Introduction
Social determinants of health can influence an individual’s well-being and health outcomes. Immigrant populations are among the most affected groups by adverse social determinants of health. Given the challenges experienced by this populace, it is crucial to identify and address the systematic issues contributing to health disparities. This paper explores the social determinants of health affecting immigrant Hispanics/Latinos. It analyzes the health disparities and forms of discrimination experienced by this population and the implications of these differences on their well-being.
Demographics of Immigrant Hispanics/Latinos
The Hispanic/Latino population is one of the largest ethnic groups living in the United States. Data from national statistics show that they account for approximately 18% of the U.S populace (Budiman, 2020). In 2017, approximately 60 million Latinos were living in the country (Budiman, 2020). The statistics further showed that about 120,000 new Mexican immigrants arrived in the country in 2018 alone (Budiman, 2020). It is projected that Hispanic/Latino immigrants, especially those of Mexican origin, will account for 31% of the total U.S population by 2065 (Budiman, 2020). The data prediction also showed that Whites and Blacks would only account for 20% and 9% of the total U.S population by 2065, respectively (Budiman, 2020). Despite the size of this population, they still experience health disparities associated with structural vulnerabilities.
Health Disparities
Health disparities refer to differences in health outcomes between populations living within the same geographical area. These disparities include differences in disease burden, mortality rates, access to healthcare services, and risks associated with diseases and disabilities. The primary health disparities faced by Hispanic/Latino immigrant populations include inadequate access to healthcare services, disease burden, and the community’s negative health-seeking behaviors.
Inadequate Access to Healthcare
Inadequate healthcare access can disproportionately affect the health outcomes of minority groups. As Castaneda (2014) puts it, healthcare is a commodity in the United States, and for one to receive this service, one must have the means to obtain them. Individuals can only get health services either through monetary exchange or health insurance. However, according to the CDC, about 20.1% of the Hispanic/Latino immigrants aged below 65 years lack insurance covers (“Stigma & discrimination,” 2016). Another survey conducted by the U.S. Department of Labor shows that over two-thirds of the immigrant Hispanic and Latino agricultural workers lack insurance covers (Painter, 2020). These disparities stem from social, economic, political, and environmental factors.
The population faces negative socioeconomic factors that limit their access to healthcare. Painter (2020) noted that the structural and social factors that lead to the mass migration of Hispanics/Latinos from their home countries are the same factors that impede them from accessing quality healthcare services in the United States. The population’s day-to-day lives are characterized by harsh living conditions, low socioeconomic status, food insecurity, crime, gang-related activities in their neighborhoods, poverty, poor working conditions, limited employment opportunities, and lack of stable income (Painter, 2020). Due to the limited employment opportunities and unstable incomes and employment, Hispanics and Latinos cannot afford deductibles and copays associated with the uninsured’ medical costs. For the undocumented Hispanics/Latinos, fear of being discovered or coming into contact with the government and the liabilities associated with apprehension, detention, and deportation makes access to healthcare a complicated decision. These structural vulnerabilities are the main factors that lead to inadequate access to healthcare services.
Prevalence of Medical Conditions and Health Issues
The Latino community’s major health issues include maternal births and infant deaths, smoking, obesity, hypertension, and health insurance coverage. The reported leading causes of death in the population include cancer, heart diseases, and unintentional injuries (Health of Hispanics,” 2020). Out of the 204,719 reported deaths in 2019, 42,066 were from malignant neoplasms, 40,537 from diseases of the heart, and 17,239 from accidents resulting from unintentional harms (“Health of Hispanics,” 2020). The CDC report further showed that chronic liver diseases and liver cirrhosis, and chronic lower respiratory diseases are the seventh and eighth leading causes of death in the community, respectively (“Health of Hispanics,” 2020). Socio-cultural factors mainly account for the disease burden and health outcomes faced by this populace.
