Category Archives: Latino or Hispanic
What’s Your “Street Race-Gender”? Why We Need Separate Questions on Hispanic Origin and Race for the 2020 Census
Nancy López, PhD, is an associate professor of sociology at the University of New Mexico (UNM). She co-founded and directs the Institute for the Study of “Race” and Social Justice at the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at the UNM. On December 5, RWJF will hold its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.
How should we measure race and ethnicity for the 2020 Census? How can health disparities researchers engage in productive dialogues with federal, state and local agencies regarding the importance of multiple measures of race and ethnicity for advancing health equity for all?
If we depart from the premise that the purpose of race, ethnicity, gender and other policy-relevant data collection is not simply about complying with bureaucratic mandates, but rather it is about establishing communities of practice that work in concert toward the creation of pathways (from harmonized and contextualized data collection, analysis and reporting) to effective policy solutions and interventions that address the pressing needs of diverse communities across the country, then we have planted the seeds of a culture of health equity and social justice.
Daniel E. Dawes, JD, is a health care attorney and executive director of government relations, health policy and external affairs at Morehouse School of Medicine in Atlanta, Georgia; a lecturer of health law and policy at the Satcher Health Leadership Institute; and senior advisor for the Transdisciplinary Collaborative Center for Health Disparities Research. On December 5, the Robert Wood Johnson Foundation (RWJF) will explore this topic further at its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more about it.
With growing diversity relative to ethnicity and culture in our country, and with the failure to reduce or eliminate risk factors that can influence health and health outcomes, it is imperative that we identify, develop, promulgate, and implement health laws, policies, and programs that will advance health equity among vulnerable populations, including racial and ethnic minorities.
Every year, the Agency for Healthcare Research and Quality publishes its National Healthcare Quality and Disparities Report, which tracks inequities in health services in the United States. Since the report was first published in 2003, the findings have consistently shown that while we have made improvements in quality, we have not been as successful in reducing disparities in health care. This dichotomy has persisted, despite the fact that health care spending continues to rise. In fact, health care costs have been escalating at an unsustainable rate, reaching an estimated 17.3 percent of our gross domestic product in 2009, according to the Centers for Medicare and Medicaid Services. Despite these high costs, the delivery system remains fragmented and inequities in the quality of health care persist. The impact of disparities in health status and access for racial and ethnic minorities is quite alarming.
Theresa Simpson, BS, is a 2003 alumna and acting assistant director of Project L/EARN, and a doctoral student at the Rutgers Department of Sociology. Dawne Mouzon, PhD, MPH, MA, is a 1998 alumna and former course instructor for Project L/EARN, and an assistant professor at Rutgers Edward J. Bloustein School of Planning and Public Policy. Project L/EARN is a project of the Robert Wood Johnson Foundation (RWJF), the Institute for Health, Health Care Policy and Aging Research, and Rutgers University.
When we began co-teaching Project L/EARN in the summer of 2006, health disparities was gaining momentum as a field.
At the time, we were both Project L/EARN alumni who shared a background in public health. We were becoming increasingly immersed in disparities through our graduate studies in the health, population and life course concentration of the sociology doctoral program at Rutgers University.
Directly as a result of that coursework, we began significantly expanding the Project L/EARN curriculum in the area of health disparities. Now, every summer, we hit the ground running the opening week of the program.
In the first lecture, an overview of the field of health disparities, Dawne introduces various theoretical frameworks for studying health disparities, followed by data on the social demography on various race/ethnic groups. She concludes with a series of charts and graphs showing race/ethnic, gender and socioeconomic status (SES) inequities in the epidemiology of health and illness.
Gabriel R. Sanchez, PhD, is an associate professor of political science at the University of New Mexico (UNM), executive director of the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at UNM, and director of research for Latino Decisions. Yajaira Johnson-Esparza is a PhD Candidate in the UNM department of psychology and an RWJF Fellow at the University.
A recent survey conducted by RWJF, NPR, and the Harvard School of Public Health focused our attention on the burdens that stress poses for Americans. We want to focus our attention in this blog post on factors that may be leading to stress among the Latino population. Although the experience of stress is very common, the experience and burden of stress is not uniform across people in the United States.
One of the main findings that emerged from the recent RWJF/NPR/Harvard survey was the strong role of health problems in stress in the United States, with 27 percent of respondents noting that illness or disease was a major source of stress over the past year. In addition to the direct impact of being sick, the financial burdens associated with needing medical care can generate a lot of stress. We have found support for this finding in some of our own work at the UNM RWJF Center for Health Policy. For example, a recent survey we helped produce found that 28 percent of Latino adults indicated that because of medical bills, they have been unable to pay for basic necessities like food, housing, or heat, with 40 percent indicating they have had trouble paying their other bills. The financial stress associated with illness can have a devastating impact on Latinos.
Latinos in the United States also face unique stressors from other Americans due to their language use, nativity, and experiences with discrimination. Being followed in a store, being denied employment or housing, and being told that you do not speak English well can all lead to stress for Latinos.
Lorenzo Lorenzo-Luaces graduated from the University of Puerto Rico–Rio Piedras, where he studied cross-cultural differences in suicidality. He is currently a graduate student in the University of Pennsylvania clinical psychology PhD program. Lorenzo-Luaces is an alumnus of Project L/EARN, a project of the Robert Wood Johnson Foundation, the Institute for Health, Health Care Policy and Aging Research, and Rutgers University.
The population of groups referred to as “minority” is growing at a faster rate in this country than Caucasians, with estimates suggesting that by 2060, 57 percent of the U.S. population will be non-White. This demographic shift could create a public health concern if racial/ethnic minorities remain underrepresented in mental health research. At present, these populations are less likely to receive mental health care than Whites. When they do receive care, it is usually of lesser quality.
