The Hispanic/Latino Community in Cincinnati: Culture and Health

1. The Hispanic/Latino Community in Cincinnati: Culture and Health Febrero,2011 Ligia Gómez,MA

2. Why is Cultural Competency Important? • Illness and disease perception vary by culture • Diverse belief systems exist on health, healing and wellness • Cultural attitudes affect physician-patient relationships • Patients may seek complementary and alternative health therapies which are unfamiliar to the physician or health care professional • Health disparities exist…

3. The U.S. and Immigrants • Immigrants and their descendants constitute the majority of the population of the U.S. • They arrive with suitcases full of dreams…

4. Immigrants to the U.S. • Hopes of… -New economic opportunities -Good schools for their children -More money -Greater peace of mind They also bring… -Their own lifestyles -Habits -Dietary Customs -Genes

5. Demographics • ~46MM Hispanic/Latinos in the US: 16% of total • Largest U.S. Minority • Fastest growing minority: • By 2020, 1 in 5 people in U.S. will be Hispanic or Hispanic descendant • By 2050, 25% of U.S. will be Hispanic

6. Distribution of Hispanics in USA

7. Hispanics in the Cincinnati Area • >50,000 Hispanic/Latinos in Cincinnati region (8 counties) • Almost half of Cincinnati area Hispanics (20,000) are under age of 18 Source: Center for Family and Demographic Research, BGSU

8. Hispanics in the Cincinnati Area • Most are from Mexico and Guatemala • Areas of concentration: Springdale, Hamilton, Sharonville, Norwood, Fairfield, Lower Price Hill, Covington, Florence.

9. Why Hispanics are coming • Seeking economic opportunities • War, oppression • Political instability in their countries

10. Where They Come From Hispanic immigrants have diverse origins: cosmopolitan cities and rural areas

11. Mexicans • Since 1948 migration to and from the U.S. has continued largely uninterrupted • Mexicans make up over 66% of the U.S. Hispanic population • 2 million seasonal workers • Primarily work in agriculture, restaurants, construction

12. Puerto Ricans • 2nd Largest group • U.S. citizens at birth • 4% of the Hispanic Population in U.S. • Come to U.S. seeking employment, higher education, better quality of life

13. Cuban-Americans • 4% of Hispanic Population • First wave had high level of education and income • Cuba 90 miles from Key West • Main reason for immigration: • Desire for personal freedom • Political exiles seeking refuge • Promise of economic opportunities

14. Central Americans • Economy tends to be unstable: • depends on few agricultural exports owned by small segment of society • Immigrate to: • Find refuge from violence: El Salvador, Nicaragua • Seek economic stability

15. South Americans • Colombia, Venezuela, Ecuador, Peru, Chile, etc. • Longer journey than from Mexico and Central America: • Arrive via plane: tend to have higher socioeconomic level • Migrate because of: • economic opportunities • political instability • Pursuit of higher education Photographs: Ronald de Hommel

16. Hispanic Culture • Culture is the sum of beliefs, practices, habits, customs, rituals and so forth that are passed to us by our families and society

17. Core Values of Hispanic/Latino Cultures • La Familia (Family) • Respeto (Respect) • Personalismo (Personal relationships) • Confianza (Trust)

18. La familia (family):the most important social unit • Include parents, grandparents, siblings, aunts, cousins, compadres (close friends), godparents (padrinos) • Emphasize interdependence over independence, cooperation over competition

19. Respeto • Dictates appropriate behavior towards others base on age, sex, social position, economic status and authority. • Health providers are given a high level of respect. • Elders are highly respected

20. Personalismo • Personal rather than institutional relationships • Hispanics expect health providers to be warm, friendly and to take an active interest in the patients life • Closer physical space • Attuned to non verbal messages • When the provider shows respect for the culture and shows personal interest wins their confianza (trust)

21. Integrated Health • Hispanics tend to view health from a synergistic point of view • The body, mind and spirit represent a continuum: all play important roles in health • Illness and death seen as normal part of life • Strong belief in fate: Lo que Dios quiera • Curanderismo (folk healers) and home remedies are highly respected

22. Acculturation • The process of adopting aspects of the mainstream culture. • External acculturation: Changing food habits, clothing, learning/adapting to the majority language. • Internal acculturation: Values and more complex patterns of behavior.

23. Low Acculturation Related to healthier diets: Higher fiber, low fat diet Higher consumption of fruits, vegetables, rice, meat, beans, whole milk More likely to breastfeed High Acculturation Higher consumption of sweetened drinks High levels of refined sugar Higher consumption of fats Lack of breastfeeding Low intake of fruits and vegetables Highly processed convenience foods The Impact of Acculturation level: Diet

24. Low acculturation: Lower rates of high blood pressure Favorable cholesterol profiles Low type 2 diabetes Low mortality rate Bicultural: Avoidance of high energy food, saturated fats, cholesterol Higher level of physical activity The Impact of Acculturation level on health indicators and outcomes • High acculturation: • Higher risk of being overweight or obese. • Higher mortality. • Type 2 diabetes

25. Hispanic Paradox -Higher poverty rates -Less access to health care -Worse health and nutrition outcomes: obesity and type 2 diabetes -But: high life expectancy! Latinas:83.7; Latinos:77.2 Specific cultural factors may buffer the negative influence of poverty

26. Feeding in a cultural context • Mexican women place high value on child nutrition: important part of being a good mother • Chubby or overweight children are consider healthy • Skinny infants are unhealthy or sick

27. Eating Habits • Meals are the central social activity of the family, with family/community news and discussion: • Desayuno (breakfast): light meal that includes tortillas, coffee, chocolate, eggs, bread, etc • Almuerzo (lunch): main meal of the day; full menu followed by a siesta • Merienda (snack): coffee, tea, rolls • Cena: A light supper; may be as late as 9 pm

28. Teaching feeding practices • While Hispanics share the same language, their cultures frequently vary • Things to consider when planning educational programs: • Educational levels • Language skills • Income levels • Cultural values

29. Barriers to Health Care and Health Services • Cultural differences: concept of time • Language • Lack of health insurance • Education • Poor understanding of U.S. care system • Poverty • Transportation • Immigration status • Limited knowledge of resources • Work schedule

30. Barriers: Insurance • 44 million Americans are uninsured • 14% of all Americans • 12% of all children • 40% of Hispanic adults • 31% of Hispanic children • Barriers to health insurance: • Employers don’t offer insurance • Unaffordable • Inability to complete paperwork (language, education) • Immigration status

31. “We have to get beyond the cultural stereotypes of the media and recognize that all our patients are human beings. We all come from the same place and have the same dreams for our families and our future, and we have to base our actions as health care professionals on trying to provide the best possible vision of healing in the very sacred places where we do our work.” -Pete Duarte, CEO Thomason Hospital, El Paso, TX