Economic and acculturation factors cause the high prevalence of obesity and its effects. Many Hispanics/Latinos tend to adopt American values, norms, and behaviors over time. Various studies have suggested that acculturation is behind unhealthy behaviors such as alcohol use and smoking and adverse health outcomes such as obesity and increased risk of HIV and sexually transmitted diseases (Painter, 2020). However, other surveys show that cumulative economic factors are more responsible for obesity and its effects than acculturation factors. For example, the high production and aggressive marketing of calorie-dense foods influence the nutritional choices of the community (Painter, 2020). Compounded by the fact that most calorie-dense foods are inexpensive, the population is likely to purchase unhealthy foods than spend more money on nutritious foods. Whether the primary cause is acculturation or economic status, it is evident that unhealthy foods have contributed to obesity and its effects on the population. The CDC’s socioeconomic factors and implications associated with the other disease burdens will be discussed in the next section.
Health Seeking Behaviors of the Community
Healthy behaviors that improve health outcomes include physical exercise, healthy diets, frequently seeking medical services (e.g., checkups), safe sex practices, and medical/medication adherence practices. Risky behaviors are one of the primary risk factors for HIV/AIDs in the population. Risky behaviors in this population are linked to depression and a coping strategy to deal with socio-cultural displacement. They can also be associated with the low education level of the population and health literacy levels. Most Hispanic/Latino immigrants have limited education and language proficiency (Painter, 2020). Rather than education level, Painter (2020) correlated the low health literacy levels to language barriers. Without adequate health knowledge, Hispanics/Latinos cannot know about treatment and care options existing within their communities. A considerable number of immigrants are unaccompanied by spouses, which encourages risky sexual behaviors.
For Hispanic/Latino women, risky sexual behaviors are caused by submission to partners, limiting their decision-making power regarding sexual consent. Various studies have demonstrated that the primary cause of HIV/STD infections among Hispanic/Latina immigrant women results from unprotected sex with their husbands or regular sexual partners (Painter, 2020). Hispanic/Latino women are also less likely to seek supportive services and report domestic or sexual violence due to their undocumented status, dependence on male figures, and/or mistrust of officials (Painter, 2020). These factors push immigrant Latino/Hispanic women into using unsafe and nonstandard sources of care for their children and themselves.
Medical checkups and prenatal care are some of the most critical services for pregnant women. However, Painter (2020) showed that immigrant/Latino women are less likely to seek prenatal care while pregnant. Inadequate access to healthcare can be correlated with high maternal and infant deaths witnessed by the community. In 2017, there were 22,341 infant deaths, 14,844 neonatal deaths, and 14,975 maternal malformations within the Hispanic/Latino populations (“Health of Hispanics,” 2020). Due to sociocultural factors and male-female power dynamics in immigrant family relationships, Hispanic/Latino women do not seek supportive services or prenatal care. Arguably, these factors have contributed to maternal, infant, and prenatal deaths in the community.
Maternal and infant deaths, obesity, hypertension, liver cirrhosis, and chronic respiratory diseases can all be linked to behavioral factors. Poor health choices mainly cause obesity and smoking. A 22-year cohort study established a causal-effect interaction between smoking and obesity and liver cirrhosis and hypertension. The survey showed that obesity and overweight were directly associated with hypertension in smokers and non-smokers. According to the study, current smoking was the strongest predictor of hypertension in females and middle-aged populations with normal weight (Yao et al., 2020). Therefore, it can be concluded that the major health issues affecting Hispanics/Latino women are related to poor health-seeking behaviors.
Forms of Discrimination
The primary forms of discrimination faced by the population are sexual- and racial-related. First, homophobia, stigmatization, and discrimination against the gay and transgender segments within the Hispanic/Latino community still exist. Gays and the transgender population are often unfairly treated due to misconceptions and negative perceptions and beliefs associated with their sexual orientation and practices (“Stigma & discrimination,” 2016). The negative perception and attitudes increase the gay/transgender susceptibility to harassment, teasing, physical assault, bullying, and suicide (Stigma & discrimination,” 2016).
The CDC also reveals that a majority of Hispanic and Latinos gays and transgender are rejected by their families, friends, and peers (Stigma & discrimination,” 2016). The lack of social support increases the risk of isolation, suicide, depression, substance use, and unsafe sex practices (Painter, 2020). Intentional self-harm, including suicide, was identified as one of the leading causes of death in the community (“Health of Hispanics,” 2020). The stigmatization also affects health-seeking behaviors such as seeking medical counseling or social support. The depression and feelings of isolation due to rejection and stigmatization can cause the gay community to depend on substance use as a coping strategy. Substance use increases the likelihood of risky behaviors, including driving under the influence and unsafe sex practices.
