Category Archives: Latino or Hispanic
Vanessa Grubbs, MD, MPH, is an assistant professor at the University of California, San Francisco, School of Medicine, and a scholar with the RWJF Harold Amos Medical Faculty Development Program. She is writing a book about what she calls the “sometimes irrational use of dialysis in America,” which will include a version of this narrative essay.
It is a Monday afternoon like any other and time to make my weekly rounds at the San Francisco General Hospital outpatient dialysis center. I push my cart of medical charts down the long aisle of our L-shaped dialysis unit and see Mr. Rojas, my dialysis patient for over a year now. He is in his mid-40s and slender, sitting in the burgundy-colored vinyl recliner. His blue-jeaned legs and sneakered feet are propped up on the extended leg rest. The top of his head shines through thinning salt and pepper hair. White earbud headphones peek through gray sideburns. He is looking intently at his Kindle, rarely glancing up at the activity around him.
I roll my cart up to his recliner, catching his eye. His right hand removes the earbuds as the left pauses his movie. He looks up at me, smiling. “Hola, Doctora. How are you?” he says with emphasis on the “are.”
“I am good. How are you doing?” I smile back at him as I grab his chart from the rack. I write down his blood pressure and pulse—both normal—and the excellent blood flow displayed on the dialysis machine. My eyes shift to his fistula, the surgically thickened vein robustly coursing halfway up his left forearm like a slithering garden snake. It is beautiful to me. Through it, Mr. Rojas is connected to the dialysis machine.
“I am good, Doctora. No problems. I feel healthy. Strong.” His brown eyes glint.
Janice Johnson Dias, PhD, is a Robert Wood Johnson Foundation New Connections alumnus (2008) and president of the GrassROOTS Community Foundation, a health advocacy that develops and scales community health initiatives for women and girls. She is a graduate of Brandeis and Temple universities and a newly tenured faculty member in the sociology department at City University of New York/John Jay College of Criminal Justice.
Policy action and discussion this month have focused on poverty, sparked by the 50th anniversary of Lyndon Johnson’s War on Poverty and Dr. King’s birthday. Though LBJ and King disagreed about the Vietnam War, they shared a commitment to ending poverty. Half a century ago, President Johnson introduced initiatives to improve the education, health, skills, jobs, and access to economic resources for the poor. Meanwhile, Dr. King tackled poverty through the “economic bill of rights” and the Poor People's Campaign. Both their efforts focused largely on employment.
Where is health in these and other anti-poverty efforts?
The answer seems simple: nowhere and everywhere. Health continues to play only a supportive role in the anti-poverty show. That's a mistake in our efforts to end poverty. It was an error in 1964 and 1968, and it remains an error today.
Let us consider the role of health in education and employment, the two clear stars of anti-poverty demonstrations. Research shows that having health challenges prevents the poor from gaining full access to education and employment. Sick children perform more poorly in schools. Parents with ill children work fewer hours, and therefore earn less. Health care costs can sink families deeper into debt.
By Janet Chang, PhD, an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections Program and an assistant professor of psychology at Trinity College in Hartford, Connecticut. Chang received a PhD from the University of California, Davis, and a BA from Swarthmore College. She studies sociocultural influences on social support, help seeking, and psychological functioning among diverse ethnic/racial groups. Her RWJF-funded research project (2009 – 2012) examined the relationship between social networks and mental health among Latinos and Asian Americans.
“Injustice anywhere is a threat to justice everywhere.”
Dr. Martin Luther King, Jr. (Letter from Birmingham Jail, April 16, 1963)
Dr. Martin Luther King, Jr. is well known for his fight against racial injustice, but he also advocated for socioeconomic justice. In particular, Dr. King said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane” (Second National Convention of the Medical Committee for Human Rights, March 25, 1966). His profound words still resonate with us today.
