Physician Faculty Scholar Explores Latinos' Access to Preventive Care

Michael Dulin finds Spanish speakers less likely to get colorectal cancer screenings.

    • December 2, 2009

Last year, a 45-year-old Latino male walked into a free health clinic in Charlotte, N.C., seeking treatment for high blood pressure only to discover he had arrived too late: during the appointment he was diagnosed with kidney failure.

The patient had been aware of his health problem for a decade, but had never taken preventive steps to address it, says his doctor, Michael Dulin, M.D., Ph.D., a primary care researcher in North Carolina and a Robert Wood Johnson Foundation (RWJF) Physician Faculty Scholar. Had he taken earlier action, he would have been prescribed a single, low-cost prescription drug to manage his hypertension and would probably have avoided the diagnosis of kidney failure. But because he waited so long to see a doctor, he had to go on dialysis three times a week, was prescribed an expensive eight-drug cocktail, and learned he would likely never work again.

It’s an extreme case of a common story, Dulin says. “When people access primary and preventive care services in a timely manner, they stay healthier, and their overall health care costs are lower.”

Sadly, millions of people lack access to such care. The problem, Dulin says, is particularly acute for Latinos, the largest and fastest growing minority group in the country, and one that is less likely than other racial or ethnic groups to have health insurance. Latinos also face cultural, linguistic and socioeconomic barriers to health care, and may avoid seeking medical help for fear that it will lead to deportation.

To help rectify the problem, Dulin participated in two recent studies related to Latino health.

Male Spanish Speakers Less Likely to Get Colorectal Cancer Screenings

In the first study, Dulin and his colleagues found that overweight men with a preference for Spanish are less likely to receive screenings for colorectal cancer, one of the top two causes of cancer deaths in Latino adults living in the United States. Lack of access to cancer screenings, according to the paper, recently published in the Open Epidemiology Journal, suggests the group also lacks access to other preventive services.

Dulin and his colleagues offer three recommendations to help bridge the divide between Latinos and their health care providers in the paper: provide translators for Spanish-speaking patients; teach Spanish to health care providers so they can communicate with their patients; and develop Spanish language health materials.

In a second study, Dulin joined a separate team of researchers to devise a mapping tool to identify neighborhoods in Charlotte, N.C., where Latinos face the highest hurdles to care. Charlotte is an ideal city in which to perform such a study because it has one of the fastest growing Latino populations in the country.

The resulting maps show locations where communities would most benefit from more preventive and primary care services. The mapping tool that was used in this study can be utilized by public health officials to make strategic decisions about where to build new health care clinics, where to place lay health advisers, and where to post helpful health information that can be easily accessed by vulnerable populations.

Two papers based on this research are scheduled to appear in forthcoming editions of the Journal of the American Board of Family Medicine.

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