Salud Para Todos Latino Health Realities

1. �Salud Para Todos�Latino Health Realities Elizabeth Lee-Rey, MD Eliana Korin, Dipl. Psic Department of Family Medicine and Community Health AECOM/Montefiore Hospital

2. �Salud Para Todos�Latino Health Realities OBJECTIVES To learn about who are the Latinos in the US and in the NYC. To become familiar with the key health issues facing Latinos. To increase awareness of the significant health disparities facing Latinos today.

3. Name all 11 countries in South America. Peru Ecuador Bolivia Chile Colombia Venezuela the Guyanas-Suriname Dutch Guyana, French Guyana Brazil Uruguay Paraguay Argentina Brazil, the Guyanas and Venezuela and to some extent Columbia are cultures influenced by African presence. The indigineous influence is more noticed in Ecuador,Peru, Bolivia, and ParaguayBrazil, the Guyanas and Venezuela and to some extent Columbia are cultures influenced by African presence. The indigineous influence is more noticed in Ecuador,Peru, Bolivia, and Paraguay

4. Name all 7 countries in Central America. Panama Costa Rica Guatemala Nicaragua Salvador Honduras Belize Where is Mexico situated?Where is Mexico situated?

5. What are the 3 groups of Hispanic origin found in the Caribbean? Cuba Dominican Republic Puerto Rico

6. Tortillas are a staple food of which ethnic group? Puerto Ricans Mexicans Salvadorians Dominicans

7. The largest ethnic parade held in NYC is celebrated by which Latino group? Mexicans Dominicans Cubans Puerto Ricans

8. Mangu is a breakfast food for which Latino group? Mexicans Cubans Puerto Ricans Dominicans The important role that nutrition plays in maintaining and improving the nation�s health has been well documented. 5 major causes of death.CAD<Stroke, Noninsulin DM.Data from the Hispanic Health and Nutrition Examination Survey7 (HHANES) showed that although there are some similarities in the prevalence of chronic disease and associated risk factors among Mexican Americans, Cuban Americans, and Puerto Ricans, there are more differences than similarities.Results of a study 1995 nutrition intake. Results indicated that Mexican Americans had a higher total fat, saturated fat,and monosaturated fat intake than did Puerto Ricans and older Cuban Americans. Cholesterol intake among Mexican American and older women where higher than those among other Hispanic groups. The diets of US hispanics lack variety and this places these populations at long term high health risk. Hispanics participating in the WIC program consume appro 2.6 fruits and vegetables a day compared to the recommended of 5 a day . Hispanics have yet to reach the recommended minimum of 5 servings a day.The important role that nutrition plays in maintaining and improving the nation�s health has been well documented. 5 major causes of death.CAD<Stroke, Noninsulin DM.Data from the Hispanic Health and Nutrition Examination Survey7 (HHANES) showed that although there are some similarities in the prevalence of chronic disease and associated risk factors among Mexican Americans, Cuban Americans, and Puerto Ricans, there are more differences than similarities.Results of a study 1995 nutrition intake. Results indicated that Mexican Americans had a higher total fat, saturated fat,and monosaturated fat intake than did Puerto Ricans and older Cuban Americans. Cholesterol intake among Mexican American and older women where higher than those among other Hispanic groups. The diets of US hispanics lack variety and this places these populations at long term high health risk. Hispanics participating in the WIC program consume appro 2.6 fruits and vegetables a day compared to the recommended of 5 a day . Hispanics have yet to reach the recommended minimum of 5 servings a day.

9. What are some of the barriers to health care for Hispanics? Poverty Less education Unemployment rates Poor access to adequate health care Discrimination Socioeconomic status Lack of health insurance Language Barriers/Literacy

10. Which group is less likely to have a regular physician? Asian Seniors Hispanic Male Adolescents African American Newborns Middle-age Women

11. Minority Boys Are Less Likely to Have a Regular Physician

12. What percentage of Latino babies are born into poverty? 50% 66% 75% 40%

13. What percentage of Latino Babies are born into poverty? � of Latino babies are born into poverty Almost 2/3 of all Latino children live below the poverty line 73% of Hispanic children are living in �distressed neighborhoods.�

14. Hispanic women make up what percentage of the total NYC female population? 29% 33% 45% 50% In 1999, Hispanic women made up approx 11 percent of the US female population- the second largest among minority groupsIn 1999, Hispanic women made up approx 11 percent of the US female population- the second largest among minority groups

15. Hispanic women make up what percentage of the total NYC female population? Latinas represent 29% of the total female population in NYC Latinas comprise approx. 51% of the Hispanic pop in NYC Their median age is lower than for all other racial and ethnic groups In 1999, hispanic women made up 11 percent of the US female population-the second largest among minority women groups 15.7 million. African american women are the largest minority women group 12.5%-17.5 million.In 1999, hispanic women made up 11 percent of the US female population-the second largest among minority women groups 15.7 million. African american women are the largest minority women group 12.5%-17.5 million.