While strides have been made in the past several decades, there continues to be inequality and unequal treatment. In 1978, the President’s commission reported ethnic/racial disparities in health services, and this is still a vexing societal problem in the United States. Compared to non-minorities, American Indians, Latino Americans, Asian Americans, African Americans, and other ethnic/racial minorities are significantly less likely to receive the care that they need and more likely to receive lower quality health care. Ultimately, these disparities compromise the quality of life of most Americans.
The factors that contribute to heath disparities are complex. As a social-cultural psychologist, I also believe that our tolerance for injustice stems in part from larger cultural forces that shape our psychological tendencies, which simplify our world and constrain our ability to take the perspective of others. In the United States, the cultural values that make our society distinctive, independent, and strong may also serve to limit our potential for greater growth—a healthier, happier, and more productive society.
Seth M. Holmes, PhD, MD, is an alumnus of the Robert Wood Johnson Foundation Health & Society Scholars program and an assistant professor of public health and medical anthropology at the University of California, Berkeley. The following is an excerpt from his recently published book, Fresh Fruit, Broken Bodies: Migrant Farmworkers in the United States.
“The first Triqui picker whom I met when I visited the Skagit Valley was Abelino, a thirty-five-year-old father of four. He, his wife, Abelina, and their children lived together in a small shack near me in the labor camp farthest from the main road. During one conversation over homemade tacos in his shack, Abelino explained in Spanish why Triqui people have to leave their hometowns in Mexico.
In Oaxaca, there’s no work for us. There’s no work. There’s nothing. When there’s no money, you don’t know what to do. And shoes, you can’t get any. A shoe like this [pointing to his tennis shoes] costs about 300 Mexican pesos. You have to work two weeks to buy a pair of shoes. A pair of pants costs 300 Mexican pesos. It’s difficult. We come here and it is a little better, but you still suffer in the work. Moving to another place is also difficult. Coming here with the family and moving around to different places, we suffer. The children miss their classes and don’t learn well. Because of this, we want to stay here only for a season with [legal immigration] permission and let the children study in Mexico. Do we have to migrate to survive? Yes, we do.
-- Dr. Martin Luther King Jr., in a speech to the Medical Committee for Human Rights, 1966
Nalo Hamilton, PhD, RN, WHNP/ANP-BC, is an assistant professor of nursing at the University of California, Los Angeles School of Nursing; and Cheryl Woods Giscombé, PhD, RN, PMHNP-BC, is an assistant professor in the School of Nursing at the University of North Carolina at Chapel Hill. Both are Robert Wood Johnson Foundation Nurse Faculty Scholars.
The New Year has begun and for some 2013 marks a time of celebration and progress, while for others it is a time of uncertainty and despair. As we pause to remember the rich contributions of Dr. Martin Luther King, Jr., we should also reflect on how his legacy can be used to eliminate the health care disparities that so disturbingly affect the underserved and underrepresented in our nation today.
The World Health Organization has determined that geographic locale, ethnicity, education, environmental stress, and access to a health care system are social determinants of health and health inequities. These factors are influenced by the disparate distribution of resources, wealth, and power.
In the United States:
- African Americans, Hispanic Americans, and Native Americans have rates of diabetes that far exceed those in non-Hispanic whites.
- African American women are more likely to be diagnosed with advanced stage breast cancer compared to white women and have the highest rate of mortality.
- Native Americans report more alcohol consumption and binge drinking than other racial/ethnic groups.
- Hispanic males age 20 or younger have the highest prevalence of obesity compared to non-Hispanic whites and African Americans.
- African American men and women are more likely to die of cardiovascular disease than non-Hispanic whites.
- Infant mortality occurs in African Americans 1.5 to 3 times more than in other races or ethnicities.
Gabriel Rincon, DDS, is the founding executive director of Mixteca Organization, Inc., in Brooklyn, N.Y., which provides a broad scope of health and education programs, including literacy and computer classes, English-language courses, and afterschool programs, to thousands of Hispanic New Yorkers each year. He is also a 2011 recipient of a Robert Wood Johnson Foundation (RWJF) Community Health Leader Award. The Human Capital Blog asked Rincon to reflect on his experience as an RWJF Community Health Leader.
