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A Closer Look at Contributors to Stress for Latinos

Jul 22, 2014, 9:00 AM, Posted by Gabriel R. Sanchez, Yajaira Johnson-Esparza

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 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.

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The Effect of Cultural Stereotypes on Mental and Public Health

Jun 4, 2014, 9:00 AM

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. 

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How to Advance Minority Health? Change the Look of Health Care.

Apr 30, 2014, 2:00 PM

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.

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How to Address Disparities? Develop Local Leadership, Listen to Communities.

Apr 30, 2014, 9:00 AM

When I was first asked to consider this question, I pondered the issues by describing theoretical approaches, including the need to address social determinants, use a social-ecologic framework, and take a life course perspective. I threw in the need to use evidence-based practices and research. I gave this first draft to someone and asked ... So what do you think? She very politely asked: Are you in outer space? 

I continue to believe that addressing inequality in our country requires that we recognize, understand, and commit to changing its root causes which include racism, inadequate affordable and safe housing, inadequate access to quality education (pre-to post graduate), and grossly uneven wealth distribution. These are deeply rooted in our political and economic structures and must be fundamentally changed if we truly want to build a culture of equality and health for all. 

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How Can Health Systems Effectively Serve Minority Communities? Shift the Cost-Access-Quality Axis.

Apr 29, 2014, 10:30 AM

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, Italo M. Brown, MPH, a rising fourth-year medical student at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Brown holds a BS from Morehouse College and an MPH from Boston University, School of Public Health. He is an alumnus of the Health Policy Scholars Program at the RWJF Center for Health Policy at Meharry Medical College.

In our domestic health care system, we nurture the drive to improve patient outcomes, and apply evidence-based knowledge to solve contemporary health care challenges. Yet, studies have demonstrated that minorities are disproportionately affected by chronic conditions, and on average are less likely to receive ongoing care/management of their comorbidities. In addition, public health experts have asserted that social determinants of health (e.g., education level, family income, social capital) directly impact the minority community, and effectively convolute the pathway to care. 

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How to Advance Minority Health? A Diverse, Culturally Competent Health Care Workforce.

Apr 29, 2014, 9:00 AM

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, Michelle L. Odlum, BSN, MPH, EdD, a postdoctoral research scientist at Columbia University School of Nursing, responds to the question, “Minority health is advanced by combating disparities and promoting diversity. How do these two goals overlap?” Odlum has more than ten years of experience as a disparities researcher. She is a recipient of an RWJF New Connections Junior Investigator award.

As a health disparities researcher, my health promotion and disease prevention efforts are rooted in sociocultural aspects of health. This approach is critical to improved outcomes. In fact, when socioeconomic factors are equalized, race, ethnicity, and culture remain contributing factors to adverse minority health. I have come to understand that the key to combating health disparities lies heavily in cultural understanding. A diverse, culturally competent health care workforce is essential to health equity.

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How Can Health Systems Effectively Serve Minority Communities? Improve Medical Literacy, Take a Holistic Approach.

Apr 28, 2014, 2:45 PM

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, Cheryl C. Onwu, BS, a public health graduate student at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Onwu is a Health Policy Scholar at the RWJF Center for Health Policy at Meharry Medical College.

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A doctor informed an African American male that he has diabetes mellitus, and medication was prescribed. However, the doctor did not mention the extent of the dangers involved in having diabetes, or “the sugars.” Additionally, the doctor did not explain the detrimental effects if the patient failed to follow the prescription regimens and other recommendations.

Some of the challenges faced by minorities include lack of medical literacy, which can affect their overall health. Clear communication between a health care provider and his or her patients is important, so patients are cognizant of their health status, the importance of maintaining a healthy lifestyle, potential threats to well-being, and how to control health problems.

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How to Advance Minority Health? A Successful, Sustainable Effort to Promote Healthy Choices in Miami.

Apr 28, 2014, 1:00 PM

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, Lillian Rivera, RN, MSN, PhD, administrator/health officer for the Florida Department of Health in Miami-Dade County, responds to the question, “Minority health is advanced by combating disparities and promoting diversity. How do these two goals overlap?” Rivera is an alumnus of the RWJF Executive Nurse Fellows program.

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In order to address this question, it is important to identify the areas within your jurisdiction where there are identified health disparities and to develop initiatives with those needs in mind.

Miami-Dade County in Florida is one of the few counties in the United States that is “minority majority,” meaning the minority makes up the majority of the population. More than two-thirds of the 2.5 million residents are Hispanic; 19 percent are Black; more than 51.2 percent are foreign-born and most of  them speak a language other than English at home (mostly Spanish and Creole);  19.4 percent live below poverty level; and 29.8 percent of the population  under age 65 (more than 700,000 individuals) is uninsured .

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How Can Health Systems Effectively Serve Minority Communities? There are Endless Opportunities.

Apr 28, 2014, 9:00 AM

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, Adrian L. Ware, MSc, a third year graduate student in public health at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Ware is a Health Policy Scholar at the RWJF Center for Health Policy at Meharry Medical College.* 

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According to the World Health Organization, “a good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well maintained facilities and logistics to deliver quality medicines and technologies.” This definition will be used as the gold standard for this discussion of service toward minority communities. It is important to underscore that the basis for this discussion is centered on public health infrastructure. Public health is the promotion of health at a community level by the government. 

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How to Address Disparities? Recognize Incarceration as a Major Threat to Health.

Apr 27, 2014, 12:00 PM

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, Elizabeth Barnert, MD, MPH, MS, a pediatrician and clinical instructor in the UCLA Department of Pediatrics, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Barnert is an RWJF Clinical Scholar at UCLA.

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While there is much to be done to improve equity and access to health care for all Americans, I believe that the most important strides in health we can make will occur by directly addressing the social and environmental determinants of health. Racial/ethnic and economic inequities strongly play out in the criminal justice system. This has important implications for health. Incarceration itself is a determinant of health.

Breaking cycles of incarceration has the potential to dramatically improve the health of entire communities, setting individuals and families on trajectories that are healthier, safer, more fulfilling, and more productive. To address incarceration, America must recognize that the patterns of mass incarceration prevalent in many disadvantaged communities perpetuate poor health outcomes, further widen social inequities, and often lead to further incarcerations within and across generations. Currently, 1 in 28 U.S. children, and 1 in 9 African American children, have a parent who is incarcerated. Two-thirds of these parents are incarcerated for non-violent offenses. By virtue of having an incarcerated parent, these children are at much higher risk of themselves becoming incarcerated at least once during their life course. 

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