16. Latinas nationally are how likely to have diabetes as compared to the general population As likely Less likely Twice as likely Three times as likely

17. Latinas and Diabetes While NYC statistics are not available be ethnicity, data from neighborhoods where Hispanics comprise more than 60% of the population indicate that the incidence of DM hospitalizations far exceeds the average. Latinas nationally are twice as likely as the general population to have diabetes. The average incidence of DM hospitalizations in NYC is 7.4 per 1000. In Bushwich, where the Hispanic population is 67%, the rate is 20.8 per 1000. Presentation by the NYC Mayor�s Office of Health Services In 1998, appro 1.2 million Hispanic Americans had been diagnosed with diabetes, and an estimated 700,000 more hispanics americans are diabetic but have not been diagnosedIn 1998, appro 1.2 million Hispanic Americans had been diagnosed with diabetes, and an estimated 700,000 more hispanics americans are diabetic but have not been diagnosed

18. Latina�s biggest cancer risk is Colon Lung Breast Cervical

19. Cancer Facts Latinas are somewhat under-represented in the total cancer statistics. This may due to the relatively younger age of Latinas Latina�s biggest cancer risk is Breast Cancer. As a whole, the rate of Latina deaths due to Breast Ca is 1.7 per 100,000. This compares to less than .5 for all other forms of cancer to the reproductive health organs. Presented by the NYC Mayor�s Office of Health Services

20. The leading cause of death for Hispanic females from birth to 49 is Cancer Heart Disease AIDS Diabetes

21. The leading cause of death for Hispanic Males age 1 to 59 is a) Homicide b) Heart Disease c) AIDS d) Cancer

22. The Leading Cause of Death for Hispanics in NYC In NYC, according to 1995 data, AIDS was the leading cause of death for Hispanic males from ages 1 yr old to 59 yrs old. It was the leading cause of death for Hispanic females from birth to 49 yrs old. Source: The seventh Annual Hispanic Federation Annual Survey Hispanic New Yorkers on Nueva York Report 4:Latinos and HIV/AIDS

23. Who are the Uninsured? Live in families with incomes higher than the federal poverty level. Poor, unemployed and belong to a racial ethnic group. Seniors over the age of 65. Children.

24. Who Are The Uninsured? Many Americans stereotype the uninsured as poor, unemployed, and minorities. While these groups run a greater risk, they do not represent the majority of Americans without health coverage.

25. Who Are The Uninsured? In fact, most of the 44 million uninsured Americans: live in families with incomes higher than federal poverty level. Are from working families with at least one full time worker. Are adults under the age of 65. Work in medium size/large businesses with more than 25 employees. Are not from America�s racial and ethnic minority groups.

26. Which Hispanic group report the worst health status and the highest incidence of acute medical conditions? Colombians Ecuadorians Puerto Ricans Mexicans

27. Which Hispanic group report the worst health status and the highest incidence of acute medical conditions ?

28. When was the category Hispanics first included in national data systems such as US census and birth/death certificates? 5 years ago In the last 2 decades Never an issue 100 years ago

29. What is the projected growth of the Hispanic population of the US population within the next 50 years? Nearly 25% Half No growth anticipated Not significant

30. Projected Resident Population by Race and Ethnicity of US 2001- 2050

31. Latinos In The United States

32. National Origin of Latinos in New York City: Est 2000 Census

33. Institute of MedicineReport to Congress Minorities in America even those with private health insurance receive lower quality care than given to whites. Highlighted health care disparities in areas of cardiovascular disease, HIV/AIDS,cancer and diabetes. Other areas of inequities identified: Language barriers, inadequate insurance coverage,bias among doctors and nurses, and lack of minority physicians.

34. Implications for Latinos and Health Financial barriers to care and health insurance. The availability of appropriate health, mental health, and preventive services across the life cycle. The disproportionate rates of diabetes, and mortality due to cancer and heart disease. Barriers to services due to language, gender, and other forms of discrimination.

35. Implications for Latinos and Health Under representation of Latinos in medical and health professions, or in the training pipeline. The lack of recognition of health practices based in Latino cultures The continuing lack of adequate health data on Latinos and Latino subgroups in particular.

