarrassment have kept many victims from coming forth and seeking treatment in a timely fashion.

* Sixty-five percent, male and female, are more likely to develop diabetes.

Hispanic Children

Children face a variety of serious health obstacles. Thirty percent are more likely to die as infants than Anglo children. Sixty percent are more likely to attempt suicide in high school, and 35 percent are likely to be obese. The need for serious restructuring of the health care system is obvious.

In January of 2015, The University of California -Los Angeles published a study about Hispanic health from the prospective of the changing Latino demographic in the United States.

That cohort presents a number of challenges to health care policy and led scientists Alexander N. Ortega, Hector P. Rodríguez, and Arturo Vargas Bustamante to study the issue. They noted previous studies had demonstrated that "Latinos tend to have the worse patterns of access to, and utilization of, health care than any other ethnic or racial group."

It is hoped that with the implementation of the Affordable Care Act (ACA) some of the age old inequities will be addressed and ameliorated. However, even with the ACA, it is expected that Latinos will continue to have problems accessing high-quality health care, especially in states that are not expanding Medicaid eligibility as provided by the ACA.

The report identified four current policy dilemmas relevant to Latinos' health and ACA implementation:

(a) the need to extend coverage to the significant number of undocumented residents;

(b) the impact of growth of Latino populations in states with limited insurance expansion;

(c) demands on public and private systems of care; and

(d) the need to increase the number of Latino physicians while increasing the direct patient-care responsibilities of non-physician Latino health care workers.

Let me end this dismal litany on a lighter note: sedentary life.

For a number of years, Allied Health professions have circulated study after study strongly suggesting that a sedentary existence can lead to a series of cardiovascular diseases and premature death.

People, it is generally recognized, can be grateful for their inherited genes. Good genes will pull you through many childhood diseases. Even our adult years are heavily influenced, read protected, by the genes we inherited. But as we age, into our 60s, their influence can be diminished by our lifestyle choices. Smoking, excessive drinking, and poor eating habits wreck their havoc on us in our later years. We can no longer count on good genes to pull us through.

In retirement, heretofore recommended behavior characterized by sedentary living is now being criticized by health professionals. Instead one is now encouraged to be as active as possible, walking, swimming, dancing and just moving the body regularly is highly recommended.

At least that has been touted for the general population. I wondered if any studies had been done on Hispanics.

I searched and found that earlier this year, the American Health Association did indeed issue a report based on research conducted among Hispanics. Titled "Sedentary Behavior and Cardiometabolic Risk Factors Among US Hispanic/ Latino Adults: The Hispanic Community Health Study/Study of Latinos." Dr. Qibin Qi, et al.

Between 2008 and 2011, sedentary behavior and diminished physical activity were measured among 12,443 Hispanic participants between the ages of 18 and 74 years from households in four cities. Participants wore an accelerometer at least 10 hours a day for at least three days.

What were the results? Once again Hispanics led the pack. "Sedentary time is high among U.S. Hispanic/Latino adults. Which leads to adverse cardiometabolic biomarker profiles."

The researchers strongly recommended that Hispanics "change their sedentary behavior to reduce deadly diseases."

We just can't win!

Higher Education

Is there light at the end of the tunnel? As readers of Hispanic Outlook know, Hispanics participation in higher education has grown tremendously over the past few decades. Every year more Hispanics attend college and more graduate. Many have gone on to notable careers in all professions.

But, as noted in previous columns I've written, an educational attainment gap with other Americans still exists and some studies indicate the gap is growing.

What about Hispanics and the health fields?

Luckily, Excelencia in Education, the respected Washington D.C.-based research and advocacy organization has just published Finding Your Workforce: Latinos in Health.

This 20,000 word document is a treasure house of information. I have studied it and present some key points. For those who want more details, the entire document can be downloaded at www.EdExcelencia.org

Overview

Health needs will continue to grow as the nation ages, as many companies and public agencies provide good health plans and as the Affordable Care Act surges to cover hundreds of thousands of individuals.

These needs and changes in the ever-growing health fields are spawning a veritable revolution of opportunities.

Thus a variety of education opportunities for Hispanics to meet health needs are sprouting up nationwide.'