Racial and Ethnic Bias
Hispanic/Latino immigrants face social marginalization and racism due to their immigrant status. Physical appearance, literacy levels, social perceptions of immigrants, language use, and the nature of work they do contribute to racism and stigmatization. Discrimination and negative bias are especially true for undocumented immigrants. Implicit biases of healthcare workers, as displayed in verbal expression during clinical interaction, can influence the community’s health-seeking behaviors. For example, unintended or intended expression of a belief that is racially biased or discriminative may naturally discourage an individual from seeking care. Without appropriate language proficiency, healthcare providers cannot adequately understand and address the health needs of the population.
Organizations Supporting the Health Needs of the Community
Planned Parenthood Action Fund
Planned Parenthood is a non-profit organization that mainly provides reproductive healthcare and sex education in various communities. The organization’s primary aim is to provide quality and low-cost healthcare services to all individuals, regardless of their immigration, income, or insurance status. The organization provides health education, advocacy services, and reproductive health services for Hispanics and the Latino population. The organization’s reproductive health services include pregnancy testing, prenatal care, adoption services, sexual violence counseling, and birth control services.
Members of the population seeking care from the program do not need to reveal their documentation status to healthcare staff. To receive healthcare services, individuals only need to inform health providers that they lack insurance, and the health workers will provide them with alternative treatment and payment options. They also offer preventive services such as diabetes, high blood pressure, colon cancer, cervical cancer, and thyroid screening. Furthermore, their health centers provide a routine physical examination, flu and tetanus vaccination, and UTI testing and treatment. For the LGBTQ community, access to support groups, service referrals, and hormone therapy are provided.
The U.S Customs and Border Protection (CBP) and the Immigration and Customs Enforcement (ICE) officials are also legally restrained from operating within the organization’s health centers. The policy was put in place to encourage undocumented immigrant workers to seek healthcare without fear (“Latinos for Planned Parenthood,” n.d.) Through the Promotores de Salud program, the organization creates awareness of health services associated with reproductive health (“Health equity issues,” n.d.). The program trains and supports local Hispanic/Latino leaders to become health educators and promoters in their communities.
Planned Parenthood helps eradicate the barriers associated with high healthcare costs and mistrust of the healthcare system. Through the provision of affordable healthcare services, community members can access essential services health services. The health advocates in the community help link the community members with healthcare resources to empower the community by boosting their health literacy level. The reproductive health education provided is bilingual, but it is also offered at individuals’ homes and community gatherings. Positioning the program at the heart of the community’s neighborhood has allowed the program to create and maintain trustful relationships with the community members. Coupled with the fact that CBP and ICE are legally prohibited from operating within its health centers, the organization has also succeeded in improving healthcare services access. The services provided by the organization are low-cost compared to other healthcare facilities within the state. Free services are also available (e.g., HIV/AIDS testing) for certain services offered by the program.
Hispanic Healthcare initiative (HHIT)
The HHIT is a non-profit organization whose main aim is to improve the Hispanic/Latino population’s health outcomes. The organization mainly focuses on the population segments that are underfunded and undocumented. It provides services such as transportation, Medication Coverage Programs, consultation, health education, legal services, home care assistance, health promotion services, and international healthcare access (Hispanic Healthcare Initiative, n.d.). The organization uses professionally trained “cultural brokers” to help coordinate and provide general medical care services and social services to the population.
It provides education on viable solutions concerning healthcare coverage issues. In cases where clients lack health insurance but need mandatory medical equipment before being discharged, the organization will provide the resources needed to pay for equipment (“Building healthier communities,” n.d.). The health education programs include creating awareness on the prevalence of chronic diseases, nutrition, exercise techniques, and self-management related to chronic disease management. Individuals can choose either one-on-one case management education at a small fee or opt for community-based training available at no cost. A program funded by the initiative called the Health Risk Assessment Program provides free and low-cost blood glucose, A1C, blood pressure, pulse, vision, and cholesterol screening (“Building healthier communities,” n.d.).
Additionally, the initiative also funds a cancer support group for all Hispanics/Latino living with any cancer. The members of the group can share their experiences as well as get insights from participating healthcare providers. Mammograms and PAP screening are free at any federally qualified health center (Hispanic Health Initiatives, n.d.). The Hispanics/Latinos can also request interpretation and translation services before or during patient-provider interactions.