Human Capital Blog: How did you come to found the Mixteca Organization?
Gabriel Rincon: In the 1990s distribution of information about AIDS was on the rise in developed nations such as the United States, but in immigrant communities—particularly Hispanic ones—levels of HIV/AIDS infection and general ignorance of the disease was still high. The City of New York was one of the locations with the highest number of Hispanics infected with HIV/AIDS. In 1991, I witnessed the lack of information available in Spanish. I decided in 1992 to take action by designing a slide presentation and organizing talks about HIV/AIDS, signs and symptoms its risks, forms of prevention, and treatments. With the use of a portable projector and informational pamphlets, I made presentations in factories, churches, houses and community centers, and on radio and TV. In 2000, together with other community members, my work was formalized; Mixteca Organization, Inc., obtained its official status as a non-governmental, non-profit community based organization.
Comilla Sasson, MD, MS, FACEP is an attending physician at the University of Colorado Hospital and Assistant Professor in the Department of Emergency Medicine at the University of Colorado. Sasson was a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Michigan from 2007 to 2010. Her latest study is published in the October 25th, 2012 issue of the New England Journal of Medicine.
Dead. How do you make someone “undead?” How, with just your two hands, can you prolong the time that paramedics have to restart a person’s heart? How can a normal, ordinary person make a difference and literally save a life?
We know that a person’s chances of surviving an out-of-hospital sudden heart arrest decreases by 10 percent for every one minute he/she does not get CPR (cardiopulmonary resuscitation). I had learned about hands-only CPR in my medical training. Hands-only CPR is where all you have to do is push hard and fast (to the tune of “Staying Alive”) at a 100 times a minute until helps arrives.
But time and time again, I cared for African-American patients in Atlanta who had laid in their families’ homes for critical minutes as their brains slowly died from a lack of blood supply from the heart. Their hearts had stopped and no one called 911. No one placed their hands on the chest and started doing hands-only CPR.
Maybe this is just Atlanta? Is it the color of a person’s skin or is the place where he or she collapses that makes the difference?
In my Robert Wood Johnson Foundation Clinical Scholars Program (RWJCSP) at the University of Michigan (2007-2010), I learned about the importance of neighborhoods in determining a person’s health. After wading through the literature, my a priori hypothesis was that having someone stop to provide CPR is completely dependent upon others; therefore, the neighborhood plays a large role in whether or not someone does CPR.
After consulting with my two RWJCSP alumni mentors, David Magid, MD, MPH, and Arthur Kellermann, MD, MPH, FACEP, the question became clear: What role does the racial and socioeconomic composition of a neighborhood have on an individual’s likelihood of receiving life-saving bystander CPR?
This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Gabriel R. Sanchez, PhD, is an associate professor of political science at the University of New Mexico, assistant director of the RWJF Center for Health Policy at the University of New Mexico, and director of Research for Latino Decisions.
The Supreme Court decision regarding the constitutionally of the signature policy victory of the Obama administration has been the most anticipated and hotly debated decision of the Court in recent memory. In the spirit of a prior Human Capital blog post I wrote back in November, I wanted to take advantage of the opportunity to participate in this series by providing a perspective on how this decision will likely impact the Latino population. I have been analyzing public opinion toward health care reform for some time now, and draw on some of this data to provide a few examples. I focus my attention here on some of the more intriguing relationships to emphasize the complexity of Latino’s views of this historic policy.
Latinos had a lot at stake in this decision, as the Affordable Care Act (ACA) is projected to expand insurance to 9 million Latinos. It is therefore not surprising that support for health care reform, and the ACA in particular, has been higher among Latinos when compared to non-Latinos. In fact, since Latino Decisions started collecting data in October 2011, on average 51 percent of Latinos have supported the ACA. Conversely, as reflected in the figure below, the percentage of Latino voters who want to repeal the law has been lower than what other polls have shown for the non-Latino population over this time period.