Stereotypes among racial/ethnic minority communities regarding mental health are complex. Research suggests that they tend to have more negative beliefs about mental illnesses than White communities; for example, they are more likely to believe that mental illnesses occur due to factors outside of the individual’s control (e.g., spiritual or environmental reasons). However, despite generally holding more negative views about mental illnesses, research shows that racial/ethnic minorities tend to have less punitive attitudes about the mentally ill. Moreover, they tend to be more accepting about mental health treatments, although they express a clear preference for psychological services over medications.
Differences in access to care, rather than attitudes, likely explain the racial/ethnic gap in service use. Besides the obvious discrepancies in socioeconomic status (SES) between Caucasians and racial/ethnic minorities, the latter’s preference for psychological services may be one barrier to access. This is because, even among the insured, psychological services are more expensive in the short term and harder to access than psychotropic medications. There also are questions as to whether psychological interventions tested largely on White populations are effective for minorities.
David Fakunle, BA, is a first-year doctoral student in the mental health department of The Johns Hopkins Bloomberg School of Public Health. He is an alumnus of Project L/EARN, a project of the Robert Wood Johnson Foundation and the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
It is always interesting to speak with my relatives when an egregious act of violence occurs, such as the shooting at Sandy Hook Elementary School back in December 2012. They are always so disheartened about the mindset of an individual who can perpetrate such a horrible act. When I mentioned that this particular perpetrator, Adam Lanza, suffered from considerable mental disorder including possible undiagnosed schizophrenia, the response was something to the effect of, “Okay, so he was crazy.”
That’s it. He was crazy. I love my family dearly, but it saddens me as to how misinformed some of my relatives are about mental health. Notice that I say “misinformed” as opposed to “ignorant” because to me, being ignorant means you are willingly disregarding the information provided to you. But that is the issue: communities of color, in many cases, are not well-informed, if informed at all, about mental health. That is what drives the negative stereotypes that are highly prevalent within communities of color.
Ayorkor Gaba, PsyD, is a clinical psychologist and project manager at the Center of Alcohol Studies, Rutgers University, as well as a clinical supervisor at the Rutgers Psychological Clinic. She has a private practice in Highland Park, New Jersey and is an American Psychological Association-appointed representative to the United Nations. She is an alumna of Project L/EARN, a project of the Robert Wood Johnson Foundation and the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
Mental illness affects one in five adults in America. A disproportionately high burden of disability from mental disorders exists in communities of color. Research has shown that this higher burden does not arise from a greater prevalence or severity of illnesses in these communities, but stems from individuals in these communities being less likely to receive diagnosis and treatment for their mental illnesses, having less access to and availability of mental health services, receiving less care, and experiencing poorer quality of care. Even after controlling for factors such as health insurance and socioeconomic status, ethnic minority groups still have a higher unmet mental health need than non-Hispanic Whites (Broman, 2012).
There are a number of factors driving these statistics in our communities, including attitudes, lack of culturally and linguistically appropriate services, distrust, stigma, and more. In our society all racial groups report mental health stigma, but culturally bound stigma may have a differential impact on communities of color. Stigma has been described as a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses (President’s New Freedom Commission on Mental Health, 2003). Stigma in the general public often leads to internalized stigma at the individual level. Several studies have shown that internalized stigma is an important mechanism decreasing the willingness to seek mental health treatment.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to blog about improving health care for all. Rashawn Ray, PhD, is an assistant professor of sociology at the University of Maryland and a former RWJF Health Policy Research Scholar at the University of California in Berkeley and San Francisco.
Some people assume that promoting diversity and combating health disparities means giving preferential treatment to minorities over Whites. However, these pursuits simply mean providing equitable opportunities and a health care system that is responsive to everyone. Education studies continuously show that promoting diversity and reducing discrimination benefits all students. Regarding health care, these pursuits may mean life or death.
The percentage of Black physicians has stayed roughly unchanged since the early 1900s. The percentage of Black and Latino professors at research-intensive university shows a similar pattern. I suggest that reducing health disparities and changing our current culture of health is contingent on more effectively integrating minorities into health professions and research positions.
How Can Health Systems Effectively Serve Minority Communities? Use Electronic Health Records to Discover How to Improve Outcomes.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Bonnie L. Westra, PhD, RN, FAAN, an associate professor at the University of Minnesota School of Nursing, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Westra is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.
Electronic health records (EHRs) are rapidly proliferating and contain data about health or the lack thereof for minority communities. Evidence-based practice (EBP) guidelines can be embedded in EHRs to support the use of the latest scientific evidence to guide clinical decisions. However, scientific evidence may not reflect differences in minority communities served.
As a first step to compare the effectiveness of EBP guidelines for minority populations, practicing nurses and nurse leaders need to advocate for implementation of EBP nursing guidelines in EHRs. Additionally, EBP guidelines must be coded with national nursing data standards to compare effectiveness within and across minority communities. Nurse researchers need to conduct comparative effectiveness research to learn how to optimize EBP guidelines for minority communities through the reuse of EHR data and to derive patient-driven evidence.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Jamila Michener, PhD, an assistant professor of government at Cornell University, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Michener is an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program at the University of Michigan, Ann Arbor.
In my undergraduate class on the politics of poverty, there is an uncomfortable yet persistent question that looms whenever the conversation turns to racial and ethnic disparities: why? The students generally (and rightly) believe that biological distinctions are not the answer and in the search for other solutions, culture frequently emerges as a likely suspect. In response, I challenge these young people to think more conscientiously about cultural explanations of poverty. I push them to problematize the notion that racial and ethnic groups are homogenous bearers of a common and undifferentiated culture. I prompt them to consider how social, economic, and political institutions constitute and are constituted by various elements of culture.