To promote healthcare access, the organization advocates equitable access to healthcare at the community and national levels. It follows up on medical appointments at the individual level and helps population members navigate smoothly through the hospital’s payment system. Regarding transportation, the institution provides air and ground ambulance services to the population (“Building healthier communities,” n.d.). The services can either be low-cost or free, depending on the circumstances and needs of the individual.
HHI has made a substantial impact on the Hispanic and Latino communities. Transportation is often cited as one of the barriers to healthcare services (Painter, 2020). By providing free or low-cost transportation services, the community’s members can quickly get to healthcare centers. Education on self-management, health insurance options, nutrition, and exercise improve the population’s health literacy. Creating health awareness on issues affecting the population can improve the health-seeking behaviors of the population. Since language is a barrier to healthcare services, interpretation, and translation services offered by the organization can improve health outcomes.
Hispanic / Latino Quality of Life Initiative
The Hispanic/Latino Quality of life program is an initiative administered by the state government. It serves the Hispanic/Latino community through policy analysis, advocacy efforts, and research translated into evidence-based policy and health interventions. The initiative’s main objective is to improve the quality of life of the Hispanics/Latinos by ensuring that the state has sound policies that promote the health, social, and economic outcomes of the population (Hispanic / Latino Quality of Life Initiative, n.d.). A team of community leaders from the Hispanic/Latino population can read and provide feedback on the organization’s annual reports before publication. The community members’ input, obtained through public forums and surveys, is also considered to ensure that the research recommendations are as inclusive as possible.
Through the Hispanic/Latino Quality of Life Resource Advisory Commission, the initiative is legally obligated to provide recommendations on programs and policies that will alleviate the population’s disparities. The agenda’s key focus areas include economic development, health, housing, community development, civic engagement, and youth services (Hispanic/Latino Quality of Life Initiative, n.d.). The city council then enacts policies and implements programs based on the initiative’s report recommendations. For example, based on the program’s proposal, the city council funded the community clinics to offer free immunization services to eligible candidates (Hispanic / Latino Quality of Life Initiative, n.d.). By translating the evidence into practice, the health policies and interventions targeting the population can adequately address the needs of the community. Including community leaders and community members of Hispanic/Latino origin promotes inclusion and population-centered care. There are no costs associated with participating in the program.
Conclusion
Hispanics/Latino immigrants are among the largest ethnic populations in the U.S. The primary health issues affecting the community include racial and sexual discrimination, negative health-seeking behaviors, disease burden, and inadequate access to healthcare. The health issues are mediated by harsh living conditions, limited language proficiency, low literacy levels, poverty, and lack of stable income. These SDH have contributed to maternal and prenatal deaths and chronic conditions associated with poor health-seeking behaviors. Women and undocumented workers have worse health outcomes compared to other population segments. Organizations such as the Hispanic Healthcare initiative and Planned Parenthood Action Fund have implemented strategies to counter the aforementioned health issues.
References
Budiman, A. (2020). Key findings about U.S. immigrants. Pew Research Center. Web.
Building healthier communities one person at a time: Direct services (n.d.). Hispanic Health Initiatives. 2020, Web.
Castaneda, X. (2014). Cultural change and impacts on migration health [Video]. YouTube. Web.
Health equity issues for the Latino community (n.d.) Planned Parenthood. 2020, Web.
Health of Hispanic or Latino population (2020). CDC. Web.
Hispanic / Latino quality of life (n.d.). Austintexas.Gov. 2020, Web.
Hispanic healthcare initiatives of Texas (n.d.). 2020, Web.
Latinos for Planned Parenthood (n.d.). Planned Parenthood. 2020, Web.
Painter, T. M. (2020). Health threats that can affect Hispanic/Latino migrants and immigrants. In Martinez A. & Rhodes S. (eds.), New and emerging issues in Latinx health. pp.169-195. Springer.
Stigma and discrimination affect gay and bisexual men’s health (2016). Web.
Yao, F., Liu, W., Zhao, R., Li, G., Huang, X., & Chen, Y. (2020). BMI modified the association of current smoking with the incidence of hypertension in Chinese population: A 22-year cohort study. BMC Public Health, 20(1), 1–7. Web.