Healthcare Inequity in the Hispanic Community

Hispanic Heritage Month (September 15 to October 15) is a time for us to acknowledge and honor the rich culture, history, and contributions of Hispanic Americans to our society. It’s also a good time to acknowledge the healthcare challenges that continue to affect this community.

Addressing the inequity is complicated by the “Hispanic Paradox”—Hispanic populations have better than expected health outcomes than would be expected given their socioeconomic challenges.

Healthcare should be a basic human right in developed countries, yet many Hispanics in the U.S. still have limited or no access. A major factor is a lack of healthcare insurance.

The most recent census data tell us that in 2020, 18.3% of Hispanics were without health coverage, compared to 5.4% of whites. This serious disparity means that almost 11 million Hispanic people will encounter major challenges accessing medical services.

Disparities extend far beyond insurance coverage. Hispanics are less likely to receive preventive care, and more likely to suffer from chronic conditions.

While whites and Hispanics have similar rates of diabetes, Hispanics are about 33% more likely to die from the disease.

Healthcare inequity means that Hispanic people, including children, are less likely to:

• have a regular doctor
• receive routine checkups
• get flu shots
• seek care when needed (due to cost)
• receive mental health care when needed
• receive dental care
• get preventive screenings such as colonoscopies or mammograms
• suppress HIV viral infection (despite HIV and AIDS rates almost four times higher than whites)
• have a healthy BMI
• self-report good health status

As we’ve seen again and again, social determinants of health play a huge part in sustaining healthcare disparities.

Seventeen percent of Hispanic families live in poverty, compared to 10% of non-Hispanic white families. Poverty affects everything. It limits access to quality healthcare, nutritious food, education, transportation, and safe housing.

Barriers to behavioral health also contribute to healthcare disparities, as medical and behavioral health comorbidities are common. In a 2021 national survey on drug use and health, only 36% of Hispanics report receiving behavioral health treatment versus 52% of non-Hispanic whites. Mental health stigma, provider shortages, and language barriers contribute to the lack of care.

While the vast majority—91%—of U.S.-born Hispanics speak English well, that’s true of only 38% of those born overseas.

Language barriers and cultural differences make effective communication between doctors and patients difficult, often leading to misunderstandings, inadequate or inappropriate care, poorer outcomes, and lower patient satisfaction.

And of course, structural racism and discrimination within the healthcare system can’t be ignored. Implicit bias among healthcare providers, often unintentional, can lead to substandard care. Studies have shown that minority patients are less likely to receive certain procedures or treatments compared to white patients with the same conditions.

The COVID-19 pandemic both exposed and exacerbated existing healthcare disparities. Hispanics experienced higher infection and mortality rates than all other racial groups except Native Hawaiian and Other Pacific Islander (NHOPI) people.

Among the reasons for this are the many essential jobs that Hispanics perform that can’t be done remotely. Another is a higher prevalence of multiple generations of a family living together, making distancing impossible, and of course limited access to healthcare and everything discussed above.

Unexpectedly, Hispanic Americans tend to have some health outcomes that are comparable or better than those of whites, despite having generally lower income and education. For example, Hispanic Americans have a higher life expectancy (77.8 years) compared to whites (76.7 years), according to the CDC. They also have lower cancer and heart disease incidence and death.

First described in 1986 by sociologists Kyriacos C. Markides and Jeannine Coreil, the paradox has a few possible explanations.

Compared to whites, Hispanics smoke less, eat better, breastfeed their babies more and, in some communities and occupations, get more exercise. The population also skews younger, and they may have lower genetic risk for some diseases. Another possible factor is the so-called “immigrant health advantage,” which theorizes that healthy vs. non-healthy people are more likely to emigrate, and/or may be coming from a country that generally has a healthier lifestyle than the U.S.

Paradox notwithstanding, it’s important to remember that Hispanics (along with Black and American Indian and Alaska Native people) face worse outcomes than white people in most metrics tracking health, healthcare access, and social determinants.

As with all issues in healthcare inequity, there’s no quick fix, but there are steps we can take to start to level the playing field.

1. Culturally Competent Care: The importance of healthcare providers understanding the languages, backgrounds, beliefs, and perceptions of their patients continues to be increasingly recognized. It’s a big undertaking, but as I wrote recently, until healthcare providers begin to show empathy and respect towards cultural differences—and take steps to accommodate them—inequities will persist.
   
2. Community Outreach and Access: Programs to educate the community about the importance and availability of preventive care and other health services can encourage utilization, improving outcomes. Collaborations with existing trusted community leaders and organizations can amplify these efforts. Ensuring local, in-community access to services is equally important.
   
3. Whole Person Care Funding and Focus : Integrated care and social determinants of health programs that address behavioral health comorbidities, housing, transportation, and other concerns can help, particularly if approached in a way that incorporates diverse providers and cultural sensitivities.

Healthcare inequity in the Hispanic community is a complex issue mired in socioeconomic, cultural, and systemic factors. While the Hispanic Paradox is an interesting phenomenon, it doesn’t mitigate the healthcare challenges faced by many Hispanics. Bridging the gap won’t be easy, but as we work towards a healthcare system that serves all patients equally—regardless of nationality, race, gender identity, religion, disability, sexual orientation, or age—we move closer to a healthier, more just society. Together, we have the power to create meaningful change and honor the contributions of the Hispanic community not just in heritage months, but every day.