37. Vignette Questions: What are some challenges presented to the physician in this encounter? Given what you have just learned about Latino health: What are some possible health issues to be addressed with this patient? What are some factors that can facilitate or hinder the doctor-patient relationship in this case? What issues seem important to this patient?

41. �To Feel Heard and Understood is Perhaps the Most Precious Gift of Life� Arthur Frank,

42. Thank You

43. Which group has had the most emerging presence in US population? Central and South America Puerto Rican Mexican Cuban

44. Emerging Latino Populations The Latino population is by all accounts growing dramatically and in the year 2000 became the country�s largest �minority� group. Immigration from the Caribbean and South America is making significant contributions to the growth of the Latino population. Relatively new Latino subgroups- Salvadorians, Dominicans, and Mexicans. Between 1980-2000 the size of the Central and South American pop doubled from 7% to 14.5%.

45. Characteristics of the Hispanic Population in the US,2000

46. Vignette You are seeing for the first time a 56 yo Latina woman who comes in because she is � feeling that her blood pressure is high�. She has a past medical history significant for Diabetes, Hypertension, Hyperlipidemia, and a family history of Breast Cancer. She volunteers to you that she had been listening to a doctor over the Spanish radio who was talking about herbal teas and concoctions (�preparaciones�) for her blood pressure which might be helpful to her symptoms. She is considering ordering a sampler package. She also wants her cholesterol checked because she also feels it is high.

47. Vignette Her 19 yo daughter who comes to the appointment her, reports that she is concerned about a breast lump that her mother found on herself about 3 months ago but had not sought medical attention for it. Patient had last mammogram 3 years ago. Results were not known.

48. PHYSICAL EXAM FINDINGS History offered by patient and daughter. Exam revealed an Overweight, Hispanic woman who appeared much older than her stated age. VSS- T98.7 BP 170/100, repeat 168/ 90 HR 70 HEENT- Fundi cotton wool spots noted and changes consistent with HTN retinopathy PERRLA- fair dentition with upper dentures Neck- Supple, No neck masses, No bruits noted Lungs- Mild upper airway rhonchi, no rales or wheezes noted. Adequate inspiratory effort noted Cor- Distant heart sounds, mild 2/6 systolic ejection murmur at apex.

49. PHYSICAL EXAM FINDINGS Breast Firm, discrete, irregular 2x4 cm, nontender mass palpated in LUQ Left breast. Left Axillary node palpated-mildly tender Abd Obese, nontender with no HSM or masses noted No abd bruits noted Ext Limited ROM with crepitus of knees noted when getting on and off exam table, 1+ edema with varicosities bilaterally. Without skin breakdown or fissue Of evidence of infection. UE arthritic changes noted bilaterally Neuro Cranial nerves intact. Monofilament testing revealed sensory deficits bilaterally

50. Vignette Medications: Allergies- NONE Atenolol 50 mg po qd Tobacco 30 yr/pack HCTZ 25 mg po qd Quit 10 years ago Zocor 100mg po qd Metformin 500mg po qd ASA 81mg po qd Premarin 4months/d/c�ed Una de gato Shark cartilage Hoja de Tilo Hoja de naranja Agria Flores de Coco Indio Anis de Estrella

51. Outcome Patient went for mammogram, which indeed revealed breast mass as palpated by patient and confirmed by MD. Subsequently, needed special views, ultrasound of the area and an excisional biopsy was ordered. Pathology revealed a fibroadenoma. No evidence of malignancy. Annual mammograms with monthly SBE were recommended Pt with positive family history will require surveillance. Diabetes and Arthritis no active issues. Remain stable and are monitored on following visits.

52. Outcome After several visits patient revealed that she had believed that a mass found in her breast meant cancer and that meant death. It was in� la manos de dios� and so had not needed attention. Patient had met with the local cuidrandero and had been going for banos. Patient starts to come to her visits unaccompanied by daughter. Daughter schedules appointment with provider.

54. Which Latino group has the highest rate of poverty? Salvadorians Mexicans Ecuadorians Puerto Ricans

56. Who was the first female Puerto Rican Congresswoman? Iris Chacon Nydia Velazquez Marife Hernandez Celia Cruz

57. Who was the first Puerto Rican Congressman? Ramon Velez Bobby Garcia Herman Badillo Luis Munoz Marin

58. Thanks to: Technical Support Carol Whitaker Maria Pasa Wilma Burgos Taneka Banks