The authors of the Excelencia study, Deborah A. Santiago, Emily Calderón Galdeano, and Morgan Taylor, present a detailed overview of Hispanics working in these burgeoning fields. As is well known, Hispanic presence is minimal, not enough to meet the needs of present-day Hispanics, much less the ever-growing demands that are developing.

The authors suggest specific steps the academic community and the public in general should undertake to prepare for the future. They wisely highlight a number of realities such as the one of proportionality that I have been writing about for 25 years. To wit: too few Hispanics enter the higher level health professions, MDs, etc.

A single example, although the number of Hispanics studying nursing increases every year, they are concentrated at the lower levels, such as certificate and two-year associate level diplomas not bachelor of nursing or graduate programs.

Follow the Money!

Fourteen of the top 20 occupations in the U.S. with the highest median annual income in 2012 were in health professions, such as dentists, physicians, and surgeons.

Health professions requiring advanced degrees (MD or PhD) have median annual salaries from $80,000 to over $185,000.

Conversely, six of the 20 fastest growing health care occupations had lowest annual pay. They are personal care aides, home health aides, and physical therapist aides.

Their median annual pay is from below $20,000 to around $32,000.

The entry-level education required for these health care support occupations is less than high school, a high school diploma or a certificate. As noted most Hispanics are at these lower levels. The die is cast, but it can and should be changed.

Exceptionality

Most Hispanic college students are first generation and many have to work to support themselves. Some face cultural, family or neighborhood, pressures they must overcome. Many attended less than stellar high schools.

They are as bright as any other cohort but their exceptionality must be addressed if they are to succeed. Not to do so will doom too many to the failure-laden sink or swim environment of the past.

Luckily, a number of very good higher education institutions have developed programs that successfully educate and graduate Hispanics at all health-profession levels.

This study highlights some of them and those institutions have been generous in sharing their strategies and experiences in the hopes of encouraging other institutions. (See cited download for details.)

The task of recruiting more Hispanics for all professional health levels and helping them through graduation is a formidable one but clearly a needed one. How to begin?

Some Strategies for Institutions

1. Engage alumni to share workforce experiences and employment opportunities.

2. Develop closer links between academic departments and student career services.

3. Workforce councils should establish relationships to connect graduates to employers within the institution's service area.

4. Apprise students of employment opportunities and salary ranges in various professions to encourage them appropriately.

These goals may seem familiar to many readers for most of our institutions have adopted them or a variation thereof. They are common sense suggestions which have worked at some institutions but many lost their initial vigor and the goals were sloughed off. Persistence is the glue that is necessary to succeed.

The Power of Population Changes

Malthus was wrong about the world not being able to absorb enormous population changes. This nation has and more is yet to come.

By 2020 Hispanics are projected to account for 75 percent of the nation's labor force's growth. In spite of jingoistic rants, most of those Hispanics are native born.

Over 20 percent of babies born in the United States are born to Hispanic mothers. These infants and mothers can be better served if their health care providers shared linguistic and cultural backgrounds.

Which institutions graduate the most Hispanics in health fields?

In 2013 only a few conferred degrees in health fields. The top 25 institutions offering Latinos health field education awarded more than 25 percent of all health credentials to Hispanics in 2013.

In 2013,16 of the top 25 institutions conferring bachelor degrees to Latinos in health fields were Hispanic-Serving Institutions. That is colleges whose student body is at least 25 percent Hispanic.

Other Data

The top 25 institutions at each academic level were primarily located in three states - California, Texas, Florida - as well as Puerto Rico.

The top 25 institutions at the doctoral level awarded 66 percent of all doctoral degrees in health fields earned by Hispanics in 2012-13.

Several of the top 25 institutions graduating Latinos in health fields in 2012-13 stand out at multiple academic levels. For example, Miami Dade College and South Texas College were represented among the top 25 at both the certificate and associate levels.

Bachelor and graduate programs are found at California State University-Long Beach, Florida International University, Nova Southeastern University, The University of Texas-Pan American, The University of Texas Health Science Center at San Antonio, The University of Texas at El Paso, Texas and Tech University Health Science Center.

I know it's a long list but all are worthy of examination.

Bottom line:

The need for more Hispanics in the health fields is enormous and many student-oriented avenues are open. Good colleges have special programs for Hispanics. Fresh financial assistance is also available. Encourage students to aim high even if they have to take a step at a time. *

Dr. Mellander was a university dean for 15 years and a college president for 20.