More than 65 million people in the US identified as Hispanic or Latino in 2023, according to US Census Bureau data, making up over 19% of the total population.
But the medical community doesn’t reflect that diversity. Though enrollment for minority students in medical school is increasing, the Association of American Medical Colleges reported that just under 7% of physicians identified as “Hispanic (alone or with any race)” in 2021.
Medical schools and healthcare centers are increasingly prioritizing cultural competency training, but it’s not clear if these efforts are mitigating health disparities. There are few studies and no established “best practices” for improving cultural sensitivity, a 2020 review funded by the Center for Diversity and Inclusion at Washington University in St. Louis found. Meanwhile, about half of Hispanic or Latino patients said they’ve had negative healthcare experiences, according to a 2022 Pew Research Center report.
To tackle disparate care, Latino and Hispanic doctors and community leaders told Healthcare Brew it’s important to have representation in medicine and provide patients with a healthcare professional who speaks their language and respects their culture. These shifts can make patients feel more comfortable and help them articulate their needs, improving their experience and outcomes, according to a 2022 study from the Hackensack Meridian School of Medicine.
“Among the benefits that a shared background or shared heritage can end up helping with [are] language, forms of communication, recognizing forms of stigma,” Reno, Nevada-based pediatrician and American Academy of Pediatrics fellow Jose Cucalon Calderon told Healthcare Brew.
Shared heritage helps. Cucalon Calderon, who speaks Spanish and is originally from Ecuador, has seen the difference his background makes in the care he can provide, particularly when it comes to discussing mental health with patients and families.
The Substance Abuse and Mental Health Services Administration states that Hispanic and Latino patients are less likely to access behavioral health care due to systemic barriers, lack of culturally sensitive providers, and stigma. In 2022, Hispanic and Latino adults were 60% less likely to have had mental health care than non-Hispanic or Latino adults, according to the Office of Minority Health.
“Even with a shared heritage, language, or culture, the amount of stigma that you find in these communities against treatment also becomes a barrier for care,” Cucalon Calderon said.
The shared background and way of communicating also helps providers understand nuances that could be missed, Ray Serrano, director of research and policy at the civil rights organization League of United Latin American Citizens (LULAC), told Healthcare Brew.
For instance, there are mental health concepts in Spanish that don’t have a direct English translation, Serrano said. Take “susto,” which might directly translate to “fear,” he said, but encompasses much more.
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“It would translate to fear, but it could almost be defined as [post-traumatic stress disorder], but it’s not necessarily,” Serrano said. “You refuse to eat; you refuse to talk to anybody.”
Efforts to bridge the gap. Motivated by their unique cultural needs and the health system’s gaps in addressing them, everyday people are seeking to solve health issues themselves.
LULAC, for example, has a network of community-based programs across the nation that it uses to promote health literacy through its Latinos Living Healthy initiative.
Among other steps, including encouraging more participation in research, the initiative trains local leaders in Hispanic and Latino communities to educate their neighbors about health, LULAC Chief Development Officer Alba Villa told Healthcare Brew. These leaders—called promotores and promotoras in Spanish—are people who community members can turn to with any health questions, Serrano said.
A treatment like dialysis, for instance, can be difficult to obtain if you do not have an eligible immigration status or lack insurance. Under the Emergency Medical Treatment and Active Labor Act, hospitals nationwide are only required to provide treatments, including dialysis, in emergencies.
“A promotora will be able to tell you which hospital to go to for dialysis, where you can get dialysis and you won’t be turned away for not having insurance or being undocumented,” Serrano said.
A problem for everyone. But you don’t have to be a promotora to improve medical care for the Hispanic and Latino communities, Cucalon Calderon said.
Though there aren’t many studies on the most effective approach for bridging treatment disparities, the American Medical Association (AMA) recommends teaching medical students cultural competence—which the organization defines as an understanding of how to deliver care to people in different cultures—and cultural humility, a term that was coined in the 1990s by Children’s Hospital Oakland doctor Melanie Tervalon and University of California, San Francisco doctor Jann Murray-García.
Cultural humility is “a self-reflection and relationship-building approach” that encourages clinicians to ask questions, listen to their patients, and avoid assumptions, Massachusetts General Hospital researchers wrote in a 2023 paper. It means reassessing biases and asking questions in order to avoid stereotyping.
One example Tervalon and Murray-García gave in a 1998 editorial involved a non-Hispanic nurse who had taken a course that led her to believe that Hispanic and Latino patients generally “overexpress” pain and later wrongly dismissed a Latina patient in pain.
The approach acknowledges that Hispanic and Latino cultures are not monolithic and vary depending on an individual’s background, such as the fact that some households may be bilingual while others speak only Spanish.
“We recognize that our patients are going to be the authorities on what their experience is,” Cucalon Calderon said.