How a Personal Experience Led to a Program of Research Focused on Eliminating Intimate Partner Violence Disparities Among Hispanic Women
The U.S. Department of Health and Human Services, Office on Women’s Health has designated May 13 to May 19 as National Women’s Health Week. It is designed to bring together communities, businesses, government, health organizations and others to promote women’s health. The goal in 2012 is to empower women to make their health a top priority. The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is launching an occasional series on women’s health in conjunction with the week. This post is by Rosa M. Gonzalez-Guarda, PhD, MPH, RN, Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar and Assistant Professor, University of Miami, School of Nursing & Health Studies.
As a young Cuban-American and Miami native who grew up in an Hispanic enclave, I was naturally drawn to Hispanic men—short, dark and handsome. Who would have expected that I would have found him during my last year of college at Georgetown University in Washington, DC? I fell in love with this other Cuban-American Miami native quickly. He was fun, smart, charming, had strong family values and, to top it all off, he could dance salsa and merengue.
It was not too long before I realized that my college sweetheart was jealous and controlling. However, this did not seem all that unusual since these are characteristics that are endorsed by many in the culture where I come from. In fact, when I questioned that he was “allowed” to go out with his friends to bars, but I was not, some family and friends agreed with him. Although I did not realize it at the time, the “allowed” language and his controlling behavior were a good indicator of what lay ahead in our relationship—a nightmare.
Moments of romance and bliss turned into moments of anger, aggression and torment. Times of peace grew shorter and shorter, as he grew increasingly emotionally abusive. He did some “man handling” too.
When I decided to go off to graduate school at Johns Hopkins University School of Nursing and the Bloomberg School of Public Health, things got worse. I was in another city and the co-chair of a social and cultural student committee. This made him feel like he was completely out of control and very jealous. He grew more aggressive and emotionally abusive. My family and friends became increasingly worried about me, as they saw my cheery personality slowly dwindle. My parents put a lot of pressure on me to break things off. I knew they were right, but for some reason I couldn’t bring myself to do it. I just needed time.
I thought that I could appease my family by getting help. I went to the school psychologist and when a faculty member at the School of Nursing looked for volunteers for a research study on teen dating violence, I quickly signed up. At that time, I had no idea that the Principal Investigator of the study was a world renowned violence researcher: who else but our very own Jacquelyn Campbell, PhD, RN, FAAN, who directs the RWJF Nurse Faculty Scholars program. Working on this study made me realize that I also wanted to conduct research on health disparities affecting my own community of Hispanic women at home. As I fell in love with the prospects of health disparities and violence research, I fell out of love with an abusive partner.
Human Capital News Roundup: Genome sequencing of tumors, Medicare physician fees, cervical cancer among Latinas, and more.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) scholars, fellows and grantees. Some recent examples:
Alejandra Casillas, MD, MPH, an RWJF Clinical Scholar, spoke to New America Media about why Latinas have the highest rates of cervical cancer. Many women don’t go to the doctor as much as recommended because of a cultural belief that their families come first, Casillas says, so raising awareness among men could help encourage more women to get Pap tests.
Healthcare Finance News reports on The Primary Care Team: Learning from Effective Ambulatory Practices (the LEAP Project), a recently launched RWJF initiative designed to make primary care more accessible and effective by identifying practices that maximize the services of the primary care workforce. Learn more about the LEAP Project and read an RWJF Human Capital Blog post about it.
A team led by scientists from the Broad Institute and Dana-Farber Cancer Institute—including RWJF Harold Amos Medical Faculty Development Program alumnus Levi Garraway, MD, PhD—has sequenced the genomes of 25 metastatic melanoma tumors, MediLexicon reports. The first high-resolution views of the genomic landscape are published online in the journal Nature.
RWJF Scholar in Health Policy Research and political scientist Brendan Nyhan, PhD, gave comments to NPR’s Morning Edition about the political landscape, discussing why and how voters reject facts about the political parties or politicians to whom they are loyal. Nyhan’s ongoing research suggests that people may be better able to deal with cognitive dissonance—“the psychological experience of having to hold inconsistent ideas in one's head”—if they are first given an image or ego boost.